Isolated zone I vertical fracture of first sacral vertebra: a case report.

Isolated sacral fractures which occur by shear forces on the pelvic ring are seen less commonly and they are commonly transversely oriented. A 29-year-old Turkish female patient, who sat in front seat in the car, was unrestrained, and another car hit them from right front side of their vehicle. Physical examination revealed considerable tenderness over the right superior gluteal region and excruciating pain during sacral and iliac compression. There was no clear fracture line in her plain radiographs. CT revealed incomplete, zone I fracture located on the superior and anterior part of the first sacral vertebra. Type 1 lateral compression pelvic fractures are relatively common and they include impacted sacral and ipsilateral rami fractures. Only a few cases, related with the isolated sacral fracture, have been reported in the literature. To our knowledge, no isolated vertical zone I fracture of the first sacral vertebra which occurred with the lateral compression injury has been described previously. Fracture of the sacrum should be suspected in the presence of sacral pain and tenderness.

Incidental finding of sacral hemiagenesis on the (99m)Tc-MDP bone scan as a casual regression syndrome type II.

A 69 years old woman with chronic low back pain referred to our Department for bone scintigraphy. Patient did not have any other complaint and his physical examination of the patient was normal. Whole-body scan was acquired 3 h after the intravenous injection of 740 MBq of technetium-99m methylene diphosphonate ((99m)Tc-MDP). Distal sacrococcygeal region could not be observed during the visual analysis of the whole-body scan. Pelvic X-rays radiography and pelvic computed tomography of the patient, demonstrated hemiagenesis of the sacrum, which was consistent with type-2 sacral agenesis. Other structural abnormalities were not detected on the pelvic CT scan of the patient. This case is presented to demonstrate the rare congenital anomaly of sacral hemiagenesis causing empty pelvis appearance in the posterior projection of (99m)Tc-MDP whole body bone scan. This congenital anomaly could be associated with extensive abnormalities of the lower vertebrae, pelvis, and spine.

Accessory cardiac bronchus and tracheal bronchus anomalies: CT-bronchoscopy and CT-bronchography findings.

Most common developmental anomalies of bronchial tree include accessory cardiac bronchus (ACB) and tracheal bronchus (TB). Minor bronchial anomalies include variants of TB, displaced segmental bronchi, and bronchial agenesis. We present CT-bronchoscopy and CT-bronchography findings of three cases with either ACB or TB. Recognition of these anomalies is important, as associated clinical complications, including recurrent episodes of infection, hemoptysis, and perhaps malignancies may be anticipated in a small percentage of patients.

Intracolonic multiple pebbles in young adults: radiographic imaging and conventional approach to a case.

Most of the foreign bodies detected in adult gastrointestinal systems are accidentally swallowed pins. In this study, we presented a case with intracolonic multiple pebbles. A 20-year-old man was admitted to emergency surgery policlinic for abdominal pain for 2 d without any alleviation or aggravation. His upright plain abdominal radiographic imaging revealed about 30-40 overt dense opacities in lumen of colonic segments, with oval and well shaped contours, each approximately 1 cm multiply 1 cm in size. The multiplanar reconstructions and three-dimensional images combined with sectional screening showed that all pebbles had passed completely into the colon and no foreign bodies had remained in the ileal segments. On psychiatric assessment, he was found to have immature personality features, difficulty in overcoming stressors and adaptation disorder. He recovered by conservative management and radiographic monitoring applied during his follow-up. Thus, it can be concluded that, in differential diagnosis of abdominal pain in adult ages, though less frequently seen than in children, gastrointestinal system foreign bodies should always be kept in mind and it should be considered that ingestion of pebbles may be one of the factors contributing to abdominal pain particularly in young adults with psychiatric problems. In such cases suspected of having foreign bodies which cannot be detected by plain films, abdominal tomography can be an alternative for diagnostic imaging.

Varices of inferior epigastric veins caused by chronic inferior vena cava obstruction: mimicking normal venous flow pattern on radionuclide venography.

A 21-year-old patient with long-standing inferior vena cava obstruction secondary to idiopathic thrombosis extending from the external iliac veins underwent a radionuclide venography with Tc-99m pertechnetate labeled erythrocytes. The blood pool phase of the study revealed bilaterally distorted inferior epigastric veins mimicking normal venous flow pattern. The authors present this case to discuss the possible alternative routes and the underlying physiopathologic mechanism of this unusual flow pattern in chronic inferior vena cava obstruction.