Twenty-six patients undergoing long-term hemodialysis who had hand and wrist abnormalities were examined for the presence of concurrent spinal disease. Six patients (23%) were found to have spinal disease on radiographs. In four, the findings resembled those of a destructive spondyloarthropathy, and in two, a less destructive erosive arthritis. A review of the spinal radiographs of 31 patients with normal hands and wrists revealed no such abnormalities. Postmortem examinations of two patients with spondyloarthropathy demonstrated extensive deposition of beta-2 microglobulin, an amyloid-like substance. The authors conclude that the disease is similar in both areas and represents a skeletal response to chronic renal failure and long-term hemodialysis. The disease may occur more frequently with an increased duration of hemodialysis, in one area of the skeleton if another area is already affected, and is probably not infectious if multiple areas are involved.

Lückenschädel, scalloping of the posterior surface of the petrous pyramids, falx hypoplasia, falx fenestration, and tentorial hypoplasia with wide incisura and tiny posterior fossa are readily identified by computed tomography (CT) in patients with Chiari II malformation. Enlargement of the foramen magnum may be appreciated on axial section CT in some cases. None of these findings is pathognomonic and each may be observed in some patients with other conditions. In the aggregate, however, these findings strongly suggest the presence of Chiari II malformation.

We found that a PSV of greater than 200 cm/s was the best criterion for the diagnosis of IMA stenosis. The sensitivity, specificity, PPV, NPV, and accuracy for the PSV were 90%, 97%, 90%, 97%, and 95%, respectively.

We describe a patient with idiopathic arterial calcification of infancy and the following unusual features of the disease: (1) prolonged survival until age 11 years, (2) discordance between the extent of vascular calcification and clinical manifestations of arterial luminal occlusion, (3) a large area of myocardial calcification, (4) symptoms of cerebral-vascular insufficiency, and (5) spontaneous resolution of hypertension.

The frequent finding of bilateral DVT and unsuspected contralateral DVT in patients with unilateral symptoms, and the even more frequent finding of DVT in patients with bilateral symptoms, clearly indicates that both categories of patients need to be evaluated with bilateral US.

Ureteral obstruction can lead to renal failure without involving detectable dilatation of the calyces, renal pelvis, or ureter proximal to the obstruction. This phenomenon was noted in seven patients who had clinical obstruction that we were not able to diagnose using computed tomography (CT) or ultrasonography (US). These patients underwent percutaneous nephrostomy (PCN), which resulted in brisk diuresis and improved renal function. We obtained an accompanying antegrade urogram in these cases, which demonstrated the level of obstruction and indicated that dilatation of the collecting system was minimal or not present. When obstructive uropathy is suspected, we believe it is essential to consider performing PCN to evaluate and potentially reverse renal failure, even when CT and US scanning do not demonstrate obstruction.

In patients with Chiari II malformations, the fourth ventricle is usually not visualized or appears small; the third ventricle is relatively small, typically has a large massa intermedia, and only occasionally exhibits parasellar and/or posterior third ventricular diverticula. The lateral ventricles are usually asymmetrically dilated, show medial pointing of the floor of the body near the foramen of Monro, flattening of the superolateral angles, and frequent absence of the septum pellucidum. Prior to and after shunting, the interhemispheric fissure may be either obliterated, or widely open with serrations corresponding to the interdigitated gyri of the cerebral hemispheres. Prominent confluent cisterns at the hind end of the third ventricle in patients with ventricular collapse may represent the CT equivalent of the dilated pericallosal, ambient and retropulvinaric cisterns seen in patients with hydrocephalus and poor ventricular filling at pneumography.

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