Characteristic Radiographic Changes Research Articles

Progressive Diaphyseal Dysplasia Presenting as Neuromuscular Disease

Two children with progressive diaphyseal dysplasia (Engelmann's disease) were initially diagnosed as having a neuromuscular disorder because of their clinical presentations of muscle weakness, a waddling gait, and limb pain. Radiographs revealed the characteristic radiographic changes.

Metacarpophalangeal arthropathy associated with manual labor (Missouri metacarpal syndrome). Clinical radiographic, and pathologic characteristics of an unusual degeneration process.

We describe 7 manual laborers with painful, palpably enlarged metacarpophalangeal joints. Characteristic radiographic changes were joint space loss, prominent osteophytes, and cystic metacarpal heads most prominent in the second and third metacarpophalangeal joints. In 3 of 4 patients, joint biopsy specimens showed subsynovial fibrosis and villous hyperplasia. All 7 patients had similar backgrounds of heavy work demanding sustained gripping motions of both hands, for periods that exceeded 30 years. We designated their condition metacarpophalangeal arthropathy associated with manual labor.

Arthritis of hemochromatosis: Clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy

Five patients who presented with arthritis as the sole manifestation of hereditary hemochromatosis and 51 family members were studied. Studies included clinical evaluation for the presence of arthritis and hemochromatosis, roentgenography of hands, knees, and pelvis, serum iron and serum ferritin measurements, complete HLA typing for 50 of the A and B loci, and, when indicated, liver biopsy. Arthritis occurred in 45 percent of persons with hemochromatosis. Although typical involvement of second and third metacarpophalangeal joints was observed in all five patients and some family members, two with typical arthritis did not have characteristic radiographic changes, two had constitutional symptoms without arthropathy, and one had unilateral hand changes. A specific HLA haplotype (A2/B17 in Family 1 and A29/B15 in Family 2) correlated with hereditary hemochromatosis but not with the arthropathy. Phlebotomy alleviated the early constitutional symptoms but did not help advanced arthritis. Anti-inflammatory drugs, intraarticular injections of glucocorticoids, and resection osteotomies of metacarpal heads were other treatment modalities.

Radiation pneumonitis: Experience following a single treatment

The acute radiation pneumonitis syndrome of increasing cough with dyspnoea and characteristic radiographic changes developed in 44 of 245 patients (17.5%) treated with a single large dose of radiation. The median onset was 100 days and proved fatal in 84 percent of cases within two weeks. Because these patients with advanced cancer had a median survival of 126 days the incidence was calculated by the actuarial method. This was 83.5 and 29 percent for single uncorrected doses of 1,000 and 800 rad: the two standard deviations were 20 and 14 percent. The risk increased with previous irradiation or intrathoracic tumor. Steroids had no obvious protective effect, but in three patients withdrawal of the drug apparently precipitated the syndrome. Vigorous supportive treatment with antibiotics and prednisone reversed the process in three cases, Radiotolerance of the lung is the limiting factor in usirgradiation as a systemic treatment for cancer.

Inferior vena caval occlusion: characteristic radiographic changes on excretory urography and barium enema examination

Acute occlusion of the inferior vena cava produces characteristic radiographic findings on intravenous urogram and barium enema examination. The urinary bladder is compressed anteriorly and superiorly giving an inverted pear-shaped appearance, and the distal ureters are medially displaced. Barium enema examinations demonstrate narrowing and elevation of the rectosigmoid region along with an increase in the presacral space. Four cases are described to illustrate the usefulness of these findings in suggesting the correct diagnosis.

Oculodento-digital dysplasia: a rare syndrome

A rare syndrome that can be diagnosed radiographically has been reviewed. A characteristic physiognomy, variable ophthalmologic anomalies and relatively specific dental and digital defects provide the diagnostic features. No hereditary component was identified and the chromosomal pattern was normal. The history, appearance and characteristic radiographic changes may, as in this case, allow the radiologist to provide a diagnosis not previously appreciated.

Differential radiographic diagnosis of lesions of the jawbones.

Many lesions involving the jawbones produce characteristic and diagnostic radiographic changes; others produce protean characteristics with resultant overlap in radiographic features. As with bone pathosis involving other skeletal areas, microscopic examination is required when radiographic features are ambiguous or equivocal. Certain radiographic alterations are indicative of the basic underlying pathologic process. The characteristic radiography of lesions unique to the jawbones and lesions occurring in the jaws which may also involve other bones are reviewed.

The soft-tissue and bone changes in frostbite injuries.

Radiographs in 82 cases of severe frostbite injury seen at the Winnipeg General Hospital and Manitoba Rehabilitation Hospital from 1962 to 1970 were reviewed. Fifty per cent of these cases eventually demonstrated characteristic radiographic changes in the involved extremity, although no convincing bony changes were demonstrated on admission. Presence of subcutaneous gas was a bad prognostic sign. The involved limb in all such cases eventually required amputation.

THE RADIOGRAPHIC MANIFESTATIONS OF GONADAL DYSGENESIS

Three diseases, Turner's syndrome, Klinefelter's syndrome and myotonia dystrophica, which have a common basis in a genetic defect that results in gonadal dysplasia, have been described and their radiographic features stressed. The more important of these are summarized. Turner's Syndrome 1. Increased radiability of the skeleton. 2. Delay in closure of epiphyseal lines. 3. Irregularity of epiphyseal plates, particularly in the knees. The latter show enlargement and deformity of the medial tibial condyle. 4. Positive metacarpal and carpal signs. 5. Osteochondrosis of the spine; square lumbar vertebrae. 6. Male configuration of the pelvic inlet. 7. Maldevelopment of ribs and clavicle. The incidence of radiographic features in patients with Turner's syndrome is sufficiently high to permit a tentative diagnosis in the majority of cases. Klinefelter's Syndrome. Radiographic findings are unremarkable. Skeletal density and maturation are normal. Occasionally a positive metacarpal sign and small sella turcica may be seen. Myotonia Dystrophica. The characteristic radiographic changes occur in the skull and include thickening of the calvarium, a small pituitary fossa, extensive pneumatization of the paranasal sinuses and hyperostosis interna. A knowledge of the clinical and radiographic features of these diseases is significant for a proper diagnosis. These patients may present to the physician problems in growth, amenorrhea, failure of development of secondary sex characteristics or sterility. With knowledge of the manifestations of these diseases, the radiologist can alert the referring physician to the underlying problems and help in his efforts to diagnose the disease.

Hematoma of the duodenum; a case report.

Gastrointestinal symptoms which are related to recent trauma may be associated with a hematoma involving the bowel. This is thought to occur in a significant number of patients who experience abdominal injury. The recent literature contains several examples of the radiographic demonstration of such hematomas (2–6). The case to be reported here was not surgically or pathologically verified, but the clinical and radiographic evidence is conclusive. This patient was treated conservatively and characteristic radiographic changes in the duodenum completely regressed in a few weeks. R. S., a 19-year-old white girl, was admitted to Grant Hospital, Chicago, on Dec. 10, 1954. Two days earlier she had struck her right side on the steering wheel of her car in an automobile accident. She felt no immediate ill effects, but during the next thirty hours nausea, vomiting, and abdominal pain occurred, leading to hospitalization. The only significant findings on physical examination were an ill-defined mass in the right upper quadrant of the abdomen and upper abdominal tenderness. The pulse rate was 104 per minute. Blood pressure, temperature, and respirations were normal. Laboratory studies revealed a red cell count of 4,180,000, hemoglobin 12.5 gm., and white blood cells 10,800. The red cell count fell to 2,960,000 within three days, but returned to normal during the patient's hospital stay. Repeated urine studies disclosed no abnormality. Roentgen Studies: A plain film of the abdomen on Dec. 11 showed possible dilatation of the stomach. An upper gastrointestinal tract examination on Dec. 20 revealed no obstruction to the flow of barium through the second portion of the duodenum. An unusual deformity of this segment with a crescentic defect, suggesting at least a partially intramural tumor, was demonstrated (Figs. 1 and 2). The lumen in the involved segment was slightly narrowed. In addition, there was a constant collection of barium in the descending duodenum on several films, considered as most likely representing a small mucosal ulceration (Fig. 3). The diagnosis of hematoma of the duodenum was made. Since there was no evidence of complete obstruction, the patient was treated conservatively. Gradual improvement ensued and she was discharged on Jan. 2, 1955. A repeat upper gastrointestinal tract examination one month after the initial study (after hospital discharge) revealed an essentially normal appearing descending duodenum, with only very slight irregularity of contour (Figs. 4 and 5). Discussion Hematomas of the bowel may be localized intramural tumors, usually subserosal in position, or they may be associated with retroperitoneal or mesenteric components. We believe that the case presented here represents a duodenal hematoma with other retroperitoneal involvement. Hematomas have been described in the duodenum (1, 2), small bowel (5, 6), and colon (3, 4).