Amy Beth Goldman

The double-contrast shoulder arthrogram. A review of 158 studies.

Experience with double-contrast arthrography indicates it is superior to the single-contrast technique. First, the double-contrast study provides additional information on the width of rotator cuff tears and on degeneration in the tendons. This information is valuable in choosing surgical candidates and electing the best surgical incision. Second, the air-distended capsule permits visualization of the entire intra-articular portion of the biceps tendon. Third, improved visualization of the articular cartilages is important in evaluating patients with previous anterior shoulder dislocations or inflammatory arthritis.

Soft tissue chondromas: diagnosis and differential diagnosis

The authors evaluated three cases of soft tissue chondromas in patients aged 55, 57, and 78 years. Two of the lesions occurred in the foot and one in the hand. All three patients had long histories (over 1 year) of a palpable mass and all three had roentgenograms showing welldemarcated lobulated soft tissue lesions with both central and peripheral calcifications. Recognition of this rare benign chondroid lesion on imaging studies is significant since it may be misinterpreted as an aggressive lesion or a primary synovial abnormality.

Case report 96

This 50-year-old man presented with chronic pain and swelling of the right ankle of four years duration, following an injury to this area. He had subsequently sought medical advice and was told that he had an old fracture of the right ankle and possible Paget disease. The patient gave a history of hypertension and mild diabetes, but the past history was otherwise noncontributory. The laboratory studies demonstrated a mild normochromic, normocytic anemia with hemoglobin values of 12.8 and 12.9 grams percent on two separate examinations. The serum alkaline phosphatase studies showed slightly increased values of 118 and 95 milli units, again obtained on two separate

Acromegalic arthropathy of the hip.

The changes in gross morphology of the femoral head, specimen radiograms, cut sections of the femoral heads, and histopathology of the synovium were examined in 11 surgical specimens from six acromegalic patients who were treated by total hip arthroplasty. The pathologic changes in six age- and sex-matched patients also undergoing 11 total hip arthroplasties for idiopathic degenerative joint disease were examined for comparison. The hip joint changes in acromegaly represent a peculiar arthropathy, which is characterized by prominent, proboscis-like medial osteophytes, moderate chronic lymphoplasmacytic synovitis, an irregular pitting of the subchondral bone observed roentgenographically, and osteopenia. When compared with idiopathic degenerative joint disease, these changes are distinctive in extent, if not in quality. The pathophysiologic relationship between these entities remains obscure.

The double contrast shoulder arthrogram: evaluation of rotary cuff tears.

Double contrast shoulder arthrograms revealed rotator cuff abnormalities in 14 of 31 cases. Although both the single and double contrast methods provide a means of diagnosing complete tears of the cuff, or partial tears of its inferior surface, the double contrast study provides additional information regarding the width of the tear, the presence of degenerative changes in the cuff, and the condition of the articular cartilages.

Posterior limbus vertebrae : a cause of radiating back pain in adolescents and young adults

Four cases of posterior limbus vertebrae are presented, three in the lumbar spine and one in the lower thoracic spine. All four patients have myelographic documentation of herniated disc material affecting the spinal canal. One patient underwent an additional discogram that confirms the pathophysiology of the limbus vertebra by demonstrating that contrast material injected into the nucleus pulposus tracks between the body and the detached fragment.

Slipped Capital Femoral Epiphyses Complicating Renal Osteodystrophy: A Report of Three Cases

Three adolescents with bilateral slipped capital femoral epiphyses complicating renal disease are presented. In one case, the severity of the deformities necessitated total hip replacement. Pathological specimens were available for evaluation. In all 3 cases, epiphysiolysis was accompanied by severe subperiosteal reabsorption along the medial aspect of the femoral neck, widening of the cartilaginous growth plate, and coxa vara. The radiographic diagnosis of a minimally displaced femoral epiphysis may precede the clinical symptoms. Early recognition of this complication is important, since the treatment of choice is prophylactic surgical stabilization before disabling deformities occur.

Case Report 280

Fig. 1 A, B. Posteroanterior and lateral views of the left knee show a well-defined, ovoid, lytic lesion in the diametaphysis of the tibia. The lesion extends to the subarticular margin of the proximal end of the tibia. The osteolytic area shows a relatively narrow zone of transition around its margins. A sclerotic rim borders the inferior aspect of the lesion. The cortex on the medial surface adjacent to the osteolytic area is thinned. An ovoid, welldefined, calcific density occupies the lower half of the osteolytic lesion. No soft tissue mass is identified and no cortical break is defined. The lesion radiologically is expanding the bone asymmetrically

Case report 774

The parosteal lipoma is a rare but recognizable lesion. The combination of (a) a well-defined, radiolucent, soft-tissue mass that on CT is confirmed to be entirely composed of homogenous mature adipose tissue and (b) an osseous excresence and/or saucerization at the attachment of the soft-tissue mass to the subjacent cortex should be diagnostic. We were unable to find any other case report of a parosteal lipoma coexisting with another lipoma in the same individual.

Femoral neck fractures complicating gaucher disease in children

In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton [16, 17]. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One childs fracture was preceeded by multiple bone “crises” localized to the proximal femora.