Teardrop And Sourcil Line (TSL): A Novel Radiographic Sign That Predicts Residual Acetabular Dysplasia in DDH After Closed Reduction

Background: Residual acetabular dysplasia (RAD) is a major problem of developmental dysplasia of the hip (DDH) after closed reduction (CR). Several parameters have been investigated as ways of predicting RAD; however, early prediction of RAD remains controversial. The purpose of this study was to evaluate the radiographic sign of teardrop and sourcil line (TSL) in pediatric patients with DDH to enable prediction of RAD after CR early.Methods: One hundred and twenty-five hips with DDH treated with CR and followed up for at least 2 years were included in this study. The mean age at CR was 18.3 months (range, 9 to 32 months) and the average follow-up time was 44.2 months (range, 24 to 83 months). The acetabular index (AI) was measured at different time points. RAD was determined according to the modified Severin criteria. The cases were divided into two groups according to whether TSL became continuous or not. The relationships among TSL, AI and RAD were analyzed.Results: The RAD incidence was 73.6% (92/125) at the last follow-up. AI at CR and TSL were the prognostic factors for RAD (p=0.017 and 0.001, respectively). Thirty-four hips showed a continuous TSL. The mean time when TSL became continuous after CR was 20.9 months (range, 8 to 57 months). There was a lower RAD rate in the TSL continuous group (p<0.001). There was no statistical difference in the AI at CR between the TSL continuous and discontinuous groups; however, the level of AI after CR was lower in the TSL continuous group. In the TSL continuous group, there was no significant difference in the time at which TSL became continuous after CR between RAD and non-RAD hips.Conclusions: The TSL continuous group had a lower AI and incidence of RAD than the discontinuous group. The TSL can be a predictive factor of RAD in DDH after CR and can predict RAD at an earlier time than AI measurement.

The Colon Cutoff Sign: The Internist’s Perspective on Diagnosing Acute Pancreatitis

The colon cutoff sign is a radiographic sign often associated with a diagnosis of acute pancreatitis. The patient highlighted in this case presented with nausea, vomiting, and abdominal discomfort and was referred with a diagnosis of viral gastroenteritis. The abdominal radiograph demonstrated the colon cutoff sign, but all other biochemical and imaging modalities were within normal limits. This case highlights the importance of relying on the entire clinical assessment when diagnosing pathology. Resume Le signe de coupure du côlon est un signe radiographique souvent associé à un diagnostic de pancréatite aiguë. Le patient mis en évidence dans ce cas présentait des nausées, des vomissements et une gêne abdominale et a été orienté vers un service de gastro-entérite virale. La radiographie abdominale a montré le signe de coupure du côlon, mais toutes les autres modalités biochimiques et d'imagerie étaient dans les limites normales. Ce cas souligne l'importance de s'appuyer sur l'ensemble de l'évaluation clinique pour diagnostiquer la pathologie.

The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

Chilaiditi’s Syndrome—What Every Endoscopist Should Know

Chilaiditi’s syndrome is a rare and often asymptomatic anomaly, typically found as an incidental radiographic sign (gas under the diaphragm) due to hepato-diaphragmatic interposition of the transverse colon. We report a case of Chilaiditi’s syndrome following colonoscopy presenting with severe abdominal pain, dyspnoea and radiograph findings similar to the presence of bowel perforation (appearance of gas under the hemidiaphragm on erect chest radiograph). Computed tomography (CT) evidence of Chilaiditi’s sign prevented unnecessary laparotomy.

The Veil of Obscuration: Additional Radiographic Sign of Posterior Shoulder Dislocation

<p><strong>Objective.</strong> To describe a new radiographic sign, “veil of obscuration”, associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs.</p><p><strong>Methods.</strong> Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the “veil of obscuration”, seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analysed with student t-test and categorical data with Chi-Square test.</p><p><strong>Results. </strong>There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and “veil of obscuration” (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while “veil of obscuration” was seen in more seizures (86%; P=0.037) and in all surgical patients. No significant difference in presence of other classic radiographic signs in regards to surgery.</p><p><strong>Conclusion. </strong>The newly described radiographic sign of posterior shoulder dislocations named the “veil of obscuration” has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.</p>