Byron G. Brogdon

Role of Radiology in a National Initiative to Interdict Drug Smuggling: The Dutch Experience

OBJECTIVE The purpose of this pictorial essay is to describe the role of radiology in a national initiative to intercept illegal narcotics concealed within the bodies of human transporters. CONCLUSION Radiologic examination is increasingly important in identifying intracorporeal drug smuggling as improved wrapping techniques undermine the usefulness of blood and urine testing and clinical observation. Detection rates of high accuracy, sensitivity, and specificity are achieved by experienced radiologists.

Luxatio erecta of the hip: a critical retrospective

Abstract The term ”luxatio erecta” has been borrowed from the shoulder to identify rare traumatic hip dislocations in which there is inferior dislocation of the femoral head and inversion of the femoral shaft. A review of the literature is presented along with an additional illustrative case. The mechanism of injury, and the radiological and physical appearance of the patient, indicate that there are two subtypes of dislocation hitherto lumped together under the single term.

Tumoral calcinosis in an infant

Abstract We report tumoral calcinosis, an uncommon disease of uncertain origin, in an infant – only the sixth instance of the disease reported in this age group. The radiologic features are typical as illustrated by three modalities. The clinical, radiologic and pathologic features are discussed along with comments concerning possible etiologies and management.

Skeletal findings in Marinesco-Sjögren syndrome

Abstract Objective. To describe the appearance and frequency of skeletal abnormalities associated with the Marinesco-Sjögren syndrome of cerebellar ataxia, congenital cataracts, mental and physical retardation and myopathy. Subjects and methods. Seventeen individuals affected with the disorder, of common ancestry and marked consanguinity, were found in an isolated area in southwest Alabama; 11 were available for radiologic examination of parts of the skeleton. The range and frequency of skeletal abnormalities thus demonstrated were tabulated. Results and conclusion. A constellation of cranial and extracranial skeletal abnormalities – including a small posterior fossa, spinal abnormalities, gracile bones, elbow and hip valgus and asymmetric metacarpal and metatarsal shortening – can lead the radiologist or orthopaedist to suggest the diagnosis, especially if appropriate neurological/neuroradiological findings also are present.

Intrathoracic fracture-dislocation of the humerus

ConclusionTwo cases of the rarest form of shoulder dislocation are presented with, for the first time we believe, CT images of the intrathoracic fracture-dislocation of the humerus. Unlike the three cases earlier reported, our patients did sustain rib fractures. However, as in the previous cases, there was no serious damage to arteries or nerves. It appears that the humeral head fragment can be left inside the thorax with impunity, and that conservative, nonoperative management of the injury is indicated.

Case report 874

Fig. 1. A Uncontrasted coronal computed tomogram (CT) of the orbit shows a 2-cm partially calcified subperiosteal mass in the superolateral aspect of the orbit, accompanied by thinning and elevation of the orbital plate of the frontal bone. B Postcontrast axial CT shows mild enhancement of the mass. Inferior displacement of the orbital contents is obvious in both planes Fig. 2. On presentation for ophthalmological examination, the patients left eyelids were swollen with narrowing of the palpebral aperture. Compared to its counterpart, the left eye was displaced anteriorly, inferiorly, and nasally

Perivascular Fibrosis in the Bone Marrow in Sickle Cell Disease

CONTEXT Magnetic resonance imaging of bone marrow in homozygous sickle cell disease (hemoglobin [Hb] SS) shows nonhomogeneous, mottled signals that increase with age and number of crises. The pattern of these signals is reminiscent of the underlying vascular architecture, but histopathology of this tissue has not been adequately studied. OBJECTIVE To elucidate the histopathology of blood vessels in the bone marrow in sickle cell disease. DESIGN Retrospective histochemical morphometric study of bone marrow arteries by point counting in HbSS (13 cases) and sickle cell Hb C (HbSC) (8 cases) compared to nonanemic normal controls (HbAA) (10 cases). All patients were nondiabetic, normotensive, younger than 37 years, and matched for age group. RESULTS The mean point count for perivascular fibrous tissue was significantly greater in the HbSS group (P <.001) in both small (P <.001) and medium-sized (P =.002) vessels, and in both age groups (pediatric, P <.001; adult, P =.005) compared with the HbAA group. Additional analysis showed the difference was significant in HbSS pediatric small vessels (P <.001) and in pediatric and adult medium vessels (P =.045 and P =.03, respectively). Ratios of fibrous tissue to muscle showed proportionately greater fibrous tissue in HbSS pediatric small (P <.001) and medium-sized vessels (P =.02), and in adult large vessels (P =.03). Mean point counts for muscle were significantly decreased in HbSS small vessels when all ages were compared as a group (P =.02), but when compared by age groups, counts were significantly increased in adult HbSS medium-sized vessels (P =.01). Overall mean point counts for muscle and fibrous tissue in the HbSC group were intermediate between those of the HbSS and HbAA groups, but were not significantly different from counts in the HbAA group (P =.78 and P =.35, respectively). CONCLUSION In sickle cell disease, arterial vessels in the bone marrow show significantly increased fibrous connective tissue and changes in muscle that vary with age and vessel size.

Posttraumatic osteochondral defect of the distal tibia

Osteochondral fracture of the distal tibia is an uncommon injury. We report two cases in which ankle trauma resulted in an elongated osteochondral defect in the distal tibia, and we describe the radiographic, scintigraphic, computed tomographic, magnetic resonance, and arthroscopic findings.

Osteoid osteoma of the mastoid tip.

This healthy 29-year-old man came to an otolaryngologist with a history of pain behind his left ear for 2-3 weeks. He denied any previous trauma, fever, otic discharge, sinus disease or other health problems. There was no significant past medical history. Minimal soft tissue swelling was present over the left mastoid tip. The pain was not elicited or enhanced by palpation, but a small area of increased firmness could be felt beneath the diffuse swelling. He was sent for a CT study, and 1.5-ram sections through the mastoid region with bone-window levels were obtained (Fig. 1). These revealed cortical thickening in the mastoid tip enclosing a 1-2 cm area of rarefaction within which resided a separate dense button or sequestrum of bone or calcium. The underlying mastoid air cells were normal. Minimal overlying soft-tissue swelling could be appreciated. The patient was taken to the operating room where the entire lesion was excised. The clinical diagnosis was osteomyelitis with sequestrum formation, but this was unsupported by the history, clinical findings or by radiographic evidence of mastoid inflammatory disease. Microscopic examination (Fig. 2) showed the 1.0 cm diameter lesion to be surrounded by a partial fibrous capsule. Small regular seams of osteoid become confluent in part of the specimen. Each seam is surrounded by plump osteoblasts with a lesser component of osteoclastic activity. The intervening stroma is fibrovascular. These features are diagnostic of osteoid osteoma.

Accessory cardiac bronchus: Demonstration by computed tomography

Distinctive computed tomography features of the accessory cardiac bronchus are illustrated. Bronchial anomalies, while rare, are important to recognize, especially if bronchoscopy or surgery is anticipated. Related clinical symptoms are thought to be secondary to retained secretions.