Biomedical subjects
Publications and source records attributed to C S Resnik.
Differentiation of the many disorders that affect the sacroiliac joints can often be accomplished by attention to radiographic detail. By evaluating the distribution of disease, the presence of erosions and other changes as noted herein, and the course of disease over a period of time, a specific diagnosis can often be made, or at the very least, suggested (Table).
Although foramina in the scapula are a rare occurrence, they produce radiolucent defects that simulate those related to skeletal metastasis or multiple myeloma. In order to define the typical location and appearance of these foramina, we initiated a radiographic and pathologic examination of macerated modern and ancient scapulae. Of 93 macerated scapulae that were examined, foramina were observed in 27 specimens (29%). These occurred at four sites: at the superior border of the bone at its junction with the coracoid process, caused by ossification of the superior transverse ligament (21 specimens); in the body of the bone inferior to the scapular spine, resulting from a disturbance in ossification during fetal development (five specimens); in the superior fossa, as a clasp-like defect (one specimen); and, at the superomedial border above the scapular spine (one specimen). The radiographic features of these foramina were compared to those produced by normal vascular channels, anatomic thinning of the bone, and skeletal metastasis or multiple myeloma. Knowledge of the typical appearance and site of scapular foramina assures accurate diagnosis.
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Radiographs of 236 patients who underwent total hip replacement (THR) were evaluated for heterotopic bone formation. There was no significant difference in the presence and degree of ossification in patients with and without diffuse idiopathic skeletal hyperostosis (DISH). The authors conclude that DISH is not a significant risk factor in the development of heterotopic bone formation following THR.
A patient with Cronkhite-Canada syndrome and an erosive arthritis whose course correlated with the activity of his bowel disease is described. We found no previous description of articular manifestations in any patients with this syndrome. Cronkhite-Canada syndrome should be added to the differential diagnosis of erosive arthritis in the appropriate clinical setting.
We describe a patient with dislocation of the lumbosacral junction. No previous report of this rare injury has included a normal lateral radiograph without displacement in an anteroposterior direction. The radiologist should be aware that marked lumbosacral abnormality may be present despite the innocent appearance of a lateral radiograph.
We present a patient with syringomyelia and neuropathic osteoarthropathy involving the elbow, wrist, and hand unilaterally and discuss the differential diagnosis of the radiographic features. The unique pattern of joint involvement in this patient may be explained by selective involvement of specific anatomic sites within the spinal cord.
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We have presented three patients who had bony expansion due to metastatic carcinoma of the prostate demonstrated by roentgenography and bone scintigraphy. Bony expansion must be differentiated from the blooming phenomenon which may occur in areas of high radioactivity. Bony expansion is not specific for Paget's disease, but also occurs in many other benign and malignant conditions.
Five cases of monostotic fibrous dysplasia involving the spine have previously been reported. We report a sixth case of this entity. The patient had a well-defined lytic lesion with several vertical septations that involved most of the sixth cervical vertebral body with extension to the right pedicle and lamina. Histologic examination revealed fibrous tissue within medullary bone with irregularly shaped bony trabeculae imbedded in the fibrous stroma. Biopsy findings confirmed the diagnosis.
The glenohumeral joint was studied in 25 cadavers and 136 patients using computed arthrotomography (CAT) and conventional arthrotomography (AT) to assess shoulder instability. Cadaver shoulders were injected with air or latex, sectioned with a band saw, and normal articular anatomy outlined. CAT was performed in 81 patients and characterized the glenoid labrum as normal, abnormal, or detached in 38 of the 44 patients who had surgery or arthroscopy (sensitivity, 96%; accuracy, 86%). Hill-Sachs defects were seen in 20 out of 29 patients with anterior labral abnormalities, while bicipital tendon abnormalities were evident on CAT in 6. Of 55 patients who had AT, the status of the labrum was clarified in 13 of the 16 patients who had surgery or arthroscopy (sensitivity, 86%; accuracy, 81%). Both methods can characterize the labrum; however, CAT is more comprehensive and appears ideal for both detection of Hill-Sachs defects and imaging the bicipital tendon. CAT requires less technical expertise and radiation than AT and is tolerated better by patients in pain.
Five cases of transscaphoid, transcapitate, perilunate fracture dislocation have been presented with a discussion of the radiologic findings, mechanism of injury, and method of treatment. Although a total of only 23 cases have now been reported in the literature, this type of injury is probably not rare as we have seen two cases within a span of six months. It is important to recognize the radiologic features of this fracture dislocation so appropriate therapy may be instituted.
Calcium pyrophosphate dihydrate crystal deposition disease and HA crystal deposition disease are two common disorders that may come to the attention of a physician because of a variety of clinical symptomatology patterns. In CPPD crystal deposition disease, characteristic radiologic features include articular and periarticular calcification and an arthropathy consisting of joint space narrowing, bone sclerosis, often prominent subchondral cyst formation, occasional severe and progressive destructive bone changes, and variable osteophyte formation. These findings are often seen in a characteristic distribution with involvement of non-weight-bearing as well as weight-bearing joints and with involvement of distinctive intraarticular sites such as the patellofemoral compartment of the knee and the radiocarpal compartment of the wrist. In HA crystal deposition disease, characteristic radiologic features consist of calcific tendinitis and periarthritis as well as a more recently described arthropathy. Awareness of the distinctive roentgenographic appearance of these two diseases should allow a specific diagnosis to be made, and an understanding of their pathologic features should aid in appropriate therapy and guide future investigation of possible etiologic factors.
The clinical records and hand and wrist radiographs of 51 patients with calcium pyrophosphate dihydrate crystal deposition disease have been analyzed, and symptomatology and radiologic abnormalities have been correlated. Characteristic roentgenographic features included cartilage and synovial calcification and arthropathy of the metacarpophalangeal joints and the radiocarpal compartment of the wrist, including scapholunate dissociation. Clinical-radiologic correlation revealed many asymptomatic patients with calcification and arthropathy and many symptomatic patients with normal radiographs. Thorough radiologic evaluation may reveal many patients with this disorder before the onset of clinical symptoms.
Radiographic features of hand and wrist involvement in 26 patients with hemochromatosis and in 26 patients with idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease were compared. Two radiologists independently examined the radiographs without knowledge of the specific group to which the patient belonged. The results of this study clearly establish that structural joint diseases in the two disorders are not identical. Characteristic findings allow the radiologist to favor one diagnosis over the other. These radiographic differences indicate that the arthropathy of hemochromatosis is related to factors additional to the presence of CPPD crystals, specifically, the more prevalent narrowing of the metacarpophalangeal joint spaces, including those in the fourth and fifth digits, peculiar hook-like osteophytes on the radial aspect of the metacarpal heads, and less prevalent separation of the scaphoid and the lunate.
An example of the "two-eyed Scotty dog," seen on the oblique radiograph of the lumbar spine, is presented. The second eye is created by a prominent mammillary process.
A case of a midline circular defect of the sternum is presented. This may represent a localized fusion anomaly.