Sonographic Findings after Total Hip Arthroplasty: Normal and Complications

PURPOSE: The purpose of this study was to determine the efficacy of sonography in the evaluation of normal pseudocapsular morphology and the detection of complications after total hip arthroplasty. MATERIALS AND METHODS: Between Janvary 1997 and June 2000, 47 patients [35 men and 12 women aged 24 to 84 (mean, 61) years] using real-time linear-array, convex US units with 3.5-MHz and 10-MHz transducers. Normal capsular morphology in 30 with total hip replacements, who had been asymptomatic for at least one year, was studied, and the prosthetic joint infection demonstrated in six of 17 who had experienced was confirmed at surgery or by US-guided aspiration. RESULTS: Sonograms indicated that a normal pseudocapsule lay straight over the neck of the prosthesis or was slightly convex toward the neck, and that the mean bone-to-pseudocapsule distance was 2.9 mm. However, in the 11 symptomatic patients in whom no evidence of infection was revealed by cultures, th mean distance was 4.7 mm; in the remaining six patients, whose joints were infected (a condition strongly suggested by the presence of extracapsular fluid), the mean distance was 5.5 mm, with no significant difference between the two groups. CONCLUSION: Sonography can be used to evaluate normal caspular morphology after total hip replacement and to diagnose infection around hip prostheses. In all patients in whom sonography revealed the presence of extra-articular fiuid, infection had occurred.

Measurement of Normal Size of Styloid Process with 3D Reconstruction CT

PURPOSE: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. MATERIALS AND METHODS: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. RESULTS: The mean length of the styloid process was 26.6 (+/-7.9)mm on the right side, and 26.4(+/-8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (+/-8.5)mm in men and 26.7 (+/-7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2(+/- 7.2)mm, and in the latter, 37.0(+/-6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). CONCLUSION: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.

Central Lung Tumors with Obstructive Pneumonitis:Ultrasonographic Findings and Usefulness of Ultrasound-guided Biopsy

PURPOSE: To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. MATERIALS AND METHODS: Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75- and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. RESULTS: Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alveolograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. CONCLUSION: In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.