Multiple myeloma: evaluation by CT

Although patients who have multiple myeloma usually have straightforward clinical symptoms and corroborative radiographs, in some instances, these patients will present atypically, with symptoms suggesting active disease but radiographs that are normal or nonspecific. We reviewed the records of 32 patients who had documented multiple myeloma and had undergone CT examinations, assessing the value of those examinations. Although CT is not indicated in all patients who have multiple myeloma, it is especially useful in patients who have bone pain and normal or nonspecific radiographs. CT provided confirmatory information in all cases in which lesions were seen on radiographs. CT also frequently demonstrated a greater extent of disease than could be appreciated on the radiographs.     

Supraacetabular insufficiency fractures

Insufficiency fractures in the supraacetabular region were identified in five women, aged 55-83 years. Factors contributing to the diminished resistance of their bones included postmenopausal osteoporosis, steroid therapy, radiation therapy, and rheumatoid arthritis. The supraacetabular fractures were seen on routine radiographs as hazy bands of sclerosis located immediately above and parallel to the acetabular roof. All five patients had additional fractures in the spine or pelvis. Supraacetabular insufficiency fractures may be an unsuspected cause of hip pain, especially in older women.     

Traumatic rupture of the thoracic aorta

Seven patients who had traumatic ruptures of the thoracic aorta are reported. Four of these died within a few hours of admission, allowing no opportunity for diagnosis or treatment. However, three survived long enough for elective surgery to be undertaken. A diagnosis of ruptured aorta was missed in one patient (case 2), and the difficulties of diagnosing this condition, even during thoracotomy, are emphasized. The value of serial chest radiography and forward aortography is discussed. Two of these patients underwent successful aortic repair, using left atrio-femoral bypass.     

Ferromagnetic materials in patients: detection before MR imaging

A number of surgical clips and other metallic materials embedded within patients have ferromagnetic properties that present a potential hazard when in the strong fields associated with magnetic resonance imaging. Several types of magnetometers and metal detectors were investigated as possible pre-imaging screening devices. The sensitivities and costs of these devices are given.     

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Current aspects of forensic lawFrom October 2004 to March 2005