Roentgen rounds #82. Osteochondritis dissecans of capitellum.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
L A Gilula
Publications and source records attributed to L A Gilula.
Roentgen rounds #83. Congenital pseudarthrosis of the tibia.
Explore the source record for details and available documents.
Child↗
Carpal ligamentous disruptions and negative ulnar variance.
Negative ulnar variance is a condition in which the ulna is relatively shorter than the radius at the carpus. It was found in 21% of 203 normal wrists. We have observed an increased incidence (49%) of this anomaly in patients with carpal ligamentous instabilities (dorsiflexion instability, palmar flexion instability, scapholunate dissociation with rotary luxation of the scaphoid, and lunate and perilunate dislocations). While the reasons for this association have yet to be adequately delineated, the presence of a negative ulnar variant may serve as an impartial clue to the presence of ligamentous instability. Many carpal instabilities present with subtle radiographic findings requiring careful evaluation of radiographs. Patients with negative ulnar variance and histories suggestive of ligamentous instability should undergo careful radiologic evaluation to assure early diagnosis of carpal disruption.
Adult↗
Three-dimensional imaging of the wrist.
The objective of this study was to determine the diagnostic quality of three-dimensional images of the carpal bones that could be constructed from raw data obtained from a computerized tomography scan. The quality of raw data collected was determined by collimation, slice interval, the number of projections, and x-ray tube operating specifications. The quality of two-dimensional images that were constructed from the raw data was determined by user-specified parameters including zoom or magnification factor, convolution kernels, and centering. The two-dimensional images were modified by erasure, the level of reconstruction, and animation, which permitted isolation of individual carpal bones, the construction of three-dimensional images viewing the external and internal surfaces of the bones, and the rotation of the images to provide multiple views. Representative images are presented.
Carpal Bones↗
Synovial cysts of the knee: CT evaluation.
Eight patients with synovial cysts about the knee were studied by computed tomography (CT). Six of the eight patients had cysts in atypical locations, four medial and two anterior. Knee arthrography, performed on five patients, demonstrated the cyst in only two cases. In all patients CT defined the location and extent of the cyst, demonstrating the following benign features: a well-defined homogeneous mass with attenuation values approximating that of water, preservation of adjacent soft-tissue planes, and absence of bone involvement. The authors conclude that CT is useful in the evaluation of a suspected synovial cyst when its position is atypical or when arthrography fails to demonstrate or completely delineate the cyst. CT provided diagnostic accuracy and determination of the optimal operative approach.
Adolescent↗
Histiocytic reaction to hip arthroplasty.
Pain secondary to loosening of a total hip prosthesis is a common complaint and a major complication after surgery. Periprosthetic lucency is a well-recognized result of loosening of the prosthesis and of infection. We describe histiocytic proliferation as an additional cause of periprosthetic lucency and lytic change in two patients. To our knowledge, this has not been previously reported in the radiological literature.
Acetabulum↗
The carpal boss: an overview of radiographic evaluation.
The carpal boss, an unmovable bony protuberance, is located on the dorsum of the wrist at the base of the second and third metacarpals adjacent to the capitate and trapezoid bones. This bony prominence may represent degenerative osteophyte formation and/or the presence of an os styloideum, an accessory ossification center that occurs during embryonic development. When this condition is symptomatic, patients present with complaints of pain and limitation of motion of the affected hand. The symptoms of carpal boss may result from an overlying ganglion or bursitis, an exterior tendon slipping over this bony prominence, or from osteoarthritic changes at this site. Radiographically, the view that best profiles the separate os styloideum is a lateral view utilizing 30 degrees of supination and ulnar deviation of the wrist. Once a diagnosis has been made, treatment can range from the use of nonsteroidal antiinflammatory medication and limited use of the wrist to surgical excision of the anatomic abnormality.
Bone Diseases↗
Ewing's sarcoma in bones of the hands and feet: a clinicopathologic study and review of the literature.
Review of current data from the Intergroup Ewing's Sarcoma Study (IESS) shows that Ewing's sarcoma (ES) is rare in bones of the hands and feet. Only 12 of 377 evaluable patients in the first two IESS studies had a primary tumor in these small, distal bones. The age distribution was typical for that seen in patients with ES at other sites. Males were affected twice as often as females, and tumors in the bones of the feet were much more common than those in the hands. All signs and symptoms were local in distribution. As in other sites, the dominant histologic pattern was categorized as diffuse. With the exception of those patients with lesions in the calcaneus, the prognosis for disease-free survival was excellent. A literature review of cases of ES reported in bones of the hands and feet showed generally comparable results.
Adolescent↗
Radiographic appearance of Ewing sarcoma of the hands and feet: report from the Intergroup Ewing Sarcoma Study.
Review of current data from the Intergroup Ewing Sarcoma Study (IESS) shows that Ewing sarcoma is rare in bones of the hands and feet. The 12 patients from the IESS protocols with hand or foot Ewing sarcoma are comparable to those already reported in the literature. With the exception of lesions in the calcaneus, the prognosis for disease-free survival is excellent. The radiographic features of hand and foot Ewing sarcoma are generally those of classic Ewing sarcoma: permeation, soft-tissue mass, and, often, associated sclerotic reaction. However, with the exception of sclerosis, features suggesting bone reaction and slow tumor growth in these patients were distinctly uncommon compared with Ewing sarcoma in general. Those radiographic features suggesting aggressive behavior were slightly more common than in the general Ewing population. Even so, neither the radiographic appearance nor the greatest dimension of the radiographic lesion can be shown to contribute significantly to prognostication in these patients. Apparently location of the lesion is important, since in the reported cases in the literature and in this series, lesions of the calcaneus fared poorly. The importance of this set of patients therefore relates to awareness and early recognition of an unusual appearance and location of Ewing sarcoma.
Adolescent↗
Hexabrix as a contrast agent for ascending leg phlebography.
Fifty patients were analyzed after a randomized double-blind study comparing Hexabrix and Hexabrix-20 in ascending phlebography. Measures of safety and patient tolerance indicated that both concentrations of Hexabrix appeared safe and were well tolerated. All studies were diagnostic, and the image quality was rated as excellent in 80% of the Hexabrix group and 72% of the Hexabrix-20 group. The authors conclude that Hexabrix and Hexabrix-20 are acceptable contrast media for ascending phlebography.
Adult↗
Musculoskeletal applications of three-dimensional surface reconstructions.
We have applied computer programs originally developed for craniofacial surgical planning and evaluation to complex musculoskeletal problems. These computer programs reformat ordinary CT scans into black and white images of the three-dimensional osseous surfaces found in the scanned volume. These reformatted three-dimensional CT scan images increase the utility of CT scan examinations of complex osseous structures, such as the wrist, spine, hip, knee, and shoulder. The software, which operates on an unmodified commercially available CT scanner, can produce high-quality surface reconstructions from CT scan slices without operator intervention. No special knowledge of the principles used in the reconstruction methods is needed to successfully use the programs.
Adolescent↗
Thrombolytic therapy for acute arterial occlusion.
To evaluate the role of selective intra-arterial low-dose thrombolytic therapy (SILDT) as an alternative to the surgical management of acute arterial occlusion, the hospital records of 40 patients who underwent 43 SILDT treatments with either streptokinase (36) or urokinase (7) between December 1979 and March 1984 were reviewed. Twenty-eight patients underwent 30 treatments (group 1) for native arterial occlusion and 12 patients underwent 13 treatments (group 2) for prosthetic or autogenous graft occlusions. Therapy was deemed successful if subsequent surgical therapy was obviated. In group 1, SILDT was successful in 13 of 28 (45%) patients with 12 of 25 lower extremity occlusions and one of three upper extremity occlusions. Successful lysis in the native artery occlusion group fell into three categories: five patients were successfully treated for arterial thrombosis complicating percutaneous transluminal angioplasty (PTA); four patients required PTA after complete lysis revealed an underlying arterial stenosis; and only three required no further therapy after SILDT. SILDT failed in all three patients with the aortoiliac occlusions. Eleven patients with femoral artery occlusions and unsuccessful SILDT required six bypass procedures, three amputations, one embolectomy, and one PTA. In group 2 only 3 of 14 treatments (21%) were successful. Bypass revision was not possible in 11 patients and all required amputation. Systemic fibrinolysis was seen in 20 (59%) of 34 patients with available data. Neither fibrinogen levels nor fibrin degradation products predicted the occurrence of complications. Minor complications occurred in 18 of 43 (43%) treatments; small hematomas at the catheter entry site were most common. Minor complications occurred in 20 of 43 treatments (44%) and included severe local hemorrhage (four), distant bleeding (three), pulmonary embolism (four), myocardial infarction (three), unmasking of an aortoduodenal fistula (one), and clot migration requiring emergency thrombectomy (four). SILDT is most effective in acute arterial thrombosis complicating arteriography or percutaneous angioplasty. It may play a role in the patient in whom thrombolysis can reveal an underlying stenosis amenable to percutaneous angioplasty. This experience shows SILDT to be of limited value in the management of prosthetic autogenous graft occlusions. Finally, thrombolytic therapy is associated with significant morbidity and mortality rates and requires cautious monitoring to detect arterial thrombus migration, worsening tissue ischemia, venous thromboembolism, intracerebral hemorrhage, and local or systemic bleeding.
Acute Disease↗
Roentgenographic-pathologic correlation of diffuse sclerosis in Ewing sarcoma of bone.
Roentgenographic review of the first 210 cases of Ewing sarcoma (ES) in the Intergroup Ewing Sarcoma Study revealed that 37.6% of cases had evidence of diffusely increased intraosseous density or diffuse sclerosis (DS). In these cases the sclerosis was usually mixed with various patterns of lysis and/or combined with a periosteal reaction. A radiograph blinded histologic review of selected biopsies showed an 83% incidence of dead bone compared to 23% in those without DS. Ten percent of the cases with DS had appositional new bone formation on dead bone whereas none of the cases without DS showed such reactions. Pathologic explanation of the roentgenographically identified diffuse sclerosis in ES has not been previously well documented in the medical literature.
Bone Neoplasms↗
Aspirin inhibition of platelet deposition at angioplasty sites: demonstration by platelet scintigraphy.
In-111 platelet scintigraphy was used to evaluate the effects of prior aspirin administration on the accumulation of In-111-labeled autologous platelets at sites of arterial injury resulting from iliac, femoral, or popliteal transluminal angioplasty in a nonrandomized study of 17 men. The degree of platelet localization at angioplasty sites was significantly less in nine men who had received aspirin in varying doses within the 4 days before angioplasty than in eight men who had not received aspirin for at least two weeks. Our results suggest that aspirin treatment before angioplasty limits the early platelet deposition at the angioplasty site in men.
Adult↗
Ankle tenography: a key to unexplained symptomatology. Part I: Normal tenographic anatomy.
Fifty cadaver ankles were examined with ankle tenography. The normal tenographic appearance of the peroneus longus and brevis, posterior tibial, flexor digitorum longus, flexor hallucis longus, anterior tibialis, extensor hallucis longus, and extensor digitorum longus tendons and sheaths are described and illustrated for clinical reference. The baseline measurements and demonstration of the normal radiographic appearance of these tendons should assist in the evaluation of hindfoot foot disability and ankle pain.
Ankle↗
Ankle tenography: a key to unexplained symptomatology. Part II: Diagnosis of chronic tendon disabilities.
Eight cases of tenosynovitis of the foot and ankle are reviewed with special attention to the value of tenography as a diagnostic and prognostic tool. Stenosing tenosynovitis of the posterior tibial and peroneal tendons may be a cause of chronic pain and disability. Surgical treatment is often required and the tenogram can be an important adjunct in decision-making.
Adult↗
Elbow arthrography: a reassessment of the technique.
Twenty-six elbow arthrograms were retrospectively reviewed. Each arthrogram consisted of conventional radiography, conventional tomography, standard double-contrast arthrography, and arthrotomography. Each of these four components was independently interpreted in a blinded fashion by six radiologists, each working alone. The four components were evaluated for presence or absence of intraarticular bodies, cartilage loss, or fractures. The results showed that conventional tomography was the most accurate single study. Arthrotomography rarely improved the diagnostic accuracy of noncontrast methods. It was useful in those few patients where detection of purely cartilaginous bodies, precise position of mineralized densities, or status of articular cartilage was desired. It may be possible to reduce the number of elbow arthrograms, thereby reducing time, cost, and radiation dose factors.
Adolescent↗
Spondylolysis of the lumbar spine: demonstration of defects and laminal fragmentation.
Fifty-six cases of spondylolysis were encountered in 1500 lumbar spine reports reviewed. The frequency of detecting isthmus defects on anteroposterior (AP), lateral, 45-degree right and left oblique, 30-degree up-angled AP, and collimated lateral views was determined. The collimated lateral view showed the largest number of pars defects, 84% of cases. The 30-degree up-angled AP view was more sensitive than the AP view, showing 55% versus 32% of cases. A previously unreported sign of spondylolysis, fragmentation of lamina demonstrated on the AP or AP up-angled view, was found in 14.2% of cases of spondylolysis.
Female↗