Quiz case. Diagnosis: Tuberculous arthritis of the knee with proliferative synovitis and necrotizing osteomyelitis (proven by histology).
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Adult↗
Biomedical subjects
C Krestan
Publications and source records attributed to C Krestan.
Magnetic resonance imaging of the postoperative hip.
Magnetic resonance imaging (MRI) of the postoperative hip for delineation of various pathological conditions has been established in addition to conventional radiography and computed tomography. MRI provides superior soft-tissue contrast than the other imaging modalities, and it can be used for visualization of structures and pathological entities that cannot be depicted by conventional radiography and computed tomography. These entities include bone marrow changes such as bone marrow edema and avascular necrosis, and infiltration of the bone marrow by tumor recurrence or infections after insertion of metallic osteosynthetic material. The image quality of MRI, which is reduced as result of artifacts caused by metal alloys, can be optimized by using spin-echo or fast spin-echo sequences, and by adapting phase- and frequency-encoding directions in cases where metallic osteosynthetic materials were used. MRI, in addition to computed tomography and conventional radiography, appears to be a valuable tool for imaging the different pathological conditions of the postoperative hip, including after implantation of metallic osteosynthetic material.
Arthroplasty, Replacement, Hip↗
Contrast-enhanced computed tomography of freely transplanted jejunal patches after surgery in the oral cavity and oropharynx.
Thirty-two patients with jejunal patches in the oral cavity and oropharynx were examined with contrast-enhanced computed tomography (CT). The morphology of the intestinal wall, the mesenteric fatty tissue, mesenteric lymph nodes and the region of the anastomosis were evaluated and correlated with clinical findings. The size and number of mesenterial lymph nodes, which were found in 16 cases, did not correlate with tumour recurrence. The benign alterations of the intestinal wall ranged from flat surfaces with no enhancement to significant enhancement with persisting folds. In cases with persisting intestinal folds, separation of tumour recurrence was achieved by identification of a typical double-layer configuration of the enhancing mucosa, and the restriction of alterations to the intestinal wall compartment. Tumour recurrences occurred at patch margins and were reliably distinguished from normal patches. For differentiation of findings, an exact localization of jejunum-patch compartments and margins with contrast-enhanced CT was, therefore, necessary.
Adult↗
Abdominal dissemination of malignant cells with hysteroscopy.
BACKGROUND: The increase in uterine pressure during hysteroscopy may lead to dissemination of malignant cells into the abdominal cavity. CASE: In a patient with adenocarcinoma of the endometrium, hysteroscopy was performed after peritoneal cytology had been obtained by washing with saline. In contrast to this first washing, a second peritoneal lavage immediately after hysteroscopy led to positive cytology. CONCLUSION: Viability and peritoneal implantation of these disseminated cells are questionable. However, routine hysteroscopy in cases of suspected endometrial carcinoma should not be recommended.
Abdomen↗
[CT and MRI of small intestine interposition after oropharyngeal tumor resection].
Freely transplanted, microvascularly anastomosed jejunal patches can be used to cover soft tissue defects in the oral cavity or oropharynx after the resection of malignant tumors. Even a patch without complications or alteration from tumor recurrence is morphologically diverse. Therefore it is difficult to distinguish between malignant and benign alterations, and knowledge of the possible morphological spectrum and the significance of an alteration is of practical interest. Computed tomography (CT; n = 30) and magnetic resonance imaging (MRI; n = 13) were used for follow-up examinations in patients who had an operative reconstruction with a jejunal patch. Three parts of a patch were differentiated with both imaging modalities: the region of the anastomosis, the mesenterial fatty tissue and the intestinal wall. The morphology of the patches correlated with clinical findings in the following cases. The patches were identified satisfactorily by CT and MRI. The appearance of patches without complications was influenced by a variable degree of fibrosis and by persistent intestinal folds. Recurrent tumors only infiltrated the margins of the patches. Destructive alterations in the patches were always less severe than those in the original orofacial soft tissue. Postoperative follow-up examinations with CT and MRI are particularly important when tumor recurrences spread under a patch, since these tumors are invisible in the clinical examinations. CT was advantageous in demonstrating osseous alterations and showed less loss of image quality in patients for whom the implantation of multiple metallic hardware during the operation had been necessary.
Adult↗