Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis?

STUDY OBJECTIVES: To determine whether bone imaging with 99mTc methylene diphosphonate is a specific method of making the diagnosis of costochondritis in patients with chest pain who rule out for myocardial infarction. DESIGN: Nonblinded prospective controlled study in 20 patients and 10 control subjects. SETTING: Inpatient medical service of a tertiary teaching hospital. PATIENTS: Two hundred consenting patients admitted to the hospital with chest pain and suspected myocardial infarction were examined. Those in whom acute myocardial infarction was ruled out were evaluated for the clinical signs of costochondritis, ie, tenderness over one or more costochondral junctions. Twenty patients who met the clinical criterion gave informed consent and were subjected to bone imaging. Ten control subjects with cancer who did not have clinical signs of costochondritis underwent bone imaging to rule out metastatic disease (normal in all cases). INTERVENTIONS: Bone imaging with I.V. 99mTc methylene diphosphonate. MEASUREMENTS: Bone scans of the investigative patients and the control subjects were read by two independent nuclear medicine specialists. RESULTS: Sixteen of the 20 patients with clinically diagnosed costochondritis showed increased technetium uptake at all costochondral junctions bilaterally; six of them also had increased uptake elsewhere on the chest wall (sternum, manubrium, or first rib). All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally. CONCLUSIONS: Bone imaging with 99mTc methylene diphosphonate is not a specific method of making the diagnosis of costochondritis.

Occipital aneurysmal bone cyst: CT features.

A case of aneurysmal bone cyst arising from the lower occipital squama with intracranial extension is presented. The case is unique in that the cyst showed fluid levels on CT. Another peculiarity of this case was postoperative recurrence.

The results of first rib resection in thoracic outlet syndrome.

Twenty cases of thoracic outlet syndrome in seventeen patients were treated by first rib resections through the transaxillary approach, after conservative therapy failed. The average follow up was twenty-four months. The mean age was thirtyfive years with a range of fifteen to fifty-four years. There were fourteen females and three males. The delay in diagnosis averaged four years with the most common mistaken diagnosis being cervical disc disease. Complications included two cases of pneumothorax, one wound infection, and one intraoperative hemorrhage. Fourteen of the patients had complete relief of pain while two of the patients were improved. There was only one patient who was considered a failure because of recurrent pain. It is concluded that this procedure should be considered when conservative measures fail. The orthopaedist is usually the first to see the patient, and therefore, the diagnosis should be considered in all patients with upper extremity pain.