Radiology
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Radiographs were compared with 99mTc scans of the bones and bone marrow as well as 67Ga-citrate scans to evaluate their sensitivity in identifying skeletal lesions in 21 children with histiocytosis X. Seven of 20 bone scans were completely normal in patients with extensive radiographic evidence of skeletal disease. ⋯ Radiographic survey of the skeleton should be the primary diagnostic test employed in patients with histiocytosis X who have suspected skeletal lesions. Bone scans should be obtained only when the radiographs are normal or equivocal.
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The use of computed tomography (CT) in the diagnosis and management of decompression sickness and diving air embolism has not been previously reported. Two unusual cases of neurological dysbarism are presented in which CT was helpful in the postrecompression evaluation and treatment. CT showed areas of infarction and of edema of the brain. The role of CT in managing dysbaric diving accidents is discussed.
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Observations on the esophageal-pleural stripe were amplified by computed tomography. The relationship of the esophagus to the trachea is variable and, at times, the two may be side by side, the esophagus to the left. Under this condition, the naturally air-filled esophagus may mimic mediastinal emphysema or tracheomegaly; the barium-filled esophagus may mimic displacement by a mediastinal tumor.
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The injection of anesthetics and/or steroids into the lumbar facet joints has been advocated in the management of low back pain. During this procedure, arthrography was performed in 70 joints of 27 patients with osteoarthritis and 3 patients with bilateral spondylolysis of a lower lumbar vertebra. ⋯ The articular capsule nearly always bursts during or after arthrography, and the path followed by the leaking contrast medium provides an explanation of how injected anesthetics and steroids act in relieving low back pain. Leakage can occur at the lateral aspect of the joint, where the branches of the posterior ramus of the spinal nerve pass, or at the medial side, where the opacification of a joint near a spondylolysis, the contrast medium may spread into the adjacent joint through the defect.
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Patients who have chronic dissections of the aorta are prone to re-dissection, extension of dissection, aortic aneurysm, and aortic rupture. Computed tomography (CT) with contrast enhancement provides a convenient, noninvasive method for follow-up of these patients. ⋯ CT demonstrated re-dissection, aneurysmal dilation of the aorta, and delayed filling of the false lumen. CT also showed persistent patency of the false lumen in almost all of the postoperative cases.