Vung D. Nguyen

Klippel-Feil syndrome: patterns of bony fusion and wasp-waist sign.

Cervical spine radiographs of 33 patients with Klippel-Feil syndrome were studied for patterns of bony fusion and presence of wasp-waist sign. Five patients were found to have the classic features of massive cervical fusion. Two patients with two adjacent levels of bony fusion showed a wasp-waist sign. Fusion at one level of the cervical spine accounted for 26 remaining cases. The wasp-waist sign was observed in 14 of the cases in which there was complete vertebral interbody fusion, making this finding a valuable radiologic sign. Partial anterior or posterior vertebral interbody fusion, or isolated fusion of the neural arch, however, may or may not be associated with the wasp-waist sign. Klippel-Feil syndrome, easy to recognize when presenting with classic features or when associated with the wasp-waist sign, may be confused with a variety of other entities.

Freiberg's disease in diabetes mellitus

We evaluated a total of 13 cases of Freibergs disease in patients aged 47–77 years collected over an 8-year period. Seven were associated with diabetes mellitus and one with chronic renal failure; the remainder had no underlying disease. Atrophy of intrinsic small foot muscles secondary to neuropathy, which is prevalent in diabetes mellitus, may play a part in the development of Freibergs infraction.

Histiocytoid hemangioma of bone: A benign lesion which may mimic angiosarcoma

Histiocytoid hemangioma is a related family of endothelial cell neoplasms, which was described by Rosai et al. [14] in 1979 and which encompasses a group of osseous, vascular and cutaneous neoplasms. These neoplasms bear a close resemblance to the angiosarcoma/hemangioendothelioma family of malignant neoplasms. A case of histiocytoid hemangioma is reported that presented as a multicentric osseous lesion and was initially diagnosed as angiosarcoma. The patient has had a remarkably benign course and at a later date developed skin and bone lesions diagnosed as angiolymphoid hyperplasia with eosinophilia identical to the initial lesion. This represents the first reported case of identical osseous and cutaneous lesions of the histiocytoid hemangioma group in the same patient and lends credence to Rosais concept. A review of the literature concerning angiosarcoma/hemangioendothelioma of the bone is presented with the conclusion that some lesions considered to represent multicentric angiosarcoma may represent the more benign histiocytoid hemangioma.

A rare bone tumor in an unusual location: Osteoblastoma of the vertebral body

Most osteoblastomas involve the posterior elements alone, or both the posterior elements and the vertebral bodies. Osteoblastomas confined in the body of the vertebrae are very rare. Spinal osteoblastomas are associated with localized pain in about 80% of cases and neurological deficits in 25% to 50% of cases. Nearly half of lumbar and thoracic osteoblastomas demonstrate coexistent scoliosis with the convex side away from the involved side of the vertebrae.

A rare cause of splenic infarct and fleeting pulmonary infiltrates: Polyarteritis nodosa

A rare multi-system disease with an incidence of about 5/million per year, polyarteritis nodosa (PAN) occasionally may cause splenic vasculitis, usually at arteriole bifurcations, leading to multiple systemic infarcts with extensive confluent systemic necrosis. PAN may also be a cause of fleeting patchy pulmonary infiltrates or pulmonary nodular lesions. The diagnosis is usually difficult and delayed because the clinical manifestations are varied and depend on the site and the extent of the arterial involvement.

Unusual feature of soft-tissue calcification in chronic renal failure: Tumoral calcification

Two cases of massive calcification in dialysed patients are described with computerized tomography correlation: one in the abdominal/pelvic cavity, which is a rare location, and the other in the abdominal wall. The cause of these calcified deposits is multifactorial and complex. Usually painless, they may cause restriction of joint movement by virtue of their bulky size.

“Idiopathic destructive arthritis” of the shoulder: A still fascinating enigma

Idiopathic destructive arthritis of the shoulder is uncommon, and all previous reports appeared in the nonradiologic literature. The clinical, radiological, and laboratory findings are described. This rare form of rapidly destructive arthritis of the shoulder bear resemblance to several neuropathic-like arthropathies, and its etiopathogenesis is still unclear.

Subcutaneous soft tissue densities: A computed tomography indicator of severe pancreatitis

Twenty patients with known acute pancreatitis had 50 computed tomography studies. Those with severe pancreatitis showed streaky and fluffy soft tissue densities in the flanks and some in the gluteal regions. The appearance and disappearance of this finding correlates with the extravascular movement of fluid due to severe pancreatic inflammation.

A rare cause of laryngeal distress: chondrosarcoma of the larynx.

Laryngeal chondrosarcomas are much less aggressive lesions than chondrosarcomas that arise elsewhere in the body. Two cases of chondrosarcoma of the larynx encountered during a seven year period are presented, with a review of the literature. Computed tomographic (CT) and magnetic resonance imaging (MRI) findings are described. The MRI findings of laryngeal chondrosarcoma are compared to those of cartilaginous tumors elsewhere in the body. The differential diagnosis, prognosis, and treatment of laryngeal chondrosarcomas are discussed.