Three-phase radionuclide bone (TPB) imaging was performed on 238 patients with sports-related injuries. A wide variety of lesions was encountered, but the most frequent lesions seen were stress fractures of the lower part of the leg at the junction of the middle and distal thirds of the posterior tibial cortex (42 of 79 lesions). There were no differences in the type, location, or distribution of lesions between males and females or between competitive and noncompetitive athletes. In 110 cases, bone stress lesions were often diagnosed when radiographs were normal, whereas subacute or chronic soft-tissue abnormalities had few specific scintigraphic features. TPB imaging provides significant early diagnostic information about bone stress lesions. Normal examination results (53 cases) exclude underlying osseous pathologic conditions.
Three-phase radionuclide scintigraphy of the hand was performed on 116 patients. Normal and abnormal patterns for radionuclide angiography, immediate post-injection blood-pool images, and delayed scans (3-4 hr.) were established. Of 80 patients with normal circulation, 61 (76%) had equal radial and ulnar artery flow bilaterally, while in 19 (24%) either the radial or ulnar artery was dominant. Abnormal studies were grouped into three categories: suspected vascular lesions (Group I), pain of uncertain etiology (Group II), and patients evaluated before and after reconstructive surgery (Group III). The diagnosis was correct in 89% of the patients in Group I (34/38), 89% of those in Group II (57/64), and all of those in Group III (14/14). Three-phase scintigraphy of the hand yields significant information about perfusion and bone metabolism.
This case describes how positron emission tomography (PET) led to the diagnosis of giant cell arteritis in a 50-year-old woman with fever of unknown origin. The patient presented with fever, weight loss, anemia, and headaches. She underwent multiple serologic, biopsy, and imaging tests that were inconclusive. Her sedimentation rate was 83. Giant cell arteritis was suspected clinically. PET revealed diffuse abnormal F-18 fluorodeoxyglucose (FDG) arterial uptake consistent with giant cell arteritis. After treatment with steroids, the patient showed prompt resolution of symptoms. A repeat PET scan showed near-complete resolution of the abnormal FDG uptake.
Testicular cancer is the most common type of cancer among young patients. At the moment of diagnosis, between 30% and 50% of them have developed metastases, which affect retroperitoneal lymph nodes and lungs especially. Hepatic compromise is rare and is associated with poor prognosis. Besides this, hepatic lesions can complicate with necrosis and overgrowth, a phenomenon that is mainly seen in primary lesions. Furthermore, bleeding of secondary lesions is very uncommon. We present a case of a patient with massive hemoperitoneum secondary to rupture of hepatic metastatic lesions of a primary testicular tumor.
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