Burton I. Ellis

Case report 710

We present a case of symmetrical EG of the lower extremities in a 36-year-old man. Several entities are considered in the differential diagnosis. However, many of the features bear a striking resemblance to ECD, which probably coexists in this case. A link between the two entities, EG and ECD, has been suggested by others. Future experience may confirm this hypothesis.

Case report 811

Fig. 2. Lateral fluoroscopic spot film during pronation again demonstrates the osseous density (arrows) extending from the proximal radial tuberosity toward the ulna Fig. 3A, B. Axial computed tomographic sections of the proximal forearm in supination and pronation demonstrate an avulsed fragment slightly separated from the underlying radial tuberosity. On pronation the fragment nearly contacts the ulna Clinical information

Case report 538

This 27-year-old black man presented to the Henry Ford Hospital (Orthopedic clinic) reporting a painful, slowly growing mass of the left foot which had become more noticeable in the past two weeks. Occasional pain had been present in the region of the mass for several months. No fever, chills, weight loss, or other constitutional symptoms were present. Bunion surgery of the first toe had been performed uneventfully nine years earlier. Physical examination revealed a firm, mildly tender mass over the dorsum of the left foot in the metatarsal region. Neurovascular status of the extremity was intact and a normal range of motion of the foot and toes was present. Laboratory data were unremarkable. Radiographs revealed a lesion of the second metatarsal shaft with mild sclerosis and marked periosteal reaction that was spiculated in one area of cortical saucerization (Fig. 1). A radionuclide bone scan showed increased uptake at the site of the lesion, nonspecific in nature. Further evaluation included computed tomography (Fig. 2) and magnetic resonance imaging (Figs. 3, 4). Definitive surgery was performed with resection of the second metatarsal and placement of iliac crest bone graft.

Replication of diagnostic radiographs using a film scanning/printing system

Digital film scanning/printing systems which do not alter the diagnostic content of radiographs are required for diagnostic teleradiography, electronic image archiving, and image enhancement. Described is a high fidelity system capable of digitizing and reprinting films with minimal alteration of detail or degradation of noise for either general radiographs or mammograms. The system transfers resolution up to 10 lp/mm and has a useful density range of 0-3.5. Examples of chest, bone and breast films are presented.

Case report 523

A 21-year-old, black man presented to Henry Ford Hospital in April, 1987, complaining of pain and swelling over the dorsum of his left foot for approximately two years, aggravated by excessive activity. He had been treated by an outside physician, in February 1987, for tendonitis of the left foot. Physical examination revealed swelling and tenderness over the dorsum of the left foot with normal strength and reflexes. Range of motion was lim-

Juxta-articular large cell lymphoma

Three patients with juxta-articular large cell lymphoma presented as suffering from monarthropathies. A spectrum of radiographic changes was observed that included subchondral sclerosis, regional osteopenia, effusion, and mottled lytic changes in the juxta-articular region of the affected joint. MRI was performed in two patients. In one, it revealed a high signal mass on T2-weighted sequences. In the second, a mass bridging the joint was demonstrated which was difficult to appreciate on CT and was not visible radiographically. In all cases, biopsies revealed large cell non-Hodgkins lymphoma of bone. We present these studies to emphasize this unusual pattern of non-Hodgkins lymphoma as well as to demonstrate the contribution of MRI to the diagnosis.

Case report 456

This 72-year-old woman presented to the emergency ward of the Henry Ford Hospital complaining of pain in the left wrist following minor trauma. Physical examination demonstrated swelling of the soft tissues around the wrist, with severe tenderness to palpation over the dorsum of the wrist. The tenderness was most marked in the region of the scaphoid, trapezium, and trapezoid bones. Routine roentgenograms of the left wrist were obtained (Fig. 1). The patient was placed in a wrist splint and observed in the Orthopedic Clinic 3 days later. At the time of follow-up, physical examination demonstrated diffuse soft tissue swelling over the dorsum of the wrist with tenderness over the scaphoid, trapezium, and anatomical snuff box. In addition, tenderness over the radiocarpal and ulnar-carpal articulations was noted. Comparison views of the asymptomatic right wrist were obtained and will be demonstrated subsequently (Fig. 2). Detailed questioning failed to elucidate a history of previous injury to the right wrist. The patient was treated with analgesics until one month later when she experienced a recurrent attack of pain in the left wrist. This episode occurred without antecedent trauma. Findings at this time were considered to be consistent with synovitis. The patient was treated symptomatically.