Pneumorrhachis is often easily visible on a lateral chest radiograph, where the air appears as linear lucencies
along the spinal canal.
Lateral (A) and ventrodorsal (B) skull radiographs of the Swainson's toucan described in Figure 1 on the day of initial presentation for chronic mucoid nasal discharge, showing excess keratin buildup proximally, diffuse patchy opacities within the maxillary diverticulum of the infraorbital sinus (arrows), and lucencies
within the mandibular diverticulum proximally (arrowheads).
She was referred to the Radiology Department for CT scan which revealed a well-defined oval shaped lesion, measuring 7.2 x4.5 cm, containing air lucencies
in the right mid abdomen abutting the ascending colon, small bowel loops and the left anterolateral abdominal wall (Figure-1, A and B).
Repeat bone imaging in 2014 identified multiple lucencies
<1 cm in the right hip and degenerative changes in both hips, but these were attributed to osteoarthritis rather than the myeloma.
Similar to other aggressive osseous tumors, bony manifestations include permeative, moth eaten lucencies
, a wide zone of transition and associated soft-tissue mass.
Advanced imaging modalities, such as CT or MRI, can be performed in cases with equivocal plain radiographs to identify occult cortex lucencies
. These imaging modalities should also be used to tract the treatment of the stress fractures [3, 10].
Upon resolution of HZ, a second biopsy was performed with findings of thickened capillary walls with lucencies
, moderate mesangial matrix expansion, and no podocytes abnormality on the light microscopy (LM) (Figure 1), and negative immunofluorescent study (IF) for IgG, IgA, C3, C1q, light chains, and faint IgM on IF, and electronmicroscopy (EM) with complete (90-100%) effacement of foot processes, acellular debris in thickened capillary walls, and sparse immune deposits in mesangium (Figure 2), which were consistent with healed membranous nephropathy (MN) and minimal change disease- (MCD-) like process.
A 3-view X-ray of the ankle confirmed the dislocation of the fibula posterior to the tibia and posterior dislocation of the talus, while showing the stable intramedullary nail and distal screw with no apparent lucencies
Illescas, "Striated intramural gallbladder lucencies
on US studies: Predictors of acute cholecystitis," Radiology, vol.
Skeletal abnormalities maybe in the forms of lucencies
(demineralization) and erosions (osseous destruction) of the proximal medial tibial metaphysis (Wimberger sign), metaphyseal lucent bands, metaphyseal serrated appearance at the epiphyseal margin of long bones (Wegner sign), diaphyseal periostitis, irregular areas of increased density and rarefaction ("moth-eaten" appearance), and multiple sites of osteochondritis [1, 7, 11].
A brain computed tomography (CT) scan was normal showing only minimal periventricular and subcortical white matter lucencies
, compatible with minimal chronic microvascular ischemic changes.
Workup revealed a normal echocardiogram with no concern for transplant rejection as well as a normal abdominal ultrasound, but abdominal X-ray (KUB) was concerning for diffuse pneumatosis intestinalis due to linear lucencies
adjacent to the cecal wall and significantly dilated and edematous bowel (Figure 1).