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.     

Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department

Hamate fractures are estimated to represent 1.7% of all carpal fractures and can occur at the hamulus (hook) or hamate body depending on mechanism of injury. Fractures of the hamate body can be exceedingly difficult to identify on standard wrist and hand radiographs in the emergency department. If the diagnosis is missed in the emergency department, orthopedic referral is often delayed. This can result in lasting functional disability for the patient, as these fractures have a propensity to destabilize the fourth and fifth carpometacarpal (CMC) joints. In this pictorial essay, we present six radiographic signs indicative of hamate body fracture with computed tomography (CT) imaging correlation. Injury mechanism and fracture classification schemes are portrayed to aid in the understanding of these injuries. Once radiographs raise suspicion for a hamate body fracture, further characterization with CT and orthopedic referral is paramount. Goals of orthopedic management include reestablishment of the fourth and fifth CMC articular surface, stabilization of the CMC joints, and appropriate treatment of concomitant soft tissue injury.     

Galactocele: three distinctive radiographic appearances

Three radiographic appearances of galactocele of the breast not, to our knowledge, described previously in the literature were studied in 11 patients. Mammary nodules with distinct and separate hydro-fat levels were observed in five cases. A nodule containing mixed water and fat densities was seen in one patient, while in the five remaining patients, pneumocystograms revealed masses of a water density mixed with the injected air.     

Hook of the hamate fracture in athletes

Hook of the hamate fracture in athletes is discussed. Patient history and physical examination, the mechanisms of injury, and pertinent anatomy is emphasized from a clinical perspective. Recommendations for treatment are made.     

Stress fracture of the hook of the hamate

Fractures of the hook of the hamate have rarely been reported. They have usually resulted from blunt trauma or a sharp strike against the hamate hook while swinging a golf club, baseball bat, or tennis racquet. Patients present with acute onset of pain localised over the ulnar aspect of the wrist and reduction in grip strength. In the case reported here, the patient complained of gradual onset of pain on the ulnar aspect of the wrist after altering his grip for serving in tennis. Once the diagnosis was made, the fracture was treated conservatively and the patient made a complete recovery.     

Automatic implantable cardioverter-defibrillator: radiographic appearance

The automatic implantable cardioverter-defibrillator is used in patients with ventricular tachyarrhythmias resistant to medical or surgical therapy. The device, which has a unique radiographic appearance, senses ventricular tachycardia or fibrillation and automatically delivers a cardioverting or/defibrillating electric shock.     

Pulmonary aspergillosis: unusual radiographic appearance

Three cases of pulmonary aspergillosis are reported in which a seldom-mentioned radiographic feature was seen, namely, a stable, well-defined nodule or mass. The diagnosis of aspergillosis was based on results of transthoracic needle aspiration biopsy. Computed tomographic scans obtained before biopsy revealed no evidence of underlying cavitary disease. Two patients had hemoptysis. The nodule in the third patient was found on a routine chest radiograph.     

Central haemangioma: variance in radiographic appearance

Central haemangioma, a "great mimicker" which, fortunately, is a relatively rare condition, may pose a lethal risk for the patient. The diagnosis may become apparent only during biopsy or tooth extraction, which poses a risk of lethal exsanguination; therefore a correct diagnosis is desirable before any biopsy is undertaken. The clinician may not anticipate the severe haemorrhage because of vague clinical history, physical findings and ambiguous radiographic characteristics of the lesion. We report a case of central haemangioma of the mandible whose clinical and radiographic features were equivocal. In addition, an attempt is made to discuss all possible radiographic presentations of central haemangioma and consider differential diagnosis. This case is significant for the reason that it had diverse radiographic appearances in various areas of the lesion in different projections.     

Angelchik anti-reflux device: radiographic appearance of complications

The authors report 8 cases of erosion of an Angelchik anti-reflux prosthesis into the stomach. Erosion is detected by the appearance of the smooth contour of the device in the stomach. One device migrated distally.     

Extracorporeal membrane oxygenation: radiographic appearance of the neonatal chest

The chest radiographs of 26 newborns treated with extracorporeal membrane oxygenation (ECMO) for intractable respiratory failure were reviewed. The typical radiographic appearance of the lungs in these patients is that of diffuse pulmonary opacification with variable volume loss. Air bronchograms and patchy basilar atelectasis are also common findings. Generally, decreasing ECMO requirements were reflected in improving chest radiographs with radiographic improvement lagging behind clinical improvement. Of 167 chest radiographs available for evaluation, 105 (62.8%) reflected changes in ECMO flow rates. Radiographs in patients with individual diagnoses of hyaline membrane disease, meconium aspiration syndrome and sepsis showed the best correlation with clinical improvement (95 [69%] of 137 radiographs). Those obtained in patients with congenital diaphragmatic hernia and persistent pulmonary hypertension of the newborn alone showed the poorest correlation (10 [30%] of 30 of radiographs). Neither the absolute degree of radiographic abnormality nor degree of radiographic improvement correlated well with ECMO requirements. Initial radiographs were useful in confirming the position of bypass cannulae and respiratory tubes. Routine daily examinations did not reveal unexpected abnormalities. However, radiographs taken during periods of increased ECMO requirements due to patent ductus arteriosus or volume overload showed worsening lung opacification.     

Bronchopulmonary dysplasia: radiographic appearance in middle childhood

Chest radiographs were compared for three groups of children 8-9 years old: 23 survivors of bronchopulmonary dysplasia (BPD), 33 survivors of hyaline membrane disease without BPD, and 35 survivors of premature birth without neonatal respiratory problems. Only four children in the second group and three in the third had abnormal lungs. Linear shadows, apparently representing strands of fibrosis or deep pleural fissuring, were seen more frequently (15 of 23) in the BPD group than in the others (P less than .0001). Seventeen children in the BPD group had definite pulmonary abnormalities, none of them severe. The anteroposterior dimension of the chest in survivors of BPD tended to be decreased (P less than .001 vs that of reported control subjects).     

POEMS syndrome: radiographic appearance with MRI correlation

POEMS syndrome is a rare disorder in which patients present with the hallmark signs of polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes. Many other clinical findings are also often present, most notably osseous lesions. The MRI appearance of the bony lesions in POEMS syndrome has been described in five cases, four of which are in the non-English literature. We report the MRI appearance of the osseous lesions in a patient with POEMS syndrome who presented with sciatic neuropathy.     

Capitate and hamate fracture in a child: the value of MRI imaging

Carpal bone fractures in children are rare, and little is known about the appropriate tools to diagnose them, particularly in toddlers. We present a 2-year-old child with a capitate and hamate fracture. Based on our experiences with this case and on a review of the literature, we discuss the value of magnetic resonance imaging in carpal trauma in children.     

Posttraumatic intestinal stenosis: radiographic and sonographic appearance

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma. Received 19 March 1996; Revision received 24 May 1996; Accepted 9 July 1996     

Fallopian tube occlusion with silicone: radiographic appearance

A new method of tubal occlusion for sterilization, which is both promising and potentially reversible, is undergoing clinical trials nationwide. At hysteroscopy, a catalyzed silicone rubber compound is instilled in the fallopian tubes where it hardens to form a radiopaque plug. Radiologists may assist the gynecologist in confirming adequate initial formation of the plug and with follow-up radiographs. Radiologists not involved in the procedure may see the radiopaque plugs on radiographs obtained for other clinical purposes, and they should be aware of this new method of sterilization.