Destructive arthritis due to silicone: a foreign-body reaction

The authors report 3 cases of erosive arthritis resulting from a foreign-body reaction to a silicone implant in the wrist. No patient had a history of inflammatory arthritis. Radiographic changes included well-defined lytic lesions with thin, sclerotic margins, normal mineralization, and loss of volume of the implant. Pathologically, a destructive foreign-body reaction was seen, with intra- and extracellular silicone debris.

NMR imaging of leg tumors

NMR images of 8 patients with neoplasms of the legs were obtained. Volumetric and/or planar NMR data were acquired using a saturation recovery (SR) approach, incorporating magnetization refocusing. NMR images revealed tumors in all patients and correlated well with the extent seen on CT. SR images with a short interpulse delay (tau) demonstrated a significant decrease in signal intensity (SI) in histologically normal fat (n = 4) and marrow (n = 1) adjacent to tumors, consistent with a prolonged T1. At certain values of tau, tumors on SR images could not be differentiated from normal muscle (tau = 200 msec.) and marrow (tau = 2,100 msec.) by SI alone. Using this sequence with fixed signal refocusing parameters, images representing several values of tau may be required to distinguish tumors from normal structures.

Medicine or meddling? use of arthrography in rheumatology

In the wardrobe of diagnostic procedures for the arthritic patient, the arthrogram is like a tuxedo. It produces striking images in black-and-white, it can be slightly uncomfortable, and there are times when it can be just the right thing. However, like the tuxedo, the arthrogram should be reserved for infrequent special occasions. Although arthrography can show changes which are characteristic of arthritis, it can seldom differentiate one type of synovitis from another. It may be useful to determine whether or not a synovial disorder is present, but this will not be necessary for the great majority of patients. Its most important uses are in the evaluation of masses in and around joints, and of the pseudothrombophlebitis syndrome. In selected cases, it may help to elucidate the stage and mechanism of disease.

Fracture of the radius with instability of the wrist

Review of 190 consecutive fractures of the distal radius revealed 14 instances of ligamentous carpal instability (7.4%). Instability was more likely to occur in older patients but was not related to the degree of fracture displacement. There was an association between instability and radial styloid fracture, and in five of nine Colles fractures a separate radial styloid fragment was present, suggesting a component of avulsive force. The relatively common coexistence of fracture and instability is not generally appreciated, and the findings of instability often are overlooked.

Osteoid osteoma: an unusual cause of articular pain

Twenty-five patients who had histologically proved osteoid osteoma and whose major symptom was joint pain were studied. Retrospective study of clinical data and radiographs revealed that almost all of the lesions were located near the painful joint and that there had been significant delay in determination of the correct diagnosis. The delay was related to the nonspecificity of symptoms, the latency between the onset of symptoms and the appearance of the lesion on radiologic study, and the evaluation sequence used in some patients. The relative effectiveness of various diagnostic modalities is discussed. Radionuclide bone scanning, plain radiography, and guided tomography are the most useful diagnostic studies.

Biomechanics important to interpret radiographs of the hip

Biomechanic principles have important implications to film interpretation. Angulation of the femoral neck results in four different types of forces: compression on the medial side, tension on the lateral side, shear stress in the center, and torque forces at the neck-shaft angle. The body's response to these forces results in recognizable trabecular patterns which respond in a predictable manner to disease states. Surgical intervention in the form of hip replacement or fracture fixation must reflect these engineering considerations.

Giant cell reparative granuloma of Paget's disease of bone: a unique clinical entity

Giant cell tumor of bone is a rare, but well-recognized complication of Paget's disease of bone. In contrast, giant cell reparative granuloma (a benign tumor of the jaws occurring primarily in young adults) has never been described in association with Paget's disease. Five patients had giant cell lesions complicating Paget's disease. In each instance, the lesion histologically more closely resembled reparative granuloma than true giant cell tumor. The location of these lesions and their sensitivity to irradiation were consistent with reparative granuloma. Unique features included the frequency of polyostotic distribution, the occurrence only in bones affected by Paget's disease, and an apparent familial or geographic clustering of the patients. We also reviewed the histologic findings of three patients from another institution and compared the cases of all eight patients with others we believe were incorrectly diagnosed as having benign giant cell tumors in Paget's disease. We suggest that giant cell reparative granuloma of Paget's disease is a unique clinical entity with specific prognostic and therapeutic implications.

Morbidity from shoulder arthrography: etiology, incidence, and prevention

A prospective study was performed to assess patient discomfort after shoulder arthrography. Three different techniques were compared using equal intraarticular volumes of: positive contrast medium alone, positive contrast medium diluted with local anesthetic, or positive contrast medium and air. Moderate or severe exacerbation of baseline shoulder discomfort, when evaluated 24-48 hr after arthrography, occurred in 74% of all patients. There was significantly less discomfort after double-contrast examinations than after other techniques, although the level of morbidity was still high. This incidence and severity of discomfort after shoulder arthrography is higher than previously reported or generally recognized. Morbidity after shoulder arthrography is probably caused by a direct irritant effect of the positive contrast medium and/or the additional influx of fluid, into an already distended joint, in response to the hyperosmolar positive contrast medium. The latter effect is consistent with the delayed onset of symptoms which usually began 4-6 hr after the procedure, peaked in intensity 12 hr later and, when severe, often lasted for several days. Smaller volumes of intraarticular contrast medium and/or the use of nonionic and polymeric contrast agents, untested in this protocol, might reduce these symptoms.

Pigmented villonodular synovitis: correlation of angiographic and histologic findings

Pigmented villonodular synovitis has a variable histologic appearance, Jaffe and others propose this reflects maturation of the process with the early cellular hypervascular phase giving way to subsequent hyalinization and fibrosis. A case of avascular pigmented villonodular synovitis in the foot was encountered and surgically verified. Eight cases of the disease were then reviewed and graded subjectively for their cellularity, vascularity, and fibrosis. The avascular case was the most hyalinized and "mature" of the group. Two other cases with the typical findings of a hypervascular arteriogram were histologically less hyalinized. These findings suggest a possible role for arteriography in determining the natural history of the disease and support Jaffe's view of its evolution.

Stressing the knee joint for arthrography

A restraining device for arthrography of the knee, made from an automobile safety belt, is described. Contrary to usual practice, the authors place the strap below the knee joint. There is less tendency for the knee to flex when compared with placement above the knee, resulting in improved demonstration ot the meniscus.

Iron content of pigmented villonodular synovitis detected by computed tomography

Pigmented villonodular synovitis is a rare lesion in which iron is accumulated. A CT scan performed on one such lesion demonstrated significantly increased attenuation values. We have calculated the amount of iron which would have to be added to muscle tissue in order to produce this increase in density. We have also measured the iron content directly. The close agreement of these two figures suggests that the observed density increase is due to the iron content of the lesion.

Fracture of the hook of the hamate

Three patients with hamate hook fractures were evaluated. These fractures were difficult to diagnose clinically and radiographically. Mechanisms of injury reported in the literature include blunt trauma to the hamulus or pisiform, forceful swinging of a grasped object, or a forceful muscular contraction. Delayed diagnosis may result in late complications including carpal tunnel syndrome, flexor tendon rupture, ulnar nerve palsy, or ulnar artery compromise. Pain when grasping or swinging an object is often a clue to the correct diagnosis. Normal standard and carpal tunnel views do not exclude this injury. Tomography may be necessary for radiographic detection and permits detailed evaluation of fracture margins. Pertinent carpal anatomy is reviewed.

Uptake of bone imaging agents by diffuse pulmonary metastatic calcification

Three cases of diffuse lung uptake of the bone scanning agent 99mTc diphosphonate, which appears to reflect metastatic pulmonary calcification, are described. Each patient had hypercalcemia and renal failure. Clinical features common to patients with this scan pattern were ascertained from a review of the literature. Renal failure was present in all, and the majority have had hypercalcemia. The bone scan may prove to be a valuable adjunct to the diagnosis of metastatic pulmonary calcification; this characteristic pattern should be more widely appreciated.

Capsular visualization in lipohemarthrosis of the knee

A new sign for the diagnosis of lipohemarthrosis on vertical beam lateral knee radiographs depends upon visualization of the joint capsule due to the presence of fat lying both within and outside of the joint. Recognition of lipohemarthrosis on routine knee radiographs may aid in the diagnosis of subtle tibial plateau fractures.