Calcific tendinitis in the proximal thigh.

Calcific tendinitis of the proximal thigh is a benign entity that may cause significant pain. It must be distinguished from chronic or malignant disorders, such as arthritis, infection, and soft tissue/cortical neoplasms. Although it may be self-limited, some patients will benefit from medical intervention. In such cases, we recommend computed tomography-guided percutaneous steroid injection. Herein we describe the clinical and radiographic features of calcific tendinitis of the proximal thigh in 5 patients.

Synovial chondromatosis of the hip. Evaluation with air computed arthrotomography.

Four patients with primary synovial chondromatosis of the hip were evaluated with air or double contrast computed arthrotomography. Air computed arthrotomography was an easy and accurate method of diagnosing the disease and delineating its anatomic extent. The use of air as a sole contrast agent allowed noncalcified chondromatous nodules to be identified. It prevented faintly calcified nodules from being obscured by positive contrast, and was a better means of assessing the narrow portions of the hip joint. Accurate diagnosis of this disease and its extent was demonstrated using air computed arthrotomography. This method provided the most complete preoperative data for the orthopaedic surgeon.

Tarsal navicular stress fractures: radiographic evaluation.

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

Percutaneous bone biopsy: the importance of aspirated osseous blood.

The diagnostic value of the microscopic examination of bone core specimen versus osseous blood, obtained by 110 percutaneous biopsies performed on 100 patients, was evaluated. A diagnosis of malignancy was made by biopsy in 54 cases. In 52 cases in which osseous blood (clot and smears) was available for examination, a positive diagnosis for malignancy was made microscopically in 49 (94%). In 46 cases in which bone cores were studied separately, a microscopic diagnosis of malignancy was made from the bone core in 39 (85%). If osseous blood had not been available for examination only 39 (72%) of the 54 biopsies would have been positive for malignancy; the other 14 biopsies would have been classified as either negative or insufficient for diagnosis. In those biopsies where both bone cores and osseous blood were available, the osseous blood showed better malignant tissue morphology and was considered better diagnostic material in 19 cases, whereas bone cores were considered better diagnostic material in only three cases. Osseous blood, which is usually easily available in bone biopsies, is valuable diagnostic material; it should be treated as a tissue specimen and not discarded.

Closed skeletal needle biopsy: review of 120 cases.

A review of 120 percutaneous bone biopsies performed on 110 patients in the Radiology Department of the Hospital for Special Surgery showed a 72% concurrence of biopsy findings with the patient's other clinical findings and subsequent course. Of the biopsies, 58% were correctly positive for malignancy or infection and 14% were correctly negative. The rest, 28% of the biopsies, were either incorrectly negative or had insufficient tissue for diagnosis and were therefore unsatisfactory. Only eight positive cultures from biopsy material were obtained in 21 cases with bone infections. In diagnosing metastasis, a higher success rate (84%) was noted in vertebral biopsies than other sites (66%). Poor success (44%) was noted, however, in biopsying primary bone neoplasm.

Radiologic evaluation of painful joint prostheses.

The most important method of evaluation of painful total joint prostheses is review of sequential radiographs. Because clinical failure from loosening occurs late, abnormalities of alignment, the cement-bone or cement-metal interface, the bony contour, or the integrity of the prosthetic components will be found in the vast majority of cases of clinical failure. In cases in which plain radiographs are normal or equivocal, radionuclide bone scanning with Tc-99m diphosphonate agents are useful. A diffuse increase in vascularity and in uptake of radionuclide is present in infection, while a normal scan suggests that infection or loosening is unlikely. Positive arthrograms are helpful in confirming loosening and in demonstrating abscess cavities and sinus tracts, but negative arthrograms have little significance. Asymptomatic patients with radiographic evidence of loosening should be followed with sequential roentgenograms for signs of progressive bone destruction.

Untreated congenital hip dysplasia in the Navajo.

Congenital hip dysplasia without dislocation was identified in 18 Navajo Indian children. Treatment had been declined and the children presented a unique opportunity to observe the natural course of hip dysplasia. In a follow-up period of three to 19 years (average, 11.2 years), none of the dysplastic hips were observed to progress to dislocation. In 15 of the children with dysplastic hips, the condition became roentgenographically normal in the course of normal growth and development. The other three children continued to show roentgenographic signs of hip dysplasia.

Radiological evaluation of painful total hip replacement.

Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. 99mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

Infantile coxa vara.

Infantile coxa vara is an unusual localized dysplasia, not evident at birth, which is first noticed when the child begins walking. Twelve cases are presented with emphasis on the characteristic roentgen findings which include abnormal ossification of the femoral neck, a vertical physis, a characteristic triangular osseous fragment at the medial inferior corner of the metaphysis, and a straight femoral shaft. Prompt diagnosis and early management can reduce severe deformity and degenerative changes of the hip. For this reason, infantile coxa vara must be differentiated from other generalized and localized causes of coxa vara, including congenital dysplasias and acquired abnormalities.

An easy method to demonstrate the cruciate ligaments by double contrast arthrography.

A reproducible technique which does not require special equipment for demonstrating the cruciate ligaments by double contrast arthrography is described. The positive contrast medium coats the synovial surfaces of the ligaments, i.e., the anterior aspect of the anterior cruciate ligament and the posterior aspect of the posterior cruciate ligaments. The ligaments appear lucent by this technique because they are delineated by a sharp positive contrast medium/lucent interface. The study is performed prior to the meniscal exam before medium absorption occurs.

Computer-assisted tomography of the knee.

The potential contributions and limitations of computer-assisted tomography of the knee have been analyzed. The knee was examined in the transaxial, sagittal, semi-sagittal and coronal planes. The positioning for obtaining intra-articular detail is outlined, and the indications are discussed. Delineation of the cruciate ligaments is remarkably clear and clinically applicable. The menisci can be demonstrated, but improvement in spacial resolution and changes in the physical construction of the scanner will be required to permit an adequate clinical evaluation.

Osteochondritis dissecans complicating Legg-Perthes disease. A report of four cases.

Osteochondritis dissecans of the femoral head occurs as a rare complication in the late onset of Legg-Perthes disease. The etiology of this complication is uncertain. Theories include: (a) persistence of an ununited fragment and (b) fragmentation of the femoral head weakened by revascularization accompanying healing. The area of osteochondritis dissecans may not be readily apparent on routine radiographs and a high index of suspicion is necessary for diagnosis. Four cases of osteochondritis dissecans of the hip presenting 6--18 years after the diagnosis of Legg-Perthes disease are described. Three patients were studied by arthrography, and the findings correlated well with symptomatology.

The limbus vertebra: an anterior disc herniation demonstrated by discography.

Limbus vertebra results from an intrabody herniation of disc material. It can be mistaken for a fracture, infection, or tumor, resulting in unnecessary invasive diagnostic procedures. A case is presented in which the lesion was diagnosed by discography. Most radiologists are unfamiliar with discograms, yet they are useful because they opacify the anteriorly herniated portion of the nucleus pulposus.

Posttraumatic adhesive capsulitis of the ankle: arthrographic diagnosis.

A disabling decrease in range of motion may be a sequelae of ankle trauma. This complication can result from secondary degenerative joint disease, osteochondrial fractures with loose bodies, or posttraumatic adhesive capsulitis. The latter entity is well recognized as a complication of shoulder injuries but is rarely described in other joints. Since adhesive capsulitis produces no specific plain film findings, the confirmation of this diagnosis depends on the usage of a contrast study. It is only recently that ankle arthrography has been utilized to differentiate between the various causes of a painful posttraumatic ankle. Once a diagnosis is established by arthrography, therapeutic efforts can be directed toward relieving the specific abnormality. Three cases of "frozen" ankles are presented. Two were the result of intracapsular fractures, while the third had previously sustained a severe injury of the soft tissue. The arthrographic findings included a decrease in the joint capacity, obliteration of the normal anterior and posterior recesses, and extravasation of contrast material along the needle track.

Neonatal septic "dislocation" of the hip: true dislocation or pathological epiphyseal separation?

The clinical and roentgenologic appearance of septic dislocation of the hip may be caused by either a true dislocation or a pathological epiphyseal separation due to osteomyelitis. Arthrography of the hip permits differentiation in the neonate. The significance of these two anatomical possibilites is discussed in terms of follow-up and results of neonatal infections about the hip, and a case of pathological epiphyseal separation at the hip diagnosed in the neonatal period by aspiration and arthrography and followed up for 3 years is presented.