Lee F. Rogers

The Spectrum of Radiologic Findings in Allergic Bronchopulmonary Aspergillosis

Early diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is important. Initiation of corticosteroid therapy in ABPA is essential to prevent progressive destruction of lung parenchyma. The earliest radiographic manifestations of the disease may be present only on bronchograms. In addition to the classic radiographic findings (infiltrate, massive homogeneous consolidation, tram-line shadow, parallel line shadow, ring shadow, toothpaste shadow, glove-finger shadow), perihilar infiltrates simulating adenopathy (pseudohilar adenopathy) and air fluid levels were frequently demonstrated.

Radiological Manifestations of Radiation-Induced Injury to the Normal Upper Gastrointestinal Tract

Radiation-induced injury to the normal esophagus, stomach, and duodenum in patients with advanced cervical carcinoma who received high para-aortic lymph-node irradiation to an average tumor dose of 5,000 rads is discussed. Radiation esophagitis is usually the result of mediastinal irradiation for bronchogenic carcinoma. The most consistent radiological finding is abnormal motility, with esophageal stricture and/or ulceration occurrring less frequently. Radiation gastritis usually presents as pyloric ulceration or irregular contractions of the antrum, simulating gastric carcinoma. Postbulbar duodenal mucosal thickening, ulceration, and strictures may occur. Pertinent clinical features, pathogenesis, and pathological correlations are discussed.

Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children.

The anterior humeral line is a valuable aid in the search for supracondylar fractures in children. When it is abnormal other signs of fracture should be carefully sought. The AHL was normal in only 5.8% of the cases reviewed (4 of 68 cases). There was other evidence of fracture in each case. Comparison of the AHLs on both sides is helpful when the AHL is normal since it may disclose subtle displacement of the line on the affected side. In children younger than 2 1/2 years the AHL may pass through the anterior third of the capitellum due to the small size of the ossification center; in these patients comparison with the opposite side may also be helpful.

The Radiography of Epiphyseal Injuries

Abstract The epiphysis, involved in 6 to 15% of childrens fractures, is responsible for bone growth. Significant disturbance occurs in only 10% of epiphyseal injuries because of relationship of usual line of fracture to germinal cells of growth plate and epiphyseal blood supply. Epiphyseal injuries are classified by radiographic appearance into 5 types, each having prognostic significance. Dislocations of major joints and disruptions of major ligaments are rare in children; if either is suspected clinically, an epiphyseal injury is likely. An accurate radiographic diagnosis can result when comparison views are obtained routinely with oblique and stress views as indicated.

Computed tomography of posterior fracture-dislocations of the shoulder : case reports

Computed tomographic (CT) evaluation of seven posterior shoulder dislocations in five patients is reported. Computed tomography provided better visualization of the trough fracture in the humeral head than did conventional x-ray films or tomography. It also demonstrated fracture fragments not seen on conventional roentgenograms. The two cases of bilateral dislocation and one case of unilateral dislocation were caused by seizures. The two other cases of unilateral dislocation were caused by trauma.

The ultrasonographic characterization of tendons

Ultrasonography has not been utilized in the diagnosis of musculoskeletal disorders. However, the superficial location of tendons and ligaments lend themselves to evaluation by this modality. The ultrasonographic characteristics of the normal Achilles tendon are described in both the rabbit and man. The characteristic ultrasonographic findings after injury to the Achilles tendon are also determined. This imaging technique provides a sharp definition of the tendon and surrounding structures and easily demonstrates abnormalities. The superficially located quadriceps tendon is also well visualized by ultrasound and representative examples are shown. Ultrasound should be considered as another useful method for evaluation of these superficial musculoskeletal structures.

The radiographic distinction of degenerative slippage (spondylolisthesis and retrolisthesis) from traumatic slippage of the cervical spine

In a review of 42 cases of degenerative arthritis of the cervical spine and 22 cases of cervical spine trauma with an observed anterior slippage (spondylolisthesis) or posterior slippage (retrolisthesis) of the vertebral bodies of 2 mm or more, characteristic features were observed which allowed distinction between degenerative and traumatic slippage of the cervical spine. In degenerative slippage the shape of the articular facets and width of the facet joint space may remain normal; however, in most cases the articular facets become “ground-down” with narrowing of the facet joint space and the articular facets themselves becoming thinned or ribbon-like. In traumatic slippage the artucular facets will either be normally shaped or fractured and the facet joint space will be abnormally widened. Plain radiographs will usually allow this distinction to be made; however, in difficult cases polytomography may be required.

Roentgen manifestations of radiation injury to the gastrointestinal tract

Radiation injury of the gastrointestinal tract requires a minimum dose of 4200 to 4500 rads. The symptoms and signs of radiation injury usually appear within 6 to 24 months following therapy. The radiation induced changes include mucosal atrophy and ulceration associated with an obliterative endarteritis in the supportive vasculo-connective tissue. The roentgen manifestations are those of an ischemic process but may also mimic those of recurrent malignant disease. Obstruction, hemorrhage, and fistula formation are common complications. Surgery is frequently required. The morbidity and mortality is considerable.

Separation of the Entire Distal Humeral Epiphysis

In order to prevent unnecessary manipulation or open reduction, separation of the entire distal humeral epiphysis must be differentiated from dislocation of the elbow and fracture of the lateral condyle of the humerus. The keys are the relationship between the radius and capitellum and the direction of displacement of the radius and ulna, The normal relationship is maintained and the radius and ulna are medially displaced in separation of the distal humeral epiphysis. This relationship is disturbed in two other injuries and the bones of the forearm are laterally displaced in dislocation. Five cases are presented.

Osteochondritis dissecans of the tarsal navicular bone: imaging findings in four patients.

We report the imaging characteristics of osteochondritis dissecans of the tarsal navicular bone in four cases and review the current literature. Its radiological findings are similar to osteochondritis dissecans found in other sites: focal lucency that disrupts the sharp cortical line, the presence of sclerosis, and cortical depression.