Roentgenographic Findings Research Articles

Congenital Clubfoot Treated with the Ponseti Method

Purpose: This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot. Materials and Methods: A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace. Results: Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace. Conclusion: The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.

Neutropénie auto-immune primaire avec autoanticorps antineutrophiles traitée avec succès par sirolimus

We report a 74-year-old man with severe chronic primary neutropenia (neutrophil count: 390 per millimeter cube) uncovered following surgery for perianal abscess collection. Clinical, laboratory and roentgenographic findings revealed no abnormality. Antineutrophil antibodies were positive in two consecutive serum samples. Under cyclosporine, neutrophil count reached 1970 per millimeter cube. However, this therapy was discontinued due to new onset of severe renal failure. After six weeks, neutrophil count was 950 per millimeter cube and sirolimus was started, resulting in renal function improvement and resolution of neutropenia.

Utilization Of Ventilation / Perfusion Lung Scan In A Cancer Hospital

Utilization Of Ventilation / Perfusion Lung Scan In A Cancer Hospital

Percutaneous endoscopic discectomy and drainage for infectious spondylitis

Fifteen patients with infectious spondylitis were treated by percutaneous endoscopic discectomy and drainage (PEDD) and associated appropriate parenteral antibiotics. Infectious spondylitis was diagnosed clinically, on the basis of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values, and on roentgenographic and magnetic resonance imaging (MRI) findings. Causative bacteria were identified in 13 (86.7%) of 15 biopsy specimens. Systemic antibiotics were administered according to sensitivity analyses of pathogens. All patients reported immediate back pain relief except for two, who required anterior debridement and fusion one week and two weeks later, respectively. Two other patients with recurrent infection and intractable pain underwent surgical intervention at one month and eight months after PEDD, respectively. The remaining 11 patients recovered uneventfully after full-course, specific, antimicrobial therapy. No surgery related complications or side effects were observed during at least 12 months of follow-up. In conclusion, PEDD can provide retrieval of sufficient specimens and has high diagnostic efficacy, thereby enabling prompt and appropriate antibiotic therapy to the offending pathogens. It can be considered an effective alternative for treating uncomplicated spondylitis.

Endotracheal-endobronchial metastases: report of 14 cases

Introduction: Endotracheal-Endobronchial Metastases (EEM) secondary to extrapulmonary neoplasm are rare. Since 1989 we have encountered 14 patients with EEM. Materials and Methods: EEM were defined as documented extra pulmonary neoplasm metastatic to subsegmental or more proximal central bronchi in a bronchoscopically visible range. The developmental modes were described on the basis of classifying categories of Kiryu. Results: The primary tumors included breast cancer (4 cases including 3 women,1 man), colorectal carcinoma 1, renal cell carcinoma 1, embryonal cell carcinoma of testis 1,uterine cervix carcinoma 2,melanoma 1,osteogenic sarcoma 2,papillary thyroid carcinoma 1and prostatic sarcoma 1. The chest roentgenographic findings were: collapse 5, parenchyma mass 5, multiple nodule 2 and hilar enlargement 2. Median interval from diagnosis of primary tumor was 39.5 months. Endobronchial lesions were detected by bronchoscopy and their metastatic nature was confirmed histopathologically in all patients. Six patients were treated with external radiotherapy, while 6 patients had chemotherapy and 2 patients underwent surgical resection of metastasis. Conclusions: The cases we have reported are similar to those found in the literature, regarding their clinical and roentgenographic presentation. Local treatment is effective for palliating symptoms. All patients with extra pulmonary malignant tumor who are suspected to have pulmonary metastasis should undergo bronchoscopy to diagnose end bronchial metastasis and to differentiate it from primary lung cancer.

THE CLASSIC: Pyogenic Vertebral Osteomyelitis

THE CLASSIC: Pyogenic Vertebral Osteomyelitis

Low Back Pain Secondary To Unilateral Facet Joint Hypoplasia In The Lumbosacral Junction

Introduction: The authors intention was to report the clinical, radiological, intraand postoperative findings of a patient with low back pain and pseudoradicular pain radiation to the left leg. As reason, a considerable hypoplasia of the left inferior facet joint of L5 and dysplastic cranial facet joint of S1 was detected. To the authors knowledge no case of facet joint dysplasia with ipsilateral pain has been reported so far. Methods: Different forms of dysplasia or false orientation of the facet joints in the lumbosacral joints are described to cause low back pain. One case of recurrent low back pain with pseudoradicular radiation is reported. Medical and radiological reports and related literature were reviewed. Results and Discussion: A 44 years old woman complained about recurrent low back pain consisting for 2 years. 4 weeks before admission to our clinic, a pseudoradicular leg pain on the left side occurred. Roentgenographic findings showed an aplasia of the left facet joint of L5/S1, MR tomography revealed disc degeneration in the lumbo-sacral junction. Computed tomography including 3D reconstruction showed a considerable hypoplasia of the left inferior articular facet L5. A possible reason for leftsided pseudoradicular leg pain, a dysplastic left sacral articular process was detected forming a sclerotic degenerated pseudoarticulation with the left hemilamina of L5. There was no pain relief after conservative treatment. Diagnostic investigations for instability including a probative chest tube and a facet infiltration of the facet joint on the left side were followed by complete pain relief. A spinal fusion in unilateral transforaminal posterior interbody fusion technique (PLIF) from the left side led to complete remission of back pain and pseudoradicular radiation. Conclusions: Hypoplasia of the facet joint in the lumbosacral junction is extremely rare to cause back pain. If conservative treatment does not result in pain relief, spinal fusion may be indicated.

Generalized arterial calcification of infancy: Different clinical courses in two affected siblings

Generalized arterial calcification of infancy (GACI) is a rare autosomal recessive disease caused by mutations in ENPP1. Due to extensive calcification of the arterial media associated with intimal proliferation leading to vascular occlusion, most affected children die within the first 6 months of life. We report on two Taiwanese siblings with an identical genotype, but different clinical course. The male sibling developed heart failure and severe hypertension, and died at the age of 6 weeks despite of treatment with bisphosphonates, ACE inhibitors, and hydralazine. The subsequent female, who was monitored closely pre- and post-natally, is having an uncomplicated clinical course up to the age of 1(1/2) year now. There were similar characteristic sonographic and roentgenographic findings in both siblings in early infancy. In both siblings, the same compound heterozygous mutations (c.1025G > T [p.Gly342Val] and c.1112A > T [Tyr371Phe]) in ENPP1 were identified. Despite the same genotype and similar sonographic and radiographic features in early infancy, the phenotype of GACI can vary to a great extent within one family.

Tuberculous Peritonitis Associated with Ovarian Teratoma Presenting as Peritoneal Carcinomatosis

Peritoneal tuberculosis (TB) is a fatal disease if not promptly diagnosed. We present a case of unexplained ascites with miliary peritoneal TB and a review of the literature. A 56-year-old woman was admitted to our hospital because of severe abdominal fullness for 20 days. Computed tomography scans of the abdomen showed massive ascites and a huge intrapelvic mass mimicking an ovarian dermoid cyst. Laboratory examinations revealed an elevated serum cancer antigen 125 level of 1,132.9 IU/mL and normal chest roentgenographic findings. About 5 L of ascitic fluid and many superficial whitish miliary deposits on the intra-abdominal and pelvic surfaces were found during exploratory laparotomy. A right ovarian cystic mass measuring 15 × 14 × 10 cm in size was noted and removed. Pathologic studies of the cyst revealed a mature cystic teratoma, and all the specimens from the peritoneum and the ovarian surface had chronic granulomatous inflammation with central caseous necrosis compatible with TB. She received postoperative anti-TB chemotherapy and was doing well 5 months after surgery. Tuberculous peritonitis is not easy to diagnose. We suggest that tuberculous peritonitis associated with ovarian teratoma should be included in the differential diagnosis of peritoneal carcinomatosis.

Hiperreactividade brônquica na sarcoidose

The purpose of this study was to measure airway responsiveness in patients with sarcoidosis using bronchoprovocation test with methacholine (BPT) in comparison to roentgenographic findings, respiratory symptoms, activity and duration of the disease. There were 17 patients with Sarcoidosis, 20 asthmatics and 21 assymptomatics. We used the tidal breathing method with standardizes output for the nebulizers. We administered increasing and successively concentrations of methacholine beginning with 0.125 to 16mg/ml. The responses were measured by changes in FEV1 or the final concentration was reached. The results were expressed as the concentration of methacholine causing 20% fall in FEV1 (PC20). Aerosolized bronchodilator was given at the completion of all tests. There were 4 patients with sarcoidosis who had positive BPT, 3 of them with PC20<8mg/ml associated with respiratory symptoms, bilateral hilar adenopathy, more than twoyear duration and active disease. All the asthmatic subjects had positive BPT with CP20<8mg/ml. The entire assymptomatic group had negative BPT. Positive bronchodilator response was reached in 6 patients with sarcoidosis, 20 asthmatics and 8 assymptomatic subjects. We concluded that: (a) airway responsiveness can be reached in 17.6% patients with sarcoidosis related to bilateral hilar adenopathy, chronic and active disease; (b) 50% of sarcoidosis patients with cough and/or wheeze had positive BPT, (c) the BPT was able to discriminate asthmatic from assymptomatic subjects.Rev Port Pneumol 2005; XI (2): 97-110

Descriptive patterns of severe chronic pulmonary hypertension by chest radiography

To find chest roentgenographic (CXR) features to help differentiate two representative diseases with severe chronic pulmonary hypertension (PH). Thirty-six consecutive patients with chronic thromboembolic PH (CTEPH), 38 with primary PH (PPH), and 37 with left heart disease and PH. CXRs were reviewed about 6 features (left 2nd arc protrusion, right descending pulmonary artery diameter (rPAD), cardiothoracic ratio (CTR), right 2nd arc width, avascular area and pleural abnormality). Hemodynamic data and the degree of tricuspid regurgitation (TR) on echocardiography were compared with CXR findings. The diagnostic pattern of CTEPH was the presence of one of two findings, an avascular area or marked rPAD (>20mm) together with pleuritic change. The diagnostic pattern of PPH was one of the two features; without pleuritic abnormality, marked left 2nd arc protrusion (>10mm) or moderate left 2nd arc protrusion (5-10mm) with marked rPAD (<20mm). The sensitivity for the diagnosis of CTEPH among the three diseases was 78% and specificity was 92%. The sensitivity for the diagnosis of PPH was 45% and specificity was 88%. CTR and right 2nd arc width were related to the degree of TR in CTEPH and PPH. Characteristic roentgenographic findings can help differentiate two frequent diseases associated with chronic pulmonary hypertension and reflect the severity of disease.

Acute idiopathic pericarditis with transient constriction

A 28-year-old man was referred to a hospital because of acute illness, fever, malaise, and retrosternal chest pain. On the admission, he was eupnoic, the heart rate was 90 beats/min, and the blood pressure was 110/80 mm Hg. Chest roentgenographic findings were unremarkable, and electrocardiography showed near-ubiquitous ST segment (J point) elevations, diffuse PR segment depression and specular elevation in the aVR lead. On auscultation, no pericardial rub was evident. The following laboratory data were obtained: hemoglobin, 13.5 g/dl, leucocite count, 11 10/mm, erythrocyte sedimentation rate, 98 mm in 1 h. Echocardiography disclosed a large pericardial effusion (Fig. 1). The clinical features of active acute pericardial disease subsided with bed rest and nonsteroidal antiinflammatory drugs (ibuprofen 800 mg every 8 h). A specific cause was not apparent after assessment according to our internal diagnostic protocol [1]. Acute idiopathic pericarditis was diagnosed. Six days after, his conditions deteriorated: dyspnea, hypotension, and marked giugular venous distension were noted. The echocardio-

Avascular necrosis of the hallucal sesamoids update with reference to two case-reports

We report two cases of nontraumatic metatarsal pain with sclerosis and fragmentation of the lateral sesamoid bone on roentgenographs and computed tomography images. One patient underwent magnetic resonance imaging (MRI), which showed low signal from the sesamoid bone. These imaging findings suggested osteonecrosis. Histology of the sesamoidectomy specimen confirmed this diagnosis in one patient. Avascular necrosis of the metatarsal sesamoid is an uncommon disorder. The suggestive roentgenographic and MRI findings rule out the other painful conditions of the sesamoid bone. The features are reviewed and the treatment options discussed.

Ostéonécrose aseptique des sésamoïdes métatarsiens ou maladie de Renander : aspects actuels à propos de 2 cas

We report 2 cases of nontraumatic metatarsal pain with sclerosis and fragmentation of the lateral sesamoid bone on roentgenographs and computed tomography images. One patient underwent magnetic resonance imaging (MRI), which showed low signal from the sesamoid bone. These imaging findings suggested osteonecrosis. Histology of the sesamoidectomy specimen confirmed this diagnosis in one patient. Avascular necrosis of the metatarsal sesamoid is an uncommon disorder. The suggestive roentgenographic and MRI findings rule out the other painful conditions of the sesamoid bone. The features are reviewed and the treatment options discussed.

Delayed dilated cardiomyopathy for major burn injuries

Purpose: The early impact on the heart of severe burns has all been well documented previously. Here, we report on the late effects of burns upon the heart, and dilated cardiomyopathy, such aspects having been little reported previously in the literature. Methods: Over the past 8 years (June 1991 to December 1998), 55 scalded or flame-burnt patients for whom the total burnt body surface area (TBSA) exceeded 50% were treated. Seventeen patients survived and were followed up. The mean age was 44 years. The mean follow-up period was 47.3 months; four patients displayed a previous history of heart disease. We used several parameters to evaluate and follow cardiac status to see the late effect of burns upon the heart. Results: Of 17 patients, 3 patients (17.7%) were found to exhibit dilated cardiomyopathies after a mean time of 6 months post-injury. A dramatic recovery from symptoms and roentgenographic findings were observed for all patients following symptomatic treatment. Conclusion: Here we report three cases of delayed dilated cardiomyopathy, a condition that has been little reported in the past. There may be many causating factors. Several recommendations are described.

Pathology of allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) occurs in patients with asthma and cystic fibrosis when Aspergillus fumigatus spores are inhaled and grow in bronchial mucus as hyphae. Chronic colonization of Aspergillus fumigatus and host's genetically determined immunological response lead to ABPA. In most cases, lung biopsy is not necessary because the diagnosis is made on clinical, serologic, and roentgenographic findings. Some patients who have had lung biopsies or partial resections for atelectasis or infiltrates will have histologic diagnoses. A number of different histologic diagnoses can be found even in the same patient. In the early stages the bronchial wall is infiltrated with mononuclear cells and eosinophils. Mucoid impaction and eosinophilic pneumonia are seen subsequently. This may be followed by bronchiolitis obliterans, granulomatous bronchiolitis, and pulmonary fibrosis. Treatment with corticosteroids appears to prevent the progression of the disease.

Roentgenographic Findings and Bone Mineral Density in the Stem Area After Cementless Total Hip Arthroplasty

Roentgenographic Findings and Bone Mineral Density in the Stem Area After Cementless Total Hip Arthroplasty

Intraosseous Hemangioma of the Orbit

A case of intraosseous orbital hemangioma is reported to alert surgeons to possible intraoperative hemorrhage during excision of such a lesion. A slowly enlarging mass was excised from the orbital rim of a 49-year-old woman. The clinical diagnosis was not suspected. In retrospect, roentgenographic findings included a focal honeycombed pattern of the zygomatic bone. Surgery was complicated by persistent low-volume bleeding. Histology showed endothelial-lined blood-filled channels within the bone. Intraosseous orbital hemangioma is a rare, benign neoplasm that can often be diagnosed clinically by characteristic roentgenographic findings. Observation should be considered as a therapeutic alternative when the radiographic diagnosis is established and when ocular function is not compromised.

Pneumocystis carinii Pneumonia Presenting as an Isolated Pulmonary Nodule in a Non-HIV-Infected Immunosuppressed Patient

Case Report. A 68-year-old male with stage 4A Mantel cell lymphoma diagnosed six months previously was evaluated for his seventh cycle of chemotherapy (Cytoxan, doxorubicin, vincristine, and rituxan, alternating with methotrexate and Ara-C). The prior cycle of chemotherapy was complicated by a 10-day episode of neutropenia without fever. At this evaluation, the patient had no complaints, but chest roentgenography showed a left-lower-lung-field nodule that was not present on a roentgenograph two weeks previously or a CT scan 10 weeks previously. Physical examination findings were unremarkable; temperature and lung findings were normal. CT of the chest confirmed a 1.0 × 1.8–cm nodule in the lower lobe of the left lung (Figure 1). A PET scan did not demonstrate increased signals from the lungs. CT-guided aspiration of the lung lesion was performed. A biopsy specimen from the nodule was described as a “frothy, honey-combed material in macrophages,” and a silver stain confirmed the presence of Pneumocystis carinii (Figure 2). The patient was treated with a three-week course of oral trimethoprim/sulfamethoxazole (160/800 mg; two tablets three times a day) and received his scheduled chemotherapy. One month later, chest CT demonstrated resolution of the nodule.FIGURE 1.: CT of chest, showing a nodule (1 × 1.8 cm) in the lower lobe of the left lung.FIGURE 2.: A lung biopsy showed giant cells (original magnification, × 250). The same area is enlarged in the upper left corner (original magnification, × 1000; both stained with hematoxylin–eosin). Lower left corner shows Pneumocystis (silver stain; original magnification, × 1000).Discussion. Pulmonary nodules in the immunocompromised host have a wide array of causes. Malignancy is a common cause, and a relapse of Mantel cell lymphoma or a second malignancy needed to be considered in this case. Infectious agents known to cause isolated pulmonary nodules include fungi such as Aspergillus, Mucor, Cryptococcus, Sporothrix, Histoplasma, Blastomyces, and Coccidioidomyces species, as well as bacteria such as Nocardia, Rhodococcus, Legionella, or Mycobacterium. It is unusual for Pneumocystis carinii to be the causative agent of an isolated nodule, and it was recognized as the cause only after fine-needle aspiration and microscopic identification. For this immunosuppressed patient, treatment was considered warranted because of the risk for the local process to spread. This case underlines the importance of a thorough workup of a new pulmonary nodule in such a setting. Pneumocystis carinii pneumonia (PCP) typically presents with bilateral interstitial infiltrates, but many other roentgenographic presentations have been described, including normal chest roentgenographic findings [1]. Atypical presentations of PCP have been associated with inhaled pentamidine prophylaxis. The incidence of upper-lobe disease, cysts, and spontaneous pneumothorax are increased in patients receiving such prophylaxis. Pneumocystis carinii has been rarely reported to cause pulmonary nodules [2]. In a prior case study, two of 150 HIV-infected patients with PCP presented with a solitary pulmonary nodule [3]. In a separate study of isolated pulmonary nodules in HIV-infected patients, one of 10 was determined to be due to Pneumocystis [4]. In non-HIV-infected patients this presentation of PCP is rare, and so far it has been reported to occur in only one pediatric patient [5] and one adult heart transplant recipient [6]. Although isolated pulmonary nodules are a common complication in transplantation patients, large case reviews have not revealed Pneumocystis as a cause [7,8]. A review of the literature and MEDLINE uncovered no other case report of an isolated pulmonary nodule due to Pneumocystis in a patient receiving chemotherapy. We have histopathologically confirmed Pneumocystis as the cause of a solitary pulmonary nodule in such a patient.

Osteopoikilosis: report of a clinical case and review of the literature

Osteopoikilosis is an uncommon benign sclerosing bone dysplasia. Herein we present a case of osteopoikilosis with characteristic roentgenographic findings and clinical findings of cervical myelopathy. The importance of the differential diagnosis in symptomatic cases of osteopoikilosis is emphasized with the review of the literature.