Lung perfusion and chest wall configuration is altered by glossopharyngeal breathing

Glossopharyngeal insufflation is used by competitive breath-hold divers to increase lung gas content above baseline total lung capacity (TLC) in order improve performance. Whilst glossopharyngeal insufflation is known to induce hypotension and tachycardia, little is known about the effects on the pulmonary circulation and structural integrity of the thorax. Six male breath-hold divers were studied. Exhaled lung volumes were measured before and after glossopharyngeal insufflation. On two study days, subjects were studied in the supine position at baseline TLC and after maximal glossopharyngeal insufflation above TLC. Tc 99(m) labelled macro-aggregated albumin was injected and a computed tomography (CT) scan of the thorax was performed during breath-hold. Single photon emission CT images determined flow and regional deposition. Registered CT images determined change in the volume of the thorax. CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion. We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.

Degenerative spondylolysis: a concise report of scintigraphic observations

OBJECTIVES

Spondylolysis is traditionally thought to be a diagnosis of adolescence and childhood, and is ascribed to mechanical stress through the immature pars interarticularis. Over the last 4 yr we have noted a presentation of spondylolysis in association with hypertrophic zygapophyseal joint disease in the lumbar spine in an older age group.

METHODS

Records of 94 patients presenting with low back pain were examined. A pattern of intense zygapophyseal joint uptake in association with extended uptake in the pars interarticularis was ascribed as degenerative spondylolysis.

RESULTS

The ages of the 94 cases ranged from 33 to 80 yr (mean 64 yr). There were 53 males and 41 females. In the group with degenerative spondylolysis the mean age was 72 yr, with four females and two males. None of these six patients gave a history of childhood spinal disease or back pain and all were relatively inactive in terms of current participation in sport. All cases of spondylolysis were confirmed by computed tomography scanning.

CONCLUSION

The finding of hypertrophic zygapophyseal joint disease in association with spondylolysis is easily recognized by scintigraphic tomographic imaging.

Importance of positioning and frequency of unexpected scintigraphic findings in a high impact sport

Stress-related injuries have been reported for numerous forms of exercise and sport. The patterns of injury and the incremental value of specially developed views were retrospectively reviewed at the end of three successive playing seasons of Australian football. The primary sites of clinical trauma were imaged, as were immediately adjacent bones and joints in order to assess concurrent trauma, and an attempt was made to evaluate the need to extend the area of scanning. Of the injuries detected, 67% of the total occurred at or below the level of the knee. Fifty-five per cent of these injuries occurred in the tibiae, fibulae and bones of the foot in a pattern reflecting the nature of the traumatic insult recurring in this particular sport. An incremental value of 28% was found for the specially developed views. Clinically unsuspected pathology was found in 54% of cases.

TI-201 scintigraphy in muscle trauma

Muscle uptake of Tl-201 thallous chloride in the larger or more major groups, particularly the legs, chest, and upper limb areas, is not uncommonly observed in healthy persons. However, as illustrated in three patients, such uptake, when localized or asymmetric, may provide evidence of unrecognized traumatized muscle, resulting from more chronic or subacute muscle overuse than the acute muscle insult that produces the marked uptake of Tc-99m phosphates associated with frank rhabdomyolysis.

Scintigraphic patterns of injury in amateur weight lifters

PURPOSE

Weight lifting is now a standard part of training in most sports. An increasing number of amateur athletes are doing strength training, mostly in unsupervised situations. A series of injuries in amateur weight lifters was analyzed by bone scintigraphy, with the aim of depicting specific patterns that would accurately identify the primary lesions.

METHODS

Twelve patients (10 men and 2 women) were studied whose ages ranged from 18 to 35 years. Patients were referred for bone scintigraphy with clinical diagnoses based on history, physical examination, and appropriate radiologic investigations. Diagnoses were confirmed by surgery, arthroscopy, arthrography, local steroid injection, and outcome.

RESULTS

Most of the injuries were in athletes undertaking free-weight training. Most injuries were in the upper limbs, particularly around the shoulder. Scintigraphic patterns of supraspinatus and bicipital tendons and also rotator cuff lesions were identified. Clavicular osteolysis, avulsion injuries, muscle damage, and vertebral lesions were also noted. Several abnormalities revealed by scintigraphy were clinically unsuspected.

CONCLUSIONS

Scintigraphic manifestations of several injuries, particularly around the shoulder, have a specific pattern. Recognition of these patterns can enhance the performance of bone scintigraphy. Scintigraphy also has the potential to detect clinically unsuspected disease.

A novel view for the scintigraphic assessment of the elbow

Using any imaging modality, the elbow is a complex joint to evaluate. The use of scintigraphy in the evaluation of the effects of acute or chronic trauma has largely been confined to epicondylitis. We developed a skyline view of the elbow that minimized the effect of overlap and assessed its incremental value in the scintigraphic assessment of several pathological conditions. Thirty-four abnormalities were evaluated in 20 patients with a range of pathologies, including epicondylitis, ligamentous avulsion injury, articular injury, fractures and synovitis. The incremental value of addition of the skyline view to the standard views was assessed in addition to the overall accuracy of scintigraphy. Overall, scintigraphy detected 27 of 34 abnormalities, with the standard views of the elbow accurately identifying 15 and the skyline view 23 abnormalities. This gave the skyline view an incremental value of 24% over the standard views. In conclusion, scintigraphy has the potential to identify a greater range of pathologies in the elbow than previously reported, due to the addition of the skyline view to the standard views.

Multiple flexion-stress vertebral end-plate fractures. An osteogenesis imperfecta presentation

A 28-year-old woman underwent bone scintigraphy for a 7-day history of severe back pain of sudden onset. Intense linear accumulation of Tc-99m HDP was present in several lower thoracic and lumbar vertebrae without vertebral body deformity. Intense uptake was also present in other thoracic vertebrae with vertebral body changes. X-rays demonstrated osteopenia and dual photon densitometry studies confirmed a significant degree of osteoporosis. Endocrine assessment identified that she and other female members of the family had osteogenesis imperfecta, Sillence type 1. This disorder should be considered in all differential diagnoses of nonobvious traumatic fractures of the vertebrae in healthy young adults.

Prominence of the C2 vertebra on SPECT. A normal variant

Mild preferential focal uptake of Tc-99m HDP in the spinous process of C2 was identified with SPECT of the cervical spine performed in patients in whom the indication for bone scintigraphy was suspected of lesions in the limbs. Its presence in all 21 subjects indicates that such uptake is a normal finding.