Gout: radiographic findings mimicking infection.

OBJECTIVE: To describe radiographic features of gout that may mimic infection. DESIGN AND PATIENTS: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. CONCLUSION: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals.

Ultrasound-guided interventional procedures in the musculoskeletal system.

Ultrasound is a low-cost, nonionizing, readily available diagnostic technique for the evaluation of tendons, muscles, soft tissue masses, cysts, and other fluid collections. Ultrasound is also a valuable tool for guiding a variety of musculoskeletal interventions. Procedures that can be performed under ultrasound guidance include aspiration of fluid for analysis, injection for medication, decompression of cysts, drainage of abscess and hematoma, biopsy, treatment of calcified tendinitis, and foreign body retrieval.

Plantar fasciitis: sonographic evaluation.

PURPOSE: To evaluate the sonographic findings of plantar fasciitis. MATERIALS AND METHODS: Both feet of 15 patients who had a clinical diagnosis of plantar fasciitis were evaluated with ultrasound (US) by using a 7.0-MHz linear-array transducer. Heel pain was unilateral in 11 patients and bilateral in four. Sagittal sonograms were obtained, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Other observations included hypoechoic fascia, fiber rupture, perifascial fluid collections, and calcifications. Both feet of 15 healthy volunteers were also evaluated as a control group. RESULTS: Plantar fascia thickness was significantly increased in the heels in patients with plantar fasciitis (3.2-6.8 mm; mean, 5.2 mm +/- 1.13) compared with their asymptomatic heels (2.0-4.0 mm; mean, 2.9 mm +/- 0.70) (P < .0001) and compared with the heels of the patients in the control group (1.6-3.8 mm; mean, 2.6 mm +/- 0.48) (P < .0001). The proximal plantar fascia of 16 (84%) symptomatic heels were diffusely hypoechoic compared with none of the patients' asymptomatic heels and only one heel of a patient in the volunteer group. No fascia rupture, perifascial fluid collection, or calcifications were identified. CONCLUSION: Increased thickness of the fascia and hypoechoic fascia are sonographic findings of plantar fasciitis. US may be a valuable noninvasive technique for the diagnosis of plantar fasciitis.

An update on the technique of double-contrast arthrotomography of the shoulder.

We review the technique of double-contrast arthrotomography (DCAT) including reference to a new, superficial and bevel-oriented puncture and the use of a special density compensation filter. We have found it possible to demonstrate the varieties, size and exact location of rotator cuff tears in the coronal and sagittal planes. Adaptation of the method to studies of the glenoid labrum also yields excellent results. DCAT is now the best technique of shoulder arthrography.

Double-contrast arthrotomography of the shoulder: correlation of radiological and surgical findings in complete rotator cuff tears.

Double-contrast arthrotomography of the shoulder appears extremely valuable; we have verified its accuracy in measurements of complete rotator cuff tears. The first 31 patients so investigated and explored surgically have been retrospectively evaluated. Accurate measurements were found in 85% of the coronal diameters and in 69% of the sagittal ones.

Ewing's sarcoma in adults.

Twenty-two adult patients, aged 18 and over, with Ewing's sarcoma of bone, were evaluated clinically and radiographically. They had clinical findings similar to younger patients with Ewing's sarcoma, except that they presented with fewer systemic symptoms. The radiographic characteristics included a preponderance of flat bone involvement (54%) over long bone involvement (36%). A soft-tissue mass was detected in only 55% of the cases. CT scans, when used, proved to be helpful in delineating a soft-tissue mass associated with the bony lesion, and in follow-up after therapy.