Imaging in the diagnosis of cholecystocutaneous fistulae.

Adhesions formed between the gallbladder and abdominal wall secondary to gallstones and cholecystitis may result in perforation through the abdominal wall. Three cases of such cholecystocutaneous fistulae are presented and the clinical, radiographic and sonographic findings of this unusual entity are reviewed.

Cockayne syndrome.

The diagnosis of Cockayne syndrome was established with the aid of cranial computed tomography (CT) in a child with growth deficiency, mental retardation, and neurologic findings which are typical for this rare childhood disorder. Calcification of basal ganglia and hydrocephalus ex vacuo are neuropathologic characteristics of Cockayne syndrome which may be present on CT as early as 3 years of age.

Hepatobiliary imaging of common bile duct obstruction by a hydronephrotic kidney.

A patient with intermittent right upper quadrant abdominal pain thought to represent acute cholecystitis had common bile duct obstruction due to an enlarged right renal pelvis. A Tc-99m-HIDA scan provided the first clue to the diagnosis. The case reinforces the value of cholescintigraphy in diagnosing pathology outside the biliary system.

Liver scans in evaluation of lesions of the diaphragm.

Three patients had chest radiographs suggesting pathology associated with the right hemidiaphragm. The patients' histories included trauma in one case, recently diagnosed leukemia in a second, and Hodgkin's disease in the third. In all three cases, the Tc-99m-sulfur colloid liver scan provided a noninvasive identification of the nature of the diaphragmatic densities seen on the chest radiographs, thus affecting patient management.

Bone scan-demonstrated urinary tract abnormalities in a patient with Rubinstein-Taybi syndrome.

A 22-month-old boy had a Tc-99m-MDP bone scan. This revealed multiple urinary tract anomalies (bladder distention, ectopic and small right kidney, hypertrophied left kidney, and bilateral hydronephrosis). The defects, fortuitously appreciated by means of the bone images, led to the correct diagnosis of urinary retention and infection as the cause of the child's symptoms. The urinary tract anomalies were associated with the Rubinstein-Taybi syndrome.

Diverse bone scan abnormalitites in "shin splints".

Four young patients who presented with pain over the anterior compartment of the legs, gave a recent athletic history suggesting stress fractures. Although radiographs were initially normal in all four cases, the bone scintigrams were positive. The individual findings, however, were quite different. In one there was a single focal area of increased radioactivity in each of the tibias; the second patient had uneven uptake of radiotracer and several foci of accumulation in the fibulas; the third showed diffuse linear tibial uptake suggesting periosteal lesions; and the fourth case revealed uptake in the lateral malleolus and in bones of the foot.

Pulmonary lesions due to Dirofilaria immitis (dog heartworm). Report of four cases with radiologic findings.

Chest radiographs of 4 patients with Dirofilaria immitis (dog heartworm) revealed solitary, small, peripheral, noncalcified nodular lesions. The pulmonary lesions were apparently produced secondary to lodging of the parasite in peripheral pulmonary vessels. None of the patients had symptoms referable to the heartworm lesions. Needle aspiration in 2 patients revealed a nonspecific inflammatory lesion.

Diagnosis of urethral diverticula in females.

Female urethral diverticula are probably a more common cause of symptomatology than is generally suspected. Radiologic techniques may play a key role in their demonstration. Particularly in the patient with clinical findings referable to the urethral area, fluoroscopy of the urethra as part of cystography as well as the use of urethral catheters may be helpful in diagnosis.

Proximal femoral focal deficiency (PFFD).

Proximal femoral focal deficiency (PFFD) is a spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximal femur. Thirteen patients with PFFD were classified based on a system describing acetabular shape and femoral position. Radiological evaluation includes identification and description of the PFFD and evaluation of the associated limb anomalies, of which ipsilateral fibular hemimelia is the most common. Contrast arthrography is indicated to disclose the presence and location of the femoral head.