Andrew L. Deutsch

IMAGING OF STRESS INJURIES TO BONE: Radiography, Scintigraphy, and MR Imaging

Although conventional radiographs continue to be used as a primary method for the diagnosis of stress fractures, the limitations of radiography in early detection have been increasingly recognized. Advanced imaging techniques, including radionuclide methods, and more recently, MR imaging, have increasingly been employed in the assessment of stress fractures, and have provided valuable insights into the spectrum of stress-related changes to bone. This article reviews the diagnostic methods available to the clinician for detection of stress injuries to bone.

Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis.

Abstract To assess the value of fiberoptic bronchoscopy and transbronchial biopsy for evaluating patients suspected of having tuberculosis, we reviewed the records of 56 patients (1974–1980). All patients (1) were clinically suspected of having active tuberculosis; (2) had an abnormality on chest roentgenogram consistent with tuberculosis; (3) had an absence of acid-fast bacilli on three sputum smears or an inability to produce sputum; (4) had undergone fiberoptic bronchoscopy and transbronchial biopsy. The evaluations included fiberoptic bronchoscopy with collection of bronchial washings and brushings, and transbronchial biopsy and postbronchoscopy sputum specimens. Thirteen patients subsequently underwent percutaneous needle aspiration and one underwent thoracotomy. Evaluations were diagnostic in 29 of the 56 patients (52 percent). Diagnoses were mycobacterial infection in 22 (39 percent) and other disease processes in seven (13 percent). Fiberoptic bronchoscopy and transbronchial biopsy provided a diagnosis when sputum cultures obtained before bronchoscopy were negative for Mycobacteria in 11 (20 percent) patients. Immediate diagnoses were made from microscopic specimens obtained from 11 of 23 (48 percent) fiberoptic bronchoscopy and transbronchial biopsy procedures on patients with previously undiagnosed mycobacterial infection. Transbronchial biopsy had the best yield for a microscopic diagnosis. On culture, bronchoscopy specimens had a lower yield (10 of 23 or 44 percent) than sputum specimens obtained before bronchoscopy (14 of 21 or 67 percent) probably due to the inhibition of mycobacterial growth by tetracaine. Of the patients in whom evaluation proved nondiagnostic, 17 of 27 were lost to follow-up; therefore, a definitive statement regarding the number of false negative evaluations is not possible. Fiberoptic bronchoscopy and transbronchial biopsy (FFB/TBB) is a useful procedure in evaluating patients with negative smears who are clinically suspected of having tuberculosis. It can improve the ability to document active tuberculosis, provide a sensitive means of making an immediate diagnosis, and uncover other disease processes presenting like tuberculosis.

Effect of a newly designed patellar realignment brace on patellofemoral relationships

The effect of applying a newly developed patellar realignment brace to a patient with lateral subluxation of the patella was evaluated using active movement, loaded kinematic magnetic resonance (MR) imaging. The brace corrected the lateral displacement of the patella as shown on the kinematic MR imaging study. The patient underwent physical rehabilitation in conjunction with the use of the patellar realignment brace and has had resolution of her painful symptoms for the past 4 months.

Tendon injuries of the lower extremity: Magnetic resonance assessment

MR is rapidly establishing itself as a premiere imaging modality for the assessment of musculoskeletal trauma. Its utility in the evaluation of the menisci and ligaments of the knee is well known, but there is far less known about the use of MR for evaluation of the tendons. MR, by virtue of its unmatched soft tissue resolution capability, can determine not only the contour of an affected tendon, but the tendon sheath and internal signal alterations that accompany tendonitis, partial and complete ruptures. Injuries to the Achilles tendon are well known to the athlete and the imager alike; however, abnormalities of the posterior tibial tendon, peroneal tendon, and flexor hallucis longus also result in significant clinical symptoms, as well as imaging abnormalities.

Sonographic Findings in Milk of Calcium Bile

The ultrasound findings in 2 cases of milk of calcium bile are reviewed. Although the plain film findings of milk of calcium bile are characteristic, the sonographic findings are variable and can lead to confusion with other disease processes. The composition and pathologic significance of milk of calcium bile are discussed.

Diagnosis of colonic varices by air-contrast barium enema examination: Report of a case

A case of colonic varices presenting as serpiginous and tubular submucosal lesions in the sigmoid on air-contrast enema examination is reported. The associated angiographic and colonoscopic findings are illustrated, and the pertinent literature is reviewed.

Articular disorders of the knee

In no musculoskeletal area has the marked growth and expansion of interest in the application of magnetic resonance imaging (MRI) been more evident than in assessment of articular disorders of the knee.1–27 The high accuracy of the method, coupled with its noninvasive nature and lack of operator dependence, has allowed MRI to challenge and indeed rapidly replace arthrography in many institutions. In addition to evaluation of meniscal and ligamentous abnormalities, MRI has demonstrated a markedly expanded diagnostic capacity to include a wide spectrum of abnormalities that may previously have escaped early detection with the use of arthrography or arthroscopy. It is anticipated that future technologic advances will further the diagnostic efficacy of the technique and its ultimate contribution to patient management. This article is based on our experience with more than 3,500 MR examinations of the knee. The discussion will emphasize salient aspects of technique, normal and pathologic anatomy, and potential pitfalls in interpretation of the examination. The accuracy of the method and its relation to other diagnostic techniques will be addressed.