Diffuse pulmonary alveolar hemorrhage after bone marrow transplantation: radiographic findings in 39 patients.

Diffuse alveolar hemorrhage is a life-threatening complication after bone marrow transplantation. We investigated the radiographic abnormalities that occurred in 39 transplantation patients with a diagnosis of diffuse alveolar hemorrhage and correlated the findings with the patients' clinical course. The initial radiographic abnormalities after diffuse alveolar hemorrhage developed an average of 11 days after bone marrow transplantation, and the radiographic abnormalities preceded the clinical diagnosis by an average of 3 days. Twenty-seven patients initially had bilateral radiographic abnormalities; 10 initially had unilateral abnormalities (seven in the right lung, three in the left lung). Two patients had normal chest radiographs throughout their clinical course. All 37 patients with radiographic abnormalities had abnormalities involving the central portion of the lung, primarily the middle and lower lung zones. The initial radiographic pattern was interstitial in 27 and alveolar in 10. In 24 patients, radiographic abnormalities were initially judged to be mild; three were severe from the onset. Radiographic abnormalities rapidly worsened in most patients over 6 days. In 30 patients, diffuse bilateral radiographic abnormalities involving all lung zones developed. Eleven patients persisted in having only interstitial radiographic abnormalities; 26 had a confluent alveolar pattern. At the height of radiographic abnormalities, 27 cases were judged to be severe, and only one case was judged to be mild. The mortality rate in patients with diffuse alveolar hemorrhage was 77%. The radiographic abnormalities of diffuse alveolar hemorrhage are nonspecific and usually precede the clinical diagnosis. The clinical course after hemorrhage is short, often resulting in death.     

Case report 696

A case of chondroblastoma involving the right acetabulum and superior pubic ramus in a 60-year-old man has been presented. Tissue was obtained by open biopsy. The clinical and radiographic characteristics of chondroblastoma in general, and this tumor in particular, were discussed. The histopathology and differential diagnosis were also considered. The relatively uncommon site of the tumor and its occurrence in an older patient made the radiographic diagnosis difficult, and other possibilities were discussed.     

Chronic recurrent multifocal osteomyelitis involving the mandible: case reports and review of the literature

Chronic recurrent multifocal osteomyelitis (CRMO) is an aseptic inflammatory disorder of unknown cause occurring in children and adolescents. It is characterized by multifocal bone lesions with pain and swelling recurring over months to years. Lesions usually involve the metaphyses of the long bones and involvement of the jaw is rare. The clinical presentation, radiographic appearance and histology of a case of CRMO involving the mandible in an 8-year-old girl are documented. The radiographic appearance of another three cases is also described.     

Hand, wrist, and elbow arthropathy in syringomyelia

We present a patient with syringomyelia and neuropathic osteoarthropathy involving the elbow, wrist, and hand unilaterally and discuss the differential diagnosis of the radiographic features. The unique pattern of joint involvement in this patient may be explained by selective involvement of specific anatomic sites within the spinal cord.     

Unusual presentation of extranodal diffuse large B-cell lymphoma in the head and neck: description of a case with emphasis on radiographic features and review of the literature

A very unusual radiographic presentation of non-Hodgkin lymphoma (NHL) involving the maxilla is described. The patient was initially managed with antibiotics prescribed to treat what was thought to represent an odontogenic infection. After unsuccessful antibiotic therapy, the patient was referred to an oral surgery clinic where CBCT was performed. CBCT revealed an atypical generalized sclerosis of the affected bone rather than the usual lytic radiographic pattern associated with NHL. Destruction of the sinus floor with infiltration of the sinus was also present. This rare radio-opaque radiographic presentation is described in detail together with the clinical presentation and histopathological findings. The important radiographic features suggesting malignancy that were present in this atypical case of NHL are discussed. A differential diagnosis highlighting the differences between NHL, osteomyelitis and osteosarcoma is also provided.     

Arthroscopic management of calcific tendinitis of the subscapularis tendon

Calcific tendinitis is a common disorder of the rotator cuff. Conservative treatment is frequently successful. For the patients remaining symptomatic after conservative treatment, excision of the calcium deposits offers a generally reliable pain relief. While calcific tendinitis is seen commonly affecting the supraspinatus tendon, it has been rarely reported involving the subscapularis tendon. We report on the clinical features, radiographic findings, arthroscopic treatment and results of one patient who presented a calcific tendonitis involving the subscapularis tendon of the left shoulder unresponsive to conservative treatment and associated subcoracoid stenosis and coracoid impingement.     

Frontal sinus fractures: evaluation of CT scans in 132 patients.

PURPOSE: To determine the frequency of detection of frontal sinus fractures on initial CT scans of patients with intracranial injuries, and to characterize associated injuries. METHODS: The initial head CT scans in 132 patients with clinical or radiographic evidence of a frontal sinus fracture were retrospectively reviewed to further characterize the fracture. Additional radiographic studies and medical records were reviewed to determine associated injuries, therapy, clinical outcome, and complications. RESULTS: In 90% (124) of the patients, the frontal sinus fractures were visualized on initial head CT scans that were obtained to evaluate suspected intracranial injury. Complex fractures involving both the anterior and posterior wall of the sinus accounted for 65% of cases (86 patients), whereas fractures of the anterior wall only or posterior wall only occurred in 24% (32) and 11% (14) of patients, respectively. Significant intracranial hemorrhage occurred in over 90% of patients with fractures involving the posterior wall. CONCLUSIONS: In general, fractures that involved the posterior wall had more complications and a worse clinical outcome than fractures that only involved the anterior wall; nearly all frontal sinus fractures can be detected on head CT studies in patients with intracranial injuries.     

Non-Hodgkin lymphoma of the small intestine

The authors present a simplified radiographic classification of non-Hodgkin lymphoma involving the small intestine. The classification system is based on radiographic findings in 22 pathologically proved cases of lymphoma involving the small bowel and consists of three major forms: primary, lymphoma complicating celiac disease, and mesenteric nodal. In this series, small bowel lymphoma was evenly distributed in the jejunum and ileum. The most common radiographic patterns were circumferential lesion (seven cases), cavitary lesion (four cases), and mesenteric nodal disease invading the small bowel (seven cases). Obstructive symptoms were usually encountered with the mesenteric nodal form. Lymphoma complicating celiac disease was typified by multiple, thickened, nodular folds involving a segment of proximal small intestine.     

Chronic diverticulitis: clinical, radiographic, and pathologic findings

OBJECTIVE: The purpose of our study is to present a series of 14 patients with chronic diverticulitis on barium enema examinations and to correlate the radiographic findings with the clinical and pathologic findings in these patients. CONCLUSION: Chronic diverticulitis is a distinct pathologic entity characterized by the frequent development of chronic obstructive symptoms and abdominal pain rather than the classic clinical findings of acute sigmoid diverticulitis. Barium enema examinations usually reveal a relatively long segment of circumferential narrowing in the sigmoid colon with a spiculated contour and tapered margins, sometimes associated with retrograde obstruction. Our experience suggests that chronic diverticulitis can often be diagnosed on the basis of the characteristic clinical and radiographic findings in these patients.     

Imaging of carotid canal sympathetic plexus schwannoma

One case report of a schwannoma involving the sympathetic plexus in the carotid canal has been reported previously. This article presents 2 additional cases of this rare entity with associated clinical and unique radiographic findings. All patients presented with diplopia among other symptoms, and they had enhancing masses that smoothly expanded the carotid canal on cross-sectional imaging. Comparison with the index case and differential diagnosis of more common pathologies in this area are discussed.     

Anatomic, clinical, surgical, and radiographic correlation of the zygomatic complex fracture.

Understanding the mechanisms by which clinical signs and symptoms are produced is a prerequisite to the correct appreciation of radiographic features. Radiographs of facial trauma are no different in this respect. This paper describes the specific clinical findings associated with each displaced bony fragment of the zygomatic complex fracture. Limitation of jaw movement and flattening of the cheek are produced by depressed fractures of the temporal process or zygomatic arch; unilateral epistaxis is a result of fractures of the zygomatic process of the maxilla or the floor of the orbit; paresthesia or anesthesia of the cheek results from fractures of the infraorbital process or orbital floor; unequal pupil heights is associated with fracture of the frontal process; and decreased extraocular muscle function with diplopia is caused by fractures of the orbital process, frontal process, or orbital floor. The clinical and radiographic findings are correlated with surgical management.     

Nonanastomotic strictures after colonic interposition

OBJECTIVE: The purpose of this study was to describe the clinical and radiographic findings in a series of patients with nonanastomotic strictures after colonic interposition. CONCLUSION: Nonanastomotic strictures usually appear on upper gastrointestinal tract radiography as relatively long segments of smooth, tapered narrowing involving the interposed colon, most likely resulting from chronic ischemia. Unlike strictures at the esophagocolic or cologastric anastomosis, these long nonanastomotic strictures generally have a poor response to endoscopic dilatation procedures and are more likely to necessitate surgical revision of the colonic interposition.     

Tumors of the pediatric chest

A wide spectrum of malignant and benign diseases can present as tumors involving the chest in children. The imaging evaluation of these children is initially directed by clinical presentation and usually begins with a chest radiograph. Further imaging with CT, MRI, or rarely ultrasonography may be performed to better detect, localize, or characterize the lesion(s). The differential diagnosis of these tumors is guided not only by tumor location and characterization, but also by patient age and clinical presentation. Familiarity with the clinical and radiographic aspects of these diseases will help the radiologist to continue to play a crucial role in the diagnosis and management of these children.     

Rheumatoid arthritis and its variants: analysis of scintiphotographic, radiographic, and clinical examinations.

99mTc pyrophosphate radionuclide scans of the axial and appendicular skeletons in 23 patients with rheumatoid arthritis and 15 patients with systemic arthritic conditions were compared to clinical and radiographic examinations. The nuclear scan was the most sensitive indicator of active disease and correlated extremely well with the other methods. A pattern of abnormal radionuclide activity in rheumatoid arthritis consisting of a symmetric peripheral joint process can be distinguished from that of the rheumatoid variants which tend to have more central skeletal involvement and asymmetric peripheral articular involvement. The nuclear scan is less specific than the radiograph in its ability to distinguish among the clinical entities. However, documentation of scintigraphic activity often antedated radiographic or clinical abnormalities.     

Preliminary study and clinical evaluation method of ioversol in angiocardiography--establishment of safety evaluation parameters and reliability of radiographic quality evaluation

A multi-center clinical study of a new nonionic iodinated contrast medium (ioversol) was performed in 26 patients undergoing left ventriculography (LVG) and coronary angiography (CAG) at four centers. The aims of this study were to try to establish a clinical evaluation method on contrast media in angiocardiography and to determine radiographic efficacy and safety of ioversol. The reliability of the method evaluating the radiographic quality of the contrast medium was also examined with statistical analysis. Excellent radiographic efficacy was observed with ioversol and morphological diagnosis was possible in all cases. The electrocardiograms (ST-segment deflection, T-wave amplitude, QT interval, corrected QT interval, arrhythmia and heart rate) and the hemodynamic parameters (left ventricular systolic and end diastolic pressures, left ventricular dp/dt max, aortic systolic and diastolic pressures) indicated no clinically significant changes. This study suggested that the monitoring of the ECGs and hemodynamic parameters for up to three minutes after injection of the contrast medium is sufficient for the evaluation in LVG and CAG, and that the monitoring in CAG during the first injection into each left and right coronary artery is also sufficient for the purpose. Heat sensation during injection was mild. A patient had a symptom of nausea after ioversol administration, but it was mild and transient and resolved spontaneously. There were no abnormal clinical laboratory data related to ioversol. The reliability of the radiographic quality evaluated by the individual clinical investigators was considered to be high and adaptable. However, the evaluation in the blinded cinefilms by the committee members involving all investigators would be more preferable for the higher objectivity. The study results suggest that ioversol is considered to be the efficacious and safe contrast medium for the cardiovascular angiography.     

Multiple enamel pearls in two siblings detected by volumetric computed tomography

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.     

Sequestrated thoracic disc herniation mimicking a tumoral lesion in the spinal canal--a case report

Calcified thoracic disc sequestration is a very rare disease. Unusual sequestered disc fragments mimic spinal tumors and other space-occupying lesions due to a lack of discernible clinical features that can be used to differentiate these disc fragments from disc herniations and tumoral lesions. In this report, we describe a patient with a dorsally sequestrated calcified disc fragment in the thoracic spine that mimicked a bony tumoral lesion of the spinal canal and present a literature review. Thoracic disc sequestration accompanied by an atypical location requires a systematic diagnostic approach involving accurate preoperative history and careful radiographic evaluation.     

Disseminated migratory osteoporosis: an unusual pattern of osteoporosis

Regional migratory osteoporosis (RMO) is a well-defined clinical entity, consisting of migratory osteoporosis involving the lower extremities with associated radiographic changes. Idiopathic osteoporosis (IO) is considered to be a separate and distinct entity, occurring in young adults and consisting of axial osteoporosis and back pain. We describe a patient who had hybrid characteristics, both clinically and radiographically, and include iliac-crest biopsy histologic correlation. We believe that this pattern of osteoporosis in many ways resembles RMO, but with severe axial involvement; hence the term disseminated migratory osteoporosis.     

Vascular anomalies: what they are, how to diagnose them, and how to treat them

Vascular anomalies are congenital lesions that most often first present in pediatric patients. Treatment of these lesions is a multidisciplinary team approach, involving several specialties, including diagnostic and interventional radiology, dermatology, general and plastic surgery, otolaryngology, and hematology. Knowing the characteristic findings of vascular anomalies on ultrasound, computed tomography, and magnetic resonance imaging leads to early, accurate diagnosis and therapeutic intervention of these lesions. This article discusses the gross and radiographic appearances and the latest treatment options for vascular anomalies.     

Bifid mandibular canal: literature review and case report

OBJECTIVES: The objective is to call attention to and to review the literature of the anatomical variation: bifid mandibular canal. METHODS: A review of the literature is summarized. Additionally, the clinical and radiographic findings of a patient who presented a unilateral bifid mandibular canal are recorded. RESULTS: Bifid mandibular canals can be detected on a panoramic radiograph. More precise information about the course of the canal can be revealed on cross sectional CT images perpendicular to the alveolar ridge. CONCLUSIONS: Bifid mandibular canals are often unrecognized. The detection of these anatomical variations is important because of its clinical implications. Special attention has to be paid in surgical procedures involving the lower jaw.