Fat Stripe Research Articles

The value of soft tissue signs in wrist trauma

A retrospective study of the wrist radiographs of 1453 patients presenting with acute wrist trauma was undertaken in order to assess the value of soft tissue signs. A total of 773 radiographs which were judged to be normal were used to evaluate the normal pronator quadratus fat stripe. The distance of the normal pronator fat stripe from the radius was shown to be significantly lower in females than in males and increased with age. The increase with age was greater in males. Although most fractures were associated with some soft tissue abnormality, certain fractures, especially greenstick fractures in children, had normal soft tissue planes. Only 4% of the wrists examined had soft tissue abnormalities with no visible fracture. The presence of soft tissue signs should therefore be considered with suspicion when evaluating wrist radiographs in trauma, but the absence of signs does not necessarily exclude a fracture.

The Scaphoid Fat Stripe in the Diagnosis of Carpal Trauma

During a ten-year period scaphoid fracture was suggested in 541 wrists, but in 283 cases could not be confirmed at the initial radiographic examination. These cases were immobilized in plaster of Paris and examined clinically and radiologically 10 to 14 days later. A total of 274 additional radiographic examinations revealed 32 scaphoid fractures not initially recognized. Two fractures were at the retrospective analysis found to have been neglected. In the 249 cases where a fracture was never demonstrated, the immobilization and resulting sick leave were in retrospect considered not to have been indicated. In a retrospective analysis of case records and radiographic material including the configuration of the scaphoid fat stripe (SFS) at the initial radiographic examination the SFS was found to be useful in diagnosing scaphoid fractures. The use of the SFS in differential diagnosis would result in reduction of costs and inconvenience for patients without scaphoid fracture.

The scaphoid fat stripe in the diagnosis of carpal trauma

The scaphoid fat stripe in the diagnosis of carpal trauma

The scaphoid fat stripe in the diagnosis of carpal trauma

The scaphoid fat stripe in the diagnosis of carpal trauma

Roentgenograms in Pericardial Effusion-Reply

In Reply.— We heartily agree with Dunn and colleagues that echocardiography is the gold standard for the diagnosis of pericardial effusion. The SCTL chest roentgenogram is intended to increase the sensitivity and specificity of the epicardial fat stripe sign—a radiological finding of pericardial effusion that is commonly cited in the radiological literature and employed in clinical practice. In our patients, the SCTL roentgenogram demonstrated the epicardial fat stripe sign in 86% of patients with a large pericardial effusion, as opposed to a 36% demonstration of the epicardial fat stripe sign by conventional lateral roentgenogram. Thus, while the SCTL roentgenogram was not perfect, it afforded a significant improvement for the detection of pericardial effusion over the conventional roentgenographic indicator. Since the inconvenience and cost of this additional roentgenogram view are minimal, the SCTL technique is recommended to improve the roentgenographic assessment of an enlarged cardiac silhouette or suspected pericardial effusion, especially

Supine Cross-Table Lateral Chest Roentgenogram for the Detection of Pericardial Effusion

We performed a prospective, blinded, controlled study to test the hypothesis that supine cross-table lateral chest roentgenograms might have an advantage over conventional lateral chest roentgenograms for the detection of pericardial effusion using the epicardial fat stripe sign. In comparison with echocardiography as the gold standard, we found that supine cross-table lateral chest roentgenograms had greater sensitivity (51%) for pericardial effusions than conventional lateral chest roentgenograms (sensitivity, 31%). Specificity was essentially the same for both techniques. A large pericardial effusion was more readily detected by supine cross-table lateral chest roentgenograms (86%) than by the conventional lateral chest roentgenograms (36%). We conclude that a supine cross-table lateral chest roentgenogram should be included in the evaluation of patients with suspected pericardial effusion or in patients in whom a large cardiac silhouette is detected on a standard chest roentgenogram.

Radiographic assessment of soft tissue signs in clinically suspected scaphoid fractures: the incidence of false negative and false positive results.

Radiographs of 127 patients who presented with suspected scaphoid fractures were reviewed to determine whether, as recent studies have suggested, an absence of dorsal soft tissue swelling of the wrist and a normal scaphoid fat stripe invariably excluded the possibility of such a fracture. Both false negative and false positive results were found to occur. False negative results (only approximately one in four patients with normal soft tissue signs had scaphoid fractures) might occur if the radiograph was obtained before the onset of edema. False positive results (only approximately a third of patients with abnormal soft tissue signs did not have any bony injury) might reflect soft tissue injury alone. Normal soft tissue signs do not exclude the possibility of a scaphoid fracture. Abnormal signs do not always indicate a scaphoid fracture.

Fat plane radiological signs in wrist and elbow trauma

With most elbow or wrist injuries, if fractures are not evident, they are probably nonexistent. But in a small percentage of cases, these signs serve to lower diagnostic thresholds. Of the four fat plane signs reviewed, the posterior fat pad sign and the navicular fat stripe seem to be more valuable than the supinator and pronator quadratus signs. However, each is useful in its own way. Although the clinical appearance of the extremity may dictate the same initial treatment whether or not a fracture is found, early identification of more subtle fractures will avoid delay of definitive treatment and provide a better estimation of healing time. None of these signs alone is completely reliable; they should be used as adjuncts in fracture diagnosis. Finally, no sign is specific to one type of fracture, although one or two types of occult fractures are most commonly identified on supplementary views when such signs are positive.

The diagnostic value of displacement of the fat stripe in fracture of the scaphoid: Cetti R, Christensen S-E Hand 14:76–79 1982

The diagnostic value of displacement of the fat stripe in fracture of the scaphoid: Cetti R, Christensen S-E Hand 14:76–79 1982

The navicular fat stripe (NFS) — Significance in the diagnosis of navicular fractures: Lorenz R, Fielder V Fortschr Geb Roentgenstr Nuklearmed Erganzungsband 137:286–290 Sep 1982

The navicular fat stripe (NFS) — Significance in the diagnosis of navicular fractures: Lorenz R, Fielder V Fortschr Geb Roentgenstr Nuklearmed Erganzungsband 137:286–290 Sep 1982

The navicular fat stripe (NFS). Significance for the recognition of fractures of the navicular bone

Navicular fractures are easily overlooked; the anatomy of the soft tissues in this region is illustrated and the significance of the navicular fat stripe in the diagnosis and follow-up of navicular and other local fractures is discussed. The differential diagnosis of pathological soft tissue signs in this region is also commented upon.

The diagnostic value of displacement of the fat stripe in fracture of the scaphoid bone

Soft tissue abnormalities on radiological examination can be useful in evaluating injury to various regions. In a retrospective study of X-ray pictures of 125 patients with injury to the wrist, it was possible to demonstrate an abnormal scaphoid fat stripe (SFS) in seventy-three out of seventy-eight cases with fracture of the scaphoid bone, compared to ten out of forty-seven cases without fracture.

The Radiographic Signs of Fatty Liver

Ninteen cases of radiographically visible fatty liver are presented. The four radiographic signs are muscle-fat interface, fat-water interface, a visible hollow viscus wall, and blurring of the medial margin of the right properitoneal fat stripe. The last sign, the authors believe, is the earliest radiographic change in developing fatty liver. In one case, isolated glycogen synthetase deficiency was the cause of fatty liver; this finding, to the authors' knowledge, has not previously been described. The value of the chest radiograph in diagnosing fatty liver is stressed.

The navicular fat stripe: a useful roentgen feature for evaluating wrist trauma.

The navicular fat stripe (NFS) is a useful roentgenographic feature for evaluating traumatic wrist injury. A radiolucent stripe, cast by a thin collection of fat paralleling the lateral surface of the navicular bone, was seen in 96 percent of 400 normal wrists examined because of trauma. Obliteration or displacement of this line (positive NFS sign) is commonly present in acute fractures of the naviculum, radial styloid process, and proximal first metacarpus. A ositive NFS sign serves to alert the radiologist that an underlying fracture is likely. In particular, the NFS sign generally accompanies a navicular fracture.

Use of the right atrioventricular fat stripe in catheterization of the right coronary artery.

Abstract By using a 20° left anterior oblique projection, the fat stripe in the right atrioventricular groove can usually be identified a short distance from the right heart border by its pulsation as visualized with image-intensified TV fluoroscopy. The superior extremity of this fat line identifies the orifice of the right coronary artery and aids in its localization for selective catheterization.

The cervical prevertebral fat stripe. A new aid in evaluating the cervical prevertebral soft tissue space.

Displacement or blurring of the cervical prevertebral fat stripe may allow for detection and localization of (1) fractures, (2) masses, (3) inflammation, and (4) confusing normal densities related to the cervical prevertebral soft tissues. This is true even when the measurement of the width of the soft tissue space falls within the wide range of normal.

Epicardial fat: Lateral plain film analysis in normals and in pericardial effusion.

Before the advent of cinefluoroscopy, the diagnosis of pericardial effusions depended upon the demonstration of enlargement of the cardiac shadow, characteristic water-bottle configuration of the cardiac silhouette, and diminished pulsations of the left cardiac border at fluoroscopy. None of these findings is consistently reliable. Diagnostic pericardiocentesis, C02 cardiograms, and angiography are all definitive but involve certain risks. In 1955 the epicardial fat line in its relationship to pericardial effusions was described both by Torrance (1) and by Kremens (2). Their method of demonstrating the fat stripe by laminagraphy is unreliable, however, due to the long exposure time and motion of the heart. In 1962, Jorgens, Kundel, and Lieber (3) described the cinefluorographic approach using image intensification in cinefluoroscopy, which was considerably more reliable in diagnosing effusions; and since the time of their paper the emphasis in such a diagnosis has been placed upon cinefluoroscopy. It is evident from our experience that, with a good knowledge of the anatomy and relationships of the subepicardial fat, in conjunction with good quality lateral chest radiographs, the diagnosis and exclusion of pericardial effusions can often be made with consistent reliability. In addition, totally unsuspected effusions are often detected. Cross-sectional preparations of the anterior mediastinum near the diaphragm reveal the essential anatomic relationships observable on lateral chest radiographs (Fig. 1). Immediately posterior to the body of the sternum and somewhat laterally placed are the internal mammary vessels with an abundant amount of fat accompanying them. Immediately posterior to this fat lies anterior mediastinal fat, and beneath this lie the parietal and visceral layers of the pericardium, usually separated by a thin film of serous fluid normally present in the pericardial sac. Beneath the visceral pericardium (or epicardium) and slightly to the left of the midline lies the anterior descending branch of the left coronary artery. This vessel also has considerable perivascular fat, as does the right coronary artery, and so the anterior part of the heart is covered with subepicardial fat, often in great abundance. It would appear, therefore, that in a lateral radiograph of the chest these fat plains would be visible and distinguishable from the soft-tissue density of the heart and the bony structure, of the sternum. In addition, the two layers of pericardium will be depicted as a thin line of soft-tissue density interposed between the anterior mediastinal fat in front and the subepicardial fat behind (Fig. 2). In our experience we have noted precisely that relationship in approximately 40 per cent of the routine lateral chest films of patients without pericardial disease.