Iliac bone defects revealing systemic sarcoidosis.

Bone lesions are fairly uncommon in sarcoidosis (5 to 10% of cases). We report the case of a 40-year-old man in whom sarcoidosis of the lungs and bones was revealed by excruciating buttock and sacral pain. Computed tomography showed multiple punched-out defects in the left iliac bone. No similar cases have been reported in the literature.

[Epiphysis-metaphysis bone ischemia in hemorrhagic rectocolitis and Crohn's disease]. / Ischémie osseuse épiphyso-métaphysaire au cours de la rectocolite hémorragique et de la maladie de Crohn.

Aseptic osteonecrosis is a rare extraintestinal manifestation in patients with inflammatory bowel disease; its true prevalence is not precisely known. Steroid treatment undoubtedly participates in the pathophysiology of avascular osteonecrosis, however, other factors like hypercoagulability may be involved. Two cases of bilateral osteonecrosis of the knees--the first occurring during the course of ulcerative colitis, the second in a patient presenting with Crohn's disease--are described. Specific location of the lesions and regression of symptoms, as well as the importance of magnetic resonance imaging for early recognition of osteonecrosis, are noteworthy.

[Post-traumatic and symptomatic lumbar intertransverse process bone bridge. Apropos of a case: review of the literature]. / Pont osseux intertransversaire lombaire post-traumatique et symptomatique. A propos d'un cas: revue de la littérature.

Osseous bridging of lumbar transverse processes is very seldom seen. A review of the literature has revealed only thirty-six reports. The first cases were thought to be of congenital origin. Subsequently however, the post-traumatic nature of osseous bridging was proved in ten cases. It is obviously a peculiar localization of myositis ossificans. We report a new case, with proof of the post-traumatic nature, associated with symptoms of sciatica.

[Chronic recurrent multifocal osteomyelitis. A diagnosis to be called to mind]. / L'Ostéite chronique récurrente multifocale. Un diagnostic qu'il faut savoir évoquer.

Chronic recurrent multifocal osteomyelitis is a rare disorder that affects children and teenagers. Clinically, it is characterized by insidious onset of local swelling and pain in several metaphyses. A symmetric, recurrent and multifocal pattern is usual. Spinal involvement is possible. Inconstant association with a cutaneous affection (palmoplantar pustulosis, acne fulminans, psoriasis), or less frequently with an inflammatory chronic gut disorder is described. Pathogenesis usually recognized is an enthesopathy. Enthesitis may progress to the osseous part of the enthese and produce an aseptic chronic osteomyelitis. Biopsy specimen with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. It is particularly true when the bone lesion is isolated. Disease course is benign and self-limited. The clinical course is characterized by recurrences and remission occurring for 6 to 10 years. Treatment based on non steroid antiinflammatory drugs is usually effective.

[Drug-induced osteopathies]. / Ostéopathies médicamenteuses.

Several drugs can induce bone disorders. Steroid-induced osteoporosis is the best known of all drug-induced bone disorders. However, bone disorders have also been described in association with newer drugs (LH-RH analogs, retinoids, cyclosporine, etc.). The purpose of this revue is to familiarize radiologists with drug-induced bone disorders in order to achieve earlier diagnosis, hence, improve treatment.

[Lesions of the rotator cuff and acromioclavicular joint. Data of arthrography. Apropos of 2 cases]. / Lésions de la coiffe des rotateurs et articulation acromio-claviculaire. Données de l'arthrographie. A propos de 2 cas.

Arthrography using an opaque medium to explore the shoulder in two cases demonstrated rupture of the rotator muscles sheath associated with a communication into the acromioclavicular joint. Rupture of the sheath allows direct contact between the humeral head and the capsule of the acromioclavicular joint which becomes eroded progressively. Recent studies have produced data indicating participation of the acromioclavicular joint in the natural history of deteriation of the sheath of the rotator muscles.

[Treatment of osteoid osteoma using laser photocoagulation. Apropos of 28 cases]. / Traitement des ostéomes ostéoïdes par photocoagulation au laser. A propos de 28 cas.

UNLABELLED: THE PURPOSE OF THE STUDY was to evaluate interstitial laser photocoagulation for local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIAL AND METHODS: 28 patients (age range from 5 to 48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high power semiconductor diode laser (805 nm) with a 400 microns optical fiber was used. The fiber was introduced into the nidus through a 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1000J) were obtained. RESULTS: 27 patients had complete pain relief, which was effective within 24 hours in 18 patients. One patient had pain recurrence after 6 weeks. The remaining nidus was treated secondarily with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 6-12 months after the procedure. CONCLUSION: Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.

[Infectious osteoarthritis of the pubis in sportmen. Apropos of 2 cases]. / Ostéoarthrite infectieuse du pubis chez le sportif. A propos de deux observations.

In athletes, osteoarthritis of the symphysis pubis is an uncommon condition that should be promptly differentiated from pubic pain due to microtrauma. The symphysis pubis is infected via the bloodstream, usually by a staphylococcus. Pubic pain with fever and severe disability suggests the diagnosis. Increased uptake of bone-seeking radionuclides is an early finding. Microbiological and histological studies of specimens obtained under radiological guidance confirm the diagnosis. Two new cases of pubic osteoarthritis in young athletes are reported. In one case the causative organism was a Peptostreptococcus, a gram-positive commensal organism normally found on the skin and mucous membranes.

[Scaphoid fissure in algodystrophy: diagnostic value of MRI]. / Fissure osseuse du scaphoîde tarsien au cours d'une algodystrophie: intérêt diagnostique de l'IRM.

Stress fractures are exceptional in patients with reflex sympathetic dystrophy syndrome, even when bone loss is severe. We report a case of stress fracture of the navicular bone documented by magnetic resonance imaging. Recurrence of localized pain in patients with reflex sympathetic dystrophy syndrome suggests either a relapse of the syndrome or a bony fissure. Magnetic resonance imaging can provide early differentiation of these two conditions.

Pitfalls in osteoarticular imaging: how to distinguish bone infection from tumour?

In this article examining pitfalls in osteoarticular imaging we examine the differential diagnosis of osteomyelitis from bone tumours. We describe the different features which differentiate these two types of disease in radiology and CT and MRI scanning.

[Acute, hyperintense, and febrile cervicalgia. Crowned dens syndrome, a monofocal microcrystalline arthritis sometimes doubly misleading]. / Cervicalgies aiguës, hyperintenses et fébriles. Syndrome de la dent couronnée, une arthrite microcristalline monofocale parfois doublement trompeuse.

Microcrystalline arthritis sometimes have atypical localizations and presentations. The crowned dens syndrome, due to hydroxyapatite or calcium pyrophosphate deposits in peri-odontoid ligaments of the atlas, can provoke acute or chronic cervicalgia or misleading presentations such as meningitidis or fever of unknown origin. We present a particularly severe new case requesting urgent surgery, and a literature review to alert clinicians and prevent misdiagnosing this syndrome. Indeed, calcifications may be very discrete or just incidental and prevent a complete diagnostic approach.

[Pseudotumoral aspect of stress fracture of the pubis]. / Aspect pseudo-tumoral des fractures de contrainte du pubis.

Stress fractures of the symphysis pubis are usually due to bone insufficiency. After describing two cases which caused diagnostic difficulties, the authors relate how these fractures may simulate tumor with deceptive bone destruction. The existence of predisposing factors, namely post-menopausal osteoporosis and a history of pelvic radiation therapy, together with the radiological characteristics associating bone destruction with peripheral sclerosis suggest the diagnostic. Awareness of this pathology may avoid unnecessary biopsies which can cause delay in bone consolidation.

Interstitial laser photocoagulation of osteoid osteomas with use of CT guidance.

PURPOSE: To evaluate interstitial laser photocoagulation (a minimally invasive percutaneous technique of thermal destruction of deep-seated tumors, with low-power laser energy) in local destruction of osteoid osteoma, with computed tomographic (CT) guidance. MATERIALS AND METHODS: Fifteen patients (age range, 8-48 years) with presumed osteoid osteoma were treated with CT-guided interstitial laser photocoagulation of the nidus. A high-power semiconductor diode laser (805 nm) with a 400-microm optical fiber was used. The fiber was introduced into the nidus through an 18-gauge needle. Around the fiber tip, well-defined coagulative necroses from 5 to 9 mm (energy delivery, 400-1,000 J) were obtained. RESULTS: Fourteen patients had complete pain relief, which was apparent within 24 hours in eight patients. One patient had recurrence of pain after 6 weeks. The remaining nidus was treated a second time, with complete relief. Treatment was unsuccessful in one patient, and surgical excision was performed. Daily activities were not restricted after the intervention. All patients were followed up for more than 1 year, with no sign of recurrence. The only notable complication was a mild reflex sympathetic dystrophy of the wrist in one patient. Sclerosis of the nidus was observed 4-6 months after the procedure. CONCLUSION: Percutaneous interstitial laser photocoagulation of osteoid osteoma seems to be a promising, simple, precise, and minimally invasive alternative to traditional surgical and percutaneous ablations.