Charles S. Resnik

Computed tomography of desmoid tumors of bone: desmoplastic fibroma

Desmoplastic fibroma of bone is a rare benign tumor, first described by Jaffe in 1958 [6]. Since then approximately 80 cases have been reported in the long bones, although the tumor also involves the jaw bones, particularly the mandible. The plain film features consist of a lytic, expansile lesion, usually in the metaphysis of bone, sometimes extending into the soft tissues. We present two cases involving the long bones in which the correct diagnosis was suggested by computed tomography (CT). The CT appearance of the lesions is described.

Case report 594

A case of destructive osseous sarcoidosis involving the lower lumbar spine, sacrum, and pelvis has been presented. The pattern of multiple small lytic lesions without sclerosis in this distribution has not been described previously. Identification of these lesions was only possible by computed tomography and differentiation from metastatic disease required open biopsy.

Translunate, palmar perilunate fracture-subluxation of the wrist

Three cases of palmar perilunate subluxation associated with a fracture of the palmar pole of the lunate are described. Wrist hyperflexion with a longitudinal loading force transmitted through the capitate probably accounts for this injury.

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.

Case report 767

Correspondence to: Charles S. Resnik, M.D., Department of Diagnostic Radiology, University of Maryland Medical System/ Hospital, 22 South Greene Street, Baltimore MD 21201, USA Fig. 1. A Anteroposterior and B lateral radiographs reveal destruction of bone within the proximal portion of the tibia, with a large soft tissue mass containing extensive poorly defined mineralization. A separate area of well-defined calcification is present in the distal portion of the femur Fig. 2. An anteroposterior scout radiograph shows a destructive lesion of the tibia and ossification in the surrounding soft tissue mass. A portion of a well-defined shell of calcification can be seen just proximal to this area at the level of the paper clip marker. A similar well-defined shell of calcification is evident in the contralateral tibia

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.

Chronic septic arthritis of the adult hip: computed tomographic features

Abnormalities on computed tomography (CT) are described in 12 adults in whom septic arthritis of the hip was diagnosed. Presenting symptoms varied, as did CT findings. Soft tissue abnormalities ranged from intra-articular effusion to large abscess formation, and bone changes ranged from minimal erosion of articular surfaces to gross destruction of the proximal femur and acetabulum. CT can be helpful in the evaluation of septic arthritis of the hip because of its superior demonstration of soft tissue detail. An accurate diagnosis can be established in unsuspected cases and can be confirmed when clinical indicators are vague.

Balancing Clinical Service and Education in the Radiology Residency

RATIONALE AND OBJECTIVES Among the various medical disciplines, the radiology residency faces unique challenges when balancing clinical service and education, which have not been explored in the literature. MATERIALS AND METHODS The authors present a summary of material generated during collaborative sessions at the 56th Annual Meeting of the Association of University Radiologists in Seattle, Washington, in March 2008, including strategies on maintaining an appropriate emphasis on education in the face of increasing service obligations, with a review of the pertinent literature. RESULTS Although the topic of service and education has been explored in the medical and surgical literature, little has been published in the radiology literature. The portability of radiology and the relative lack of patient contact can lead to the redistribution of residents as a matter of convenience to fill service gaps, often at the expense of the educational goals of training programs. Residents and faculty members alike must take part in both service and educational obligations without compromising patient care. Physician extenders, call schedule optimization, and other strategies and resources can help ensure that a proper balance is maintained. CONCLUSION The radiology residency presents unique challenges to the service and education balance. The authors highlight several strategies to address these challenges.

Case report 780

This 29-year-old woman presented to the painful foot clinic approximately 1 year after the onset of bilateral anterior ankle pain. She gave a history of walking along the beach for a distance of approximately 4 miles (7 km) while on vacation. On the return leg of her walk, she experienced two distinct periods of acute severe pain in the anterior ankle areas. Several days later she noticed swelling and bruising at these sites. The pain became chronic but continued to be debilitating, progressing to the point where she could only walk one to two blocks before she had to stop. She had to discontinue all sports activity, dancing, and any other activity requiring prolonged standing. Her past medical history was remarkable only for Grave s disease. She did recall diffuse ankle pain on occasion while she was growing up, but no t reatment was ever sought. She was working full time as a laboratory technician on the University campus. Her physical exam revealed normal feet and a bilateral heel-toe antalgic gait. Vascular and neurological evaluations were unremarkable, with no sensory or moto r deficit noted. Mild diffuse tenderness over the sinus tarsi area bilaterally and localized tenderness directly over both talonavicular joints were present. The range of mot ion was normal at the

Case report 660

An adamantinoma of the tibia is presented, for which the CT and MRI characteristics are described. Both imaging modalities were excellent in providing information as to the extent and invasiveness of the tumor, although MRI had the advantage of providing immediate high quality sagittal visualization. Comparison is made briefly between adamantinoma and both fibrous dysplasia and osteofibrous dysplasia.