Rad-6. Ghosts and goblins of the past.

Beginning at the turn of the last century, plain film radiography started to play an increasingly important role in diagnosis. This was especially true for diagnosis and evaluation of the various disease processes affecting the skeleton since radiography was the only non-invasive method available to evaluate the bones. For more than half a century, plain film radiography remained as the mainstay of x-ray diagnosis. Along with advances in the field of radiology such as introduction of computerized tomography, ultrasonography and magnetic resonance imaging, the pattern and incidence of disease processes seen in clinical practice also changed significantly. The old time disease processes such as bony tuberculosis and syphilis, Hensen's disease (leprosy) and fungal osteomyelitis are either not seen with the same frequency or rarely seen today. Similarly, complications such as advanced neuropathic joints as complications of diabetes or syphilis are rare. Due to availability of methods to make diagnosis in early stages diseases such as gout, blood dyscrasias and malignancies are not seen radiographically in late stages. Similarly, both benign and malignant conditions affecting the skeleton such as bony and cartilaginous tumors, Paget's disease and multiple myeloma are not seen in advanced stages due to improved methods of detection and treatment. Radiographs obtained during the first half of last century showed many of these afflictions which now are the ghosts and goblins of the past. Radiographic examinations of these "old" diseases, many in advanced stages, afforded a wealth of information to understand the natural biologic behavior of the disease process by depicting the pathophysiologic mechanisms as abnormalities on plain films. This exhibit is a compilation of those ghosts and goblins.

Ramesh B. Patel, MD, FACR, and Nancy Lawhon, MD, FACR. University of Mississippi Medical Center, Jackson, MS.