Der Radiologe
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A 73-year-old woman presented with a swelling of the right sternoclavicular joint the size of a hens egg which had persisted for 2 years. After a corticosteroid injection 8 months previously the swelling was asymptomatic. ⋯ The constellation is indicative of Tietze syndrome, an inflammation of costochondral junctions of the ribs or chondrosternal joints. The treatment is usually directed at pain relief and benign conditions are often self-limiting.
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Areas with reduced density are a common finding with thin-slice computed tomography (CT) examinations of lung parenchyma. Diffuse and localized patterns can be differentiated. The most frequent cause for a diffuse decrease in density is pulmonary emphysema which can be classified into centrilobular, panlobular and paraseptal emphysema based on the distinct anatomical features. ⋯ Langerhans cell histiocytosis and lymphangioleiomyomatosis are the most frequent cystic diseases of the lung parenchyma. Based on the geometry and anatomical distribution of the cysts a differentiation is mostly possible. Rare diseases leading to a reduced lung density include the Birt-Hogg-Dubé syndrome, lymphoid interstitial pneumonia as well as congenital diseases or diseases which are acquired during early childhood, such as cystic adenomatoid malformation or Swyer-James syndrome.
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As a rule vertebroplasty and kyphoplasty can prevent further collapse of a previously broken vertebra. Pain is probably caused by collapse of the porous bone resulting in instability of the vertebra. Stabilization of the vertebra by injecting cement results in a clear improvement in the complaint and a clear reduction in pain resulting in better mobilization. ⋯ In approximately 15-45% of patients the zygapophyseal joint is the cause of the back pain. Anesthesia of the zygapophyseal joint can be carried out by direct intra-articular application of a local anesthetic or by a block of the medial branch of the posterior branch of each of two spinal nerves. The simplest method is by computed tomography-guided zygapophyseal block.
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Inflammatory diseases of the spine and the spinal cord (myelon) can be caused by a wide range of pathological conditions. Except for degenerative inflammatory diseases of the spine, infectious and autoimmune disorders are relatively rare. ⋯ Inflammation of the myelon cannot be depicted with conventional radiographs in general and by computed tomography only occasionally. In these cases magnetic resonance imaging is the method of choice to detect early abnormalities of the myelon and to provide detailed information for the differential diagnosis.
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Postoperative imaging after spinal surgery is usually performed to document the correct positioning of implants or to rule out complications if patients still suffer from pain after surgery. Depending on the question various imaging modalities can be used all of which have benefits and limitations. Conventional X-ray is used for the documentation of the correct positioning of spinal implants, stability (olisthesis) and during follow-up to rule out fractures or instability of the implants, whereas soft tissue changes cannot be completely assessed. ⋯ Soft tissue changes including persistent or recurrent herniated disc tissue, hematoma or infection can best be depicted using magnetic resonance imaging (MRI) which should be performed within the immediate postoperative period to be able to distinguish physiological development of scar tissue from inflammatory changes in the area of the surgical approach. Often imaging alone cannot differentiate between these and imaging can therefore only be considered as an adjunct. Computed tomography is the modality of choice for the evaluation of bony structures and an adjunct of new therapies such as image-guided application of cement for kyphoplasty or vertebroplasty.