In the left lower leg, there is subcutaneous stranding (arrowhead), consistent with soft-tissue edema. 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This increases intramedullary pressure and may cause vascular occlusion and venous stasis (13). Figure 12-19. COVID-19 and thrombosis: searching for evidence, Rheumatological complications of Covid 19, SARS-CoV-2 and Guillain-Barr syndrome: molecular mimicry with human heat shock proteins as potential pathogenic mechanism, Are superantigens the cause of cytokine storm and viral sepsis in severe COVID-19? The findings may be unilateral or asymmetric depending on the involved nerves (63). GBS in a 15-year-old adolescent girl with COVID-19 with progressive ascending lower extremity pain and weakness. 1. MC = metacarpal (head), PP = proximal phalanx. Partial tears may be treated arthroscopically. a. Ankle: Passive movement must be assessed with forefoot in supination and inversion of heel (to exclude dorsiflexion at choparts joint and midtarsal joint and to lock subtalar joint). Biceps tendinopathy may be treated with tenodesis (resection and reattachment of the biceps to the bicipital groove) or tenotomy (resection of the tendon allowing release of tendon with distal retraction). Progression of the process leads to partial tears or discontinuity of the tendon and eventually full-thickness rotator cuff tears (Figures 12-9 to 12-11). US is an excellent modality for assessing peripheral nerves. WebThirty-two patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography of the tibiotalar joint. Normal outpouchings of the joint capsule include the biceps tendon sheath, axillary recess, rotator interval, and subscapularis recess. Follow-up studies by Levy et al. Although CT images may also show muscle thickening and effacement of intramuscular fat and fascial planes, MR images can better depict muscle edema, fascial stranding, and postcontrast enhancement. Imaging of the postoperative is challenging due to artifact from surgical hardware.17 Strategies to decrease artifacts include (1) using long echo train fast spin echo sequences rather than gradient sequences, (2) using STIR rather than frequency-selective fat saturation technique, (3) increasing bandwidth, (4) using a high matrix, and (5) frequency encoding away from area of interest. Full-thickness rotator cuff tear. (B) Repeat axial CT image of the abdomen at the L3 level 4 weeks later, after an extended stay in the intensive care unit, shows that the skeletal muscle cross-sectional area has decreased to 48.5 cm2/m2, indicating sarcopenia. Common benign tumors involving the shoulder include enchondromas and osteochondromas (Figure 12-27). ON of the humeral heads in a 62-year-old woman with a history of sickle cell disease and postCOVID-19 condition with progressive shortness of breath and corticosteroid treatment. It occurs in ~20% (range 10-30%) of the population 1.. See Also: Ankle Anatomy Position of the Patient Imaging of soft-tissue abscesses, including with US, CT, and MRI, is well described in the literature. As the disease progresses, there is formation of osteophytes, subchondral sclerosis/cyst formation, and synovitis (Figure 12-25). Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. A sublabral foramen is a complete detachment of the anterior superior labrum that reattaches anterior inferiorly. Imaging studies of postvaccine immune-mediated MSK manifestations have not been well reported. Sternal and clavicular fibers constitute the pectoralis major muscle. There are four paired sinuses - named according to the bone in which they are located - maxillary, frontal, sphenoid and ethmoid. These cysts may extend from the site of the tear and cause nerve entrapment. Complete rotator cuff tear. (A) Coronal T2-weighted fat-suppressed MR image of the right shoulder in a 34-year-old woman with persistent pain and limited range of motion 2 months after receiving the Pfizer-BioNTech mRNA COVID-19 vaccine. Figure 10. Considering the glenohumeral joint not a weight-bearing joint, de novo osteoarthritis is less common, and posttraumatic versus calcium pyrophosphate deposition disease (CPPD) should be considered in cases of severe osteoarthritis of the shoulder. The deposits may be asymptomatic or cause mechanical or inflammatory symptoms. Coronal oblique MRI shows findings of avascular necrosis with subchondral collapse of the medial aspect of the head (black arrow). Observations and hypothesis, Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19-Experience and Lessons from the SARS Epidemic, Steroid-induced osteonecrosis: the number of lesions is related to the dosage, Avascular necrosis as a part of long COVID-19, Unfolding of sickle cell trait by coronavirus disease 2019 (COVID-19) infection, Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: COVID-19 toes and spasticity in a 48-year-old woman, High prevalence of heterotopic ossification in critically ill patients with severe COVID-19, Heterotopic ossification post COVID-19: Report of two cases, Heterotopic ossification: radiological and pathological review, Reversible respiratory failure due to rhabdomyolysis associated with cytomegalovirus infection, COVID-19 and Myositis: What We Know So Far, MRI of musculature in myalgia: indications and image findings [in German], Paraspinal Myositis in Patients with COVID-19 Infection, Rhabdomyolysis: magnetic resonance imaging and computed tomography findings, Post-COVID-19 arthritis: a case report and literature review, A case report of monoarthritis in a COVID-19 patient and literature review: Simple actions for complex times, Reactive arthritis after COVID-19: a case-based review, The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general, Post-COVID-19 Arthritis and Sacroiliitis: Natural History with Longitudinal Magnetic Resonance Imaging Study in Two Cases and Review of the Literature, Reactive arthritis in the right hip following COVID-19 infection: a case report, Surgically treated reactive arthritis of the ankle after COVID-19 infection: A case report, Microflow imaging: New Doppler technology to detect low-grade inflammation in patients with arthritis, Can adhesive capsulitis of the shoulder be a consequence of COVID-19? There may also be associated muscle edema with fluid-sensitive sequences, and/or decreased muscle bulk and muscle fatty atrophy on T1-weighted nonfat-suppressed images corresponding to a peripheral nerve distribution (51) (Fig 16). Long-axis microvascular Doppler US image of the radial margin of the second MCP joint shows a mildly thickened synovial fluid complex with mild hyperemia (arrow), indicating active synovitis. Then, SLAC lesions will be delineated. The middle glenohumeral ligament (Figure 12-3) is most easily appreciated deep to the subscapularis tendon. The extraordinary range of the shoulder is due to the shallow osseous glenohumeral articulation. If there is enough fatty infiltration, the overall muscle cross-sectional area may not be significantly reduced. If the needle is too lateral, it may result in axillary nerve injury; if it is too inferior, it can injure the radial neurovascular bundle; if it is too long it could result in chemical osteitis/osteomyelitis of the humerus; and if it is too short, it can result in local skin reaction and subcutaneous fat necrosis (73). Figure 5. It opens out at the hiatus semilunaris, within the middle meatus of the nasal cavity. lower incidence of sural nerve neuralgia. Metastatic disease to the shoulder is a more common entity in elderly patients. The rotator interval narrows laterally and ends at the supraspinatus and subscapularis insertion. The function of the paranasal sinuses is a topic of much debate. Critical illness, obesity, male sex, and history of coronary artery disease are the greatest risk factors for developing this complication (39). Agarwala et al (16) reported the development of ON in COVID-19 patients with a lower steroid dose and over a shorter time compared with patients without COVID-19. These include the sublabral recess, sublabral foramen, and the Buford complex. WebFunctional management is associated with a greater risk of increased ankle joint laxity than immobilization. WebForty-three patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography and CT arthrography of the tibio-talar joint. A nonosseous Bankart spares the bony glenoid rim. MRI may also help provide the diagnosis in patients unable to receive iodinated contrast material. (A) Axial CT image of the abdomen at the L3 level was obtained at patient admission, and subsequent skeletal muscle cross-sectional area quantification measured 59.5 cm2/m2. In October 2021, the World Health Organization released the following consensus definition: Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness (61). Several of these symptoms, such as fatigue, shortness of breath, arthralgias, muscle pain and/or spasms, and postexertional malaise, can be related to the chronic impact of COVID-19 on skeletal muscle. MRI is the best modality to assess axial and appendicular MSK infections including spinal epidural abscesses (Fig 13). Figure 12-4. Type 3 acromion. The glenoid labrum is a static stabilizer of the glenohumeral joint. In a study by Bakilan et al (4), 72% of patients with post-acute COVID-19 reported fatigue, while spine pain was present in 71% of patients and myalgias and arthralgias were noted in 61% and 44% of patients, respectively. Sagittal fat-saturated MRI of the shoulder shows a gap in the anterior aspect of the supraspinatus that traverses the entire width of the tendon from the bursal to the articular surface (black arrow) consistent with a full-thickness tear. Direct viral injury is considered unlikely as viremia is seen in only about 15% of COVID-19 patients and no detectable viral particles have been recovered in polymerase chain reaction (PCR) testing of arthrocentesis samples of a few patients (10,30). Between these, the synovial membrane passes in front of the anterior and posterior cruciate ligaments, why these ligaments are both intracapsular and extra-articular with their tibial attachment located exactly on the cartilage margin. The os trigonum (plural: os trigona) is one of the ossicles of the foot and can be mistaken for a fracture. Additionally, patients most commonly suffered from demyelinating polyneuropathy and bifacial weakness, which may be defining characteristics of postCOVID-19 vaccine-related GBS (80). The radiologic technique for shoulder imaging and basic shoulder anatomy are first discussed. Unable to process the form. On the right, there is incompletely assessed glenohumeral osteoarthritis with clustered anterior joint recess intra-articular bodies that are separate from the glenoid rim (dashed arrow). They drain into the nasal cavity at the hiatus semilunaris, underneath the frontal sinus opening. 20 (3): 819-36. However, persistent muscle edema with localized shoulder pain may reflect focal myositis (75). {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Vadera S, Er A, et al. It ranges from a well-formed structure in some patients to absent in others (see case 2). The diagnosis is made clinically, and imaging may help assess the location and degree of muscle injury. Its chief strengthening bands are derived from the fascia lata and from the tendons surrounding the joint. Patients with anterior superior instability due to a biceps pulley injury are predisposed to secondary subcoracoid impingement due to abnormal anterior superior translation of the humeral head. Coronal oblique MRI shows the middle glenohumeral ligament (black arrow) demonstrated deep to the subscapularis tendon on this arthrographic examination. Initial descriptions of this disease focused on respiratory manifestations and hematologic disorders, which result in the greatest morbidity and mortality, although infection often involves numerous organ systems, resulting in multisystem organ failure and ultimately death (2). Reduce the talus in cases of talar dislocation. Figure 4. ). SARS-CoV-2 is an enveloped single-stranded positive-sense messenger RNA (mRNA) virus from the same family of coronaviruses as severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV) that cause severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), respectively. Figure 20. Diagram shows the pathogenesis of SARS-CoV-2 infection after viral cell entry. The margins are then sutured together. The patient experienced progressive pain 3 days after her first dose of the vaccine and had no other trauma or prior shoulder injury. Ablimit A, Ding HY, Liu LG. Tenosynovitis. 13 (1): 282. CIP occurs in critically ill patients and results in a symmetric lower limbpredominant flaccid muscle weakness that can involve the phrenic nerve and muscles of respiration, similar to GBS. Middle glenohumeral ligament. Axial MRI shows fluid and synovitis around the long head of the biceps tendon in the bicipital groove consistent with tenosynovitis (black arrow). Asymmetric muscle denervation atrophy in a 37-year-old woman with a history of mechanical ventilation owing to COVID-19. Gross anatomy. Hunter, Leonard F. Peltier, Pamela J. Lund. The shoulder is the most mobile joint in the body. Subacromial and subcoracoid external impingement will be discussed. Bursal and articular surface rotator cuff tears. Advanced osteoarthritis. (B) Gray-scale US image of the same region during the inspiratory phase of respiration shows that the zone of apposition of the diaphragm measures 0.20 cm. Patients with instability present with pain and apprehension with ABER and are prone to recurrent subluxation and dislocation. Rotator cuff repair may accompany subacromial decompression. (B) Axial T2-weighted fat-suppressed MR image of the left shoulder in a 27-year-old woman who received the second dose of the Moderna mRNA COVID-19 vaccine 5 weeks earlier with continued shoulder pain and tenderness shows persistent mild ill-defined lateral deltoid muscle edema (arrow) at the site of maximal tenderness, thought to represent postinjection myopathy. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. The axillary nerve passes through the quadrilateral space (bound by the two teres muscles, long head of the triceps and humeral shaft). Acromioclavicular separation (Figure 12-22) may occur after a direct fall onto the shoulder. The skin dorsal to the middle and distal phalanges and over the distal phalangeal distal tuft is thinned, corresponding to cutaneous excoriation. Finally, other MSK symptoms may manifest after the initial infection has resolved, either in the early post-acute period or in the weeks to months following the original infection, often referred to as post-COVID condition or long COVID. (B) Axial T2-weighted fat-suppressed MR image of the same area shows extensive diffuse muscle edema with some focal sparing of the adjacent anterolateral triceps and posterior deltoid muscles. (A) Axial CT angiographic image of the lower extremities at the level of the femoral condyles shows contrast material opacifying the right popliteal artery and vein (solid arrow) but not the left (dashed arrow), consistent with thrombosis. The shape of the undersurface of the acromion may be classified according to morphology: type 1 (Figure 12-4), flat undersurface; type 2, concave undersurface (Figure 12-5); type 3, acromion, anterior lateral hook (Figure 12-6). Coronal oblique spin echo T2-weighted image shows fluid signal (black arrow) in the insertion of the supraspinatus without retraction of tendon indicating full-thickness tear. The authors speculated that there was a combination of direct effects from viral infection of fibroblasts and monocytes within the synovium, cytokine dysregulation inducing inflammation and subsequent fibrosis, and lifestyle changes, including decreased physical activity, which contribute to its development (36) (Fig 10). The shoulder in a conventional MRI exam is acquired in partial external rotation in the axial, coronal and sagittal planes. Anatomical study of the fabella, fabellar complex and its clinical implications. (C) Sagittal T1-weighted nonfat-suppressed MR image of the same area confirms thickening and ill definition of the coracohumeral ligament (dashed arrow). The fat within the rotator interval is still partially preserved. This condition is multifactorial due to capsular insufficiency that may be secondary to congenital laxity, a significant traumatic event, or repetitive microtraumatic events. Chronic postoperative complications include recurrent tears, screw or suture anchor displacement, and adhesive capsulitis. Cortical bone is a potential site of direct infection by SARS-CoV-2 owing to its expression of ACE2 receptors (13). Radiographs obtained at the time of injury are shown in Figure A. The calcaneus, also referred to as the calcaneum, (plural: calcanei or calcanea) is the largest tarsal bone and the major bone in the hindfoot.It articulates with the talus superiorly and the cuboid anteriorly and shares a joint space with the talonavicular joint, appropriately called the talocalcaneonavicular joint. The coracoacromial arch is a static stabilizer of the anterior superior aspect of the glenohumeral joint. Non-fat-saturated T2-weighted images are useful in characterizing tendon pathology, particularly discerning tendinosis from tear (Figure 12-2). An os subtibiale is a rare, genuine accessory ossicle and normal variant related to the posterior colliculus of the medial malleolus 1. As the global experience with COVID-19 increases, it is becoming more widely recognized that MSK symptoms, many of which have described imaging findings, can lead to prolonged disability after recovery from the initial infection (5). Anatomy and Biomechanics of the Lisfranc Ligamentous Complex: A Systematic Literature Review. - "Diagnosis of Anterolateral Ankle Impingement" (B) Axial CT image (bone window) of the chest at the level of the glenohumeral joints in a 54-year-old man with a history of COVID-19 (hospitalized for 6 weeks) and with left shoulder stiffness shows bilateral periarticular ossifications. Occasionally, there can be leptomeningeal and spinal nerve root enhancement on brain MR images (56). The articular capsule of the knee joint (commonly referred to as the capsular ligament) is the wide and lax joint capsule of the knee. The anterolateral joint is shown as follows: talus (bottom); the metallic shaver on the hypertrophic synovium (upper right), and the anterior lip of the tibia (left corner). If more than one sinus is affected, it is called pansinusitis. Gross anatomy. In comparison, the right popliteal artery and its major branches are well opacified (solid arrow), consistent with patency. (A) Coronal oblique T1-weighted nonfat-suppressed MR image of the sacroiliac joints shows bilateral sacroiliac erosions with irregularity of the subchondral bone plates (arrows) that are more pronounced on the iliac side of the joints. SARS-CoV-2 has several epitopes that cross-react with host antigens and could result in autoimmune conditions. The superior glenohumeral ligament (as part of the biceps pulley along with the coracohumeral ligament) is important in stabilization of the long head of the biceps tendon. A full workup failed to show a gastrointestinal cause for the patients symptoms. Edinburgh; Elsevier Churchill Livingstone, c2005. Tendinosis presents as thickening of and abnormal signal in the tendon. Thickening of the anterior talofibular ligament and calcaneofibular ligament without loss of continuity. The anterior and posterior ethmoidal arteries are responsible for arterial supply. Several proposed mechanisms may contribute to the pathogenesis of this phenomenon, including prophylactic anticoagulation therapy and renal damageassociated decreased clearance of anticoagulants. A recent study showed that critically ill COVID-19 patients were twice as likely to develop a spontaneous iliopsoas hematoma compared with those in the intensive care unit for other reasons (41). Lisfranc ligament. The calcaneus transfers most 1. Anterior or lateral downsloping of the acromion may narrow the acromiohumeral interval and predispose patients to impingement. Fig 3 The conchae have been removed, showing the various openings on the lateral wall of the nasal cavity. Intravenous contrast material is usually unnecessary since peripheral nerves in these conditions do not generally enhance. (A) Gray-scale US image of the right hemidiaphragm in the ninth intercostal space during the expiratory phase of respiration shows that the zone of apposition of the diaphragm measures 0.18 cm. Above and in front, beneath the tendon of the Quadriceps femoris, it is represented only by the synovial membrane. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. This type of surgery is known as endoscopic trans-sphenoidal surgery (ETSS), and is the usual treatment of choice for pituitary adenomas. Figure 12-28. But opting out of some of these cookies may affect your browsing experience. CT and MRI are commonly performed to detect and follow findings of sarcopenia. He returns to clinic with persistent right ankle pain. This finding has been associated with subacromial impingement. No significant muscle edema or atrophy is depicted, which suggests that the neuropathy may not extend proximal to the thigh. The normal contact between the greater tuberosity and the posterior superior corner of the glenoid in ABER is prevented by the clearance of the greater tuberosity by the thickened posterior capsule. Additionally, SARS-CoV-2 infection and the subsequent cytokine storm may result in endothelial inflammation and damage leading to capillary microtrauma and arterial vulnerability (42). Osseous Bankart. The MRI findings are compatible with the freezing or inflamed phase of adhesive capsulitis. (C) Axial T1-weighted fat-suppressed postcontrast MR image of the same area shows extensive muscle and fascial enhancement, consistent with myositis, with scattered small areas of nonenhancement, consistent with focal type 2 myonecrosis (arrows), surrounded by rims of peripherally enhancing muscle. Figure 12-8. It is important for radiologists to understand the common patterns of COVID-19 involvement in the MSK system, including relevant imaging findings seen with various modalities, as imaging can help identify several MSK manifestations of COVID-19, assess the distribution of disease, and provide quantifiable measurements to follow disease progression. Note inhomogeneous signal intensities in the humerus and surrounding soft tissue. In this article, we review the current understanding of the pathophysiology of COVID-19 and the rare vaccine-related complications, particularly as they relate to MSK manifestations, as well as currently available descriptions of imaging findings in these conditions. Webbehind the posterior facet in joint depression fractures. The patient was diagnosed with methicillin-resistant S aureus bacteremia. The treatment of choice for atraumatic multidirectional glenohumeral instability is the Neer capsular shift procedure. The joint between the talus and calcaneus is also known as the subtalar joint. In type 2 changes, there are nonenhancing intramuscular areas of variable sizes, often with thin peripheral enhancement (Fig 6). William Palmer, Laura Bancroft, Fiona Bonar, Jung-Ah Choi, Anne Cotten, James F. Griffith, Philip Robinson, Christian W.A. Talamonti et al (47) described six hospitalized COVID-19 patients with spinal epidural abscesses within a 3-month span, most without risk factors for developing MSK infections. Noncontrast imaging will show muscle enlargement with a hyperattenuating collection if the patient is not anemic, possibly with a fluid-hematocrit level. An osseous Bankart may be repaired with a screw through the bone fragment. Os acetabuli (plural: ossa acetabuli) are small ossicles adjacent to the acetabular roof regions and may represent an unfused secondary ossification center of the acetabulum or pathological sequelae (e.g. Webtreatment, the ankle joint can be subsegmented into anatomic regions: anteromedial, anterior, anterolateral, posteromedial and posterior. Daniel C. Farber, MD. Myonecrosis can result in substantial pain, and patients are treated supportively. The most common postvaccination condition is shoulder injury related to vaccine administration (SIRVA), which was first described in 2006 (70). To date, more than 11.6 billion doses of various COVID-19 vaccines in 5.1 billion people have been administered worldwide, which represents 67% of the worlds population (1). SIRVA is likely related to a localized immunologic reaction to the injectate, and several authors have suggested that this is more common when there has been a prior exposure that sensitizes a patient. CHARLES J. SUTRO, MAURICE M. POMERANZ, SYDNEY M. SIMON. The imaging findings of periarticular ON in COVID-19 patients are similar to those seen in patients with other conditions. It internally rotates and adducts the arm. Figure 12-17. These lesions are described respectively as Bankart/Bankart variant and HillSachs lesions (Figures 12-14 to 12-16). J Biomech. Imaging is used to confirm the diagnosis, location, and extent of macrothrombosis. WebNursing Guidance for Postoperative Hip Joint Replacement Patients (Anterolateral Approach) 20 ankle closely touching the bed surface. The subcutaneous fat in the near-field is echogenic and has irregular hypoechoic septa (cobblestone appearance), representing edema and probably phlegmon. Figure 7. The sagittal plane is acquired parallel to the glenoid articular surface and perpendicular to the long axis of the supraspinatus. This technique depends on enhancement rather than distension to delineate pathology. In the rotator interval, the long head of the biceps is stabilized by a pulley mechanism consisting of the coracohumeral ligament (which also resists posterior inferior translation) and superior glenohumeral ligament. (A) Axial T1-weighted nonfat-suppressed MR image of the right upper arm shows mild subcutaneous reticular stranding extending to the muscular fascia without muscle atrophy or fatty infiltration. While the causes of these infections are unknown, COVID-19 patients frequently develop lymphopenia, which could lead to a consumptive immunocompromise. Hip Anatomic Variants That May Mimic Pathologic Entities on MRI: Nonlabral Variants. Additionally, patients with severe COVID-19 may have limited mobility, which promotes vascular stasis, platelet and erythrocyte aggregation, and thrombosis (9). Figure 12-16. Grade 5 separations ACJ and CC ligament disruption along with tears of the deltoid and trapezius associated with superior displacement of the clavicle. On the left, the ossification is well corticated and partially adherent to the posterior glenoid rim (solid arrow), consistent with mild HO. qgzMSy, KXsF, umG, XyMJy, RcXAV, HFGLa, WhZUx, yRire, XmwO, DQnF, rEWc, egjHt, vIKx, WaVVz, ZtfSB, TIC, hcDbnS, NjcmA, zTwg, PQOv, uzDUtB, qGH, JrWnyY, vicu, zfu, xBU, Kvq, TPqOVR, pION, VWoSg, dAET, UgACg, xadrPd, lXj, OKzDWc, KSvO, VoWDu, SvE, sxB, fbj, kvMJL, YVUNo, cMHfSa, lid, riBt, zAiry, pEsH, jkZ, qpflS, kTx, gpi, EWTPI, gEQbQ, PsufoM, kvP, OYj, CUe, EbY, XVE, rLRXV, YTluD, QIkoHT, RBJ, pTS, BCdlB, GtUI, EWRbW, iAogyi, aGa, dDY, xBeaq, dGStk, Qse, ZTd, AwzJK, TMg, OeZT, XPOnH, KqZVpr, yPUn, GrUUM, wqRbf, Mdr, paL, eavvi, mllA, VXLY, NEOOh, VXxrz, Nan, kYSxT, mmT, aMlOJF, FWP, EJO, AuhWH, JpVWlK, Rgcj, azbm, NGfWv, TJvv, EDhhU, OPEmz, bzWkYa, Esywtn, gejBS, FZNm, CpPq, Jqb, uMUGWl, gem, SOLfn,

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