Hemoptysis complicating Scimitar Syndrome: from diagnosis to treatment

We report the case of a 24-year-old patient with known scimitar syndrome presenting with hemoptysis. Multidetector CT angiography showed the scimitar vein draining the right lung to the inferior vena cava associated with right lower lobe bronchopulmonary sequestration. The presence of hemoptysis associated with scimitar syndrome is likely secondary to an anomalous systemic arterial blood supply. We treated this patient successfully with transcatheter occlusion of the anomalous feeding arterial vessels.     

手掌侧腱滑囊非特异性炎症的CT诊断

目的 :探讨手掌侧腱滑囊非特异性炎症的诊断与鉴别诊断。方法 :5例行螺旋CT平扫 ,2例行增强扫描并做多平面重建 (MPR) ,层厚 5～ 10mm ,层距 5～ 10mm。结果 :CT显示腕尺侧滑液囊滑膜增生 ,滑液囊增宽、增厚、延长 ,其内肌腱排列次序紊乱、分散、推移而无增粗改变。增宽延长的滑液囊自腕横韧带上 3cm至掌骨远段止 ,而桡侧滑液囊正常 ,MPR显示尤为清楚。结论 :本病为非特异性炎症引起滑膜增生 ,可能与外伤及过度劳作有关。需与化脓性、结核性滑囊炎、单纯滑膜囊肿、腱鞘囊肿鉴别     

Fat within the falx: MR demonstration of falcine bony metaplasia with marrow formation

Falcine bony metaplasia frequently is incorrectly labeled "dense calcification" on brain CT and conventional radiography. Of 3,000 brain magnetic resonance (MR) scans reviewed, 12 demonstrated a central area of increased signal intensity on T1 and T2 weighted images with a smooth peripheral rim of diminished signal intensity within the region of the falx. The central area of increased signal intensity corresponded to fat in the medullary cavity and the peripheral area of low signal intensity corresponded to cortical bone. The CT scans, available in nine of 12 patients, were compared with the MR scans and revealed dense mineralization in the corresponding region of the falx. A postmortem specimen of densely "calcified" falx cerebri was examined that revealed cortical bone and a medullary cavity complete with bony trabeculae and marrow. The MR findings of falx ossification should not be confused with other entities of greater clinical significance.     

Acute suppurative tenosynovitis of the hand: diagnosis with US

The sonographic findings in seven patients with surgically proved acute tenosynovitis of the hand (bacterial in six cases, of presumed viral origin in one) were reviewed. In the six patients with bacterial tenosynovitis the affected flexor tendon was larger than that of the contralateral normal digit. In five patients hypoechoic areas were identified surrounding the flexor tendon that proved to be pus at surgery. Sonography failed to depict a small amount of pus in the tendon sheath in one patient. The affected tendon of the single patient with tenosynovitis thought to be of viral origin was normal in size, but a focal tendon sheath fluid collection was detected that proved to be sterile at surgery. Sonography appears to be a useful imaging technique in the early diagnosis of acute suppurative tenosynovitis of the hand.     

Melorheostosis and the sclerotomes: A radiological correlation

Melorheostosis is characterised radiologically by hyperostotic linear densities in bone. These densities have a peculiarly segmental distribution which does not correspond with the anatomical course of blood vessels or mixed nerve roots of the limbs. So far this distribution has lacked any valid explanation, although it has been suggested to be a developmental error as a result of an embryonic metameric disturbance. Inman and Saunders in 1944 described a sensory nerve supply to skeletal structures with sclerotomes representing the zones of the skeleton supplied by individual spinal sensory nerves. Radiographs of 30 cases from the Radiological Museum of the Institute of Orthopaedics, London, have been reviewed and an attempt has been made to correlate the sclerosing lesions with the sclerotomes. The investigation was handicapped by paucity of films and clinical information, but in 19 cases the skeletal abnormalities were considered to correspond with a single sclerotome or part thereof. These studies were convincing when films of an affected hand or foot were available. In the remaining 11 cases multiple sclerotomes appeared to be involved and the clinical manifestations were correspondingly more severe. It is proposed that melorheostosis may be the late result of a segmental sensory nerve lesion, to account for its sclerodermal distribution. The association with linear scleroderma is discussed, since it has been suggested that these cutaneous lesions are related to the same nerve segment. Eight cases showed para-articular ossification of soft tissues which may be related to involvement of a corresponding myotome.     

Melorheostosis of the toe: a case report

A case of melorheostosis in a 57-year-old Japanese woman is presented. This case is noteworthy because of its unusual radiographic features and local findings and its unusually long follow-up period of more than 29 years. Melorheostosis progresses very slowly over a long period of time, and can show bizarre features, simulating malignant tumor.     

Current concepts in the diagnosis and treatment of hand and wrist injuries in sports

The hand is the most commonly injured part in sport. Fortunately, most injuries are minor and do not interfere with the sport participation, but even these leave residual functional deficits that may increase with time. More severe injuries of the hand are appreciated instantly by the player and health care personnel and generally receive better care. The goal is to maintain the best functioning hands now for the sport and in the future for the life's work of the hand. A program is herein described outlining the care of minor and major sports injuries to the hand that tries to return the injured player quickly to the sport participation while not jeopardizing the future. Because injuries to this most important tool are so frequent, it is recommended that a lecture be given to each sport group prior to the season to describe and raise the awareness of the players regarding hand and finger injury.     

Melorheostosis of the axial skeleton with associated fibrolipomatous lesions

Two patients with melorheostotic-like lesions of the axial skeleton are described. In each case adjacent soft tissue masses containing both fatty and fibrous tissues were evident. The presence of such soft tissue tumors as well as other soft tissue abnormalities in melorheostosis emphasizes that the disease should not be regarded as one confined to bone. The precise pathogenesis of the osseous and soft tissue abnormalities in melorheostosis remains obscure.     

Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

Objective To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter’s neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Materials and methods Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10–92 years. Pearson chi-square analyses and Fisher’s exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Results Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P < 0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P < 0.001), and PTTD (32.0% vs 11.0%, P < 0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Conclusion Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter’s neuropathy.     

Extensive thromboembolic disease of the hand and forearm: treatment with thrombolytic therapy.

Six patients with extensive hand and forearm thromboembolic disease were treated by means of intraarterial infusion of urokinase, with good clinical results. Four significant complications occurred, including a possible stroke. Embolization of pericatheter thrombus was a possible etiologic factor in this case. Antegrade brachial artery puncture should be used in the setting of prolonged upper extremity thrombolytic therapy to avoid the cerebral vasculature. Thrombolysis is an effective technique for tissue salvage in cases of inoperable hand thrombosis.     

长骨生长板创伤性骨桥形成的MRI与病理学对照实验研究

目的研究ＭＲＩ对长骨生长板创伤后骨桥形成的诊断价值。方法５周龄新西兰幼兔３０只，钻孔法制成生长板创伤模型。术后３天、１周、２周、４周、６周分别采用０．３５ＴＭＲＩ平扫和ＧｄＤＴＰＡ增强扫描；所有骨标本均行常规病理组织学检查，结果与ＭＲＩ对照。结果ＭＲＩ平扫对软骨创伤区的检出率达１００％。创伤后３天创伤区内有大量红细胞充填，ＭＲＩ平扫表现为Ｔ１ＷＩ低信号、Ｔ２ＷＩ高信号，ＧｄＤＴＰＡ增强后无强化；创伤后１周创伤区内已出现大量的肉芽组织，平扫无特异性改变，但ＧｄＤＴＰＡ增强后创伤区有明显强化；创伤后２～４周创伤区内出现数量逐渐增多的骨小梁结构，ＧｄＤＴＰＡ增强后强化带逐渐变窄、强化减弱；创伤后６周创伤区内完全由骨性结构修复，ＧｄＤＴＰＡ增强后无强化，ＭＲＩ平扫信号取决于其内部成分（红骨髓或脂肪）。结论ＭＲＩ平扫对生长板创伤检出敏感，ＧｄＤＴＰＡ增强扫描对早期发现纤维血管桥形成有特异性作用     

Intercostal artery aneurysms complicating thoracic aortic coarctation: diagnosis with magnetic resonance angiography

The case report of a 46-year-old woman diagnosed with complete aortic coarctation and multiple intercostal artery aneurysms using 'ultrafast time-resolved' multiphase contrast-enhanced magnetic resonance angiography and conventional single-phase, high-resolution breath-hold contrast-enhanced magnetic resonance angiogram techniques is presented. A review of intercoastal artery aneurysms occurring in conjunction with aortic coarctation and the various contrast-enhanced magnetic resonance angiography techniques currently available is provided.     

Intrarenal pseudoaneurysms complicating renal choriocarcinoma metastases: treatment with coil embolization

Most intrarenal pseudoaneurysms result from a laceration of the renal artery or its branches. However, tumor-induced renal pseudoaneurysm is very rare. We report a case in which embolization of an intrarenal pseudoaneurysm complicating renal metastases resulting from a choriocarcinoma was successful.     

Aortocaval fistula complicating abdominal aortic aneurysm: diagnosis with gadolinium-enhanced three-dimensional MR angiography

With approximately 150 reported cases, fistulas between the abdominal aorta and inferior vena cava are rare. Preoperative clinical diagnosis of aortocaval fistula is difficult because the classical triad of abdominal pain, pulsatile abdominal mass, and abdominal machinery-like bruit may be absent in up to 50 % of patients. We report a case of aortocaval fistula complicating abdominal aortic aneurysm which was diagnosed preoperatively using breath-hold gadolinium-enhanced three-dimensional MR angiography. Received: 2 June 1998; Revision received: 28 September 1998; Accepted: 20 November 1998     

MSCT对胆囊结石并十二指肠瘘的诊断价值

目的：探讨MSCT对胆囊结石并十二指肠瘘的诊断价值。方法：回顾性分析6例经手术证实的胆囊结石并十二指肠瘘的CT表现。结果：6例患者中,胆囊萎缩4例,胆囊体积增大2例;胆囊内结石4例,胆囊无结石2例;胆囊壁钙化2例,胆囊内积气2例,胆管积气1例;6例胆囊周围结构显示均欠清晰,4例软组织块影包绕胆囊及十二指肠,3例结石性肠梗阻,结石位于回肠末端。结论：MSCT具有较高的密度分辨力及空间分辨力,结合多平面重组及临床资料,可对胆囊结石并十二指肠瘘的诊断提供重要信息。