Jack G. Rabinowitz

Congenital rickets associated with magnesium sulfate infusion for tocolysis

The records of five neonates born to mothers treated with intravenously administered magnesium sulfate for tocolysis were retrospectively reviewed to assess the presence of radiographic, clinical, and biochemical abnormalities. Two infants had radiographic bony abnormalities; one had frank rachitic changes and dental enamel hypoplasia. One of these patients, as well as an additional infant, had transient hypocalcemia. We hypothesize that prolonged infusion of magnesium sulfate, especially when initiated during the second trimester, may lead to fetal parathyroid gland suppression with consequent abnormalities resembling rickets.

Pleural involvement in sarcoidosis

Abstract A review of the records of 227 patients with biopsy proved sarcoidosis disclosed roentgenographic evidence of pleural reactions (pleural effusion and/or pleural thickening) in 23 (10.1 per cent). Pleural effusions were noted in 15, and in all of these the disease process showed signs of progression to stage 2 or beyond. Transudative effusions were found in eight patients. Pleural biopsies in seven patients with effusion disclosed noncaseating granulomas consistent with sarcoidosis. An extensive evaluation for other underlying disease processes, in all cases was negative. The effusions resolved, but in two patients serial roentgenographic studies showed progression to chronic pleural thickening. Pleural thickening was observed initially in eight patients and was always associated with an advanced stage of sarcoidosis. Biopsies performed in five of these patients showed thickened fibrotic pleura interspersed with noncaseating granulomas. On review of lung biopsy specimens from 11 patients with no roentgenographic indication of pleural reactions, noncaseating granulomas in simultaneously obtained pleura were found in four. The pleura is affected in sarcoidosis more frequently than has been recognized. The occurrence of pleural involvement and reaction is a consequence of sarcoidosis and appears to be associated with the progression of the disease process.

Trisomy 18, Esophageal Atresia, Anomalies of the Radius, and Congenital Hypoplastic Thrombocytopenia

Since the initial description of trisomy 17–18 as a clinical syndrome (1), a large number of reports have delineated a variety of its clinical and roentgen features (2–4). The combination of characteristic findings often permits diagnosis prior to chromosomal confirmation. We have recently observed three cases of trisomy 18 with unusual manifestations that warrant inclusion in the expanding clinical spectrum of this syndrome. These changes were esophageal atresia, malformations of the radius, and congenital thrombocytopenia. Radial anomalies were present in all three infants, esophageal atresia and thrombocytopenia in two. One child died within thirty hours after birth, and a chromosomal karyotype was not obtained. The clinical, roentgenological, and pathological findings, however, were characteristic of trisomy 18. Karyotype confirmation of trisomy 18 was obtained in the other two infants. CASE I: A 1600 g female was delivered by a 30-year-old mother following a forty-week gestation. Labor was induced be...

Fibrous mediastinitis: a late manifestation of mediastinal histoplasmosis.

Fibrosing mediastinitis is an uncommon manifestation of histoplasmosis that occurs primarily in younger patients. Findings include tracheobronchial narrowing, compromise of the main pulmonary artery and veins, and circumferential narrowing of the esophagus. The initial chest radiograph is often diagnostic, although additional studies including tomography and angiography help clarify the extent and severity of the disease process.

Central pontine myelinolysis with clinical recovery: MR documentation.

Magnetic resonance (MR) features of a patient with profound hyponatremia and clinical findings of central pontine myelinolysis are presented. Resolution of the MR findings paralleled the clinical recovery.

Atypical skeletal tuberculosis mimicking neoplasm.

Although the radiographic features of skeletal tuberculosis are well described, little has been written regarding tuberculous involvement of the shaft of tubular bones. In general, para-articular regions are mainly affected. Only 10% of cases spare the joint, and the majority of these are metaphyseal. Diaphyseal disease is rare and the radiographic features are variable and at times confusing. Pulmonary tuberculosis with subsequent skeletal tuberculosis is being encountered with increasing frequency (DHHS, 1988). Our recent experience with two unusual presentations prompted this report. Two patients, both women, were diagnosed with focal bone tuberculosis. The lesion involved the left tibia in a 40-year-old woman of Chinese extraction and the pubic ramus in a 46-year-old black woman. Conventional radiography, bone scanning and computed tomography (CT) were performed on both patients. In addition, angiography and magnetic resonance imaging (MRI) were also performed on the second patient. The diagnosis was ...

Macroaggregated RISA Lung Scan in Congenital Heart Disease

Macroaggregated RISA lung scans in 60 children with various congenital heart diseases were correlated with abnormal patterns of certain specific types of abnormality. Renal activity in patients with right-to-left cardiovascular shunts and its amount could be used as an index to shunt magnitude. Scans following surgery helped evaluate its effectiveness. Patency of a sub-clavian-pulmonary anastomosis was verified by demonstrating diminished activity in the lung on the side of the shunt and in the kidneys. In severe cyanotic congenital heart disease, the lung scan served as an additional guide when findings suggestive of thrombosis were observed.

Renal pelvic carcinoma. An angiographic re-evaluation.

A series of 22 cases of renal pelvic carcinoma were reviewed in an attempt to find characteristics which would distinguish this entity from hypernephroma which it closely resembles. Distinctive angiographic characteristics are enlarged pelviureteric artery, fine neovascularity, vascular encasement, and absence of arteriovenous shunting. Since ureteronephrectomy is the preferred treatment for renal pelvic carcinoma, the importance of differentiating this tumor from other renal lesions is strongly stressed.

Pulmonary manifestations of blastomycosis. Radiological support of a new concept.

The pulmonary manifestations of blastomycosis were observed in 51 patients and correlated with their location in the lungs and the clinical appearance of the patient. Blastomycosis is primarily an airbone infection that occurs in both acute and chronic forms and follows a specific pathway within the lungs. It must be strongly considered in the differential diagnosis of pulmonary lesions in geographical areas endemic to the disease.

Case report. Aneurysm of the ductus arteriosus in an adult.

Aneurysm of the ductus arteriosus is unusual in the adult. Computed tomography (CT) may be critical in making a preoperative diagnosis. The value of CT in the diagnosis of this entity, as well as its likely pathogenesis, is discussed.