Clinical features, treatment, and outcome of dogs with Coccidioides osteomyelitis

OBJECTIVE To describe signalment, clinical signs, serologic test results, treatment, and outcome of dogs with Coccidioides osteomyelitis (COM) and to compare those findings with findings for dogs with osteosarcoma (OSA). ANIMALS 14 dogs with COM and 16 dogs with OSA. PROCEDURES Data were retrospectively gathered from electronic medical records. RESULTS Dogs with COM were younger and weighed less than dogs with OSA. Six dogs with COM had appendicular lesions, 5 had axial lesions, and 3 had both appendicular and axial lesions; 9 had monostotic disease, and 5 had polyostotic disease. Axial lesions and nonadjacent polyostotic disease were more common in dogs with COM than in dogs with OSA, but radiographic appearance was not different between the 2 groups. Median IgG titer at diagnosis of COM was 1:48 and was significantly decreased after 6 and 12 months of treatment. Percentage of dogs with COM that had clinical signs was significantly decreased after 1, 3, 6, and 12 months of treatment. One year after initiation of treatment, 9 of 9 dogs were still receiving fluconazole and 8 of 9 dogs had positive results for serum IgG titer testing. CLINICAL RELEVANCE Dogs with COM typically had a rapid improvement in clinical signs after initiating treatment with fluconazole but required long-term antifungal treatment. Dogs with COM differed from dogs with OSA, but radiographic features had a great degree of overlap between groups, confounding the ability to make a diagnosis on the basis of diagnostic imaging alone.

Solitary Radiolucent Erdheim-chester Disease: A Case Report and Literature Review

Background: Erdheim-chester disease (ECD) is a rare non-Langerhans histiocytosis of unknown etiology, which typically presents with bilateral symmetric osteosclerosis and multi-organ involvement. Lesions may be intraosseous or extraosseous and involve the heart, pulmonary system, CNS, and skin in order of decreasing likelihood. Objective: The objective of this study is to discuss a case of erdheim-chester disease and conduct a review of the literature. Case: We describe a rare case of erdheim-chester in an asymptomatic 37-year-old male who was diagnosed after suffering a right ulnar injury. Subsequent evaluation revealed a solitary radiolucent ulnar lesion without multi-system involvement. Results & Conclusion: The case is unique in its solitary distribution, lytic radiographic appearance, and asymptomatic presentation preceding pathologic fracture. This presentation may simulate multiple other bone lesions.

A case study of breast siliconoma

Background: Silicone or foreign materials injection is widely used for aesthetic breast augmentation and reconstructions in many countries. Once injected, it will stimulate a foreign body reaction between body tissues and silicone. This reaction can cause the formation of a granuloma known as siliconoma, which represent by the lumping at the breast. This symptom usually mimics breast cancer and sometimes be the origin of breast cancer. This paper is focused on the discussion on radiographic appearance of silicone and a case study of breast siliconoma. Case Study: A 66-year-old Chinese female with a family history of cancer presents with palpable painless lumps in her breasts. The lumps were present in both breasts without any mobility and other inflammatory processes. Mammographic examination demonstrated a dense bilateral mass towards the chest wall and asymmetrical rounded densities in both breasts. There are no breast cancer indications were reported. The pathology demonstrated a siliconoma.

Scaphocapitate fracture syndrome in a child

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

A retrospective study of avascular necrosis of the femoral head in dogs in Delta State, Nigeria

The study evaluated the prevalence of avascular necrosis of the femoral head in dogs in Delta State, Nigeria. For ten years, data of cases presented to Veterinary Clinics in five government clinics in Delta state were evaluated and analysed. The breed of dog, sex, age on presentation, the limb affected and the radiographic appearance of the lesions on presentation were reviewed. The treatment and clinical management approaches were also reviewed and discussed. Of the cases of avascular necrosis of the femoral head recorded (N = 24) for the period under review, breed prevalence recorded 62.5% (Alsatians); 16.67% (Caucasians) and 20.83% (Mixed Breeds). Sex prevalence recorded 79.17% females and 20.83% males. According to age at the time of the first presentation, 83.83% of the affected dogs were 6-12month old, 12.5% were 13-24month old, and 4.16% were 25–36 month-old. Lameness was observed in 91.67%, while 8.33% of cases presented non-weight bearing lameness. Pain in the limbs during palpation of the hip joint was detected in 100% of the cases. Atrophy in the hind limb was identified in 41.66% of the patients, while 62.5% of the dogs showed different degrees of medial patellar luxation. In 91.6% of cases, the disease was unilateral, with 63.63% unilateral lesions in the right hind limb and 36.37% in the left hind limb. The study results showed a high prevalence of avascular necrosis of the femoral head in large breeds of dogs in the Delta state. The management of the disease is mainly conservative with poor follow-up. Cost of surgery and management may discourage owners from follow up. However, surgery remains the gold stand of care for managing avascular necrosis of the femoral head in dogs.

NIMG-76. DISCRETE LOWER-GRADE GLIOMA (DLGG) VERSUS INFILTRATIVE LOWER-GRADE GLIOMA (ILGG): CORRELATION OF RADIOLOGICAL CHARACTERISTICS WITH CLINICAL OUTCOMES

INTRODUCTION Lower grade gliomas encompass grade 2 and 3 tumors. However, this term is more generalized and does not include the spectrum of radiological and tumor morphological patterns seen. Here we have established two distinct patterns of radiographic appearance seen within lower grade gliomas: ILGG and DLGG. Imaging plays a vital role in diagnosis, surveillance, characterization, and monitoring of intracranial tumors. Of particular importance is the differentiation of tumor features to reliably predict malignancy, tumor grade, possible molecular or genetic features, disease progression and recurrence, potential for malignant transformation, and postoperative outcomes. Our study will look at these radiographic characteristics of diffuse and infiltrating lower grade gliomas and discuss their predictive value. Understanding the distinct nature of these varieties of LGG will help us in surgical decision-making, prognostication, biopsy target and precision medicine. METHODS Pre-operative and post-operative MRI images of Grade 2 and 3 tumors were identified and analyzed in order to extract radiographic data, and correlated with patient demographics, clinical outcomes, extent of surgical resection, and molecular genetic analysis. RESULTS Out of 35 patients evaluated, 22 (62.9%) were labeled ILGGs and 13 (37.1%) were deemed DLGGs according to the pre-defined criteria. T2 habitat was higher in ILGG (mean = 2162) than DLGG (mean = 1482) as well as size, in cm (6.02 vs. 4.92). ADC habitat, lesion ADC, and percentage of the lesion that showed contrast-enhancement were similar. T2-FLAIR mismatch was significantly higher in ILGG (p = 0.02). Post-operative KPS scores were significantly higher in the DLGG group (p = 0.03). CONCLUSION T2-FLAIR mismatch can be a significant classifier for lower-grade gliomas. Our study shows there are differences in tumor morphology of diffuse and infiltrative lower-grade gliomas which can be correlated to outcomes after surgery. *Indicates corresponding author.

Odontomas and imaging diagnosis: the concise systematic review

Introduction: Odontomas are tumors of odontogenic origin. They represent on average 70% of all odontogenic tumors found. Early diagnosis and treatment prevent the loss of tissue element, tooth impaction, bone malformations, and displacement of bone structures, differentiating their types through panoramic radiographic images. Objective: To carry out a concise systematic review of the characteristics of odontomas, differentiating their types through panoramic radiographic images. Methods: The research was carried out from May 2021 to June 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 84 articles were found. A total of 36 articles were evaluated in full and 17 were included and evaluated in the present study. A total of 3 Studies with a High Risk of Bias and 1 Study with Uncertain Risk. Radiographic examination is extremely important for the study and diagnosis of odontomas. Odontomas present a characteristic radiographic appearance. In complex odontomas, radiopacity is not specifically determined, showing itself as an irregular and disorganized mass surrounded by a narrow radiolucent zone. In the composite type, the radiographic image is pathognomonic. In the radiopaque image, dozens of denticles simulate small teeth surrounded by a thin radiolucent area. Composite odontoma, on the other hand, consists of the same calcified structures arranged in an orderly and related manner, similar to normal teeth contained in a fibrous capsule. The differential diagnosis of complex odontoma includes osteomas and condensing osteitis. Conclusion: Radiographic and/or tomographic examination is the best way to obtain an accurate diagnosis, precisely delimiting the lesion and nearby and involved structures.

Radiographic Features of Facial Cosmetic Material: Report of Two Cases

Recently, the use of noninvasive facial cosmetic procedures has been widely disseminated. In the face, cosmetic fillers, threads, and implants are used to reduce or delay the effects of aging or adjust facial defects caused by trauma or disease. The dentist or dental specialist may encounter these materials in the radiographic images of their patients. There are few reports in the dental literature describing the radiographic appearance of some materials along with the diseases they mimic. As the procedures and materials advance and evolve, dentists and dental specialists must be aware of their radiographic appearance to avoid errors in diagnosis. This is a report of two cases that include panoramic radiography and CBCT scan. Among these cases, there is an unusual appearance of a cosmetic filler due to a subperiosteal injection method. Moreover, it will discuss common types of cosmetic materials used in the face and their imaginological appearance. This is the key to dentists and dental specialists due to increasing use of facial cosmetic materials and a parallel increase in the use of cone beam CT and chances to encounter such findings.

Chronic Recurrent Multifocal Osteomyelitis Involving the Mandible – A Rare Case Report

Chronic recurrent multifocal osteomyelitis (CRMO) is an uncommon, aseptic, autoinflammatory condition characterized by multifocal bone lesions with pain, swelling, and frequent exacerbations and remissions. It is noteworthy that these lesions occur without any identifiable etiology or microbiologic finding. The clavicle and metaphyses of the long bones are often involved whereas involvement of the mandible is considered rare. It is usually diagnosed by exclusion of other diseases. As it shares most of its features with the more commonly occurring infective osteomyelitis, patients are often unnecessarily subjected to prolonged courses of antibiotics, serial radiation exposures, and repeated bone biopsies. We present a case of CRMO involving the mandible. Our primary objective is to demonstrate the clinical features of this uncommon disorder, highlighting the radiographic appearance. Familiarity with this condition among radiologists greatly increases the likelihood for early diagnosis and formulating an appropriate treatment plan.

Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis?

OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors’ aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)–back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to −2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.