Jack Edeiken

Complications of radiation therapy: Adult bone

T HE skeletal effects of radiation are dependent upon many variables, but the pathologic features are consistent. Radiation may cause immediate or delayed cell death, cellular injury with recovery, arrest of cellular division, or abnormal repair with neoplasia.‘* Fabrikant et al. administered bone-seeking isotopes to rats and caused changes similar to those seen in humans, namely growth and modeling disturbances, bone necrosis, and neoplasia.’ The effects of radiation in childhood are discussed elsewhere in this Seminar and hence are not included in this paper. Hypoplasia of the ilium and scoliosis secondary to abnormal vertebral configuration are characteristic roentgen features.21’23

Computed tomography of stress fracture

An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic.

Tubular carcinoma of the breast. Mammographic appearance and pathological correlation.

Xeromammographic and pathological findings in 17 cases of tubular carcinoma of the breast are presented. No patients had axillary lymph node involvement. The mean lesion size was 0.95 cm. Thirteen lesions (76%) were clinically occult. Because of the characteristic histological pattern of infiltrative growth and marked desmoplasia, 81% (13/16) were seen on xeromammography as scirrhous masses, 19% (3/16) only as microcalcifications. None appeared as a well-circumscribed mass or poorly defined density.

Fibrous dysplasia of the facial bones and mandible

Five cases of fibrous dysplasia isolated to the facial bones and mandible are presented. A review of the clinical and roentgen features of facial fibrous dysplasia are described.

Ischemic necrosis of the femoral head simulating chondroblastoma.

Two cases of ischemic necrosis strongly resembling chondroblastoma are described. The subtle differentiating features consist of round or oval borders in chondroblastoma vs. partially angular or straight borders in ischemic necrosis. In chondroblastoma, the calcific densities seen in about 50% of cases are sometimes floccular-punctate in appearance, hence distinguishable from the mottled trabecular arrangement of healed ischemic necrosis.

Use of radiography for screening employees for risk of low-back disability.

Low-back pain continues to be a major industrial health problem in terms of compensation costs and disability. Preemployment lumbar spine radiographic screening was first used on a large scale during the early post-World War II period. Since then, numerous publications have argued for or against its use. Nevertheless, studies have been limited to one company or industry, controls have been lacking, and the research design has often been poor. This paper summarizes the available information and argues for the need to design and implement a study to determine the value of preemployment radiographs in predicting future low-back pain and injuries.

Arteriovenous malformation of the hand with involvement of bone

A case of arteriovenous malformation of the hand involving bone is presented. Changes in the involved bone may be characteristic but are usually not diagnostic. The value of arteriography in the diagnosis of arteriovenous malformation is emphasized, since biopsy may be hazardous and even misleading.