Mahvash Rafii

Sudden quadriplegia after a minor trauma. The role of preexisting spinal stenosis.

Three patients are described who became quadriplegic after a minor trauma to the spine without suffering a spinal fracture dislocation. Radiologic investigation revealed marked stenosis of the spinal canal, due to developmental stenosis with superimposed degenerative changes in two patients, and calcification of posterior longitudinal ligament of the spine in one. Two patients recovered almost completely with conservative measures. The spinal cord may be able to tolerate slowly increasing mechanical pressure for many years and conform to the shape of the spinal canal without causing any neurological symptoms. However, when stenosis is severe, any additional pressure, for example, swelling and edema from trauma, may cause a neurologic catastrophe.

Pathologic fracture in systemic mastocytosis. Radiographic spectrum and review of the literature.

Systemic mastocytosis is a multiorgan disease that most commonly affects the skin and skeletal system. Radiographically, the skeletal changes in the majority of patients consist of either a wide-spread mixture of bone lysis and osteosclerosis or generalized osteoporosis. The osteoporotic form is less well known but may lead to severe generalized demineralization and pathologic fractures. Mast cells secrete a number of substances, two of which (heparin and prostaglandins) are believed to have a role in the induction of osteoporosis. Sclerotic lesions are induced by another mast cell by-product, histamine. One hundred seventy-eight cases of bony mastocytosis have been reported in the literature, including the four patients in the present report. Special staining procedures are necessary for identification of mast cells. Diagnosis may be delayed in patients who do not have the skin lesions (urticaria pigmentosa) and in the osteoporotic form of the disease.

Primary multifocal tuberculous osteomyelitis with involvement of the ribs.

Abstract Two cases of primary multifocal tuberculous osteomyelitis with involvement of the rib cage are presented. The lungs were normal and the appearance of the skeletal lesions did not suggest tuberculosis. These lesions were predominantly lytic, with minimal soft tissue involvement. Tuberculosis should be high in the differential diagnosis of multiple destructive bone lesions, especially in patients from regions where tuberculosis is endemic.

Fibrobullous disease of the upper lobes: An extraskeletal manifestation of ankylosing spondylitis

Fibrobullous disease of the upper lobes of the lungs is a rare extraskeletal manifestation of ankylosing spondylitis, occurring in 1.3% of patients with ankylosing spondylitis. We present a patient with this disease, and discuss this pulmonary manifestation. Because the radiographic appearance of the chest in this disease resembles that in tuberculosis, many patients are misdiagnosed and treated for tuberculosis despite negative bacteriology. Computed tomography is useful in delineating the extent of pleural thickening, bullous changes, volume loss, parenchymal fibrosis, and bronchiectasis, as well as identifying or excluding an intracavitary pulmonary mycetoma.

Quantitative computed tomography assessment of spinal trabecular bone. II. In osteoporotic women with and without vertebral fractures

Computed tomography was utilized to measure the bone mineral content of the spinal trabecular bone in 96 osteoporotic women. A significant overlapping was found between the values obtained for these patients and the age-matched normal values. Sixty-six percent had bone mineral content values below the fifth percentile for age-matched normals. Eighty-five percent of those with vertebral fractures had bone mineral content values below the fifth percentile for normal premenopausal women (fracture threshold). It is suggested that diagnosis of osteoporosis be made when the spinal bone mineral content value is below the fracture threshold.

Radiation induced fractures of sacrum: CT diagnosis

Sacral insufficiency fracture due to bone atrophy may develop as a complication of irradiation of pelvic malignancies. Pain is the presenting symptom and the clinical diagnoses most often considered are recurrence of the original malignancy and metastatic disease. Computed tomography provides the most specific information helpful for the detection of these fractures and for exclusion of recurrent malignancy.

Epithelioid hemangioma of bone.

Abstract Although no specific radiographic appearance has emerged to date for the epithelioid subtype of hemangioma, these lesions most typically exhibit well-defined osteolysis. Other relatively common features include surrounding sclerosis, cortical expansion and cortical destruction. We present a case of epithelioid hemangioma of the spine with an unusual radiological appearance which to our knowledge has not previously been reported: diffuse sclerosis of the involved vertebral body. The diffuse sclerosis seen in this case resembles the osteosclerotic process seen not only in benign entities such as subacute and chronic osteomyelitis, but also in malignant lesions such as osteoblastic metastatic disease and lymphoma.

The impact of CT in clinical management of pelvic and acetabular fractures.

Thirty-eight consecutive patients admitted to the hospital with pelvic and acetabular fractures underwent CT examination. The axial plane of CT is shown to be the most suitable for evaluation of these fractures. The fracture pattern is readily demonstrated, facilitating fracture classification. The degree of fracture fragment displacement and rotation, hip joint stability, and intra-articular osseous fragments can be determined. A number of unsuspected fractures were detected, including five sacral and four anterior acetabular wall fractures; the latter were due to extension of superior ramus fractures. Soft tissue injuries included several hematomas, serosanguinous cysts in one patient, and bladder laceration in one patient. It is concluded that in patients with pelvic fracture CT examination is the method of choice following preliminary radiographic evaluation, if further radiographic investigation is deemed necessary.

Computed tomography of spinal chordomas

Computed tomography of 16 spinal chordomas revealed lytic lesions, or lytic and blastic lesions, of 2 or more adjacent vertebrae and a fairly well-delineated soft tissue mass in 16 patients. Intravenous contrast enhancement revealed multiple zones of hypodensity in 5 tumors pathologically proved to contain areas of cystic degeneration. Invasion of the epidural space was noted on computed tomography in 2 vertebral and 7 sacral lesions, and on myelography in 7 vertebral lesions. Computed tomography is ideal for delineation of the soft tissue component of these lesions, detection of sacral lesions at an early stage, planning of surgical excision or irradiation treatment, and detection of recurrence.

Computed tomography of septic joints

Twenty-six patients with suspected or known septic joints who had been studied by computed tomography were retrospectively reviewed. Eighteen patients (20 joints) proved to have septic arthritis. Computed tomography was advantageous in patients with acute septic arthritis of deep-seated axial joints, such as the hip and sacroiliac, where it demonstrated particular soft tissue swelling as early as 36 hours after the onset of symptoms. In three patients, this finding on computed tomography was helpful in accurately localizing the disease process and facilitating a diagnostic closed needle aspiration biopsy procedure. Four patients had a primary osseous focus of infection in an adjacent epiphyseal region that was documented by computed tomography. Computed tomography was superior to conventional radiology in revealing early articular bone erosion in joints with curved and overlapping articular surfaces in five patients, and resulted in alteration of their treatment. Fat-fluid levels within the suprapatellar bursae were noted in one patient (two joints). Computed tomography is a valuable modality for evaluation of patients with suspected septic arthritis of axial joints, particularly in the acute stage. Furthermore, it is helpful for evaluation of possible periarticular abscess formation and can serve as a guide for a percutaneous drainage procedure. Computed tomography can also be used when articular bone erosion or medullary extension of osteomyelitis is suspected but not fully documented by conventional radiography.