The radiographic signs of fatty liver.

Ninteen cases of radiographically visible fatty liver are presented. The four radiographic signs are muscle-fat interface, fat-water interface, a visible hollow viscus wall, and blurring of the medial margin of the right properitoneal fat stripe. The last sign, the authors believe, is the earliest radiographic change in developing fatty liver. In one case, isolated glycogen synthetase deficiency was the cause of fatty liver; this finding, to the authors' knowledge, has not previously been described. The value of the chest radiograph in diagnosing fatty liver is stressed.     

The chance fracture: Anteroposterior radiographic signs

Chance fractures and their ligamentous equivalents may be readily diagnosed on lateral radiographs of the thoracolumbar spine, but often, the lateral view is of insufficient diagnostic quality in the emergency setting. It is imperative, therefore, to recognize the findings of Chance injuries on the anteroposterior view of the spine. This pictorial essay emphasizes the various manifestations of the Chance fracture on the anteroposterior radiograph, an understanding of which is facilitated by a review of the mechanism of this injury.     

Using CT to diagnose tracheal rupture

OBJECTIVE: A retrospective study was performed to assess CT sensitivity for diagnosing tracheal rupture. Intubated cadaver tracheas were examined to assess endotracheal tube balloon overdistention and deformity and to evaluate the relationship of balloon pressures to tracheal injury. MATERIALS AND METHODS: Neck or chest CT scans of 14 patients with tracheal rupture and 41 control trauma patients with pneumomediastinum but without tracheal injury were reviewed and compared to assess the presence and location of extrapulmonary air, whether direct visualization of tracheal wall disruption was possible, the size and shape of endotracheal tube balloon, signs of transtracheal balloon herniation in intubated patients, and the location of the extratracheal endotracheal tube. Intact and experimentally injured cadaver tracheas were used to evaluate tube balloon pressure and configuration. RESULTS: All 14 patients with tracheal rupture had deep cervical air and pneumomediastinum. Overdistention of the tube balloon occurred in 71% (5/7) of the intubated patients, and balloon herniation occurred in 29% (2/7). Direct tracheal injury was seen in 71% (10/14) of the patients as a wall defect (n = 8) or deformity (n = 2). Overall, CT was 85% sensitive for detecting tracheal injury. Patients with tracheal injury had a significantly lower incidence of pneumothorax (p = 0.01) than did the control group. The CT appearance of balloon herniation through defects in the cadaver tracheas closely mimicked those of patients with tracheal injury. The amount of balloon pressure required to rupture the intubated trachea was extremely high and rupture was difficult to obtain. CONCLUSION: CT can reveal tracheal injury and can be used to select trauma patients with pneumomediastinum for bronchoscopy, leading to early confirmation and treatment.     

气管破裂的外科治疗

目的探讨气管破裂的诊治方法和效果。方法回顾性分析我科1980年10月-2006年10月收治的21例气管破裂临床资料。对其临床特点、诊断方法及治疗措施进行分析。结果术前均明确诊断。气管修补12例,气管重建9例。无手术死亡。术后随访2～5年,患者恢复良好。结论气管破裂可结合病史、查体、X线、CT和纤维支气管镜确诊,手术治疗效果满意。     

Fractures of the hook of hamate: radiographic signs

Isolated fractures of the hamulus, formerly considered rare, are being seen more frequently. Many of these injuries are sports related, particularly in golf, tennis, racquetball and baseball players. Failure to make an early diagnosis can result in severe pain and sometimes incapacitating disability. We studied the clinical and radiological findings in 12 patients who had fracture of the hook of the hamate. We propose three radiographic signs of fracture that are readily seen on routine PA projections: "absence" of the hook of the hamate; "sclerosis" of the hook; and lack of cortical density, i.e., a barely visible outline, of the hamulus.     

强直性髋关节炎平片与MRI分析

目的：分析强直性髋关节炎骨盆骨质疏松的细微结构和骨坏死的病理性征象。方法：收集北亚骨科医院强直性脊柱炎患者100例，其中8例行MR成像检查。分析髋部骨质疏松的特殊性和骨坏死征象以及关节软骨破坏程度。结果：髋部多发区域性骨小梁丢失、减少发生率最高85％，骶髂关节侵蚀破坏或骨性强直为100％，股骨头灶性骨坏死，吸收后表现单囊或多囊状破坏或有小死骨34％，关节破坏狭窄54％，股骨头关节软骨边缘滑膜骨化突出33％，耻骨联合吸收或硬化24％，坐骨结节骨化43％。结论：强直性髋关节炎主要表现为区域性迁移骨疏松和股骨头多发灶性骨坏死。     

Early radiologic signs of stress fractures

The authors present a retrospective evaluation of radiograms of 57 fractures from skeleton overload dealing with lower extremities. Three kinds of symptoms detected in the first radiological examination are presented. In addition to periostosis and sclerosis there is also a clearing as an expression of interrupted bone in a form of infraction, fissure or fracture. The symptoms may occur in combination.     

Development and duration of radiographic signs of bone healing in children

OBJECTIVE: Few articles report the evaluation of pediatric fracture healing and dating based on radiographic appearance. We established a timetable for expected radiographic changes visible during bone healing in otherwise healthy children. MATERIALS AND METHODS: We examined 707 radiographs of fractured forearms in 141 patients. Each fracture was assessed by a pediatric radiologist who was unaware of the timing of the initial injury. Assessment included the following features: fracture margins, fracture gap, periosteal reaction, callus, bridging, and remodeling. The time interval between injury and the appearance of the radiographic features and the duration of radiographic signs were determined and correlated with age, sex, angulation, displacement, and location. RESULTS: Sclerosis at the fracture margins was evident in 85% of fractures 5 weeks after injury. Widening of the fracture gap was observed in 62% of fractures at 6 weeks. Periosteal reaction was evident on all images by 4 weeks, and after 7 weeks, periosteal reaction was separable from cortex in only 10% of fractures. Fracture callus had a density equal to or greater than that of adjacent cortex 10 weeks after injury in 90% of fractures. CONCLUSION: A wide variation exists in the appearance and duration of the radiographic signs of bone healing. Marginal sclerosis should be an expected radiographic sign of normal bone healing. Applying maximum and minimum time spans to objective radiographic signs may aid in fracture dating.     

Radiographic signs of acute traumatic rupture of the thoracic aorta

The initial chest radiographs of 54 trauma patients who were referred for angiography of the thoracic aorta were reviewed. Retrospective evaluation used eight radiographic signs that have been described in possible aortic injury. This review was undertaken to establish the occurrence and validity of these signs in the diagnosis of aortic tear. Results indicated that loss of the aortic arch contour and mediastinal widening were the most reliable signs of disruption of the aorta. In patients with at least one of these two signs, there was a high percentage of positive angiograms.     

Multiplanar CT evaluation of aneurysm rupture signs in subarachnoid hemorrhage

Emergency Radiology - In subarachnoid hemorrhage, noncontrast CT features are used to guide the localization of ruptured aneurysms on CT angiography and DSA. Multiplanar CT may improve the...     

CT cystography: radiographic and clinical predictors of bladder rupture

OBJECTIVE: Our goal was to identify radiographic and clinical variables that correlate with bladder rupture that may then be used as selection criteria for CT cystography in trauma patients. SUBJECTS AND METHODS: Hemodynamically stable trauma patients with hematuria were examined under standardized protocol with dynamic oral and i.v. contrast-enhanced CT of the abdomen and pelvis, followed immediately by CT cystography. CT cystography consisted of contiguous 5-mm axial scans of the pelvis after retrograde distention of bladder with 300-400 ml of 4% iodinated contrast material. Radiographic and clinical variables (pelvic fracture, pelvic fluid, intraabdominal visceral injury, degree of hematuria, hematocrit, units of blood transfused, base deficit, injury mechanism, seat belt use, sex, age) were assessed and statistically analyzed using the two-tailed Fisher's exact test and Wilcoxon's rank sum test. Positive and negative individual and multivariate predictors were analyzed. RESULTS: Of the 157 patients entered in our study, 12 (eight males and four females) had bladder rupture. One or more pelvic fractures were present in nine (75%) of the 12 patients (p < 0.001). Pubic symphysis diastasis, sacroiliac diastasis, and sacral, iliac, and pubic rami fractures were statistically associated with bladder rupture. Isolated acetabular fractures did not correlate with rupture. Eight (67%) of the 12 patients with bladder rupture revealed on CT cystography had gross hematuria (p < 0.001). No ruptures were seen in patients with <25 RBC/HPF (red blood cells per high-power field). All patients with rupture had pelvic fluid revealed on standard contrast-enhanced CT (p < 0.001). CONCLUSION: Gross hematuria, pelvic fluid, and specific pelvic fractures were highly correlated with bladder rupture; identification of these findings may help in selection of trauma patients for CT cystography.     

乳腺癌X线征象与免疫组化标记物之间关系的研究进展

乳腺癌在我国是女性第二位常见的恶性肿瘤,并且发病率逐年递增,早期发现、早期诊断、早期治疗对提高生存率、降低病死率、改善预后非常重要,其中钼靶X线检查对早期乳腺癌敏感性较高,在全球范围内得到了广泛的应用。现今对乳腺癌的影像学研究已经发展到分子生物学和病理生理学领域,结合免疫组织化学方法测定的生物学标记物和基     

Subtle chest radiographic abnormalities in patients with traumatic aortic rupture

Objective: We reviewed admission chest radiographs of 107 patients with surgically proven traumatic aortic rupture (TAR) to determine if any of the studies appeared normal or nearly normal with regard to the aortomediastinal contour. Materials and Methods: The study group consisted of 107 patients with proven traumatic aortic rupture admitted to our institution from 1982 through 1992. Three radiologists reviewed these chest radiographs and by consensus excluded studies that had either a markedly abnormal aortomediastinal contour or were suboptimal technically. The remaining radiographs were evaluated to define any subtle abnormalities of the aortomediastinal contour that might indicate mediastinal hemorrhage. Results: There were no patients with TAR who had an entirely normal chest radiograph. Thirteen patients (12%) had subtly abnormal aortomediastinal contours, all of which had been prospectively interpreted as abnormal. Findings included an abnormal aortic contour or silhouette (13 patients), increased mediastinal/chest width ratio (6), a widened left paraspinal stripe (3), a widened right paratracheal stripe (2), and a widened right paraspinal line (1). Only 1 of the 13 patients had a mediastinal width greater than 8.0 cm. Conclusion: In this series no patient with proven TAR had a normal aortomediastinal contour, but abnormalities may be subtle and detection requires careful inspection of the aortic contour, and paraspinal and paratracheal soft tissues.