Intraosseous calcifications in tophaceous gout.

Intraosseous calcification in association with gouty arthritis was observed in six patients and a single cadaver. This finding, which is usually associated with chronic tophaceous gout, extensive articular destruction, and severe renal disease, is usually seen in the hands, wrists, and feet. It may be associated with additional calcific deposits in the adjacent soft tissues. Although the radiographic appearance of the calcification simulates that of an enchondroma or bone infarct, the abnormality seems related to intraosseous penetration of calcified urate deposits.

Echographic and radionuclide detection of hepatoma.

The clinical, echographic, radionuclide and CT studies of 19 patients with tissue-proved hepatoma were reviewed retrospectively. All patients had undergone ultrasound examination while 18 also had 99mTc-sulfur colloid studies, and 11 had gallium scans. Ultrasonically, the lesions were classified as discrete, sonodense (six cases), discrete sonolucent (five cases), disorganized hepatic parenchyma (six cases), and normal parenchyma (two cases). All sulfur colloid studies showed areas of decreased uptake, while all gallium scans showed relative increased uptake in the area of decreased sulfur colloid activity. It was concluded that radionuclide imaging is more accurate than ultrasound in the diagnosis of hepatome.

The hemodynamic significance of massive pneumopericardium in preterm infants with respiratory distress syndrome. Clinical and experimental observations.

Radiographic and clinical data were evaluated in 12 preterm infants with pneumopericardium complicating ventilator therapy of respiratory distress syndrome. Eight infants had massive or tension pneumopericardium, reflected by bradycardia, hypotension, and cyanosis of abrupt onset; cardiac size decreased dramatically but returned to approximately the former size after aspiration of the pneumopericardium. In puppies, pneumopericardium large enought to reduce heart size by 32 +/- 3% caused decreased mean arterial pressure (-22 +/- 7%) and right ventricular peak systolic pressure (-11 +/- 2%) and increased right ventricular diastolic and intrapericardial pressures. These findings suggest that pneumopericardium per se causes severe hemodynamic compromise. When it is large enought to reduce heart size, drastic circulatory impairment is produced and pericardiocentesis should be performed immediately.

Critical aortic stenosis in neonates.

Twelve infants with valvular aortic stenosis manifested symptoms of heart failure during the first 2 months of life. Nine became symptomatic and demonstrated cardiomegaly and pulmonary vascular congestion during the first week of life. The other 3 infants became symptomatic at 3-8 weeks. Echocardiograms revealed normal or enlarged left atrial and ventricular dimensions excluding hypoplastic left heart. Left ventriculography demonstrated segmental dysfunction in 7 infants and generalized hypokinesis in 2 others. Trabecular effacement corresponded with the sites of left ventricular dysfunction. Postoperative studies revealed a decrease in cardiac size and improvement in segmental dysfunction in most infants.

Enostosis of the spine.

Five patients with single sclerotic vertebral body lesions had serial radiographs demonstrating no change in size of the radiodensities. Radionuclide bone imaging, obtained in 4 of these patients, showed no increased radioisotopic uptake in the areas in question. The absence of growth of the lesions on follow-up radiographs and the presence of negative bone scans support the diagnosis of enostoses of the spine. It is important for the radiologist to realize that benign sclerosis of a single vertebral body may simulate skeletal metastasis.

Bony proliferation of terminal toe phalanges in psoriasis: the "ivory" phalanx.

Twenty-eight per cent of our patients with psoriatic arthritis involving the feet demonstrated osseous proliferation and increased radiodensity of the terminal phalanges. This sign, the "ivory" phalanx, is a poorly recognized radiographic manifestation of the disease, but is particularly important in the absence of articular abnormality or of resorption of the tufts. It is almost invariably associated with nail diseases of the same digit.

Salicylate-induced pulmonary edema.

A case of pulmonary edema secondary to salicylate intoxication is described. The pulmonary wedge pressure was normal, excluding cardiogenic pulmonary edema. Thus salicylate intoxication should be considered as a rare cause in the differential diagnosis of pulmonary edema with a normal heart size. The pulmonary edema resolved gradually over 8 days. Literature relative to salicylate-induced pulmonary edema is reviewed.