Jeremy W. R. Young

The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine

Widening of the retropharyngeal soft tissue space (RSTS) has been interpreted as a sign of cervical spine trauma. Widely differing measurements are reported in the literature. However it is clear that, using the currently acceptable limits of normal, a large number of patients without spinal injury are subjected to further tests. The RSTS on lateral cervical spine radiographs of 318 patients with a history of cervical spine trauma were measured at the C2−C4 level. The values for patients found to be normal or with fractures/dislocations were evaluated. Statistical analysis of the results demonstrates a considerable overlap in the RSTS of normal and abnormal patients. Therefore we suggest that RSTS measurements are of limited diagnostic value. Using the statistical probability of abnormality, guidelines that indicate which patients may require additional study are suggested.

Giant cell tumor of the spine: computed tomography appearance and review of the literature

Giant cell tumor of the vertebral body is a rare but well-recognized entity with a reported incidence between 1.3% and 9.3% of all giant cell tumors. It has been suggested that computed tomography may be helpful in making the diagnosis, although computed tomography appearances have only been described on two occasions. A case of giant cell tumor of the thoracic spine and a review of the literature regarding this entity are presented. The computed tomography appearance of this lesion is described. However, a distinctive pattern, as previously suggested, is not demonstrated. Although we are not convinced that computed tomography provides a definitive diagnosis in cases of spinal giant cell tumor, it is a valuable asset in defining the extent of the tumor and in posttherapy evaluation and follow-up.

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.

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

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.

The bowler hat: a valid sign of colonic polyps?

This report briefly describes several cases of diverticula simulating colonic mucosal lesions. We have found that the bowler hat configuration, in particular, frequently occurs in the presence of diverticular disease. In our series, no polyp was found to exhibit the bowler hat sign, while 12 cases of diverticular disease displayed 1 or more “bowler hats.” Differentiation between polyps and diverticula displaying the bowler hat sign may be possible, but we conclude that the bowler hat sign per se is a nonspecific finding and that additional views may be necessary to confirm the presence of polyps.

Malignant fibrous histiocytoma of the spine: Computed tomography appearance and review of the literature

Malignant fibrous histiocytoma of bone was first described as a separate entity in 1972. It is an uncommon tumor occurring in older age groups and only rarely occurs in the spine. The plain film radiographic features of this condition have been described, however, we have found no reports of the computed tomography appearance. We present a case of spinal malignant fibrous histiocytoma that occurred in a 17-year-old female. The computed tomography characteristics of this lesion are described, and use of computed tomography in the evaluation of malignant fibrous histiocytoma of the spine is defined.

Case report 618

A patient with a history of angioblastic meningioma 7 years previously developed lytic metastatic disease to the femur at two separate sites. The controversy in terminology of angioblastic meningioma and hemangiopericytoma and the similarity in radiological and pathological appearance of primary and metastatic hemangiopericytoma of bone illustrate the need for an accurate clinical history to arrive at a correct diagnosis.

Case report 604

An 18-year-old female first noticed a small lump on the anterior surface of her tibia approximately 1 year prior to admission. It had since been growing slowly until the past month (before presentation) when it began to grow more rapidly and became increasingly painful. The pain was present at rest and was exacerbated by activity. On physical examination, the palpable mass was approximately 2 c m x 4 c m and was markedly tender to palpation with no associated redness or soft tissue swelling. All laboratory values including erythrocyte sedimentation rate were normal. Radiographs of the proximal portion of the tibia revealed a very welldefined, multilocular radiolucency within the anterior cortex. There was bulging of the anterior surface corresponding to the palpable mass, with some sclerosis surrounding the lesion (Fig. 1). Computed tomography confirmed the intracortical location of the lesion and demonstrated no breakthrough into soft tissue or medullary involvement (Fig. 2). Surgical resection of the lesion was performed.