Juvenile nasopharyngeal angiofibroma is a rare, benign tumor that occurs mostofteninadolescent males. Common practice is to excise the tumor with open or endoscopic surgery. We report the case of a 17-year-old male who presented in 1995 with a mass filling the left posterior nasalcavity. A diagnosis of juvenile nasopharyngeal angiofibroma was obtained with computed tomography and magnetic resonance imaging. The patient elected to have no treatment. On annual scans, the lesion changed little until 1998, when it began to gradually decrease in size. Although it is not wellproven, the natural history of these tumors seems to be regression over time. This case supports the argument that a policy of watchful waiting with regular imaging studies may postpone or eliminate the needfor surgery and its attendant risks.

PurposeTo assess the efficacy and usefulness of photo messaging in orthopaedic surgery, specifically in the assessment of trauma radiology. MethodsProspectively, 100 sets of X-rays from patients presenting to our emergency department with a clinical hip fracture were collected. Digital images of these AP pelvis X-rays were taken using a Panasonic GD87 mobile picture-messaging phone ( Fig. 1) by one of the authors using a standard technique. These images were then blindly assessed by two orthopaedic surgeons for the presence of a fracture with a clinical history of a patient with hip pain and inability to weight bear after a fall. Results from the digital imaging were then correlated with the actual X-rays reviewed by the same two surgeons. ResultsFifty-eight patients had a hip fracture on plain Xrays, four had a pubic rami fracture, one had a cystic abnormality in the femoral head and 37 had normal X-rays. Digital imaging at 640  480 pixel resolution with images at 3.2 cm  4.4 cm correctly identified 47/58 fractured hips (Fig. 2) and three out of the four pubic rami fractures. Digital imaging missed four undisplaced fractured hips visible on plane films (Fig. 3) and the cystic abnormality. However, 18 out of 37 normal sets of digital images were thought to show possible undisplaced fractures or were inconclusive. ConclusionDigital images taken and viewed on currently available mobile phones were of insufficient quality to identify most fractures visible on standard plane films. A false positive rate of nearly 50% and a significant false negative rate however mean that this technology is not of sufficient accuracy to allow its safe use in orthopaedic practice.

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