Case report 544: Metastatic chordoma to humeri (originating in sacrum).
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Aged↗
Biomedical subjects
C S Resnik
Publications and source records attributed to C S Resnik.
Case report 522: Concurrent adjacent osteochondroma and enchondroma.
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Adult↗
The laminar space in the diagnosis of rotational flexion injuries of the cervical spine.
We measured the distance between the spinolaminar line and the articular pillars of the cervical spine (the laminar space), identified on lateral radiograph, to determine the diagnostic value of changes in this measurement in cases of unilateral facet dislocation. Twenty-seven cases of unilateral facet dislocation were compared with 70 normal spines and with 29 cases of hyperflexion injuries without unilateral facet dislocation. Abrupt alteration of the laminar space between two adjacent levels was found to be an accurate measure of rotation of the spine at the levels concerned; on the basis of this alteration, we were able to correctly diagnose 23 of 27 cases of unilateral facet dislocation and 22 of 23 cases of unilateral facet dislocation between C2 and C6. In only two of the 70 normal cases was a similar alteration of the laminar space seen, and one of these was due to a previous fracture. In none of the 29 cases of hyperflexion injury without unilateral facet dislocation was there abrupt alteration of the laminar space. We conclude that abrupt alteration of the laminar space is an accurate determinant for rotational anomalies of the cervical spine and, in particular, for unilateral facet dislocation.
Cervical Vertebrae↗
Diagnostic imaging of pediatric skeletal trauma.
Because many injuries to the pediatric skeleton are unique and can present with only subtle radiographic abnormalities, familiarity with their appearance can aid in accurate diagnosis. These include physeal injuries, incomplete fractures, and avulsion injuries. Recognition of characteristic fractures also allows correct identification of a battered child. As illustrated in examples of injury to the elbow, an organized search for clues to abnormal alignment is particularly helpful in the evaluation of pediatric skeletal trauma.
Battered Child Syndrome↗
Computed tomography of desmoid tumors of bone: desmoplastic fibroma.
Desmoplastic fibroma of bone is a rare benign tumor, first described by Jaffe in 1958. Since then approximately 80 cases have been reported in the long bones, although the tumor also involves the jaw bones, particularly the mandible. The plain film features consist of a lytic, expansile lesion, usually in the metaphysis of bone, sometimes extending into the soft tissues. We present two cases involving the long bones in which the correct diagnosis was suggested by computed tomography (CT). The CT appearance of the lesions is described.
Adolescent↗
Periarticular calcification in immunosuppressed cardiac transplant patients.
A retrospective study was performed to determine whether the likelihood of developing periarticular calcification in the hands is increased significantly in cardiac transplant patients. Two groups of patients were identified: those whose transplant occurred before the routine use of Cyclosporine as an immunosuppressive agent and those who received Cyclosporine at the time of transplantation. Seven of nine patients in the former group demonstrated periarticular calcification at multiple sites in the hands, but no patient in the post-Cyclosporine group had calcification at more than one site. Cardiac transplant patients on high dose systemic steroids for an extended period of time are likely to develop periarticular calcification. This appears to be related to steroid dose and duration of treatment and also may be influenced by other immunosuppressive agents.
Arteries↗
Infection versus tumor in the spine: criteria for distinction with CT.
To develop criteria to distinguish among pyogenic infection, nonpyogenic infection, and neoplastic processes in the spine by means of computed tomography (CT), the authors retrospectively analyzed 17 cases of pyogenic infection (20 sites), 40 cases of neoplastic disease (56 sites), and five cases of granulomatous infection (eight sites). Reliable criteria for pyogenic infection were complete prevertebral soft-tissue involvement, diffuse osteolytic destruction, gas within both bone and soft tissue, and a process centering on an intervertebral disk. Neoplastic disease was characterized by posterior element involvement, partial or absent prevertebral soft-tissue swelling, and osteoblastic alterations. In a limited number of cases, nonpyogenic infection was characterized by focal lytic bone involvement and marginal sclerosis. Blinded testing of these criteria indicated potential for improved diagnostic accuracy in clinical practice.
Humans↗
Chronic septic arthritis of the adult hip: computed tomographic features.
Abnormalities on computed tomography (CT) are described in 12 adults in whom septic arthritis of the hip was diagnosed. Presenting symptoms varied, as did CT findings. Soft tissue abnormalities ranged from intra-articular effusion to large abscess formation, and bone changes ranged from minimal erosion of articular surfaces to gross destruction of the proximal femur and acetabulum. CT can be helpful in the evaluation of septic arthritis of the hip because of its superior demonstration of soft tissue detail. An accurate diagnosis can be established in unsuspected cases and can be confirmed when clinical indicators are vague.
Abscess↗
Sternocostoclavicular hyperostosis: rheumatologic, radiologic, and dermatologic characteristics.
Two recently observed patients with sternocostoclavicular hyperostosis exemplify the characteristic presentation of this rheumatologic disorder. We describe its manifestations, review the literature on this subject, and discuss clinical and radiologic aspects, including the frequently associated dermatologic disorder palmoplantar pustulosis. Sternocostoclavicular hyperostosis is an increasingly common diagnosis, and practicing physicians should be aware of the distinctive features that allow accurate differentiation from psoriatic arthritis and other diseases.
Bone Diseases↗
Septic arthritis of the hip: a rare complication of angiography.
Local infection at the puncture site following percutaneous angiography has been reported as exceedingly rare. We describe the first patient with documented septic arthritis of the hip following percutaneous transfemoral arteriography. Radiologists should be aware of this potentially serious complication.
Angiography↗
The architecture of the proximal femur: an imaging analysis.
The proximal femur is a dynamic region whose internal architecture reflects the biomechanical demands of weight-bearing. It is composed of two major trabecular systems arranged along the lines of compressive and tensile stresses. Adaptive alterations in these trabeculae occur in a variety of disorders, including osteoporosis, osteoarthritis, and ischemic necrosis. Plain film radiography and computed tomography (CT) have been utilized to study these changes and provide insight into the pathophysiology of these disorders. Analysis of the order of resorption of trabeculae in osteoporosis, the proliferation of trabeculae in osteoarthritis, and the reparative changes in ischemic necrosis often allows accurate assessment of the severity of involvement and can give valuable information to aid treatment planning.
Femoral Neck Fractures↗
Case report 353: Giant cell tumor of distal end of the femur, containing a fluid level as demonstrated by computed tomography.
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Adult↗
Ossification centers of the pediatric elbow: a rare normal variant.
A 7-year 9-month-old boy sustained a transcondylar humeral fracture during a fall. Radiographs revealed a trochlear ossification center without evidence of a medial epicondylar center. This combination, although apparently quite rare, should be recognized as a normal variant.
Child↗
Arthroscintigraphic evaluation of the painful total hip prosthesis.
Arthroscintigraphy was performed in 19 patients with a painful total hip prosthesis by injecting both Tc-99m sulfur colloid and iodinated radiographic contrast material intra-articularly. Scintigraphic and radiographic results correlated exactly in 15 patients, with one false-negative scintigram, one false-positive scintigram, and one false-negative arthrogram. One patient was evaluated by scintigraphy alone. Although arthroscintigraphy is potentially more sensitive than conventional arthrography in the detection of femoral component loosening, acetabular component loosening cannot be evaluated by scintigraphy alone. A combination of scintigraphy and conventional arthrography appears to be the most accurate imaging method in the evaluation of hip prosthesis loosening.
Arthrography↗
Sternocostoclavicular hyperostosis: a review and report of 11 cases.
Sternocostoclavicular hyperostosis is a benign ossifying diathesis of unknown etiology characterized by hyperostosis and soft-tissue ossification between the clavicles, anterior portion of the upper ribs, and manubrium, with variable hyperostosis or ankylosis in the spine and sacroiliac joints. Our cumulative experience with 11 cases is reported, with emphasis on radiographic features of the condition. Scintigraphic results in five patients and computed tomographic findings in one patient are presented. A review of the literature and our own material indicates that sternocostoclavicular hyperostosis may be more common than has been previously recognized.
Adult↗
Trabecular bone density in the proximal femur: quantitative CT assessment. Work in progress.
A new technique has been developed for quantitative assessment of trabecular bone content in the proximal femur using computed tomography (CT). The method employs the same contoured calibration phantom currently used for vertebral mineral studies and can be performed on any standard body scanner. Both femurs are evaluated simultaneously, and an integral approach to mean density determinations compensates for the complex geometry and trabecular architecture of the region. Specimen studies have documented acceptable reproducibility, and radiation dose and examination time are comparable to those of quantitative CT in the spine. Greater inherent accuracy has been achieved more rapidly through the addition of three-dimensional histogram analysis using a free-standing CT data processor. High correlation with vertebral trabecular bone content has been documented in the limited number of patients studied to date. Widespread availability of the technique and the high frequency of fractures related to metabolic bone disease in the proximal femur render the method a potentially valuable contribution to noninvasive bone densitometry.
Absorptiometry, Photon↗
Incomplete carpal coalition.
Congenital coalition between the lunate and triquetrum is a common anomaly that may have several different radiographic appearances. We report seven patients with partial coalition and rounded radiolucencies in the subarticular region of both bones. The most likely cause of this combination of findings is abnormal differentiation of the joint space and remnants of misplaced synovial tissue that formed during the disorganized process of joint development.
Adult↗
Pentazocine induced myocutaneous sclerosis.
A patient who developed myocutaneous sclerosis as a result of aggressive parenteral administration of the analgesic pentazocine is described and the literature reviewed. In addition to the dermatopathologic and myopathic abnormalities usually present in this disorder, our patient manifested unique features of brachial plexus neuropathy and radiographically evident soft tissue calcification. Our report serves as a reminder that caution should be employed when the use of pentazocine as a longterm analgesic agent is considered.
Calcinosis↗