Osseous drill holes to promote granulation tissue: radiologic appearance.

Skin grafting following extensive soft-tissue loss is often delayed until adequate granulation tissue can be generated. Surgical drill holes into the marrow cavity promote development of granulation tissue. This article illustrates the radiology appearance of these drill holes in four patients.

Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study.

The American College of Surgery currently recommends routine performance of lateral cervical radiography of C-1 to C-7 for all patients admitted with a history of major blunt trauma. A survey of 125 North American hospitals with experience in acute trauma care revealed that 96% obtain cervical radiographs as a routine or protocol study on all patients who have suffered major blunt trauma. To ascertain the cost-benefit effect of this practice, a prospective study was conducted during a 19-month period to compare the results of admission bedside clinical assessment of the cervical spine and the outcome of cervical radiography and computed tomography (CT) performed on 408 patients admitted with a history of major blunt trauma.

Mediastinal tumors presenting as spontaneous hemothorax, simulating aortic dissection.

The usual causes of hemomediastinum and hemothorax include chest trauma, rupture of an aortic aneurysm or aortic dissection. We report two patients who presented with a clinical picture of aortic dissection. In both patients, the chest radiograph revealed anterior mediastinal masses.

Rupture of the cervical esophagus and trachea associated with cervical spine fracture.

Rupture of the cervical esophagus and trachea secondary to cervical spine fracture-dislocation occurs rarely. Herein we describe a case and propose a mechanism to account for these associated injuries. Awareness of this complication of cervical spine fracture is crucial for prompt recognition and management.

Value of chest radiography in excluding traumatic aortic rupture.

A retrospective review of chest radiographs from 205 patients with blunt chest trauma who also underwent aortography was performed. Forty-one of the 205 had aortographically proved aortic rupture. Discriminant analysis of 16 radiographic signs indicated that the most discriminating signs were loss of the aorticopulmonary window, abnormality of the aortic arch, rightward tracheal shift, and widening of the left paraspinal line without associated fracture.

Presternal soft tissue calcifications following mediastinal radiotherapy for Hodgkin's disease.

A patient is described in whom dense calcifications developed in the presternal soft tissues of the chest four years after mediastinal radiotherapy. This is believed to represent dystrophic calcification in previously normal but incidentally radiated tissues following standard dose radiotherapy to the mediastinum for stage IIA Hodgkin's disease.

Transient hilar lymphadenopathy due to bacterial endocarditis.

Transient hilar and mediastinal lymphadenopathy accompanying right-sided bacterial endocarditis without concurrent roentgenographically-demonstrable pulmonary parenchymal abnormalities has not, to our knowledge, been previously reported. The roentgenographic finding of hilar or mediastinal lymphadenopathy should not be considered incompatible with the diagnosis of bacterial endocarditis in the appropriate clinical setting. Possible mechanisms for the development of lymphadenopathy secondary to bacterial endocarditis are discussed.

Posttraumatic tension pneumopericardium: the "small heart" sign.

Radiographic measurements of the cardiothoracic ratio in four adult victims of blunt thoracic trauma with pneumopericardium demonstrated a sudden, substantial decrease in the size of the cardiac silhouette, which was accompanied by pathophysiologic effects of cardiac tamponade. The sudden decrease in cardiac size could not be attributed to a decrease in intravascular volume or to changes in positive airway pressure. Following surgical relief of tension pneumopericardium, the cardiac size was restored to baseline dimensions and the hemodynamic effects of tamponade resolved.

Differentiation of jaundice in infancy: an application of radionuclide biliary studies.

Atresia and hypoplasia of the bile ducts are the most common congenital biliary anomalies of clinical importance. Surgical correction can help about 10% of these infants. However, surgery should be performed within the first month of life to avoid irreversible liver parenchymal changes.

Colonic diverticulum perforation: report of two cases as a complication of coronary artery bypass (perforated diverticulum after coronary artery bypass).

Perforation of a sigmoid diverticulum occurred in two patients in the immediate postoperative period after coronary artery surgery. Etiological factors leading to diverticular perforation after coronary artery bypass grafting are discussed. The significance of pneumoperitoneum on the postoperative chest radiograph, which prompted diagnosis in these cases, is also discussed.

Resolution of pulmonary cyst after steroid therapy of asthma.

Emphysematous lung cysts in rare instances are associated with bronchial asthma, as evidenced by our patient and possibly another. Particularly in young patients, a trial period of steroid therapy should be instituted to confirm this possible association, to avoid unwarranted surgery and its attendant morbidity.

Fatal barium embolization due to incorrect vaginal rather than colonic insertion. An ultrastructural and x-ray microanalysis study.

Fatal generalized barium sulfate (BaSO4) embolization followed erroneous vaginal insertion of the enema tip intended for colon examination. Light microscopy revealed the presence of swollen, granular reticuloendothelial cells in most visceral organs such as lung, liver, spleen, bone marrow, kidney, and brain. Transmission electron microscopy showed the reticuloendothelial cells loaded with uniformly electron-dense granules of various sizes.

Spontaneous penetration of an antireflux prosthesis into the stomach.

The Angelchik antireflux prosthesis is a ringlike device used in the surgical treatment of sliding hiatal hernia and gastroesophageal reflux. This article describes an unusual postoperative complication whereby the prosthesis had migrated into the lumen of the stomach.

Interhemispheric intradural cyst.

Intracranial intradural cyst represents a rare congenital malformation of the dura. Computed tomography and autopsy findings in a child with a rapid and progressive enlargement of the head indicated the presence of a large interhemispheric cystic mass. A large dural-like interhemispheric cyst was confirmed at autopsy.

Bleomycin toxicity simulating metastatic nodules to the lungs.

Pulmonary nodules may develop following bleomycin therapy, a previously undescribed entity that may simulate metastatic disease. Two asymptomatic patients are reported with nodules that developed following low dose bleomycin treatment for testicular tumors. One patient had previously documented pulmonary metastases that had resolved after chemotherapy.

CT in head trauma: a review.

The diagnosis and management of head trauma has changed significantly with the availability of computed tomography. CT not only demonstrates the presence of a mass, but also delineates acute bleed from brain swelling. CT is useful in determining whether the hematoma is intracerebral or extracerebral, as well as its volume, extent, and multiplicity.

Sonographic patterns of ectopic pregnancy - how do they help in making the diagnosis?

The diagnosis of ectopic pregnancy is clinically difficult. To determine how the different sonographic patterns help in making the diagnosis of ectopic pregnancy, the ultrasound examinations of twenty-three patients were retrospectively reviewed. Four sonographic types of ectopic pregnancy were found: Type 1--Cystic adnexal mass with a fetal pole.

Roentgenographic changes during long-term diphenylhydantoin therapy.

Diphenylhydantoin (Dilantin) is a well known anticonvulsant with well documented effectiveness. The complications, unfortunately, are multiple and well recognized clinically. This paper deals with the roentgenographic changes encountered in long-term diphenylhydantoin use.

Stercoraceous perforation of the colon.

Stercoraceous perforation of the colon is most often unsuspected and is usually diagnosed at operation or autopsy. Abdominal radiographs show large fecal masses in the rectum and sigmoid colon, and occasionally lying free in the peritoneal cavity. Free intraperitoneal air is present.