Avascular necrosis of the epiphysis of the first metatarsal bone.

We report a case of avascular necrosis of the epiphysis of the right first metatarsal in a 6-year-old boy. Radiographs showed sclerosis, collapse and a crescent sign in the epiphysis. The diagnosis was confirmed by magnetic resonance imaging and scintigraphy. Arch support was the therapy of choice. Six months after the onset of symptoms, a definite reossification was present. To our knowledge, this is the first radiological report of avascular necrosis of the epiphysis of the first metatarsal bone in the world literature, which prompted a review of the osteochondroses and their etiology.

Ectopic localisation of adrenal cortex.

We present a case of concurrence of ectopic adrenal cortex with a renal cell carcinoma. The diagnosis of the accessory adrenal tissue was made by CT-guided biopsy. With this case report, we draw attention to a specific differential diagnostic problem, policy and to the MR characteristics of ectopic adrenal cortex.

MRI diagnosis of osteomyelitis of the cuboid bone in two infants.

We describe two infants in whom MRI diagnosed osteomyelitis of the cuboid bone when conventional X-rays were negative. Neoplastic, traumatic and ischaemic aetiologies could be excluded with the initial MR examinations.

The use of preoperative fistulography in patients with a second branchial cleft anomaly.

The preoperative fistulography used in cases of second branchial cleft anomalies is an effective method of showing the exact anatomy and topography of these fistulas in the neck. This visualisation is very important because the only therapeutic solution is complete surgical resection. This method is easy to perform and is painless. We report two patients with branchiogenic anomalies. The diagnosis was established by fistulography and histological examination.

Strecker stent placement in the superior mesenteric artery for recurrent ischemic colitis.

We report on a case of recurrent superior mesenteric artery (SMA) stenosis with symptomatic mesenteric angina after SMA angioplasty. Stent placement of postostial atherosclerotic disease was proposed, with successful result. Moderate aortic protrusion was noted. Feasibility of PTA and stenting of mesenteric stenoses become increasingly obvious, but long term follow-up studies still have to provide sufficient results on clinical outcome and possible complications.

Aortic coarctation associated with an aberrant right subclavian artery.

We report a case of aortic coarctation associated with an aberrant right subclavian artery in a young male who was investigated for hypertension. Angiography, CT examination with multiplanar reconstruction and MRI were useful in delineating the extension of the coarctation and the exact anatomy of the aberrant right subclavian artery.

Systemic to pulmonary artery shunting.

Two cases showing systemic to pulmonary artery shunting, during the venous phase of bronchial arteriography are presented. In the first patient with chronic bronchiectasis, the shunting is believed to be due to newly formed vessels in the granulomatous tissue. At pulmonary angiography, the increased pressure in the pulmonary arteries simulated an angiographic defect due to dilution of the contrast by retrograde opacification from a left to right shunt. In a second patient with proven pulmonary embolism a true defect was present at pulmonary angiography. Systemic to pulmonary artery shunting is believed to develop secondary to hypoxia.

Radiological aspects in preoperative planning and postoperative assessment of cementless total hip arthroplasty.

Some radiographic aspects in the preoperative measurement of prosthetic component size in cementless total hip arthroplasty were evaluated, primarily the magnification factor of the x rays. The influence of femoral rotation on the assessment of the pre- and postoperative AP x rays was investigated.

Intracavernosal injection of prostaglandin E1 as an alternative for papaverine in penile angiography.

Arteriography of the penile vasculature was performed after intracavernous injection of prostaglandin E1 in five patients. Penile tumescence was obtained in three patients with a dose of 10 micrograms and in the other two patients with a dose of 20 micrograms. Mean duration of penile tumescence was 1 h 36 min. Visualization of the penile vasculature was adequate in all patients. Local pain was a minor side effect in one patient. These preliminary results suggest that prostaglandin E1 might represent an alternative for papaverine in the angiographic study of male impotence.

Renal artery stent placement with use of the Wallstent endoprosthesis.

The Wallstent endoprosthesis was placed in 12 renal arteries of 11 patients; a total of 15 stents were placed. Indications for placement were restenosis after dilation and insufficient result after dilation. In two patients, malpositioning of the stent required placement of a second stent. Complications included a case of massive cholesterol embolization and a case of unexplained transient hematuria, proteinuria, and deterioration of renal function. At repeat angiography of seven renal arteries after stent placement, one was occluded and required thrombolysis and dilation. Another showed restenosis due to shortening of the stent and required redilation and, later, placement of another stent. This stent became occluded after 1 month. In this patient and in three other cases, angiography disclosed tissue buildup in the stent but without significant stenosis after this short-term follow-up. After a clinical follow-up of 6.7 months +/- 3.4 in 10 patients treated for hypertension, three were cured, four were improved, and three were unchanged when blood pressure levels before stent placement were compared with those obtained after stent placement.

Intravascular ultrasonography, a new alternative for the assessment of vascular lesions.

Intravascular ultrasonography (IVUS) was performed in ten patients undergoing a diagnostic or therapeutic angiography. The ultrasound probe was inserted in a 6 French catheter and introduced through a 7 or 8 French sheath. Exact information was yielded about the extent of arteriosclerosis, the stenotic process and the composition of the atheromatous plaque (soft plaque or presence of calcifications). In the patients undergoing a percutaneous transluminal angioplasty, the status after dilation was also assessed, and intimal tears and residual atheromatous plaques could well be evaluated.

Percutaneous transluminal laserangioplasty with balloon centered direct argon laser light. Experience with 12 patients and a minimal follow-up of 6 months.

Laser angioplasty with direct argon laser light, combined with a special centering balloon (Lastac system) was performed in 12 patients with a single superficial femoral artery occlusion. The mean length of the occlusion was 5.4 +/- 2.15 cm with a mean duration of occlusion of 7.8 +/- 5.9 months. Initial angiographic success was obtained in 9/12 procedures. Reason of failure was perforation in 1 patient and impossibility to pass the stenosis due to calcifications in 2 patients. Early rethrombosis in 1 patient reduced the primary success rate to 8/12 procedures. Peripheral emboli occurred in 2 patients, both successfully treated by thrombolysis or surgery. Of the 8 recanalized arteries, all remained patent with a mean follow-up of 7.1 +/- 0.68 months. It remains to be determined on larger series whether the Lastac system offers substantial advantages over other, less expensive systems of laser angioplasty.