Normal Radiographic Appearance Research Articles

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.

DOUBLE CONTRAST GASTROGRAPHY IN THE CAT

Radiographic diagnosis of gastric mucosal disease has not been reported in the cat. This may be due to the difficulty in making these diagnoses with survey or single contrast radiography. Double contrast gastrography (DCG) allows direct visualization of gastric mucosal surfaces. The DCG technique in the cat is described, and the normal radiographic appearance is illustrated.

Radiographic appearance of the normal temporomandibular joint in newborns and small children.

The radiographic anatomy of the normal temporomandibular joint in newborns and children up to 4 years of age was investigated, partly on specimens, obtained at autopsy, with methods corresponding to clinical procedures, and partly on patients. A rather flat mandibular fossa and immature mandibular head were found at birth, whereas a well-developed articular tubercle and an adult-like radiographic appearance of the joint were found at about one year of age. No evident changes of the radiographic anatomy seemed to occur from one to 4 years of age. A striking similarity was observed between the dystrophic temporomandibular joint in patients with juvenile rheumatoid arthritis and micrognathia and the normal radiographic appearance in the first months of life, indicating an early involvement of this joint in patients developing micrognathia.

THE UPPER GASTROINTESTINAL EXAMINATION IN THE CAT: NORMAL RADIOGRAPHIC APPEARANCE USING POSITIVE CONTRAST MEDIUM

The normal radiographic appearance of the feline upper gastrointestinal (UGI) examination following oral administration of barium sulfate suspensions was described. Important findings included the minimal gastric air and small bowel gas present on survey abdominal radiographs. Gastric appearance was nearly constant. A normal duodenal pattern, referred to as a “string of pearls”, was described. Small bowel lumen size was consistently less than 12 mm. Small bowel mucosal patterns varied widely. The most commonly identified normal radiographic UGI patterns in this study were found consistently in a group of 26 cats thought to be without gastrointestinal disease. Because of the consistency of observation of many radiographic patterns, rapid gastric emptying, and a short small bowel transit time, normal UGI examinations in the cat present a more constant appearance than in the dog, thus making them more valuable as well as easier to conduct.

EPIDUROGRAPHY IN THE NORMAL DOG: TECHNIC AND RADIOGRAPHIC FINDINGS

Ten clinically normal adult mongrel dogs were examined using lumbosacral epidurography in an effort to determine a reproducible technic and a normal radiographic appearance. The site of contrast medium injection was the ventral epidural space at the sacrococcygeal junction or the cranial coccygeal region. An initial dose of 0.15 ml/kg of metrizamide for the right lateral recumbent radiograph with 0.10 ml/kg additional metrizamide for additional right lateral or the subsequent dorsoventral radiographs was considered adequate. Two numerical values were observed for each normal epidurogram: the sacrovertebral angle; the ratio of the contrast medium column width to L6 body length. A statistically significant relationship between hindlimb positioning and the numerical value of the sacrovertebral angle was identified. Some advantages of epidurography for delineating the lumbosacral area are obvious: (1) it overcomes the limited value of lumbosacral area myelography; (2) it is technically easier than intraosseous vertebral venography; (3) there is minimal patient trauma; (4) there was no apparent adverse sequela to repeated contrast medium injections.

Normal anatomy of thymus and anterior mediastinum by pneumomediastinography.

Normal radiographic appearances of the thymus and anterior and superior mediastinum based on 34 pneumomediastinograms performed on myasthenia gravis patients are discussed. Knowledge of (1) end-on shadow of major vessels in the mediastinum, (2) topographic relation between major vessels and bilateral lobes of the thymus, (3) variable shape, size, and uneven outline of the normal thymus, and (4) irregularly distributed mediastinal fat, helps make more precise radiographic interpretation in this region.

The Radiographic Appearance of Complications Following Nissen Fundoplication

Seventy patients had an upper gastrointestinal examination following Nissen fundoplication for reflux esophagitis associated with hiatal hernia. Thirty-nine were asymptomatic and the fundoplication appeared normal. Of the 31 patients with symptoms (dysphagia, pain, or vomiting), 15 had spontaneous relief and demonstrated a normal postsurgical radiographic appearance of the stomach. The other 16 had both persistent symptoms and radiographic abnormalities, including 5 stenoses, 3 recurrent hernias, and 8 pouch deformities of the fundus. The roentgenographic features and etiology of these surgical failures are discussed and the importance of the radiographic examination in discerning successful surgical repair from failure despite similar postsurgical symptoms is stressed.

Radiological evaluation of the aortic-pulmonic window.

Knowledge of the roentgen anatomy of the aortic-pulmonic window will minimize confusion of pathologic and normal radiographic appearances. When deep intrusion of lung into the window is seen or when the window is outlined by far within it, gross enlargement of ductus nodes or masses in this area can be excluded with a reasonable degree of certainty. If masses or lymph nodes are present in the window, the mediastinal pleura "closing" on its lateral side will show on abnormal configuration with convexity directed laterally. Medial extension of masses or enlarged lymph nodes may cause impression on the left lateral wall of the esophagus and may compromise the left recurrent laryngeal nerve.

Congenital left posterolateral diaphragmatic hernia with previously normal chest x-ray

Three patients who presented with left congenital posterolateral diaphragmatic hernia at the ages of six months, two years and six years and who had a normal chest x-ray earlier in life are reported. In two children the late onset of symptoms and previously normal radiographic appearance might be explained by the spleen acting as a plug in the diaphragmatic defect. A normal chest x-ray in early infancy does not exclude the diagnosis of congenital posterolateral diaphragmatic hernia.

The Spheno‐Occipital Suture of the Horse: Its Normal Radiographic Appearance

The Spheno‐Occipital Suture of the Horse: Its Normal Radiographic Appearance

The Lymphatics: Diseases, Lymphography and SurgeryThe Lymphatics: Diseases, Lymphography and Surgery. By KinmonthJohn B., M.B., M.S. (Lond.), F.R.C.S. (Eng.). Cloth, $43.50. Pp. 420, with numerous figures. Baltimore, Williams & Wilkins, 1972.

In the preface, Professor Kinmonth quotes Osler as saying, If you have the good fortune to command a large clinic, remember that one of your chief duties is the tabulation and analysis of carefully recorded experience. ' , Years of experience with the lymphatic system is the basis of this interesting book. More than anyone else, Professor Kinmonth has led the way in developing a technically useful niethod for the radiological demonstration of the lymphatics. Indeed, his first papers describing lymphography in man were published in Clinical Science in 1952. Although he is a surgeon, Dr. Kinmonth's name is very familiar to all radiologists. The book 15 divided into 20 chapters; all but four were written by Kinmonth, First described are the methods of lymphography. The normal radiographic appearances of the lymphatics of the extremities, pelvis and retroperitoneal area follow. The illustrations are excellent and the descriptions short and to the point. After a brief discussion of the physiology of tissue fluids, several chapters are devoted to the clinical problems associated with lymphedema. These rare entities, which often pose diagnostic problems, are presented with detailed clinical case histories. The appropriate lymphograms and photographs of the patients are shown. Modalities of treatment of each entity are described, followed in many instances by a brief discussion of surgery. The nine chapters which discuss the different lymphedemas are followed by a discussion on tumors of the lymph vessels, including the angiosarcomas. There is a short discussion of lymphography of lymph node disease such as metastases or lymphomas. The radiologist might have wished that these chapters be somewhat more detailed. . Of particular interest is the chapter on endolymphatic therapy written by J. M. Edwards. Probably more than any other group, Dr. Kinmonth and his associates have used the route of endolymphatic radiation for the treatment of patients with melanoma. They have studied the use of 198Au, 90y, 131Iodine Lipiodol and 32p Lipiodol. Some of their results are reported in this chapter. Since relatively little has been written on this subject, and since only very few controlled or long-term studies are available, it is unfortunate that this chapter has not been expanded. Despite these minor limitations, the book will prove very useful to many radiologists, and certainly should be available in departmental libraries. It is a good reference book stressing diseases and syndromes which are not always familiar. P. RUBEN KOEHLER, M.D.

The Normal and Pathological Radiographic Appearances of Bone

The Normal and Pathological Radiographic Appearances of Bone

PARAPLEGIA IN HYPEREXTENSION CERVICAL INJURIES WITH NORMAL RADIOGRAPHIC APPEARANCES

1) A case is reported of paraplegia with normal radiographic appearances in which cervical cord damage was shown at autopsy to have been due to hyperextension injury. 2) The mechanism of such injuries is discussed, together with the differential diagnosis from acute prolapse of an intervertebral disc. 3) The grave dangers of using the fully extended position of the cervical spine in the management of these cases is noted.

Radiology in the Teaching of Anatomy

THE progress made by radiology in the examination of the human body has led to its increasing use in the diagnosis of disease, so that to-day every general practitioner must have some knowledge of the normal radiographic appearances of the body if he is to understand the meaning of the radiologist's report. The time has passed when it was sufficient only to read the report, as was so prevalent some years ago, without understanding, from an examination of the film, the reasoning on which the report was based. In the final qualifying examinations it has been the custom now for many years to examine candidates on the appearances shown by radiographs of pathological conditions. The clinical examiner has already recognized that radiological appearances are playing an ever-increasing part in the detection, study, and control of many diseases. It entitles him to expect from the candidate for examination a fair knowledge of radiological diagnosis, much in the way as a knowledge of morbid histology is expected from students in every qualifying examination. In many schools there has been no attempt to teach the student the appearances of the normal radiograph, so that he has attempted to learn the interpretation of radiographs of pathological conditions while he has had only a very superficial knowledge of the normal. It is plain that any attempt to teach students the meaning of radiographs showing abnormal conditions without first teaching them to interpret radiographs of the normal is like trying to teach morbid histology without having first a knowledge of normal histology. To remedy this, the Board of Examiners for Anatomical Study of the University of London, in April, 1938, decided that students presenting themselves for examination in anatomy must show some knowledge of the radiological appearance of the human body. As a result, the teaching of radiological anatomy, which had been in progress only at certain schools for a number of years, has now become general. The radiological teaching in most schools is carried out by a radiologist appointed as demonstrator of normal radiology to the department of anatomy. It is necessary that a radiologist should carry out the teaching of radiology in close co-operation with the teachers of anatomy, because in most cases the demonstrator of anatomy has not the necessary technical knowledge. Radioscopy, in particular, should be carried out only by a radiologist, because of the injuries which may occur from overexposure to x-rays by inexperienced operators. The teaching of normal radiology in the anatomy department, as well as making the subsequent teaching of radiographs of pathological conditions easier, also exerts a favorable influence on the student's approach to his anatomical studies.