Jonathan S. Luchs

Amyand's hernia: prospective CT diagnosis.

We report two cases of Amyands hernia, which is the development of acute appendicitis within an inguinal hernia. Both patients were clinically thought to have incarcerated inguinal hernias, but were correctly prospectively diagnosed as having Amyands hernia on the basis of preoperative computed tomography (CT) examinations. Our cases again show the utility of CT of the acute abdomen and pelvis in revealing a previously unsuspected diagnosis and rapidly triaging patients to the appropriate management.

Utility of hematuria testing in patients with suspected renal colic: correlation with unenhanced helical CT results

OBJECTIVES To determine the utility of hematuria testing in a large series of patients with suspected renal colic using unenhanced helical computed tomography (CT) as the reference standard. METHODS A retrospective review of the CT reports of all patients who underwent unenhanced helical CT for suspected renal colic at one institution during a 3.5-year period and who also underwent a formal microscopic urinalysis within 24 hours of the CT study was conducted. The sensitivity, specificity, positive predictive value, and negative predictive value of the presence of any blood on the urinalysis for renal colic were calculated. RESULTS Urolithiasis was present in 587 (62%) of the 950 patients, and 363 patients had negative examinations for renal colic, including 69 with significant alternative diagnoses in the latter group. Of the urinalyses, 492 were true-positive, 174 were true-negative, 189 were false-positive, and 95 were false-negative, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 48%, 72%, and 65%, respectively. Forty-six percent of the urinalysis results were negative for blood in the subset of patients with significant alternative diagnoses. CONCLUSIONS The sensitivity of hematuria on microscopic urinalysis for renal colic using unenhanced CT as the reference standard was 84%, and the specificity and negative predictive value was low. The presence or absence of blood on urinalysis cannot be used to reliably determine which patients actually have ureteral stones.

McCune-Albright Syndrome: intensely hypermetabolic polyostotic fibrous dysplasia on F-18 FDG-PET.

We present a 30-year-old woman with a medical history of McCune-Albright Syndrome who underwent an F-18 FDG-PET scan for further evaluation of cervical adenopathy noted on a recent computed tomographic examination. Intensely hypermetabolic foci were noted in the axial and appendicular osseous structures, correlating with foci of polyostotic fibrous dysplasia seen on CT scan. Increased uptake of Tc-99 MDP or HDP in polyostotic fibrous dysplasia is well described. The potential for misdiagnosis of intensely hypermetabolic foci involving fibrous dysplasia on F-18 FDG-PET scan has also been described. This is a rare case of FDG-PET hypermetabolism of polyostotic fibrous dysplasia in the setting of McCuneAlbright Syndrome.

Cubital tunnel syndrome caused by a synovial cyst: report of a minimally invasive image-guided treatment

Cubital tunnel syndrome is defined as ulnar neuropathy caused by compression in the region of the cubital tunnel and can be related to a variety of pathological aetiologies. Treatment involves decompression of the nerve and varies depending on the offending agent. We report the case of an 81-year-old man avid tennis player who presented with symptoms related to ulnar neuropathy. The patient was referred for an ultrasound of the elbow which demonstrated ulnar neuropathy related to compression by an 8 mm synovial cyst extending into the cubital tunnel. Magnetic resonance imaging of the elbow was performed confirming the cystic nature of this lesion. Ultrasound-guided aspiration of the cyst was performed followed by injection with corticosteroids. The patient experienced complete resolution of symptoms after treatment.