SAPHO: syndrome or concept? Imaging findings.

The SAPHO syndrome was a term coined to include a variety of musculoskeletal disorders associated with skin conditions, mainly palmoplantar pustulosis and acne conglobata. It is more correctly a spectrum which includes the following: skin lesions, osteoarticular manifestations of synovitis hyperostosis and osteitis affecting particular target sites, and.a clinical course marked by relapses and remissions. The major sites of involvement are the anterior chest wall, the spine, long bones, flat bones, and large and small joints. The distribution and severity of involvement varies from the adult to the pediatric form of chronic recurrent multifocal osteomyelitis (CRMO). The diagnosis of SAPHO syndrome is not difficult when the typical osteoarticular lesions are located in characteristic target sites. The diagnosis is more difficult if atypical sites are involved and there is no skin disease.

Mesenchymal hamartoma of the chest wall in infants: report of three cases and literature review.

Mesenchymal hamartoma of the chest wall in infants is a rare abnormality. We present a report of three cases and a brief review of the literature, emphasizing the role of the radiologist in diagnosis and management.

Spinal biomodeling.

STUDY DESIGN: A prospective trial of stereolithographic biomodeling in complex spinal surgery. OBJECTIVES: To investigate the use of stereolithographic biomodeling as an aid to complex spinal surgery. SUMMARY OF BACKGROUND DATA: Of the array of imaging methods available to assist the spinal surgeon, no single method provides a complete overview of the anatomy, although three-dimensional imaging has been shown to have advantages. METHODS: Stereolithographic biomodeling is a new technology that allows data from three-dimensional computed tomographic scans to be used to generate exact plastic replicas of anatomic structures. Five patients with complex deformities were selected: two children with congenital deformities, a patient with an osteoblastoma, a patient with basilar invagination caused by osteogenesis imperfecta, and a patient with a failed lumbar fusion. Computed tomographic scanning was performed and stereolithographic biomodels generated. The stereolithographic biomodels were used for patient education, operative planning, and surgical navigation. RESULTS: The surgeons reported that biomodeling was useful in complex spinal surgery and was an effective technology. Stereolithographic biomodels were found to be particularly useful in morphologic assessment, in the planning and rehearsal of surgery, for intraoperative navigation, and for informing patients about surgical procedures. CONCLUSIONS: Stereolithographic biomodeling allows imaging data to be displayed in a physical form. This intuitive medium may improve data display and allows surgical simulation on a proxy of the surgical site. Draw-backs of the technology were a minimum 24 hours' manufacturing time and the cost.

Paranasal sinus osteomas: a review of 46 cases.

In a survey of 1500 coronal sinonasal CT scans, 46 patients were found to have paranasal sinus osteomas. The overall incidence was 3%, with a predilection for decades 5 and 6 and a male-to-female ratio of 1.3:1. The frontal sinus was most commonly involved, and of these lesions 37% were in the immediate vicinity of the nasofrontal duct and 21% above and lateral to the ostium. Tumour size varied from a mean diameter of 1.5 mm to 30 mm; however, 17 lesions were 5 mm in size or less. Five matrix patterns were observed. Only two patients were symptomatic and only three osteomas excised. Isotope bone scanning may be a useful screening test with specific follow-up utilising computed tomography.

Anatomic variants in sinonasal CT.

The computed tomographic scans obtained in a series of 800 patients referred for evaluation for functional endoscopic sinus surgery were examined to determine the prevalence and significance of anatomic variants. Fifty-two normal variants were identified within two major groupings of primary bony abnormalities and sinus air cell extensions. Although 743 (93%) patients had one or more variants, the nature of the variants in many instances was such that 325 (41%) patients could be considered "endoscopically" normal. Among the remaining cases, variations of the septum and middle turbinates, with or without anterior ethmoid sinus extensions, were found, usually in recognizable combinations, that could produce significant obstruction of the drainage pathways. However, where such obstructive patterns existed, an equal prevalence of patients with and without sinus disease was found in the presence of the same variant combination. Thus, the presence of anatomic variations, singly or in combination, does not represent a disease state per se.

Posttraumatic calcification of the annular ligament of the radius.

Eight cases of calcification following anterior dislocation of the head of the radius are described. It was demonstrated as early as 2 weeks after injury and in 7 cases appeared in the form of a shell on the volar aspect of the head. The other type exhibits a cuff of calcification related to the radial neck. Parallel cases are drawn from a literature review, and the distinction is made between calcification in the disrupted annular ligament/capsule or oblique cord and myositis ossificans. Regression in several cases may be a consequence of open reduction.

Isolated avulsion fracture of the lesser tuberosity of the humerus.

Three cases of isolated avulsion fracture of the lesser tuberosity are described together with a review of six previously reported cases. Of the total cases, six had a well-documented mode of injury, in which a strong abducting force was applied to the medial aspect of the upper arm, causing exaggerated abduction and external rotation. The contracting subscapularis muscle displaces the avulsed bony insertion to a position below the glenoid to give a characteristic appearance on the radiograph. This appearance should not be confused with calcific tendonitis. The lesion may warrant surgical intervention which has been successful in half the cases.