Technique and use of supine oblique views in acute cervical spine trauma.

STUDY OBJECTIVE: To determine whether the addition of the supine oblique view of the cervical spine can detect fractures or ligamentous injury not seen on the standard three-view examination. DESIGN: Radiographs of patients with documented cervical spine injury were reviewed retrospectively by three neuroradiologists. Patients were included in the study if the initial interpretation of the three-view series was normal and the abnormal supine oblique view enabled a correct diagnosis to be established. SETTING: The emergency department of a university-affiliated hospital with Level I trauma center status. TYPE OF PARTICIPANTS: Eighty-three consecutive patients with documented cervical spine injury evaluated during a 20-month period. RESULTS: Eight patients demonstrated abnormality to best advantage on the supine oblique view. These included six fractures and two ligamentous injuries. Five patients had abnormalities confined to the supine oblique view, and the remaining three had subtle abnormalities on the cross-table lateral view. CONCLUSION: The supine oblique view may detect fractures or ligamentous injury not identifiable on the standard three-view examination. We recommend the routine use of a five-view cervical spine series with the inclusion of 30-degree supine oblique views in the evaluation of acute cervical spine injury.

Case report: bilateral upper lobe Pneumocystis carinii pneumonia in a patient receiving aerosolized pentamidine.

A case of progressive bilateral upper lobe Pneumocystis carinii pneumonia in a patient receiving aerosolized pentamidine is presented. This is a recently recognized pattern in patients with acquired immunodeficiency syndrome on aerosolized pentamidine. Pneumocystis carinii pneumonia must be considered as a possibility when this select subset of patients presents with this atypical upper lobe pattern.

Malignant fibrous histiocytoma: etiology for a cold defect on technetium-99m-methylene diphosphonate bone scan.

Various causes for cold defects on bone scans (e.g., avascular necrosis) have been described. A case is presented in which a cold defect on a technetium-99m-methylene diphosphonate bone scan was the result of malignant fibrous histiocytoma.

Penetrating injury of the vertebral artery: a unique management approach.

We have reported a case of traumatic vertebral artery transection discovered during an emergency neck exploration for penetrating injury with acute hemorrhage. Knowledge of the surgical anatomy of this vessel and awareness of the treatment alternatives that must be considered for its acute injury are important. A cooperative approach between the surgeon, anesthesiologist, and radiologist in this case, using a combination of anesthetic hypotension, surgical tamponade, and angiographic embolization, resulted in a successful outcome in this difficult case.

Aneurysm of the internal iliac vein as a rare source of pulmonary thromboembolism.

This is the first reported case of internal iliac vein aneurysm, manifested by recurrent pulmonary embolism. The case emphasizes the importance of searching for unusual sources of unexpected and unexplained pulmonary emboli. Venous aneurysms may have various manifestations and sequelae. Antecedent trauma and arteriovenous fistulas should be excluded.

The reliability of excretory urography as a screening examination for blunt renal trauma.

A prospective study was designed to evaluate the reliability of excretory urography (EU) in excluding renal damage in patients with blunt abdominal trauma, using contrast-enhanced computed tomography (CECT) as the "gold standard" of diagnostic studies. Sixty patients with indications for genitourinary evaluation and with normal EU underwent CECT. Five renal injuries were demonstrated by CECT in patients with negative EU: one contusion, one subcapsular hematoma, two perirenal hematomas, and one renal laceration. All of these lesions resolved with conservative patient management. Thus, the CECT findings did not alter treatment in these five patients.

Radiographic, clinical, and histopathologic evaluation with surgical treatment of Forestier's disease.

Diffuse idiopathic skeletal hyperostosis (Forestier's disease) is a common disorder found in the spinal region, but the notable finding in this case presentation is the associated dysphagia and dysphonia that occurred with it. Asymptomatic hypertrophic spurs of the anterior surface of the cervical vertebrae may occur in 20% to 30% of the population. Rarely, dysphagia and/or dysphonia may be caused by these cervical osteophytes pressing against the esophagus, trachea, or pharyngeal tissues. A recent case of spondylitic dysphagia exhibited striking radiographic and computerized tomographic (CT) findings. In this case, the anterior cervical exostosis was resected through the anterior cervical approach with excellent relief of dysphagia.

Complications associated with intra-arterial BCNU administered in combination with vincristine and procarbazine for the treatment of malignant brain tumors.

We have used intra-arterial (i.a.) 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) either alone or as part of adjuvant chemotherapy in patients with malignant brain tumors over a 3 year period (1979-1982). The i.a. BCNU technique was used 111 times to infuse 134 arteries in 37 patients. These patients, 28 cases with glial tumor and 9 cases with brain metastasis, received i.a. BCNU in combination with Vincristine and Procarbazine every 6 weeks. Complications encountered were transient and included: periorbital erythralgia or occipital-nuchal pain in 23 (62%), mild confusion and disorientation in 14 (38%), and ipsilateral conjunctival edema in 10 (27%). Reversible myelosuppression was not found. Our findings suggest that BCNU (100 mg/M2) may be given by i.a. infusion in combination chemotherapy without persistent severe untoward effects with a cumulative dose of 700 mg/M2.

The radiologic diagnosis of thoracic aortic rupture on plain film.

This paper reviews the recent literature (1968-1982) describing the radiologic diagnosis of aortic rupture and attempts to define causal relationships between rupture and radiologic signs as well as assessing respective predictive values. Also presented is a case report of a patient with thoracic aortic rupture in whom esophageal (nasogastric tube) displacement occurred to the left rather than the right, in apparent violation of one of the more newly established radiologic signs of aortic rupture.