Hossein Firooznia

Computed tomography (CT) arthrography of shoulder instabilities in athletes

Sixty professional and recreational athletes underwent CT arthrography of the shoulder for evaluation of sus pected shoulder joint derangement. These athletes, 46 males and 14 females ranging in age from 15 to 60 years (mean, 32 years), all had persistent pain that interfered with their sports activity and was resistant to conservative treatment. Seventeen patients had shoulder instability based on clinical manifestations and CT arthrographic findings. An additional five patients, also based on clinical mani festations and CT arthrographic findings, were consid ered to have an unobtrusive degree of anterior joint laxity. Patients with anterior instability (20 cases) all had an anteroinferior tear or detachment of the glenoid labrum, as well as some violation of the insertion of the joint capsule onto the scapula. Those with posterior instability (two cases) had a combination of labral and capsular tears. Two other major patterns of labral tears, both unaf filiated with shoulder instability, were identified. These included total or partial detachment of superior seg ments of the labrum, and anterior labral tears at the midglenoid level. Moreover, various degrees of labral attenuation (or, less often, enlargement), osteophyte formation, and alterations in articular cartilage were observed. Surgical correlation was obtained in 25 pa tients, with 95% accuracy of CT arthrographic findings. CT arthrography is a minimally invasive and highly accurate technique for investigation of glenohumeral derangement. Specifically, the extent of pathologic changes associated with instability can be determined and differentiated from other intraarticular causes of incapacity, such as labral tears caused by throwing, or degenerative changes.

Sudden quadriplegia after a minor trauma. The role of preexisting spinal stenosis.

Three patients are described who became quadriplegic after a minor trauma to the spine without suffering a spinal fracture dislocation. Radiologic investigation revealed marked stenosis of the spinal canal, due to developmental stenosis with superimposed degenerative changes in two patients, and calcification of posterior longitudinal ligament of the spine in one. Two patients recovered almost completely with conservative measures. The spinal cord may be able to tolerate slowly increasing mechanical pressure for many years and conform to the shape of the spinal canal without causing any neurological symptoms. However, when stenosis is severe, any additional pressure, for example, swelling and edema from trauma, may cause a neurologic catastrophe.

Quantitative computed tomography assessment of spinal trabecular bone. I. Age-related regression in normal men and women

Computed tomography, utilized in conjunction with a calibrated phantom containing a set of reference densities (K2HPO4 and water), is capable of determining the mineral content of the trabecular bone of the spine with an accuracy of about 6% of the ash weight of the vertebrae scanned (specimen studies). Other modalities measure a composite of cortical and trabecular bone. Computed tomography is capable of exclusively measuring the mineral content of the trabecular bone of the spine, where the earliest and most pronounced changes of spinal osteoporosis occur. Quantitative computed tomography measurements are useful for a precise and objective assessment of the spinal mineral content and its changes with age, disease, and drugs.

Pathologic fracture in systemic mastocytosis. Radiographic spectrum and review of the literature.

Systemic mastocytosis is a multiorgan disease that most commonly affects the skin and skeletal system. Radiographically, the skeletal changes in the majority of patients consist of either a wide-spread mixture of bone lysis and osteosclerosis or generalized osteoporosis. The osteoporotic form is less well known but may lead to severe generalized demineralization and pathologic fractures. Mast cells secrete a number of substances, two of which (heparin and prostaglandins) are believed to have a role in the induction of osteoporosis. Sclerotic lesions are induced by another mast cell by-product, histamine. One hundred seventy-eight cases of bony mastocytosis have been reported in the literature, including the four patients in the present report. Special staining procedures are necessary for identification of mast cells. Diagnosis may be delayed in patients who do not have the skin lesions (urticaria pigmentosa) and in the osteoporotic form of the disease.

Disseminated Extrapulmonary Tuberculosis in Association with Heroin Addiction

Twenty-one cases of disseminated extrapulmonary tuberculosis occurring in heroin addicts are tabulated and three are discussed in detail. The most frequent sites of involvement were the ribs and spine followed by the femur, clavicle, skull, and pelvis. While disseminated extrapulmonary tuberculosis also occurred in the nonaddict population, the marked increase in incidence in the addict population suggests the possibility of an alteration in the immune mechanism related to the use of heroin.

Hypertrophic Pulmonary Osteoarthropathy in Pulmonary Metastases

Hypertrophic pulmonary osteoarthropathy is most commonly encountered in association with bronchogenic carcinoma and tumors of the pleura. Its association with pulmonary metastases from extrathoracic neoplasms is rare, with only 44 documented cases in the literature. Three additional cases are reported. Nearly half of the reported cases have been sarcomas, mainly of bone and soft tissues; among the rest are tumors of the nasopharynx and uterus and cervix. It has recently been noted that symptoms can be dramatically relieved by intrathoracic or cervical vagotomy.

Fibrobullous disease of the upper lobes: An extraskeletal manifestation of ankylosing spondylitis

Fibrobullous disease of the upper lobes of the lungs is a rare extraskeletal manifestation of ankylosing spondylitis, occurring in 1.3% of patients with ankylosing spondylitis. We present a patient with this disease, and discuss this pulmonary manifestation. Because the radiographic appearance of the chest in this disease resembles that in tuberculosis, many patients are misdiagnosed and treated for tuberculosis despite negative bacteriology. Computed tomography is useful in delineating the extent of pleural thickening, bullous changes, volume loss, parenchymal fibrosis, and bronchiectasis, as well as identifying or excluding an intracavitary pulmonary mycetoma.

Quantitative computed tomography assessment of spinal trabecular bone. II. In osteoporotic women with and without vertebral fractures

Computed tomography was utilized to measure the bone mineral content of the spinal trabecular bone in 96 osteoporotic women. A significant overlapping was found between the values obtained for these patients and the age-matched normal values. Sixty-six percent had bone mineral content values below the fifth percentile for age-matched normals. Eighty-five percent of those with vertebral fractures had bone mineral content values below the fifth percentile for normal premenopausal women (fracture threshold). It is suggested that diagnosis of osteoporosis be made when the spinal bone mineral content value is below the fracture threshold.

Radiation induced fractures of sacrum: CT diagnosis

Sacral insufficiency fracture due to bone atrophy may develop as a complication of irradiation of pelvic malignancies. Pain is the presenting symptom and the clinical diagnoses most often considered are recurrence of the original malignancy and metastatic disease. Computed tomography provides the most specific information helpful for the detection of these fractures and for exclusion of recurrent malignancy.

The impact of CT in clinical management of pelvic and acetabular fractures.

Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary.