Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and "cock robin" deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.
Picture archiving and communication systems (PACS) for imaging studies is rapidly being adopted in hospitals throughout the UK. However, very little comparison has been made between PACS and laser hard copies for assessing the diagnostic accuracy of detecting fractures by emergency physicians. A prospective paired comparison study was undertaken looking at correct reporting of scaphoid X-rays on PACS and conventional film by emergency department medical staff. A total of 34 imaging studies were reported by 38 physicians using both PACS workstations and laser-printed films. The percentage of emergency physicians correctly reporting imaging studies was similar when comparing PACS images to laser film copies (80.7% versus 81.0%). The sensitivity and specificity of PACS for diagnosing scaphoid fractures was 79.5% and 81.6%, versus 78.1% and 83.8% for conventional films. There is no significant difference in accuracy of diagnosis between PACS and laser film copies when scaphoid X-rays are reported by emergency physicians.
Clinical history A 57 year old female presented with a one year history of low back pain and left sided sciatica. Her general health was unremarkable. Plain radiographs ofthe lumbar spine were abnormal (fig 1). These films revealed a spondylolisthesis at the L4/5 level. There was no evidence of an underlying spondylolysis and the degenerative L4/5 facet joints predisposed to the forward listhesis.The patient was given a lumbar support and a course of physiotherapy. Although the symptoms improved transiently, they gradually became worse, obliging her to give up her work as a secretary, because of constant back pain. She was referred for an MRI scan ofthe lumbar spine for further assessment.Radiological findings Magnetic resonance imaging (MRI) of the lumbar spine was performed (Siemens 1 Tesla Impact) using sagittal and axial Ti and T2 weighted sequences. This revealed a soft tissue mass 1 cm in diameter on the medial aspect of the left L4/5 facet joint causing expansion of the lateral recess of L5 (fig 2A). The mass exhibited intermediate signal intensity on the Ti weighted sequences (fig 2A), and high
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.