Diagnostic Reliability of Plain Radiography in Osteonecrosis of the Femoral Head: General Radiological Features Revised.

BACKGROUND AND OBJECTIVES: Osteonecrosis of the femoral head (ONFH) is an incapacitating disease that frequently results in the collapse of the femoral head and secondary osteoarthritis. The diagnosis and staging of this pathology, which usually rely on imaging studies, are challenging. Currently, conventional radiography is the basis of the initial diagnostic assessment. In recent decades, however, radiographs have been considered insensitive to early changes in ONFH and thus, a suboptimal diagnostic tool. Paradoxically, the imaging features of radiographs are often profuse, substantial, and characteristic. This study aimed to elucidate the real limitations of this radiologic tool by assessing the diagnostic reliability of the key radiologic features and staging. METHODS: This was a retrospective study in which radiographs from 28 idiopathic ONFH confirmed cases who underwent hip arthroplasty were analyzed by eight observers who were asked to identify the presence or absence of ONFH universally reported imaging features in AP hip radiographs. RESULTS: Concordance analysis revealed a poor agreement between observers for most of the assessed imaging features. Only the identification of femoral head flattening and osteoarthritis signs exhibited moderate agreement with statistical significance. In contrast, the detection of radiological osteoporosis and the loss of trabeculation showed the lowest reliability, with negative kappa coefficients. CONCLUSION: There is a lack of agreement between qualified observers, even for the identification of the most characteristic ONFH radiographic feature. The reliability of plain radiography for the detection of basic radiological elements is even weaker in the early stages of the disease.

Otras causas de dolor abdominal: síndrome de la arteria mesentérica superior / Other causes of abdominal pain: superior mesenteric artery syndrome

La clínica del síndrome de la arteria mesentérica superior se basa en los siguientes síntomas: dolor epigástrico postpandrial, saciedad temprana, náuseas o vómitos biliosos, sobre todo en pacientes con una pérdida significativa de peso reciente o con una intervención quirúrgica previa, en la mayoría de ocasiones por escoliosis. En nuestro trabajo presentamos el caso de un varón de 83 años con antecedentes de fibrilación auricular y EPOC e intervenido por colecistitis litiásica crónica y ulcus péptico, que acude al servicio de urgencias con dolor abdominal intenso junto con vómitos y ausencia de ventoseo y deposición. Debemos pensar en este síndrome una vez descartadas las causas más frecuentes de dolor abdominal. Mediante la sospecha clínica y la realización del TC conseguimos un diagnóstico temprano, y evitamos complicaciones posteriores como alteraciones electrolíticas, perforación gástrica o gas venoso portal

The symptoms of superior mesenteric artery syndrome are: postprandial epigastric pain, early satiety, nausea or bilious vomiting, particularly in patients with significant recent weight loss or with previous surgery, most often scoliosis. We present the case of an 83-year-old man with a history of atrial fibrillation and COPD and previous surgeries due to peptic ulcer and chronic calculous cholecystitis, who arrives in the Emergency Department with severe abdominal pain, vomiting, not passing gas and constipation. We must think about this syndrome once the most frequent causes of abdominal pain have been ruled out. Thanks to clinical suspicion and CT scan we can obtain an early diagnosis and avoid later complications such as electrolyte imbalance, gastric perforation or portal venous gas