Abnormal Radiographic Findings Research Articles

Six-minute walk test among silicosis patients: Its correlation with abnormal radiographic findings on chest radiograph and high resolution computed tomography scan

Six-minute walk test among silicosis patients: Its correlation with abnormal radiographic findings on chest radiograph and high resolution computed tomography scan

Male National Basketball Association G-League and Collegiate Basketball Athletes Have a High Prevalence of Radiographic Ankle Abnormalities

PurposeThe purposes of this study were to characterize radiographic foot/ankle bony abnormalities in elite-level, asymptomatic male basketball athletes, and to investigate the association between anthropometric (age, height, weight) or sport-specific characteristics (total exposures, player position, pregame ankle taping) and the prevalence of abnormal radiographic findings in asymptomatic basketball athletes MethodsElite-level basketball players who underwent routine, pre-season static radiographic imaging, including antero-posterior, lateral, and mortise views of the ankle were included. Radiographs were collected from asymptomatic athletes participating in pre-season history and physical with negative anterior drawer/talar tilt test. Radiographs were evaluated by a musculoskeletal radiologist and board-certified orthopedic surgeon; kappa statistics were used to evaluate agreement. ResultsFifty-four basketball players (34 collegiate, 20 professional; mean age 21.5 years) were included, totaling 5,148 player exposures from 2017-2019. 106 ankles presented with radiographic findings (98.15%). The most prevalent radiographic finding was pes planus (47.22%), followed by degenerative joint disease (DJD) (33.33%), talonavicular sclerosis (28.70%), prominent stieda process (25.93%), os trigonum (20.93%), os subfibulare (11.11%), pes cavus (5.56%), subtalar coalition (2.78%), and cavovarus (0.93%). Height ≥ 80” was significantly associated with talonavicular sclerosis and Kellgren-Lawrence 1 changes. ConclusionsThis study demonstrated a strong association between height and talonavicular sclerosis and DJD, as well as a relatively high prevalence of pes planus and DJD in asymptomatic collegiate and professional basketball players.

Clinicopathologic Features of IgG4-Related Kidney Disease

IntroductionIgG4-related disease (IgG4-RD) is a systemic immune-mediated disease that can involve nearly any organ. IgG4-RD can affect the kidney in different disease patterns, collectively referred to as IgG4-related kidney disease (IgG4-RKD). MethodsWe conducted a tissue-based cohort study with clinicopathological correlation in 125 patients with IgG4-RKD. ResultsThe mean age at biopsy (n=120) or nephrectomy (n=5) was 63 years; 80% were male. 118 patients (94%) had IgG4-related tubulointerstitial nephritis (IgG4-TIN); 20 patients (16%) had IgG4-related membranous glomerulonephritis (IgG4-MGN; 13 with concurrent IgG4-TIN). The primary clinical indication for biopsy/nephrectomy was acute or chronic renal failure in 78%, proteinuria in 17%, and mass lesion(s) in 15% (with overlap in primary indication). 52% (41/79) had abnormal radiographic findings, including mass(es) in 30% (24/79). All patients with IgG4-MGN had proteinuria. Extra-renal involvement by IgG4-RD was present in 79%. Median serum creatinine at presentation was 2.5 mg/dL (range 0.7-12). Serum IgG and/or IgG4 was increased in 91% (53/58); hypocomplementemia was present in 56% (43/77). Light microscopy showed plasma cell-rich interstitial nephritis in all cases of IgG4-TIN. 92% showed increased IgG4+ plasma cells. 7% showed an acute interstitial nephritis (AIN) pattern, and 5% showed non-necrotizing arteritis. Tubular basement membrane immune deposits were present in 83% of IgG4-TIN. Treatment information was available for 71 patients; 62 were treated with immunosuppression. Of those with elevated creatinine, 72% (41/57) showed a treatment response. ConclusionThis largest tissue-based series more clearly defines the disease phenotype of IgG4-RKD.

Routine follow-up imaging is not necessary in uneventful early recovery after distal radius fractures treated with volar locking plate in working-aged patients: A retrospective single-center cohort study.

The purpose of our study was to evaluate whether routine follow-up radiographs after distal radius fracture (DRF) treated with volar locking plate (VLP) influenced clinical decision-making and treatment in working-aged patients (18-65 years). We evaluated the possible correlation between clinical status and problems with follow-up radiographs and analyzed the overall reoperation rate. The study population of this retrospective cohort study consisted of working-aged (18-65 years) patients with DRF who were treated with VLP between January 2010 and December 2020. Baseline data, follow-up visits, and radiographs were collected. Radiographs were classified as either routinely assigned or according to clinical findings. Patients were divided into four groups based on abnormal radiographic findings or major symptoms leading to reoperation. Patients also received patient-rated wrist evaluation (PRWE) questionnaire, which were analyzed. A total of 861 patients were included in this study. Routine follow-up radiographs were available for 844 (98%) patients. In 7.0% of patients, 6-week radiographs led to a change of standard treatment protocol, most commonly additional imaging and/or clinical follow-up. Nine (1.1%) patients underwent an urgent reoperation, and 15 (1.8%) patients underwent reoperation later in the follow-up period. All these patients were exceptionally painful/symptomatic. In addition, 33 (3.9%) patients who underwent additional imaging and follow-up after abnormal radiograph, but did not undergo reoperation, were asymptomatic or suffered only mild pain. A total of 89 (10.5%) patients had reoperation for any reason during the follow-up period. Routine follow-up radiographs after the treatment of DRF with VLP in the working-aged population rarely leads to changes in treatment strategy or reoperation in asymptomatic patients suggesting that it would be safe and cost-effective to reduce routine follow-up radiographs and focus instead on those patients with moderate-to-severe symptoms.

Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children.

Respiratory syncytial virus (RSV) is a common cause of bronchiolitis and pneumonia in infants and young children. Starting in December 2010, RSV monoclonal antibody (RSV mAb) was endorsed by Taiwan National Health Insurance and given to children with prematurity and/or congenital heart diseases, which are considered high-risk factors for severe RSV diseases. Investigating other important contributing risk factors is warranted. We conducted a cohort study at National Taiwan University Hospital to determine the rate of severe outcomes among children hospitalized due to RSV infection from 2008 to 2018. Adjusted for age, sex and birth cohorts born before and after RSV mAb endorsement, we identified risk factors for severe RSV infection, defined as the requirement of invasive ventilator support. There were 1985 admissions due to RSV infections. Among them, 66 patients (3.3%) had severe RSV infection. The proportion of severe RSV infections decreased significantly after RSV mAb endorsement. Multivariable analysis revealed that age <1.5 months and cardiovascular and congenital/genetic diseases were high-risk underlying conditions. In addition, bacterial coinfections, elevated creatinine levels and initial abnormal chest radiograph findings posed warning signs for severe RSV infection. Children younger than 1.5 months of age with cardiovascular or congenital/genetic diseases were predisposed to severe RSV infection and might benefit from RSV mAb prophylaxis.

Abnormal Wrist Sagittal Kinematics in Gymnasts With Dorsal Wrist Pain: A New Syndrome

Background: The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear. Purpose/Hypothesis: The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint. Study Design: Controlled laboratory study. Methods: Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups. Results: At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P = .020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P = .004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P = .002) than gymnasts without dorsal wrist pain. Conclusion: Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed “gymnast’s lunate dyskinesia.”

1621. "False-Positive" Cytomegalovirus (CMV) Screening Tests in Neonates: A Real Dilemma!

Abstract Background PCR testing of clinical specimens has been associated with false-positive test results. Detection of CMV DNA by PCR in saliva and urine has been used to identify neonates with congenital CMV infection, but the frequency of false-positive PCR results is not fully known. Our objective is to describe the frequency of "false-positive" saliva and urine CMV PCR tests when performed as screening for congenital CMV infection. Methods From 2018 to 2023, neonates were screened for CMV infection if they had abnormal clinical, laboratory, or radiographic findings, referred on the newborn hearing screen, and since 2019, on admission to the 9 neonatal intensive care units (NICU) of the Nationwide Children’s Hospital neonatal network, Columbus, OH. Pertinent demographic, clinical, audiologic, laboratory, and radiographic data were obtained and managed using REDCap. Infants who had an initial positive PCR screening test for CMV but subsequent negative PCR tests were identified. Results During the 6 year study period, 139 infants were diagnosed with congenital CMV infection. An additional 28 (17%) neonates tested positive for CMV DNA in saliva (n=26) or urine (n=2) but subsequent tests of urine specimens were negative for CMV. Most of the infants were tested as part of universal NICU screening (n=22), 5 had symptomatic disease, 3 referred on the newborn hearing screen, and 1 had thrombocytopenia. The infants were tested at a median (IQR) age of 3 (2-6) days. Their median (IQR) birth weight and gestational age were 2458 (1865-3360) grams and 37 (33-39) weeks, respectively. Four infants had their dried blood spot tested for CMV by PCR and were negative. 17 (77%) of 22 infants had known maternal milk exposure in the neonatal period. Conclusion Neonatal saliva and/or urine screening for congenital CMV infection was associated with a “false-positive” test result in 17% of neonates who tested positive for CMV DNA by PCR. These results suggest that confirmation of a diagnosis of congenital CMV infection by PCR requires testing of multiple specimens with one of them being urine. Disclosures Asuncion Mejias, MD, PhD, MsCS, Astra-Zeneca: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Sanofi-Pasteur: Advisor/Consultant Alexandra Katherine Medoro, MD, Merck: Grant/Research Support Amy Leber, PhD, Biomeriux: Grant/Research Support|BioRad: Advisor/Consultant|Cephied: Grant/Research Support|Diasorin: Grant/Research Support

Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain

BackgroundWhile most COVID-19 cases have uncomplicated infection, a small proportion has the potential to develop life-threatening disease, as such development of a prediction tool using patients baseline characteristics at the time of diagnosis should aid in early identification of high-risk groups and devise pertinent management. Hence, we set up this retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19 in the Kingdom of Bahrain Materials and methodsA retrospective study was conducted from 1 September 2020 to 30 November 2020 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥ 14 years who attended Al-Shamil Field Hospital (SFH) in the Kingdom of Bahrain for triaging and assessment with recording of the following parameters: systolic blood pressure, heart rate, respiratory rate, temperature, the alert, verbal, pain, unresponsive neurological score, age, oxygen saturation, comorbidities, Body Mass Index (BMI), duration of symptoms and living with immunocompromised populations to develop our local adjusted MEWS as predictor for ICU admission & for consideration of suitable isolation at home.Follow up data of all patients was obtained from the electronic medical records system including CXR findings, treatments/medications received, need of oxygen supplements /intubation, needs of ICU care, and the outcome (death /discharged alive)IBM SPSS statistic version 21 program was used for data analysis. ResultsOur study showed that using the locally developed adjusted MEWS score, there was an significant association between high value of this adjusted MEWS score and abnormal radiographic finding (49.7 % Vs. 17 % for patients with high score Vs. those with low score respectively). Out of the 181 patients with high scores on adjusted MEWS; 38.7 % required oxygen via nasal cannula, 14.4 % required face mask and 8.3 % non-rebreather mask; this proportion was significantly higher than their counterpart patients who score low on adjusted MEWS (20.9 %, 7.7 %, 4.8 %respectively) with statistically significance difference between the two groups (p value of 0.00, 0.00,.004 respectively)Requirement of ICU admission was significantly higher among patients with high score in comparison to those with low score (14.4 % vs. 3 %) with significant p value (0.00)But higher score value was not associated significantly with increase mortality rate among COVID patients. ConclusionDevelopment of our new Adjusted MEWS score system by adding the additional elements of age, oxygen saturation, comorbidities, Body Mass Index (BMI) and duration of symptoms found to be very useful predictor tool for preadmission triaging of COVID patients based on their risk assessment to help clinician to decide on the appropriate placement to different level of isolation facilities.

Covid-19 omicron variant infection in neonates of Guangdong province-a report of 52 cases.

To analyze the clinical characteristics of neonatal infection during the outbreak of COVID-19 omicron variant in Guangdong province of China. The clinical data of neonates infected with COVID-19 omicron variant were collected from three hospitals of Guangdong province, their epidemiological history, clinical manifestation and prognosis were summarized. From December 12, 2022 to January 15, 2023, a total of 52 neonates with COVID-19 infection were identified across three hospitals in Guangdong Province, including 34 males and 18 females. The age of diagnosis was 18.42 ± 6.32 days. 24 cases had clear contact history with adults who were suspected to be infected with COVID-19. The most common clinical manifestation was fever (43/52, 82.7%), the duration of fever was 1-8 days. The other clinical manifestations were cough (27/52, 51.9%), rales (21/52, 40.4%), nasal congestion (10/52, 19.2%), shortness of breath (2/52, 3.8%), and vomiting (4/52, 7.7%). C-reactive protein was only increased in 3 cases. Chest radiological examination was performed in 42 neonates, twenty-three cases showed abnormal chest radiographic findings, including ground-glass opacity and consolidation. Fifty cases were admitted with COVID-19 presentation, two cases were admitted for jaundice. The hospital stay was 6.59 ± 2.77 days. The clinical classification included 3 cases of severe COVID-19 and one critical case. Fifty-one cases were cured and discharged after general treatment, and one critical case with respiratory failure was intubated and transferred to another hospital. The COVID-19 omicron variant infection in neonates is usually mild. The clinical manifestation and laboratory results are not specific, and the short-term prognosis is good.

Sternal Abnormalities on Thoracic Radiographs of Dogs and Cats.

Evaluation of the sternum is part of the routine examination of small animal thoracic radiographs. However, descriptions on frequency and type of abnormalities are lacking. This retrospective observational study aimed to describe abnormal radiographic findings of the sternum in a cross-section of client-owned dogs and cats undergoing thoracic radiography between 1 January 2019 and 1 January 2021 for reasons unrelated to diseases of the sternum. The study population consisted of 777 dogs (mean age, 7.3 ± 3.9 years) and 183 cats (mean age, 7.3 ± 5.1 years). Sternal abnormalities were observed in 189/777 (24%) dogs and 53/183 (29%) cats, mostly around the intersternebral cartilages, accounting for 32/80 (40%) dogs and 20/35 (57%) cats. This was followed by an abnormal number of sternal segments (8% dogs, range 3-9 sternebrae; 15% cats, range 7-9 sternebra). Pectus excavatum was observed in 6/777 (0.8%) dogs and 6/183 (3%) cats, and pectus carinatum in 18/777 (2%) dogs and 2/183 (1%) cats. Post-traumatic changes, such as subluxation, were observed in nine dogs (1.1%) and three cats (1.6%). Presumed prostatic carcinoma metastasis and malignant lymphoma were observed in two dogs (0.2%). Incidental radiographic sternal abnormalities are common in cats and dogs but mostly of unknown clinical relevance.

Waterproofing Spray-Associated Lung Injury Review: Differences between Cases of Early and Delayed Improvement of Waterproofing Spray-Associated Lung Injury

Waterproofing spray-associated lung injury (WALI) is an acute respiratory disorder characterized by bilateral diffuse lung injury on chest computed tomography (CT). In most cases, the symptoms and abnormal radiographic findings of WALI patients improve spontaneously over several days; however, some cases have persistent symptoms and abnormal shadows for >1 week. The distinctive features of each WALI are unknown. Herein, we present two new cases of WALI that we encountered in our hospital, and we previously reported two other cases of WALI. We examined the characteristics of WALI in our cases and 39 other cases of WALI definitively diagnosed and reported in PubMed and the Japan medical board with verifiable data during a 15-year period. We compared the clinical characteristics of the 22 cases in which the patients' symptoms were resolved within 1 week (early improvement) to those of the 21 cases in which the symptoms were resolved after >1 week (delayed improvement). The WALI cases with delayed improvement had significantly more shadowing that extended over the entire lung field and was not biased in intensity toward the upper or lower lung field. In addition, the serum white blood cell (WBC) counts and serum Krebs von den Lungen-6 (KL-6) levels differed significantly between the cases of early and delayed improvement of WALI.

Increased Complication Rate of Ports Placed into the Subclavian versus Internal Jugular Vein

Purpose: Totally implantable venous access ports are commonly placed via subclavian or internal jugular (IJ) veins. The purpose of this study is to investigate the rate of radiographic abnormalities in clinically dysfunctional ports for subclavian versus IJ venous ports. Methods: This retrospective study included 152 ports in 150 patients placed by multiple operators in both surgery and interventional radiology departments. Contrast-based, fluoroscopically guided vascular access studies performed for clinically dysfunctional ports from January 2019 to September 2020 were included. The port studies were evaluated for subclavian versus IJ access and to determine if there were radiographic abnormalities present, including catheter fracture, fibrin sheath, or catheter malposition. Results: Of the 152 ports investigated, 30 were placed into the subclavian vein and 122 into the IJ vein. During vascular access checks, subclavian ports (n=23, 76.7%) demonstrated significantly more radiographic abnormalities compared to IJ ports (n=66, 54.1%, p=0.025). Of the dysfunctional ports with abnormal radiographic findings, subclavian ports were significantly more likely to have a major abnormality (n=15, 65.2%), defined as a malpositioned or fractured catheter, compared to IJ ports (n=21, 31.8%, p=0.005). The most common finding during vascular access checks for all ports investigated was no abnormality, with a well-functioning port and the catheter tip in an appropriate position (n=63; 41.4%). Conclusions: This study suggests that for patients undergoing implantable port evaluation, ports placed into the subclavian vein are more likely to demonstrate a radiographic abnormality, as well as having increased likelihood of catheter malposition or fracture, compared to those placed into the IJ vein. Additionally, this study suggests that a relatively high rate of clinically dysfunctional ports referred for IR port checks have no demonstrable abnormalities on fluoroscopic port evaluation.

The Utility of Routine Postoperative Radiographs in the Asymptomatic Total Hip Arthroplasty Patient

BackgroundTotal hip arthroplasty (THA) patients often receive routine radiographs in the year following their index surgery. This study sought to investigate the clinical and economic value of obtaining routine postoperative hip radiographs for asymptomatic patients following primary elective THA. MethodsA retrospective cohort study of consecutive patients who underwent primary elective THA from 2016 to 2019 was conducted. Patients undergoing nonelective or revision THA, radiographic follow-up <10 months, and patients aged <18 years were excluded. All radiographs were reviewed for abnormalities in the first postoperative year by an arthroplasty fellowship-trained orthopaedic surgeon, blinded to the symptoms of the patient. ResultsOf the 327 patients (351 hips) included, 57.2% were women and 68.2% were White, with an average age of 65 years (range, 22-97 years) and average body mass index of 29.1 kg/m2 (range, 16.2-49.8 kg/m2). Only four (0.4%) radiographic series revealed abnormalities with the potential to alter postoperative management. One patient experienced a change in management directly related to their abnormal finding (closed reduction for dislocation at 10.2 months postoperatively). The remaining three abnormal radiographic findings included femoral stem subsidence, progressive radiolucencies around an acetabular component, and cement mantle fracture. The average cost for each radiographic series was $155.27, resulting in total direct charges of $167,691.60. ConclusionRoutine postoperative radiographs may be of limited utility in the asymptomatic patient in the first year following elective primary THA. Consideration should be given to limit postoperative radiographs following standard elective THA, while reserving postoperative radiographic evaluation for patients who are symptomatic. Level of EvidenceLevel III.

2162. Risk Factors Associated with Hospitalization among 0 to 21 Years Old Patients with Active Asthma/Active Airway Disease: Preliminary Findings from Multi-Center Study Across United States.

Abstract Background More data are needed to understand the risk for COVID-19 severity among pediatric asthma patients. We present findings from a national registry characterizing COVID-19 hospitalizations among pediatric asthma patients. Methods Data were obtained from the Pediatric COVID-19 US Registry, which included medical records of COVID-19 cases &amp;lt; 21 years old between March 2020 and May 2021. Those with asthma were eligible while immunocompromised and transplant cases were excluded. Descriptive statistics and chi-square tests were performed. Results Of the 1089 eligible asthma cases, half were 12 to 17 years old [Figure 1], the majority were male [Figure 2], a third Black African American [Figure 3], and most were Non-Hispanic/Latino 825 (76%). 242 (22%) reported a history of smoking. A fourth of cases (257 (23.6%) were hospitalized for COVID-19. More than half (54%) reported asthma as their only pre-existing condition. The majority (n=71, 28%) were taking regular inhaled corticosteroids. Almost half (n=120, 47%) had abnormal chest radiographic findings, 20 (7.8%) had abnormal CT findings, and 24 (9%) progressed to lower respiratory infection. About 10% (n=25) needed mechanical ventilation. A third (n=88, 34%) required ICU care with 33% of those receiving inhaled corticosteroids. A quarter needed mechanical ventilation [Figure 5]. Compared to asthma patients not hospitalized for COVID-19, those hospitalized were significantly (P&amp;lt; 0.05) more likely to be non-Hispanic, havemultiple pre-existing conditions, and be obese [Figure 6]. Compared to those not admitted to ICU, ICU cases were significantly more likely to be obeseand be diagnosed with MIS-C [Figure 7]. Demographics The majority of cases (N=479, 44%) were between 12 and 17 years old, Male (N=610,56%) and Black or African American (N=410, 38%). Clinical Characteristics Risk factors assessment Conclusion This is one of the first national studies examining COVID-19 among pediatric cases with asthma. Our data suggest that children with asthma who have multiple pre-existing conditions and/or are obese have a higher risk for hospitalization. These early data may aid clinicians in developing future prospective studies to understand COVID-19 risk among this vulnerable population. Disclosures Lara A. Danziger-Isakov, MD, Ansun BioPharma: Contracted clinical research|Astellas: Contracted clinical research|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Contracted clinical research|Pfizer: Contracted clinical research|Takeda: Grant/Research Support|Takeda: Contracted clinical research|Viracor: Grant/Research Support.

Mediastinal "deep freeze"-transcarinal lymph node cryobiopsy.

BackgroundThe diagnostic yield of endobronchial ultrasound‐transbronchial needle aspiration (EBUS‐TBNA) from mediastinal lymph nodes ranges from 66%–89%. However, in many cases cytologic material is not sufficient for full molecular evaluation. A novel method of transcarinal cryobiopsy aims to provide bronchoscopically obtained, larger specimen samples from mediastinal lymph nodes. We aimed to assess the efficacy and safety of transcarinal EBUS‐guided lymph node cryobiopsy.MethodsPatients referred for EBUS‐TBNA, based on abnormal mediastinal clinical and radiographic findings, were enrolled into this prospective interventional study between July 2020 and August 2021. All EBUS‐TBNA procedures were performed using ProCore 22G needle (Cook Medical) to create, both a transcarinal tract for the cryoprobe and to obtain TBNA samples. For EBUS guided transcarinal cryobiopsy, we used flexible 1.1 mm or 1.7 mm cryoprobe inserted into the working channel of the EBUS scope and into the target subcarinal lymph node.ResultsTwenty‐four patients with male predominance 2:1 and mean age of 60.12 ± 10.16 years were enrolled. All target lymph nodes had hypoechoic, homogenic consistency with demarcated borders, without central structures. Cryobiopsy provided pathological diagnosis in 20 cases (83.33%), with 1.1 mm cryoprobe in 14 and with 1.7 mm cryoprobe in 6 cases. In one case each, pathology was provided by TBNA or by cryoprobe alone. No immediate or late complications were encountered during the procedures.ConclusionTranscarinal EBUS guided lymph node cryobiopsy following EBUS‐TBNA proved to be efficient with a high diagnostic yield and can be considered safe, because no immediate or late complications occurred.

Craniocervical Junction Visualization and Radiation Dose Consideration Utilizing Cone Beam Computed Tomography for Upper Cervical Chiropractic Clinical Application a Literature Review.

ObjectivesTo highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient.MethodsA review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT.ResultsIncidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs.ConclusionsThe use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.

Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions

Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions. The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable. Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability (κ > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate (κ= 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none. The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.

Fixed-Bearing Trabecular Metal Total Ankle Arthroplasty Using the Transfibular Approach for End-Stage Ankle Osteoarthritis: An International Non-Designer Multicenter Prospective Cohort Study.

Background:This multicenter prospective cohort study assessed the safety and performance of the Trabecular Metal Total Ankle System (TM Ankle; Zimmer) for primary total ankle arthroplasty (TAA).Methods:One hundred and twenty-one consecutive patients qualifying for primary TAA were enrolled in the study. All patients received the TM Ankle implant. Clinical outcome examinations and radiographic evaluations were conducted at 6 weeks, 6 months, 1 year, 2 years, and 3 years. Patient-reported outcome measures (PROMs) were evaluated with use of the EuroQol-5 Dimensions questionnaire (EQ-5D), Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society questionnaire (AOFAS), and patient satisfaction at each time point. Complications were classified according to the Canadian Orthopaedic Foot and Ankle Society (COFAS) system.Results:The average AOFAS, EQ-5D, AOS pain, and AOS difficulty scores showed significant improvement at 6 weeks, 6 months, 1 year, 2 years, and 3 years as compared with the preoperative baseline (p < 0.001). The Kaplan-Meier survival estimate for revision when used in primary cases was 97.35% at 3 years. During the 3 years of follow-up, 9 patients showed abnormal radiographic findings. Two ankles had intraoperative complications, 38 had complications that were non-surgical or device-related, and 3 ankles underwent revision.Conclusions:The results of the present study indicated that patient well-being significantly increased following TAA with use of the TM Ankle. Radiographic parameters also demonstrated a low incidence of abnormal findings.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

De Quervain's Tenosynovitis and Radial Styloid Osseous Changes.

This study aimed to determine the radial styloid osseous changes observed on posteroanterior wrist radiographs of patients with de Quervain's tenosynovitis who required surgery or conservative treatment. The surgically treated group included 24 patients with de Quervain's tenosynovitis. The conservative treatment group and the healthy control group each comprised 24 age- and sex-matched subjects. We evaluated the presence of bone apposition, periosteal reaction, sclerosis, osteopenia, erosion, and contour bulge in the epiphyseal remnant at the radial styloid. The incidences of abnormal radiographic findings were compared between these three groups. The correlation of radial styloid bony changes with the duration of symptoms was also analyzed. No significant differences were found between the three groups in terms of periosteal reaction, erosion, and contour bulge at the epiphysial remnant. Significant differences were found between the three groups in the incidence of bone apposition, sclerosis, and osteopenia (p < 0.001). Bone apposition incidence in the surgically and conservatively treated groups was significantly higher than that in the control group (p < 0.001). Sclerosis and osteopenia significantly differed between the surgically and conservatively treated groups (p < 0.001, p = 0.002, respectively). No significant association was observed between the duration of symptoms and the radial styloid osseous changes (p > 0.05). We found a variable incidence of abnormal radiographic findings on the radial styloid in patients with de Quervain's tenosynovitis and asymptomatic individuals. The presence of sclerosis and osteopenia may be potential risk factors for patients who do not respond to conservative treatment and need surgical intervention.

PATTERN OF CHEST RADIOGRPAHIC FINDINGS IN RELATION TO CD4 COUNT AMONG THE HAART NAÏVE HIV POSITIVE ADULTS IN SOKOTO NORTHWESTERN NIGERIA

Background: HIV/AIDS epidemic has evolved to become a major task in global health with the greatest impact in sub-Saharan Africa, where most of the transmission occurs horizontally between sexually active individuals. The CD4 count being a reliable pointer of immunosuppression has a close relationship with the likelihood of developing some pulmonary diseases and other chest conditions in HIV patients, which can be picked on chest radiograph. Aims and Objectives: To determine the pattern of chest radiographic findings in relation to CD4 count among the HAART naïve HIV positive adults in Sokoto. Materials and Methods: One hundred and forty newly diagnosed HIV positive adults, yet to commence any antiviral treatment were recruited. They had chest radiographs done in the Radiology Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, North-western Nigeria, using Silhoutte VR System GE diagnostic x-ray equipment. The findings from the radiographs and the result of their CD4 counts were analysed using SPSS version 23. Results: The CD4 count of the studied participants ranged from 69-1222 cells/?L with mean (± SD) of 448.3(± 287.0) cells/?L. Most of the participants 59(42.1%) had CD4 counts &lt;200 cells/?L. Pulmonary consolidation was the predominant radiographic finding in the CD4 range of 200-499cells/?L while a normal appearance was the commonest finding amongst participants with CD4 count ?500 cells/?L There was statistically significant association between the level of CD4 counts and the overall chest radiographic findings using chi- square test with a chi value of 23.993 and p-value of 0.000. Conclusion: The study showed abnormal chest radiographic finding as the predo