Test Paper 6
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
An 80-year-old patient with history of rheumatoid arthritis, has been involved in a 40 mph head-on car crash. Air bags were deployed. You are asked to review a cervical spine trauma series. No fracture is identified. The patient has mid-cervical spine tenderness. The patient wants to go home. Which of the following is the best option? Let the patient be discharged since trauma series is normal.Repeat lateral and AP views.Request a flexion and extension lateral cervical spine.Cervical spine CT.Bone scintigraphy.
Tumours
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Traditionally, a skeletal survey required X-rays of the spine, skull, pelvis, ribs/sternum, and the humerus/femurs to screen for osseous lesions, and assess tumour burden and fracture risk. Classic ‘punched-out’, osteolytic lesions with cortical thinning can be seen, which in the skull may cause a ‘pep-per-pot’ appearance (Figure 9.30). More often found in the axial skeleton (particularly spine, skull and pelvis), long-bone lesions are typically metaphyseal. CT is superior for demonstrating fractures, osteolytic lesions, and soft-tissue masses and may aid in distal staging of disease. MRI scanning is useful to stage the extent of marrow infiltration, visualization of focal masses and areas most at risk of fracturing, and to highlight response to treatment. Bone scintigraphy underrepresents the extent of disease as it relies on osteoblastic activity.
Pelvic fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Supplementary imaging is usually required to establish the diagnosis. Bone scintigraphy will demonstrate increased uptake, but it may be 48–72 hours after injury before the scan is positive. Bone scans typically show a characteristic H-shaped pattern of radionuclide uptake across the sacrum and sacroiliac joints.50 CT scanning will reveal the diagnosis in most cases with either fresh fracture lines in early cases or sclerotic healing fractures in later presentations. Even on CT scans, the findings may be quite subtle. However the main differential diagnosis is either osteomyelitis or bone malignancy and the CT scan will usually rule these out. MRI scan is the most useful and sensitive investigation for establishing the diagnosis, particularly T2 weighted short tau inversion recovery (STIR) images and T2 weighted images with fat suppression.
Microwave ablation with chemoembolization for large hepatocellular carcinoma in patients with cirrhosis
Published in International Journal of Hyperthermia, 2018
Hao Hu, Guo Feng Chen, Wei Yuan, Jian Hua Wang, Bo Zhai
Four weeks after the first treatment using MWA-TACE, dynamic enhanced computed tomography or magnetic resonance imaging was performed to assess the extent of the treated areas. Thereafter, the patients were followed up once every 3 months for the first 2 years. At each follow-up visit, contrast-enhanced CT/magnetic resonance imaging and blood tests, including serum liver function tests and alpha-fetoprotein, were conducted. Chest radiography was performed once every 6 months. Bone scintigraphy was performed when clinically indicated. Follow-up started from the day of MWA-TACE, and it ended at patient death, last visit or liver transplantation. Local tumor progression (LTP) and intrahepatic distant recurrence (IDR) were evaluated at 3-month intervals [22]. The definitions of local tumor treatment response used were based on the modified Response Evaluation Criteria in Solid Tumors, included complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD). Major and minor complications were assessed in accordance with the Society of Interventional Radiology guidelines [23]. Transaminitis requiring medication was defined by an increase in serum transaminase to more than three times the upper limit of normal values.
Classification and management strategies for paediatric chronic nonbacterial osteomyelitis and chronic recurrent multifocal osteomyelitis
Published in Expert Review of Clinical Immunology, 2023
Shabnam Singhal, Caren Landes, Rajeev Shukla, Liza J McCann, Christian M Hedrich
Imaging of bone lesions, their distribution, and complications are among the most important tools to diagnose and monitor CNO/CRMO. Examples of pathological changes on imaging can be seen in Figure 5 and are summarized in Table 3. Whole-body (WB)-MRI has become the gold-standard for both diagnosis and monitoring of treatment response. Bone scintigraphy has been superseded by MRI but may be considered as an alternative where WB-MRI or serial MRI imaging is unavailable or contraindicated for safety reasons. MRI is preferred because it does not involve ionizing radiation, allows assessment of bone marrow and soft tissues and has greater sensitivity at detecting the overall number of lesions compared to x-rays and bone scintigraphy [10,79,80]. The metaphyses show physiologically increased uptake on bone scintigraphy making identification of pathology at these sites very difficult and MRI has been shown to be superior in detecting metaphyseal lesions [79–81].
Prevalence of cardiac amyloidosis among elderly patients with systolic heart failure or conduction disorders
Published in Amyloid, 2019
Ángela López-Sainz, F. Javier de Haro-del Moral, Fernando Dominguez, Alejandra Restrepo-Cordoba, Almudena Amor-Salamanca, Aitor Hernandez-Hernandez, Luis Ruiz-Guerrero, Isabel Krsnik, Marta Cobo-Marcos, Victor Castro, Jorge Toquero-Ramos, Enrique Lara-Pezzi, Ignacio Fernandez-Lozano, Luis Alonso-Pulpon, Esther González-López, Pablo Garcia-Pavia
Our study describes a 2% (95%CI: 0–4%) prevalence of ATTRwt amyloidosis in elderly patients with advanced conduction disorders requiring pacemaker implantation (Figure 3). Although, this prevalence could be judged as small and not sufficiently relevant to justify a systematic screening effort, we would highlight that bone scintigraphy is an inexpensive, widely available and non-invasive test, and that the ECG, echocardiographic and clinical characteristics of the two patients identified would not have been enough to establish a diagnosis of ATTRwt (mild and non-specific phenotype). Moreover, several new pharmacological agents are currently under development to treat ATTR cardiomyopathy and some of them have already shown positive results and will be available soon [25]. As in other infiltrative diseases, prompt recognition of the disorder and early initiation of therapy has been associated with better outcomes. Accordingly, it is of the utmost importance to raise a diagnosis of ATTR cardiomyopathy as early as possible. In this regard, several clinical, electrocardiographic and echocardiographic signs including the presence of carpal tunnel syndrome, spinal lumbar stenosis, ruptured biceps tendon, pseudo-infarct ECG pattern, pericardial effusion or a decreased ECG voltage/echocardiographic mass ratio, have been described to facilitate cardiac amyloid diagnosis [11,26,27]. In our opinion, an unexplained conduction problem should be added to this red-flag list and cardiac amyloidosis, particularly ATTRwt amyloidosis, should always be ruled out in elderly patients with unexplained AVB.
Related Knowledge Centers
- Bone REModeling
- Bone Tumor
- Inflammation
- Metastasis
- Positron Emission Tomography
- Scintigraphy
- Bone Fracture
- Radiography
- Nuclear Medicine
- CT Scan