Felix S. Chew

Massive periarticular calcinosis of the soft tissues is a unique but not rare radiographic finding. On the contrary, tumoral calcinosis is a rare familial disease. Unfortunately, the term tumoral calcinosis has been liberally and imprecisely used to describe any massive collection of periarticular calcification, although this term actually refers to a hereditary condition associated with massive periarticular calcification. The inconsistent use of this term has created confusion throughout the literature. More important, if the radiologist is unfamiliar with tumoral calcinosis or disease processes that mimic this condition, then diagnosis could be impeded, treatment could be delayed, and undue alarm could be raised, possibly leading to unwarranted surgical procedures. The soft-tissue lesions of tumoral calcinosis are typically lobulated, well-demarcated calcifications that are most often distributed along the extensor surfaces of large joints. There are many conditions with similar appearances, including the calcinosis of chronic renal failure, calcinosis universalis, calcinosis circumscripta, calcific tendonitis, synovial osteochondromatosis, synovial sarcoma, osteosarcoma, myositis ossificans, tophaceous gout, and calcific myonecrosis. The radiologist plays a critical role in avoiding unnecessary invasive procedures and in guiding the selection of appropriate tests that can result in a conclusive diagnosis of tumoral calcinosis.

PURPOSE: To evaluate the diagnostic yield of computed tomography (CT)-guided percutaneous needle aspiration procedures in the setting of suspected spontaneous infectious diskitis and to assess the usefulness of concurrent cytologic examination as a supplement to microbiologic evaluation. MATERIALS AND METHODS: A retrospective study was performed to evaluate 105 consecutive CT-guided percutaneous disk space aspiration procedures in 92 patients suspected of having spontaneous (non-postoperative) infectious diskitis. Our criterion standard for the presence of active infection was the identification of a pathogen either from the CT-guided aspiration specimen or from a surgical specimen. All cases had microbiologic analysis, 78 cases had cytopathologic analysis, and 31 cases had open surgery. RESULTS: Microbiologic analysis of the CT-guided percutaneous aspiration specimens was positive in 39 of 43 cases proved to have active infections, with four false-negative and no false-positive cases (sensitivity, 91%; specificity, 100%). The false-negative cases were all active fungal infections identified from surgical specimens. Adding cytopathologic analysis to microbiologic analysis improved sensitivity but reduced specificity. The most common pathogens were species of Staphylococcus, Streptococcus, Candida, and Mycobacterium. All 30 active bacterial infections were identified with the CT-guided procedures, but only five of nine fungal infections were identified. CONCLUSION: CT-guided percutaneous needle aspiration is an accurate method for identifying active bacterial disk space infections but is less reliable for identifying fungal infections.

The Anterolateral Ligament of the Knee: MRI Appearance, Association With the Segond Fracture, and Historical PerspectiveJack Porrino, Jr.1, Ezekiel Maloney1, Michael Richardson1, Hyojeong Mulcahy1, Alice Ha1 and Felix S. Chew1Audio Available | Share

OBJECTIVE: Chronic sinusitis is one of the most commonly diagnosed illnesses in the United States. The educational objectives of this review article are for the participant to exercise, self-assess, and improve his or her understanding of the imaging evaluation of sinonasal disease. CONCLUSION: This article describes the anatomy, pathophysiology, microbiology, and diagnosis of sinonasal disease, including chronic and fungal sinusitis, juvenile nasopharyngeal angiofibroma, inverted papilloma, and chondrosarcoma.

OBJECTIVE: Osteoid osteomas are benign painful skeletal neoplasms that preferentially afflict young male patients and are readily treatable. This article focuses on the various imaging manifestations of the tumor, while also discussing its clinical presentation, pathogenesis, and treatment. CONCLUSION: Knowledge of the common imaging features of osteoid osteomas will improve our diagnosis of this condition, subsequently facilitating treatment and reducing morbidity.