Bilateral distal tibial osteochondral lesion: a case report.

Osteochondral lesion of the talar dome is a well-known clinical and radiographic entity. Less known is osteochondral lesion of the articular surface of the distal tibia. A case report, which demonstrates bone-scintigraphy and MRI findings of bilateral osteochondral lesion of tibial plafond and related literature, is presented.

Bone scintigraphic findings of os trigonum: a prospective study of 100 soldiers on active duty.

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty. PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated. RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum. CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.

Lower extremity scintigraphy: the foot and ankle.

Disorders of the ankle and foot are common and may pose a significant clinical problem. Acute injuries of the ankle and foot are routinely evaluated by radiographs and, if inconclusive, by magnetic resonance imaging (MRI) or computed tomagraphy (CT). In subacute or chronic injuries, where prolonged pain is unexplained, bone scintigraphy may play a significant role. The bone scan may differentiate soft tissue from bone pathology, and, being a sensitive test, it may indicate the region that needs further specific radiologic examination. It may also indicate the clinical significance of a radiologic finding. Moreover, in some clinical settings bone scintigraphy can be specific in the diagnosis. Careful attention to the technique enhances the efficiency of bone scintigraphy and SPECT allows better investigation of the hindfoot. The importance of ankle and foot injuries in the orthopedic practice and the better understanding of subacute and chronic injuries in athletes and in the general population has led to an increased use of specific tests such as MRI, CT, and bone scintigraphy. With improved technique and instrumentation it is no longer sufficient to indicate a focal abnormality in the ankle or foot on bone scintigraphy. More precise information about perfusion, blood pool, and specific location of a lesion can be obtained by high resolution and tomographic images. The role of bone scintigraphy in the diagnosis of such disorders will be presented with a focus on subacute traumatic injuries and related disorders, as well as its role in systemic inflammatory disorders that often involve the ankle and foot.

Scintigraphy of posterior tibial tendinitis.

UNLABELLED: Our goal was to describe the typical scintigraphic pattern of posterior tibial tendinitis. METHODS: Bone scintigraphs were reviewed to study the scintigraphic characteristics of posterior tibial tendinitis in nine patients with posterior tibial tendinitis related to generalized rheumatic disease and in eight patients with isolated posterior tibial tendinitis. RESULTS: The scintigraphic pattern of posterior tibial tendinitis is elongated increased uptake in the blood flow and blood-pool phase along the anatomical course of the tibialis posterior tendon at the medial aspect of the ankle (malleolus region). Static images demonstrate increased focal abnormal uptake at the medial malleolus and in the navicular bone. CONCLUSION: Bone scintigraphy depicts a characteristic pattern of posterior tibial tendinitis. It is useful for the early diagnosis of idiopathic- or rheumatic-related posterior tibial tendinitis.

Bone scintigraphy findings in Lisfranc joint injury.

Three-phase bone scintigraphy diagnosis of Lisfranc injury in a patient after foot trauma is discussed. Early diagnosis of Lisfranc joint injury is frequently missed and radionuclide bone scintigraphy may show a specific pattern where the x-rays are inconclusive.

Remodeling of the calcaneus apophysis in the growing child.

Radiography and computer-aided analysis of tomography of the os calcis in 35 children with Sever's disease and of 52 control children were concurrently evaluated with histologic appearance of six calcanei of victims of road accidents, which were radiographically compatible with the same syndrome. Histology showed abrupt interruption in continuity of the apophysis of perpendicular fibrous plates with evidence of an ongoing reparative process. Computer-aided analysis of orientation of the "fragmentation" lines and histologic data both support the hypothesis of a stress remodeling process owing to excessive bending forces acting on the calcaneal apophysis.

Clubfeet associated with hydrocephalus: new evidence of gradual dynamic development in utero.

Clubfoot, a relatively frequent congenital malformation, may be associated with several genetic syndromes or other malformations, or may appear as an isolated idiopathic anomaly. We describe the intrauterine development of clubfeet subsequent and in parallel to fetal hydrocephalus formation, as followed by serial transvaginal sonographic scans at 11-16 weeks' gestation. The possibility of a causal relationship between the central nervous system malformation and the clubfeet is suggested. To the best of our knowledge, this is the first description of the dynamic, in vivo fetal development of hydrocephalus and clubfeet at 11-16 weeks' gestation.

[Encephalitis without pneumonia caused by Legionella bozemanii].

Legionnaire disease (LD) is characterized by a clinical picture of pneumonia and is usually accompanied by multisystem involvement. Neurologic manifestations tend to appear concurrently with, or soon after the onset of fever. Cases in which neurologic manifestations precede the development of pneumonia are exceedingly rare. We recently treated 3 patients with LD who presented with a clinical picture of severe viral encephalitis without pneumonia. There were high serum titres of IgG and IgM antibodies against several Legionella species. However, a positive reaction in the spinal fluid was detected only against L. bozemanii. All 3 patients were discharged without sequellae. We suggest that LD should be included in the differential diagnosis of viral encephalitis.

Mastitis caused by hemolytic Escherichia coli in the ferret.

Hemolytic Escherichia coli was isolated from the mammary glands of 8 ferrets with gangrenous mastitis. Clinical signs included firm swelling of one or more mammary glands and discoloration of the overlying skin. Peracute disease and acute septicemia were observed, and in some cases the animals rapidly became moribund. Antibiotic therapy alone did not alter the course of the disease. Wide surgical resection of the involved glands in combination with systemic antibiotic therapy (ampicillin 10 mg/kg, BID, and gentamicin 5 mg/kg, SID) was the most successful treatment. Histopathologic changes included extensive edema, hemorrhage, and necrosis, with a mixed leukocytic infiltrate and large numbers of bacteria. The agent of this disease was isolated from rectal swab specimens from clinically normal ferrets as well as ferrets that had mastitis.