35-year-old man with histiory of trauma

 

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Doctor's Information

Name : Hamidreza
Family : Haghighatkhah
Affiliation :Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree : Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

 

Case Section

Muskuloskeletal System

 

Patient's Information

Gender : Male
Age : 35

 

Clinical Summary

35-year-old man with histiory of trauma

 

Imaging Findings

On coronal MR images,non complete visualization of the anterior horn of lateral meniscus as well as the appearance of a larger posterior horn than anterior horn are depicted.Displacement of the central fragment of the anterior horn of lateral meniscus into the intercondylar notch is indicative of a bucket handle tear.On sagittal images,the displaced fragment can be seen lying anterior and parallel to the PCL which known as the double PCL sign.

 

Differential Diagnosis

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Final Diagnosis

Bucket-handle tear of lateral meniscus

 

Discussion (Related Text)

Bucket-handle tears are displaced longitudinal tears. The displaced inner fragment often has the appearance of a handle, and the remaining peripheral segment attached to the tibial plateau resembles a bucket- hence the name bucket-handle tear. A sensitive but nonspecific sign on MRl is the absent bowtie sign, in which fewer than two consecutive sagittal images of the bowtie-shaped meniscal body is seen. A caveat of the absent bowtie sign is that it may be identified in the intact small meniscus of a child or small adult and in the partially resected meniscus. Thus, confirmation of a bucket-handle tear is mandatory and can be made by identification of a displaced fragment. In fact, the most reliable sign is the finding of a displaced fragment of meniscus in the inter- condylar notch, which can be seen better on coronal images .This sign is associated with a truncated or shortened meniscus on coronal images. On sagittal images, the displaced fragment can be seen lying anterior and parallel to the PCL. This is known as the double peL sign.Partial tear of ACL is also noted.

 

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.

 

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