Maxwell H. Poppel

Basilar Impression and Platybasia in Paget's Disease

Basilar impression (known also as basilar invagination) and platybasia are not synonymous nor need they necessarily be coexistent simultaneously or otherwise. Their only relationship lies in the fact that both represent specific types of abnormality of shape of a portion or portions of the base of the skull which under certain conditions may coexist. Basilar impression is related to the entire foramen magnum region of the floor of the posterior fossa, while platybasia is related to the floors of the anterior and middle cranial fossae and involves only that portion of the floor of the posterior cranial fossa which extends from the dorsum sellae to the anterior margin of the foramen magnum. Accordingly, basilar impression may be defined as an abnormal cephalad invagination of the foramen magnum region as determined by the relation of the odontoid process to Chamberlains line (1), which is drawn from the posterior margin of the hard palate to the posterior margin of the foramen magnum on the lateral roentge...

The Roentgen Manifestations of Relapsing Pancreatitis

Relapsing pancreatitis is a disease of recurring exacerbations separated by varying intervals of seemingly relative clinical quiescence. At any given time it represents the summation of all previous episodes. In recent years, the pathologists have increasingly emphasized the continuing, chronic, relapsing, and progressive nature of this disease as well as its varied manifestations and associated conditions. The clinicians, also, now clearly recognize relapsing pancreatitis as a distinct entity, even though it is a complex syndrome with many aspects. Its presence may be difficult to detect, or even suspect, since the clinical picture may vary in the history of any one patient. Especially is this true in the subclinical phases. Facts relating to etiology, pathogenesis, sex, age, the role of obesity, alcohol, trauma, common channel, infection, etc., have been well covered by Doubilet and Mulholland (5 and 6) and need no further elaboration. The roentgen manifestations of relapsing pancreatitis can be divided...

Agnogenic Myeloid Metaplasia1

A Gnogenic myeloid metaplasia may best be defined as a disorder involving hematopoiesis outside the usual marrow sites, most frequently accompanied by fibrosis of the marrow. This condition represents a distinct clinical-hematologic-roentgenologic entity, with characteristic features. The literature dealing with this disease is voluminous and confused. References are made to primary and secondary forms and some investigators have even considered it to be a variant of leukemia, including it among the “myeloproliferative disorders.” Synonyms include “pseudoleukemia with splenic-cachexia,” “osteosclerosis with myelofibrosis,” “splenic pseudoleukemia,” “aleukemic myelosis,” “myeloproliferative syndrome,” “myeloid metaplasia,” “panmyelosis,” “megakaryocytic myelosis,” etc. The term agnogenic myeloid metaplasia is becoming increasingly acceptable. It is not within the purview of this presentation to review and evaluate the entire literature. Some of the classic articles which may best be read in the original ar...

Rapid osseous changes in syringomyelia.

The Roentgen manifestations of neuropathic arthropathies are well known (1–4). The correlation between the onset of disease and significant roentgen changes, however, is not clear and deserves further consideration. Cases of syringomyelia have been described (7, 8) in which joint changes developed within a relatively short time, yet the exact mechanism was not always satisfactorily established. Pathogenesis and Pathology Several theories (9) have been advocated to explain the pathogenesis of syringomyelia: (a) that cavities arise in gliotic tissue within ependymal cell rests; (b) that the condition is a developmental anomaly related to imperfect formation of the central canal, which, however, does not explain the frequent finding of cavities in the dorsal part of the posterior horn, where ependymal cells are never found; (c) that the significant factor is the presence of intramedullary vascular anomalies (9). Vascular hemorrhage and occlusion, with a concomitant alteration of blood flow, would account for...

Volvulus of the splenic flexure.

SummaryTwo proved cases of volvulus of the splenic flexure the second and third to be reported in the literature, are described, and the associated congenital and acquired colonic disease are discussed.

Intravenous Cholangiography: Pitfalls in Interpretation

Shortly after the introduction of Cholografin, numerous reports stressing the excellence of this new agent for the direct investigation of the biliary tree appeared. In the hands of Bell, Berk, Glenn, Orloff, their associates, and others (1–4), and at our own hospital, symptomatic postcholecystectomy states often have been resolved into basic abnormalities amenable to definitive therapy. Unusual conditions in the region of the intra-and extrahepatic biliary tree, including tumor, inflammation, and sinus tracts, have been visualized with Cholografin. Gallbladders unresponsive to oral cholecystographic media have been opacified, allowing positive preoperative diagnoses. The purpose of this report is not to detract from the proved worth of intravenous cholangiography with Cholografin, but to illustrate several pitfalls in the interpretation of such roentgenographic studies and means for their avoidance. Pitfalls A. Masking Effect of Small Lucent Calculi: Small lucent calculi may be missed, their presence mas...

Some Migratory Aspects of Inflammatory Collections of Pancreatic Origin

In recent years roentgenologists have become increasingly aware of the continuing, chronic, relapsing, and progressive nature of pancreatitis, as well as its varied manifestations. Its presence may be difficult to detect, or even suspect, since the clinical picture and history may vary from patient to patient and even in the same patient at different times. Accordingly, possibly because of some enzymatic activity of the inflammatory collection, more likely because of the favorable action of various anti-inflammatory agents attenuating the disease, and also because of better methods of roentgen diagnosis, we have in the past ten years observed more than 30 patients in whom inflammatory collections of pancreatic origin migrated to various regions in the abdomen or thorax. In many instances, these inflammatory collections presented at a distance as the initial phase of the disease, masquerading as a local abscess, a perinephritic abscess, a subphrenic abscess, a fistula, a pleurisy, an empyema, a mediastinal...

Roentgen Manifestations of Milk Drinker's Syndrome

The roentgen finding of calcinosis in the presence of a history of prolonged and excessive milk consumption (usually for peptic ulcer) and renal insufficiency should indicate the diagnosis of milk drinkers syndrome. It is our purpose in this paper to present the clinical syndrome, demonstrate its roentgen manifestations, and discuss its pathological physiology. Historical In 1949, Burnett et al. (3) described a syndrome following prolonged intake of excessive quantities of milk and alkali. The essential components were hypercalcemia without hypercalcuria or hypophosphatemia, calcinosis manifested by band keratitis, renal insufficiency with azotemia and mild alkalosis, and improve-ment on a diet low in milk and absorbable alkali. The cases resembled hyperparathyroidism with renal insufficiency but were differentiated from the latter by normal urinary calcium, normal or elevated serum phosphorus, absence of skeletal demineralization, and lowering of serum calcium on a low calcium diet. On theoretical groun...

Buckling of the carotid artery demonstrated by angiocardiography.

Excerpt The demonstration by angiocardiography of buckling of the right common carotid artery has not previously been reported. The purpose of this article is to document such a case, in which the ...

The Carpal-bridge View: A Position for the Roentgenographic Diagnosis of Abnormalities in the Dorsum of the Wrist

1. A riebtgebigraphic position, called the carpal-bridge view, is introduced for the diagnosis of abnormalities in the dorsum of the wrist. 2. The value of this position in the diagnosis of lunate dislocation, navicular fracture, foreign body in the dorsum, fracture of the triangular, and tendinitis calcarea is briefly described.