Thrombophlebitis diagnosed on indium-111 labelled white cell scan.

A 64-year-old lady with type 2 diabetes and a non-resolving right foot ulcer, had an indium-111 labelled white cell scan (indium-111 WCS) to investigate the possibility of underlying osteitis. The scan suggested the possibility of infective thrombophlebitis. Unknown to the clinical team who requested the scan and the radiologist who performed it, the lady was admitted to hospital 2 days following the procedure with cellulitis and septic thrombophlebitis in the right leg. There is only one previous report in the literature of septic thrombophlebitis being diagnosed in this way. Perhaps indium-111 WCS has something to offer in the diagnosis of this condition and in determining those who require antibiotic treatment.

Extensive soft tissue uptake of 99Tcm methylene diphosphonate in a patient with multiple myeloma.

Bone scintigraphy is not usually performed in multiple myeloma (MM), as marrow deposits characteristically show no tracer uptake. However, metastatic bone disease often mimics MM both clinically and biochemically, resulting in a substantial number of MM patients undergoing bone scintigraphy. Variable appearances in these cases have been reported, ranging from normal to a superscan, the latter a result of massive tracer uptake within bone. Soft tissue uptake has been documented, often when MM is complicated by secondary amyloidosis. This usually results in mainly solid organ uptake of tracer. We report a case of MM where massive soft tissue uptake occurred, primarily within muscles, with very little isotope elsewhere.

The secondary radiation grid; its effect on fluoroscopic dose-area product during barium enema examinations.

The secondary radiation grid is placed between the patient and the image intensifying screen, during fluoroscopy, to attenuate the incident forward scattered radiation. This reduction in scatter improves the radiographic contrast and hence image quality. However, this improved quality is achieved at the expense of greater radiation exposure to the patient, as this higher exposure is required to produce satisfactory image density. Patients scheduled to have a barium enema were randomly allocated into two groups. One group had the procedure performed with the grid in situ throughout the procedure. The second group was examined with the grid removed for fluoroscopy but returned for image acquisition. The fluoroscopic dose-area product (DAP) was recorded for both groups using a dose-area product meter. The DAP was not recorded for spot film acquisition. The results suggest that there is approximately a 50% reduction in DAP to the second group. We can be 95% certain that, on average, the ratio of doses in patients without the grid in situ to those screened with the grid is between 0.40 and 0.58, with the best estimate being 0.48. Multiple regression methods to take account of the effects of weight, sex and time, revised this estimate as 0.57, with 95% confidence interval from 0.52 to 0.63. Sex, weight and exposure time accounted for 61% of variation in dose-area products, with time alone accounting for 41%. Grid status accounted for another 22% of variation, which represents over a half of the remaining variation once sex, weight and exposure time have been allowed for. We therefore recommend that the routine use of an antiscatter grid during fluoroscopy should be abandoned. The use of a grid should be restricted to those patients (usually obese) when poor visualization is obtained in its absence.

Percutaneous ultrasound guided extraction of non-palpable soft tissue foreign bodies.

Ultrasound is being increasingly used in the diagnosis of the soft tissue foreign body (FB), in particular for the nonradio-opaque materials which may not be visualized with conventional radiography (Fornage & Schernberg 1986). A simple technique for ultrasound guided FB extraction under local anaesthesia is described, and comment is made upon our preliminary experience and pitfalls.

Low dose low osmolar intravenous urography.

A prospective double blind randomised trial using 25 ml of Hexabrix 320 (ioxaglate, May and Baker), Niopam 370 (iopamidol, Merck) or Omnipaque 350 (iohexol, Nycomed) intravenous urography was carried out. The results showed no perceptible difference in the diagnostic quality of urograms with each of the media. An additional 25 ml of contrast medium was required by 4% of patients in order to obtain a satisfactory examination. We recommend that a dose of 25 ml of low-osmolar medium be used for all patients with the exception of the obese, those taking diuretics or those who have renal impairment.

Post-traumatic skull radiographs. Time for a reappraisal.

504 patients who had skull radiographs for head injury are included in this study. Only 9 (1.9%) had demonstrable fractures. 129 (25%) of the patients reviewed were admitted to hospital. 93 of these were admitted for up to 24 hours, and 36 for a longer period, usually for conditions unrelated to the head trauma. All but 1 of the patients with a demonstrable skull fracture were admitted to hospital, and the radiographic findings initiated active medical intervention in 2 of these cases. There was no correlation between radiographic findings and the need for hospital admission, and little correlation between radiographic findings and the presenting signs and symptoms. It is, therefore, suggested that the indications for skull radiography in the management of head injuries require reappraisal.