Roentgen Changes Research Articles

Cathartic colon

Cathartic colon is an infrequent and severe manifestation of chronic irritant laxative abuse. Little is known of its natural history after cathartics are stopped. Previous reported cases have shown residual roentgen abnormalities on follow-up examinations. A case is presented of cathartic colon caused by more than 70 years of laxative abuse that demonstrated complete reversal of the roentgen changes four months after stopping the medication. Some pathophysiologic correlates of this dramatic reversibility are discussed.

Radiological Findings in Perinatal Infections

The specific diagnosis of a specific congenital infection depends on the results of special laboratory tests and roentgenographic findings. Roentgen changes in different organ systems in infants with cytomegalic inclusion disease, rubella, herpes simplex virus, toxoplasmosis, congenital syphilis, and group B streptococcal infection are illustrated.

The spectrum of osteoblastoma

Benign osteoblastoma is a rare tumor, more frequent in males, usually occurring in patients under the age of 30 years, and is seen most frequently in the spine, femur, tibia, and mandible. Its varied roentgenographic appearance may suggest a large osteoid osteoma or an aneurysmal bone cyst, but about one-fourth of cases present a picture consistent with a malignant neoplasm. The roentgen changes in the spine are frequently subtle and require care for identification. Differentiation from osteogenic sarcoma is sometimes difficult even with histological material, because some low grade osteogenic sarcomas contain areas resembling osteoblastoma. Conservative surgery is the treatment of choice for osteoblastoma.

Current perspectives on giardiasis.

Giardia lamblia infestation can cause severe diarrhea and malabsorption, and the diagnosis is usually made by identification of cysts in the feces, but small intestinal biopsy or smears may be required. A wide spectrum of roentgen changes may be seen. In patients with a normal immune status, the small bowel is normal or shows an inflammatory bowel disease pattern. Eradication of the parasite reverses these changes. In some patients with IgA deficiency, nodular lymphoid hyperplasia occurs, and this is usually not reversible. Other patients with hypogammaglobulinemia or dysgammaglobulinemia and giardiasis may show a sprue pattern. This pattern most often persists after eradication of the parasite. Although the triad of giardiasis, IgA deficiency, and nodular lymphoid hyperplasia has a particularly high association, these, together with diarrhea, malabsorption, and various altered immune states may occur in any combination.

Manifestations of systemic disease

EW DENTAL SPECIALISTS have the opportunity of working in a medical environment with close communication and shared interest with specialists in diagnostic roentgenology, surgery, and pathology; however, when that opportunity exists, a contribution may develop such as that made by Stafne4 which “stands tall.” Recognition of a disease is possible because of familiarity with the signs and symptoms, pathology, and roentgen changes that characterize it. Occasionally, the roentgen features are the most striking and may be pathognomonic. Roentgen changes in the jaws are of particular interest, for the appearance of the teeth often provides an aid in determining the time of onset of a disorder, a measure of its severity or its response to therapy, or a means of documenting its congenital nature. A comparison of films made over a period of years affords an opportunity to study its course. For example, any developmental disorder that is manifest in the primary dentition must have its onset from about 17 wk after conception to 1 yr of age. If the second dentition shows alterations in the crowns of developing teeth, onset from birth to the time of formation of the second molars is indicated. The inception of ectodermal dysplasia, for instance, can be measured against the chronology of dentition present at the time of examination. The chronology of developing and erupting teeth correlates roughly with skeletal maturation. The film :zcords in enamel and dentin the approximate time of onset of certain disorders because once a tooth is completely formed it changes little. The effects of systemic disease on the jaws and dental structures can best be determined when both intraoral and extraoral roentgenograms are available for study. PITUITARY DISORDERS

Tuberculous dactylitis in the adult.

TUBERCULOUS DACTYLITIS IN THE ADULTFRIEDA FELDMAN, M.D., RICHARD AUERBACH, M.D. and AUSTIN JOHNSTON, M.D.Audio Available | Share

Tumor bulge into the sphenoid sinus. A roentgen sign of parasellar meningioma.

TUMOR BULGE INTO THE SPHENOID SINUS A ROENTGEN SIGN OF PARASELLAR MENINGIOMAROGER D. GIFFORD, M.D., JOHN A. GOREE, M.D. and JOHN P. JIMENEZ, M.D.Audio Available | Share

Two Cases of Hemarthrosis

Hemophilia is an hereditary disorder of the blood transmitted as a sex linked mendelian recessive from the male through an unaffected daughter to a grandson and may occur bleeding tendency after most trivial injury.Hemoarthrosis is one of complication resulting from hemorrhage in hemophilia.The knees, the elbows and the ankles are most frequently affected.Hemoarthrosis may be repeated, the joints consequently incur contracture and permanent deformity.We give a report of two cases of hemoarthrosis which we experienced recently.Case 1; twenty six years of age.He shows severe contracture and deformity of the left knee joint. The other joints show middle contracture.There are demonstrable roentgen changes.Case 2; twenty years of age.He shows especially contracture of the both knee joints and elbows, not finding deformity. There are slight roentgen changes.

Suture diastasis following rapid weight gain. Pseudopseudotumor cerebri.

IN THE past, suture diastasis has been interpreted as a sign of acute raised intracranial pressure in children under the age of 10.1However, Capitanio and Kirkpatrick2have described three children suffering from deprivation dwarfism who developed spread of several cranial sutures following the correction of their malnutrition. The description of four additional patients, including the youngest in whom this phenomenon has been observed, and the one with the most rapid development of the roentgen changes, is the subject of this report. Report of Cases CASE1.—A 3-year-old Mexican-American boy was admitted for failure to thrive. A product of a normal pregnancy, the infant was delivered by cesarean section. Birth weight was 3,260 gm (7 lb 3 oz). At 1 year, his weight was 8,165 gm (18 lb) and his developmental milestones were normal. During his second year of life, he developed pneumonia, for

Rubella-like bone changes in congenital cytomegalic inclusion disease.

A classic case of congenital cytomegalic inclusion disease (CID) shows osseous roentgen changes identical to those in congenital rubella syndrome. The normal osseous patterns are markedly disorganized but without periosteal reaction. Gross lucent areas are interspersed between smaller zones of sclerosis; metaphyseal ends are serrated. In this case, lesions healed radiographically within five weeks.

Roentgen findings in extramedullary hematopoiesis.

ROENTGEN FINDINGS IN EXTRAMEDULLARY HEMATOPOIESISPAUL ROSS, M.B., B.S. and WENDE LOGAN, M.D.Audio Available | Share

Earliest roentgen changes in polyarthritis of the rheumatoid type. Continued investigations.

In 1963 (1) and 1965 (2) it was first announced that hitherto unnoticed, very early and yet significant roentgen changes in polyarthritis could be demonstrated. Since then, these changes have formed the basis for diagnosis and treatment of several hundred cases of early polyarthritis in our hospital, fulfilling our expectations of their significance. In 1966 Clemmesen (3) published a clinical critique of the diagnostic value of these earliest roentgen changes dorsoradial on the proximal end of the first phalanx of the four ulnar fingers as compared with hitherto applied clinical and serologic criteria for rheumatoid polyarthritis. Of 100 consecutive patients in whom polyarthritis of the rheumatoid type was clinically established according to the criteria set up by the American Rheumatism Association, the duration of disease in all cases being short (one month to two years), characteristic roentgen changes had been demonstrated at the initial x-ray examination in no less than 89. At the same time the blood...

Aseptic Necrosis Following Renal Transplantation

In twenty-seven patients who survived for six months or longer following renal homotransplantation, osseous changes developed in ten patients. Nine demonstrated aseptic necrosis of the femoral head, five had involvement of the hips alone, five showed aseptic necrosis at the knee joint, and two had aseptic necrosis of the humeral heads. The average time after transplantation when symptoms arose was seven months and the roentgen changes usually were seen two months later. The etiological explanation based on fatty embolization is theoretically satisfactory but unproved.

Correlation of Chest Roentgenograms and Hemodynamic Findings Following Surgical Closure of Secundum Atrial Septal Defects

Although the diagnosis of an atrial septal defect can be suspected on the plain roentgenograms of the chest (13), the critical features of such a defect—the degree of intracardiac shunting, the pulmonary artery pressure, pulmonary vascular resistance, and anatomic definition of the lesion—are determined by cardiac catheterization and angiocardiography (4, 7–10). The chief value of chest roentgenograms, therefore, is in following the progression of the lesion and the possible development of pulmonary hypertension (11). Roentgen observation of the changes in vascular structures following surgical closure may also give valuable information about the adequacy of the repair (10, 13, 14). The purpose of this study was to determine the roentgen changes occurring in the chest following complete closure of secundum atrial septal defects and the rate at which these changes occur. Materials And Methods The chest roentgenograms and catheterization data of all patients with surgical repair of secundum atrial septal defects from January 1959 to September 1965 in whom pre- and postoperative cardiac catheterizations were performed were independently analyzed. Cases of residual postoperative shunts were excluded from the study. Preoperative and postoperative chest roentgenograms, including barium swallow examinations in all cases, were evaluated for cardiac size; both the cardio-thoracic ratio and the specific chamber enlargement were recorded. Cardio-thoracic ratios less than 0.50 were considered normal, 0.50–0.54 slightly enlarged (1+), 0.55–0.59 moderately enlarged (2+), and 0.60 or greater markedly enlarged (3+). Specific chamber enlargement, as well as main pulmonary artery size, hilar pulmonary artery size, and peripheral pulmonary vasculature, was judged normal, slightly increased (1+), moderately increased (2+), or markedly increased (3+) according to established criteria (1–3). Catheterization data evaluated included: (a) pulmonary artery pressure (over 30/12 was considered increased), (6) the ratio of pulmonary to systemic flow (a ratio less than 2:1 was considered a moderate left-to-right shunt, while one greater than 2:1 was considered a large shunt), and (c) the ratio of pulmonary vascular resistance to systemic vascular resistance (less than 0.25 was normal, 0.26 to 0.50 moderately elevated, and greater than 0.50 markedly elevated) (4, 7, 9, 10). Ages of the 78 patients without postoperative residual shunting ranged from four to fifty-two years. Of these, 35 were less than twenty years old when operated upon, while 43 were older. Forty-six were female, and 32 were male. Results Postoperative changes in main pulmonary artery size, hilar pulmonary artery size, and peripheral pulmonary vascular prominence are summarized in Tables I–III and Figure 1.

ACCURACY OF PREDICTING PULMONARY BLOOD FLOW, PULMONARY ARTERIOLAR RESISTANCE AND PULMONARY VENOUS PRESSURE FROM CHEST ROENTGENOGRAMS

ACCURACY OF PREDICTING PULMONARY BLOOD FLOW, PULMONARY ARTERIOLAR RESISTANCE AND PULMONARY VENOUS PRESSURE FROM CHEST ROENTGENOGRAMSARTHUR LIEBER, M.D., HAROLD D. ROSENBAUM, M.D., DANIEL J. HANSON, M.D. and H. M. KWAAN, M.D.Audio Available | Share

Correlation of chest roentgenograms and hemodynamic findings following surgical repair of ventricular septal defects.

The diagnosis and hemodynamic evaluation of ventricular septal defect are made at cardiac catheterization. The present-day value of the plain chest roentgenogram, then, is in following the evolution of the defect, and it has proved especially useful in detecting Eisenmenger's reaction and its associated pulmonary hypertension. Little emphasis, however, has been placed on the changes seen following surgical closure of the defect. This study was undertaken to determine the roentgen changes in the chest following successful closure of the ventricular septal defects and the rate at which such changes evolve. Materials and Methods The chest films and catheterization data of all patients operated upon for the repair of uncomplicated ventricular septal defects from January 1959 to December 1965 and in whom preoperative and postoperative cardiac catheterizations were performed were analyzed independently. Patients with residual postoperative shunts were included in the original analysis, and the person evaluating the films was unaware of the catheterization data. Patients with residual shunts were subsequently excluded from the series. Plain chest roentgenograms, including barium swallows in all cases, were evaluated for the degree of cardiac chamber enlargement, the extent of main pulmonary artery enlargement, and the degree of pulmonary vascularity. Left atrial and main pulmonary artery size and peripheral pulmonary vasculature were judged as normal, slightly increased (1+), moderately increased (2+), or greatly increased (3+), using established criteria (1–4, 10, 15, 16). All available follow-up films up to one year after surgery were examined. Catheterization data utilized included the pulmonary artery pressure, the ratio of pulmonary-to-systemic flow (the degree of left-to-right shunting), and the ratio of pulmonary vascular resistance to systemic vascular resistance (8, 9). A ratio of pulmonary-to-systemic flow of less than 2:1 was considered to be a moderate left-to-right shunt, and those ratios greater than 2:1 were considered to indicate large shunts. Pulmonary vascular resistance less than 0.25 was considered normal, from 0.26 to 0.50 moderately elevated, and greater than 0.50 markedly elevated. There were 61 patients in the original analysis, with ages ranging from three to forty-eight years. Forty-nine showed no evidence of residual shunting at the time of postoperative cardiac catheterization, and the age distribution for the final group is as follows: one to five years, 13 patients; six to ten years, 14 patients; eleven to twenty years, 12 patients; twenty-one to thirty years, 6 patients; thirty-one to forty years, 2 patients, and forty-one years or more, 2 patients.

Mucormycosis infection of the craniofacial structures.

MUCORMYCOSIS INFECTION OF THE CRANIOFACIAL STRUCTURESWILLIAM H. GREEN, M.D., HERBERT I. GOLDBERG, M.D. and GEORGE T. WOHL, M.D.Audio Available | Share

Ulcerative disease of the intestinal tract proximal to partially obstructing lesions. Roentgen appearance.

1. Three patients with ulcerative changes in the bowel proximal to stenotic lesions of the colon are reported.2. The roentgen changes are described and their similarity to inflammatory disease of the bowel is emphasized.3. The inflammatory and ulcerative changes may mask the primary pathologic process.

Bone changes following electrical injury; case report and review of literature.

BONE CHANGES FOLLOWING ELECTRICAL INJURY CASE REPORT AND REVIEW OF LITERATURELOUIS B. BRINN, M.D. and JOHN E. MOSELEY, M.D.Audio Available | Share

Changes of the sella turcica in chromophobic adenomas and eosinophilic adenomas.

The increase in therapeutic modalities for the various lesions in the intrasellar and suprasellar areas necessitates an accurate differential diagnosis. This should be advanced as far as possible by the plain skull film examination. Our study is directed toward the evaluation of the osseous changes in and about the sella turcica in chromophobic adenomas and eosinophilic adenomas. Our primary aim is to compare the classical description of the roentgen changes in each of these pituitary tumors in surgically and pathologically verified material. Previous Studies Since Oppenheim (22) in 1899 first reported roentgenographically demonstrable changes in a pituitary tumor, the literature dealing with the radiologic diagnosis of these adenomas has become extensive. There seems to be agreement that the osseous changes caused by intrasellar tumors in most instances can be distinguished from those of suprasellar lesions (2–4, 6, 8, 11, 14–19, 29, 30). With respect to the differentiation between the various types of pituitary tumors, however, different opinions are held. In general, American and British authors (12, 24, 29) do not emphasize this aspect, which has been dealt with by Austrian, German, French, and Scandinavian writers (3, 6, 9, 11, 14, 15, 19, 23, 26, 30). Many features considered characteristic of each type of adenoma were described previously by the Vienna school, and gradually a classical description has evolved which can be summarized as follows. The sella of the eosinophilic adenoma is typically balloon-shaped, indicating that the sellar entrance is either minimally widened or not at all. The angle between the planum sphenoidale and the anterior wall of the sella is acute, and the dorsum sellae is not tilted backward. In addition, the dorsum sellae is not significantly eroded. These findings are in contrast to the roentgen changes in the chromophobic adenomas, in which a cup-shaped or “open” sella is considered typical. Also, the angle between the planum and the anterior sellar wall is obtuse, and the sellar entrance is widened, primarily because of the backward tilt of the dorsum. The dorsum sellae is described as eroded, and the asymmetrical enlargement of the sella as usually present in the chromophobic adenomas. Also, it is thought that in the chromophobic adenoma the sella is usually much larger than in the eosinophilic. In later years, Lindgren (14, 15) and Mayer (19), among others, maintained that this description generally holds true, but others (17, 31) do not entirely concur. On the basis of material consisting of 4 eosinophilic and 34 chromophobic adenomas, Mahmoud (17) concluded that his findings did “not confirm the statement of Lindgren of a greater incidence of the balloon sella in esoinophilic rather than chromophobic adenomas.” In fact, many opinions seem to be based on limited material, especially with respect to eosinophilic adenomas.