Chondromyxoid fibroma of two thoracic vertebrae

We report on a case of chondromyxoid fibroma involving two adjacent thoracic vertebrae with features of aggressive behaviour on radiographs, CT and MRI. Histology revealed typical chondromyxoid fibroma with unusually coarse calcifications. Chondromyxoid fibroma of the spine is rare, and only 30 of these tumours have been reported so far. Involvement of two contiguous vertebral bodies by chondromyxoid fibroma, as reported here, appears exceptional. Received: 10 August 1998 Revision requested: 14 September 1998, 29 December 1998 Revision received: 22 December 1998, 19 January 1999 Accepted: 21 January 1999     

MR imaging of inflammatory joint diseases of the foot and ankle

Pain affecting the foot and ankle is a common complaint frequently attributable to inflammatory joint diseases. Although conventional radiography is regarded as the initial step in the diagnostic investigation, MR imaging may contribute to further evaluation of these patients due to the direct visualization of the inflammatory soft tissue formed in the disease and its effects on bone, cartilage and para-articular structures. The high spatial resolution of MR imaging combined with tissue characterization often allows initial detection of inflammatory joint abnormalities at a stage that precedes radiographic evaluation. The typical MR appearance of certain inflammatory joint disorders may be helpful in narrowing the wide differential diagnosis. Furthermore, MR imaging can be used for an exact assessment of the extent of the disorder as well as its complications. Accurate diagnostic information can guide the clinician in further diagnostic tests and implementation of proper therapeutic treatment. Received: 12 November 1998 Revision requested: 12 February, 10 June 1999 Revision received: 14 September 1999 Accepted: 20 September 1999     

Cystic fibrous dysplasia mimicking giant cell tumor: MRI appearance

We report the case of a 43-year-old man who presented with an osteolytic and expansive lesion in the left distal femur mimicking a giant cell tumor. Magnetic resonance imaging (MRI) showed that most of the lesion was cystic, and histological examination revealed fibrous dysplasia with marked cystic degeneration. Radiographic findings of cystic fibrous dysplasia in the end of a long bone may be similar to those of a giant cell tumor, and a biopsy is essential for the final diagnosis. Received: 4 June 1999 Revision requested: 10 August 1999 Revision received: 13 September 1999 Accepted: 15 September 1999     

Atypical adult non-calcified pilomatricoma

We present a rare case of a non-calcified pilomatricoma in a 67-year-old man. This tumor was extremely large in size, and its location, in the lower extremity, was very unusual. The clinical, radiographic, and histopathological features are described in detail. The role of magnetic resonance imaging (MRI) in the diagnosis of this entity is discussed. Definite internal reticulations and septations were observed. A possible explanation for this observation is that the high signal intensity reticulations may represent edematous stroma surrounding basaloid cells. Received: 8 July 1999 Revision requested: 28 July 1999 Revision received: 10 September 1999 Accepted: 13 September 1999     

MRI-induced retrocalcaneal bursitis

This case report describes a patient with acute retrocalcaneal bursitis, which developed after MRI examination of the ankle. The sagittal T2*-weighted gradient echo sequence revealed an extensive susceptibility artifact in the area surrounding the Achilles tendon near its insertion at the os calcis. This artifact was caused by postsurgical metallic particles. We postulate that these particles were mechanically stimulated by the magnetic field and induced the inflammatory response. Received: 20 July 1998 Revision requested: 14 September 1998, 16 March 1999 Revision received: 15 February 1999, 20 May 1999 Accepted: 21 May 1999     

Proteus syndrome: MRI characteristics of plantar cerebriform hyperplasia

Proteus syndrome is a rare congenital hamartomatous syndrome with a variety of abnormalities. It shares many features with other congenital hamartomatous disorders, but cerebriform hyperplasia of the soles and the palms is known as a quite distinctive characteristic in the dermatologic literature. The purpose of this case report is to demonstrate the MRI features of plantar cerebriform hyperplasia in a 9-year-old boy with known Proteus syndrome. Received: 8 July 1999 Revision requested: 8 September 1999 Revision received: 27 September 1999 Accepted: 8 October 1999     

Intraosseous schwannoma of the metacarpal

Intraosseous schwannoma (neurilemmoma) is an extremely rare, benign neoplasm, constituting less than 0.2% of primary bone tumors. It infrequently involves the bones of the hand. We present a case of intraosseous neurilemmoma of the metacarpal. Received: 26 July 1999 Revision requested: 16 August 1999 Revision received: 16 September 1999 Accepted: 4 October 1999     

Hyperfunctioning parathyroid carcinoma

Primary hyperparathyroidism is rarely caused by carcinoma. We report a patient who manifested many of the clinical and radiographic features of the disease. When encountering symptomatic hypercalcemia with or without a palpable neck mass, carcinoma should be considered in the differential diagnosis. Patient survival depends on an aggressive surgical approach to the primary lesion and recurrent disease. Received: 27 May 1999 Revision requested: 28 June 1999 Revision received: 22 September 1999 Accepted: 27 September 1999     

Premature epiphyseal fusion and degenerative arthritis in chronic recurrent multifocal osteomyelitis

A 9-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis affecting multiple sites. During an 8-year follow-up he developed premature closure of a distal radial epiphysis and degenerative changes in the adjacent radiocarpal joint. Received: 26 July 1999 Revision requested: 24 August 1999 Revision received: 27 September 1999 Accepted: 8 October 1999     

Primary hemangiopericytoma of the tibia: MR and angiographic correlation

The Magnetic Resonance Imaging (MRI) appearances of primary osseous hemangiopericytoma (HPC) have been rarely described. We report on a 46-year-old Chinese man with primary osseous HPC of the right tibia. The characteristic vascular distribution of this tumor, presenting with a ”spoke-wheel” appearance on MR images and with angiographic correlation, is described. Although not pathognomonic, this MR appearance may be an important finding in suggesting the diagnosis of osseous HPC. Received: 3 March 1999 Revision requested: 26 April 1999 Revision received: 13 September 1999 Accepted: 15 September 1999     

Hemangioma of bone arising in the ulna: imaging findings with emphasis on MR

An 18-year-old woman presented with left elbow joint pain. Radiographs and computed tomographic scan showed a well-defined osteolytic lesion of the left ulna associated with a honeycomb appearance on the radiographs. Magnetic resonance images showed intermediate signal intensity on T1-weighted images and mixed intermediate and high signal intensities on T2-weighted images. Only the periphery of the lesion enhanced with intravenously injected gadolinium-diethylenetriamine pentaacetic acid. The lesion was curetted to avoid pathologic fracture, and a histologic diagnosis of cavernous hemangioma of bone was made. Hemangioma involving the ulna is rare, but should be included in the differential diagnosis of a radiographic osteolytic lesion with a honeycomb appearance. Received: 17 September 1999 Revision requested: 31 October 1999 Revision received: 10 December 1999 Accepted: 13 December 1999     

Progressive destructive vertebral sarcoid leading to surgical fusion

Skeletal sarcoidosis is rare. This report describes a 31-year-old African American man who presented with a destructive osteolytic lesion of C2 and another lesion in a rib. The lesion at C2 was treated with corpectomy and bone graft. Four months later the lesion recurred and a new lesion was discovered in the cervical vertebral column. The patient declined surgery for instability for another 3 months, choosing to remain in a halo. Seven months following the initial operation, a technetium bone scan showed spread of the disease to the calvarium and thoracic and lumbar vertebrae. The patient had no symptoms referable to these sites. The patient agreed to have his neck fused at this point. For the next 10 months, the patient was on steroids and a further new lesion appeared at L5 without localizing signs or symptoms. The patient declined further evaluation over the next 12 months and is now considered lost to follow-up. Received: 29 July 1999 Revision requested: 26 August 1999 Revision received: 1 September 1999 Accepted: 2 September 1999     

Giant ancient schwannoma of the pelvis

A 43-year-old man with a large ancient schwannoma of the pelvis, presenting with varicose veins, is reported. Ancient schwannoma (neurilemmoma) is a benign tumour of nerve sheath origin characterised histologically by features of severe degeneration and which rarely can grow to a large size. Malignant transformation, though reported, is extremely rare. Received: 17 September 1999 Revision requested: 13 October 1999 Revision received: 22 June 2000 Accepted: 28 June 2000     

Retroisthmic cleft: a stress fracture of the lamina

The retroisthmic cleft is a rarely diagnosed defect in the lamina of the lumbar spine. It has always been considered a congenital anomaly. This is the first report we are aware of showing radiological changes in a retroisthmic cleft over a period of time. The follow-up of this patient over a period of 6 years, the radiological and scintigraphic appearances and a review of the literature suggests that the retroisthmic cleft is a stress fracture of the lamina. Received: 9 September 1999 Revision requested: 12 October 1999 Revision received: 1 December 1999 Accepted: 2 December 1999     

Indirect wrist MR arthrography: the effects of passive motion versus active exercise

Purpose.In the wrist, to determine whether passive motion or active exercise yields a better indirect MR arthrographic effect following intravenous gadolinium administration. Design and patients. Twenty-six consecutive patients were studied by indirect wrist MR arthrography. In half active exercise and in half passive motion was performed. Four regions of interest were studied including the distal radioulnar joint, the radiocarpal joint, the midcarpal joint, and the triangular fibrocartilage. Ranges and means of signal intensity were calculated. Surgical follow-up was performed in 22 patients. Results. The joint fluid intensity was greatest in the distal radioulnar joint. Fluid signal intensity was greater and more consistent in the passive motion group although the results did not achieve statistical significance. Imaging accuracy appeared similar in the two groups and was excellent for the triangular fibrocartilage (100%) and scapholunate ligaments (96%). Conclusion. Active exercise and passive motion yield similar degrees of wrist arthrographic effect, but the effect of passive motion is somewhat more consistent. Preliminary data show good accuracy for internal derangements. Received: 4 June 1999 Revision requested: 6 August 1999 Revision received: 14 September 1999 Accepted: 20 September 1999     

Osteosarcoma of the metatarsal bone

A case of osteosarcoma arising from a metatarsal bone is reported, focusing on the radiological findings and differential diagnosis. Received: 16 November 1998 Revision requested: 17 December 1998 Revision received: 11 January 1999 Accepted: 14 January 1999     

Subchondral insufficiency fracture of the femoral head and medial femoral condyle

This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture. Received: 22 May 1999 Revision requested: 5 August 1999 Revision received: 13 September 1999 Accepted: 15 September 1999     

Arthritis and hidradenitis suppurativa diagnosed in a 48-year-old man

We report the case of a 48-year-old man who presented with an erosive, seronegative, HLA-B27-negative, peripheral polyarthritis, associated with hidradenitis suppurativa of axillae and buttocks. The pertinent literature is reviewed. This paper is the second devoted to this topic in a radiological journal and the first to document erosion of the posterior aspect of the calcaneus. Received: 15 September 1998 Revision requested: 28 October 1998 Revision received: 22 February 1999 Accepted: 22 February 1999     

Spontaneous lung herniation after a single cough

Herniation of the lung is commonly caused by congenital rib abnormalities, blunt trauma, or thoracic surgery. Spontaneous hernias are rarely described in the literature. We report a case of a spontaneous intercostal pulmonary hernia following a single cough. In addition, a review of the literature is presented which outlines the classification, causes, and incidence of lung hernias. Some reference is made to possible methods of treatment. Received: 26 March 1999; Revision received: 21 September 1999; Accepted: 27 September 1999     

Rapid chondrolysis after an intra-articular leak of bone cement in treatment of a benign acetabular subchondral cyst: an unusual complication of percutaneous injection of acrylic cement

Percutaneous injection of methylmethacrylate is now increasingly employed to treat bone lesions, both malignant and benign. However, the risks of this procedure are still to be fully established. In this report, we describe a case of rapid chondrolysis appearing after the intra-articular leakage of cement during injection of an acetabular subchondral cyst, resulting in hip replacement. Although the mechanism of such chondrolysis is unknown, this event suggests a chondrolytic effect of the acrylic cement. Thus, it is essential to systematically search for the presence of an intra-articular passage before injecting bone cement into a peri-articular cyst. This unusual complication highlights the need for rigorous evaluation of the benefits and risks of percutaneous injection of acrylic cement in the treatment of benign lesions, especially close to an articulation. Received: 30 September 1999 Revision requested: 1 December 1999 Revision received: 27 December 1999 Accepted: 27 December 1999