Standard Lateral Views Research Articles

Rigid Painful Flatfoot Secondary to Tarsal Coalition

Rigid flatfoot secondary to tarsal coalition requires proper clinical and roentgenographic evaluation. In patients with limited subtalar motion and pain in the tarsal area, a coalition should be suspected. Proper roentgenographic evaluation with standard anteroposterior, lateral, and oblique views is essential. Calcaneonavicular coalition, as visible on an oblique film, may be a solid bony fusion or, more often, a cartilaginous coalition, which is characterized by flattening of the calcaneus and navicular at their junction. Axial (Harris) views demonstrate coalition in the middle and posterior facets, which may be cartilaginous or osseous. Lateral tomography is used to demonstrate irregularities of the anterior facet or the undersurface of the talar head. When symptomatic, a calcaneonavicular coalition with no degenerative changes of the tarsal joints is treated by resecting the bar and inserting the extensor digitorum brevis into the area from which the coalition is excised. An osseous bar is resected, or, if degenerative changes are noted, a triple arthrodesis is performed. Talocalcaneal coalition is first treated conservatively by a regimen of Plastizote shoe inserts, short-leg casts, or an ankle-foot orthosis. If conservative treatment fails to alleviate pain, a triple arthrodesis is indicated.

Angiographic study of univentricular heart of right ventricular type.

An angiographic analysis of 10 cases of univentricular heart of the right ventricular type is reported. This congenital malformation is characterized by a large chamber with right ventricular morphology that receives both atrioventricular valves, and a second, smaller chamber, a trabecular pouch, with left ventricular morphology. These chambers are separated by a posterior septum but are connected by an inlet septal defect. The angiographic studies were done using the angled angiographic techniques in three patients and the standard frontal and lateral angiographic views in seven cases. The atrial situs in seven patients was solitus, in one inversus, and in two it was ambiguus with left isomerism. In seven patients the usually large right ventricular chamber received two atrioventricular valves and in four patients, one atrioventricular valve was straddling. Three patients had atresia of one atrioventricular valve. The trabecular pouch was small in seven patients but relatively large in three. In six patients the trabecular pouch was located posterior and to the left of the right ventricular chamber and in four anterior and to the right. Double outlet right ventricle was present in all cases. The aorta arose anteriorly to the pulmonary artery in nine patients and posteriorly in one. An autopsy was performed in one case and its correlation with the angiographic findings was remarkable. The angiographic demonstration of the anatomicaly details of this entity and its associated anomalies was facilitated by angled angiography.

Selective use of the oblique projection in mammography.

We reviewed the radiographs of patients undergoing negative breast biopsies on the basis of false positive mammograms. In a small number of these patients, the radiologic error was attributable to the summation effect of superimposed focal areas of normal or dysplastic breast tissue giving the false impression of a mass. This summation effect more frequently results in an equivocal radiologic impression, often with a recommendation for short interval repeat mammograms, rather than an actual biopsy. This false positive mammographic appearance can often be suspected on the basis of a discrepancy in the appearance of the suspicious area on the standard lateral and craniocaudad views. In a prospective study we identified women in whom suspicious mammograms were felt to possibly relate to this superimposition effect, and in this small selected group of patients an additional oblique projection was obtained. The oblique view frequently enabled the initially equivocal abnormality to be definitely assessed.

Angled views in cineangiocardiography of congenital heart disease.

Simple and compound sagittally angled views of the heart obtained cineangiocardiographically with a parallelographic U-arm device were evaluated clinically in 132 patients with congenital heart disease. The principle advantage of the apparatus was the case with which axial and oblique projections were obtained without repositioning of the patient, although rotation and angulation of the image intensifier-X-ray tube unit resulted in some increase in scattered radiation. Certain angled views, particularly the 40 degree cranial and the compound 25 degrees cranial/70 degrees left oblique projections, were better than standard frontal and lateral views for visualization of pulmonary arteries in the mediastinum, in ventricular septal defects and anomalies of the left ventricular outflow tract.

Pulmonary arteriography in congenital heart disease.

Pulmonary outflow tract obstruction may occur at subvalve, valve, or pulmonary artery level. Selective ventriculography will usually define the intracardiac obstruction (whether valve, subvalve, or both) and may define pulmonary arterial abnormalities. Increasing experience in the surgical management of patients with tetralogy of Fallot and other conotruncal abnormalities characterized by significant pulmonary outflow tract obstruction suggests that preoperative recognition of pulmonary arterial stenosis is essential to the successful operative management of these patients (1-4). Because of the anatomicospacial relationships of the pulmonary arteries in "simple" (tetralogy of Fallot) and complex conotruncal malformations, selective ventriculography may not invariably provide sufficient detail about the morphologic state of the pulmonary arteries. Similarly, even selective pulmonary arteriography in the standard anterioposterior, lateral, and oblique views may not always allow accurate anatomic assessment of these vessels. Therefore, we wish to document a maneuver that has proved valuable in the assessment of pulmonary arteries during selective pulmonary arteriography. This maneuver was originally suggested to Peter M. Olley by Dr. L. M. Bargeron, Jr., and the surgical valve obtained from this angiographic view was stressed by Dr. John Kirklin in his John Keith lecture at the Canadian Cardiovascular Society (5). Although it is being used at some cardiovascular centers, we feel its application warrants this report.