Crystal deposition disease.

Calcium pyrophosphate dihydrate crystal deposition disease and HA crystal deposition disease are two common disorders that may come to the attention of a physician because of a variety of clinical symptomatology patterns. In CPPD crystal deposition disease, characteristic radiologic features include articular and periarticular calcification and an arthropathy consisting of joint space narrowing, bone sclerosis, often prominent subchondral cyst formation, occasional severe and progressive destructive bone changes, and variable osteophyte formation. These findings are often seen in a characteristic distribution with involvement of non-weight-bearing as well as weight-bearing joints and with involvement of distinctive intraarticular sites such as the patellofemoral compartment of the knee and the radiocarpal compartment of the wrist. In HA crystal deposition disease, characteristic radiologic features consist of calcific tendinitis and periarthritis as well as a more recently described arthropathy. Awareness of the distinctive roentgenographic appearance of these two diseases should allow a specific diagnosis to be made, and an understanding of their pathologic features should aid in appropriate therapy and guide future investigation of possible etiologic factors.

Periarticular calcification in immunosuppressed cardiac transplant patients.

A retrospective study was performed to determine whether the likelihood of developing periarticular calcification in the hands is increased significantly in cardiac transplant patients. Two groups of patients were identified: those whose transplant occurred before the routine use of Cyclosporine as an immunosuppressive agent and those who received Cyclosporine at the time of transplantation. Seven of nine patients in the former group demonstrated periarticular calcification at multiple sites in the hands, but no patient in the post-Cyclosporine group had calcification at more than one site. Cardiac transplant patients on high dose systemic steroids for an extended period of time are likely to develop periarticular calcification. This appears to be related to steroid dose and duration of treatment and also may be influenced by other immunosuppressive agents.

An aid to image interpretation and differential diagnosis.

RATIONALE AND OBJECTIVES: Proven case conference is a weekly 1-hour session designed to aid diagnostic radiology residents in their ability to interpret images and formulate differential diagnoses. This article provides a detailed description of the format of this conference and its use in evaluating resident performance. METHODS: The scores of all residents on the written portion of this conference over a 2-year period were compiled. Results were divided according to each residency class, and each resident was compared with the mean of his or her class and with previous performance. RESULTS: There was overall improvement of the group over the course of residency. All individual scores showed improvement during the 2-year period studied. CONCLUSION: Proven case conference is a simply performed, well-accepted aid to image interpretation and differential diagnosis. It affords residents an ongoing opportunity for practical learning and provides the residency program director with an objective tool for resident evaluation.

Intra-articular pressure determination during glenohumeral joint arthrography. Preliminary investigation.

Utilizing cadaveric and patient shoulders, normal values of intra-articular pressure were established during injection of increasing volumes of fluid within the glenohumeral joint. The characteristic biphasic pressures vs. volume curve that was normally observed was then compared with curves obtained in patients with a tear of the rotator cuff or with adhesive capsulitis. This method of examination should allow accurate objective assessment of the presence and severity of adhesive capsulitis.

Diagnostic imaging of pediatric skeletal trauma.

Because many injuries to the pediatric skeleton are unique and can present with only subtle radiographic abnormalities, familiarity with their appearance can aid in accurate diagnosis. These include physeal injuries, incomplete fractures, and avulsion injuries. Recognition of characteristic fractures also allows correct identification of a battered child. As illustrated in examples of injury to the elbow, an organized search for clues to abnormal alignment is particularly helpful in the evaluation of pediatric skeletal trauma.

Aspiration cytology of heterotopic ossification. A case report.

Heterotopic ossification (myositis ossificans) is usually a posttraumatic reactive process involving new bone formation. This nonneoplastic process can be clinically and radiologically confused with osteosarcoma. A case of heterotopic ossification is reported in which cytologic material was obtained from a partially calcified thigh mass from a 17-year-old, athletic male. Aspiration cytology revealed numerous osteoclastic giant cells containing multiple plump nuclei. These cells were admixed in a benign-appearing stromal background composed of mature fibroblasts and were typified by elongated spindle cells. A small incisional biopsy showed new bone formation, osteoclasts, osteoblasts and fibroblasts consistent with maturing heterotopic ossification. Heterotopic ossification may be distinguished cytologically from osteosarcoma by the presence of numerous uniform benign stromal cells composed of mature fibroblasts and osteoclastic giant cells. The differential diagnosis may be more difficult in the early stages of this reactive and proliferative process. Adequate sampling of suspected heterotopic ossification by aspiration cytology may avoid surgery in a selected group of patients.

Arthroscintigraphic evaluation of the painful total hip prosthesis.

Arthroscintigraphy was performed in 19 patients with a painful total hip prosthesis by injecting both Tc-99m sulfur colloid and iodinated radiographic contrast material intra-articularly. Scintigraphic and radiographic results correlated exactly in 15 patients, with one false-negative scintigram, one false-positive scintigram, and one false-negative arthrogram. One patient was evaluated by scintigraphy alone. Although arthroscintigraphy is potentially more sensitive than conventional arthrography in the detection of femoral component loosening, acetabular component loosening cannot be evaluated by scintigraphy alone. A combination of scintigraphy and conventional arthrography appears to be the most accurate imaging method in the evaluation of hip prosthesis loosening.

Wrist and hand injuries.

Wrist and hand injuries are common occurrences. These are often caused by a fall on the outstretched hand, but other mechanisms, from sports-related injuries to high-speed motor vehicle collisions, can lead to injuries that may be subtle on initial imaging or may produce characteristic radiographic findings. In all cases, careful attention to certain anatomic details along with a sound understanding of different injury patterns should allow an accurate diagnosis to be made. The following this article illustrates these concepts, emphasizing features that should be familiar to both radiologists and orthopedic surgeons.

Septic arthritis: a rare cause of drooping shoulder.

Drooping shoulder, or inferior subluxation of the glenohumeral joint, must be differentiated from true dislocation of the humeral head. In some instances, widening of the glenohumeral joint can be attributed to a large volume of intra-articular fluid. Three patients with septic arthritis leading to drooping shoulder are described, representing the largest series with this development reported to date.

Monostotic fibrous dysplasia of the cervical spine: case report.

Five cases of monostotic fibrous dysplasia involving the spine have previously been reported. We report a sixth case of this entity. The patient had a well-defined lytic lesion with several vertical septations that involved most of the sixth cervical vertebral body with extension to the right pedicle and lamina. Histologic examination revealed fibrous tissue within medullary bone with irregularly shaped bony trabeculae imbedded in the fibrous stroma. Biopsy findings confirmed the diagnosis.

Midline circular defect of the sternum.

A case of a midline circular defect of the sternum is presented. This may represent a localized fusion anomaly.

Fracture of the pelvis: current concepts of classification.

Historically, pelvic fractures have been classified according to whether there is pelvic stability or instability, although confusion has been caused by the inclusion of many eponyms that mainly reflect the observation of a single author on a particular fracture pattern. Pennal and Tile were the first authors to attempt to classify pelvic fractures according to the force vector causing them. This concept was refined by Young and Burgess, who provided a more detailed classification system, again relating to force vectors. This article focuses on this classification and its significance with regard to pelvic stability, type of pelvic disruption, and hence the type of corrective forces that should be applied in the surgical management. Use of a classification system of pelvic fractures based on force vectors allows the orthopedic surgeon to apply external fixation in the most appropriate manner to correct pelvic deformity and to maximize patients' survival.

Ossification centers of the pediatric elbow: a rare normal variant.

A 7-year 9-month-old boy sustained a transcondylar humeral fracture during a fall. Radiographs revealed a trochlear ossification center without evidence of a medial epicondylar center. This combination, although apparently quite rare, should be recognized as a normal variant.