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Diffuse alveolar hemorrhage (DAH) is a clinical syndrome, which refers to injury to the capillaries, arterioles and venules, leading to red blood cell accumulation in the distal air spaces. It is defined by the clinical triad of hemoptysis, anemia and progressive hypoxemia. Chest radiographs reveal non-specific patchy or diffuse bilateral pulmonary consolidation. Multiple conditions are associated with DAH, of which Wegener’s granulomatosis is the most frequent, and underlying disease determines the prognosis and treatment. This case describes DAH as a result of oral amphetamine abuse in a young patient of which the diagnosis was established by laboratory, clinical and radiologic findings. The patient experienced a rapid recovery without significant sequelae.

Damage to the meniscus is one of the most common causes of pain in the knee joint. Accurate imaging of the meniscus is essential to evaluate the damaged area and to select the most appropriate treatment. Similarly, in the postoperative meniscus, imaging is important for treatment, follow-up and identification of any further injury. A number of factors have to be considered when selecting the most appropriate imaging technique. Currently, magnetic resonance (MR) imaging is the preferred imaging modality for the virgin, operated or transplanted meniscus. MR imaging is a non-invasive but highly sensitive technique for the detection of meniscal lesions. MR arthrography does not improve on the accuracy of MR imaging in the non-operated knee, but the technique is useful for detecting a retear in the sutured meniscus. Computed tomography (CT) arthrography is used less frequently and in situations where MR imaging is contraindicated, e.g. in the presence of orthopaedic hardware. This chapter describes the available imaging techniques for the assessment of the meniscus and reviews the use of MR imaging in both the non-operated and postoperative meniscus.

To define an imaging prototype of Ewing's sarcoma (ES).Sixty-four patients with a histopathologically and/or genetically proven diagnosis of ES were analyzed for clinical parameters (age, gender and location), radiographic and CT appearance (distribution, matrix, margins, periosteal reaction, articular extension, cortical reaction and the presence of a pathologic fracture). Size, local extension, signal intensity, degree and pattern of enhancement, and the presence of skip metastases were evaluated on MRI. Distant metastases were recorded on bone scintigraphy and chest CT scan.Patient's age ranged between 7-67 (mean 17.9). Male/female ratio was 2.4/1. Location in the pelvis was most frequent (31%), followed by the femur (20%) and tibia (11%). Most tumors were mixed lytic-sclerotic (75%), and purely lytic in 25%. Plain films and CT scan showed a spiculated periosteal reaction in 50%. A Codman's triangle was seen in 27%. Articular extension was difficult to assess on radiographs. Cortical permeation and destruction is seen in respectively 31 and 42%, whereas cortical thickening is seen in 20%. Pathologic fracture occurred in 7.8%. MRI showed a large mass, with a soft tissue component of more than 50% in 67%. Degree and pattern of enhancement pattern was variable. Signal intensity on T1- and T2-WI was non-specific. Joint involvement was seen in 23%. Isolated involvement of the soft tissue (extraskeletal ES) was seen in 1.5%. Skip metastases at initial presentation were present at initial presentation in 14% and distant metastases in 22%.ES occurs in young patients. On radiographs/CT, 37.5% are located in the axial skeleton and 62.5% in the peripheral skeleton. ES is mostly mixed sclerotic-lytic. A spiculated periosteal reaction is most frequent. The most characteristic finding on MRI is the presence of a large soft tissue mass.

Pelvic inflammatory disease with tuboovarian abscess is rare in postmenopausal women. Clinical and sonographic findings are usually sufficient to recognize pelvic inflammatory disease in premenopausal women, but in the elderly the disease may easily be overlooked, largely by unexpectedness. Computed tomography can be helpful when the clinical and sonographic findings are complex or equivocal. However, when the level of suspicion is low, it can be very difficult to interpret, especially when complicated with peritonitis, as illustrated in the present case report.

The excellent soft-tissue contrast and multiplanar imaging capabilities of MR imaging have led to its emergence as the most significant advance in the imaging of musculoskeletal tumors. MR imaging is the modality of choice for local staging, evaluating response to preoperative chemotherapy, and long-term follow-up in bone tumors. MR imaging is the most effective modality for both primary staging of soft-tissue malignancy and detecting recurrences. This article reviews the role of conventional spin echo techniques versus newer techniques, and then discusses the indications in the diagnosis, staging, evaluation of preoperative chemotherapy, and detection of recurrences in bone and soft-tissue tumors.

Tumors of nerves are classified into benign (schwannoma and neurofibroma) and malignant nerve sheath tumors. Schwannomas almost always occur as solitary lesions, whereas neurofibromas may occur alone or in a greater number, especially in patients with the peripheral form of von Recklinghausen's disease. Benign nerve sheath tumors often present as asymptomatic, slowly growing soft tissue masses. Although malignant nerve sheath tumors are relatively rare, a sudden increase in the size of a lesion, in particular in a patient with neurofibromatosis, should raise the suspicion of malignant change. On computed tomography (CT) and magnetic resonance imaging (MR) a benign nerve sheath tumor usually appears as a well-defined, oval, spherical or fusiform mass with smooth borders and distinct outlines, located in the subcutaneous tissue or centered at the expected anatomic location of a nerve, with displacement of adjacent soft tissues. Generally nerve sheath tumors have a low density on unenhanced CT scans. On MR they are isointense to muscle on T1-weighted images, whereas on T2-weighted images the signal intensity is high. Both on CT and MR the degree of contrast enhancement is moderate to marked and may be homogeneous or inhomogeneous. MR has become the method of choice for evaluating the anatomic location, contour, and relation of a nerve sheath tumor to adjacent neural, vascular, and muscular structures. The imaging criteria for malignant nerve sheath tumors are not specific enough to distinguish them from other malignant soft tissue tumors, so that neither CT nor MR can establish a definite diagnosis.