Tension pyopneumothorax is a rare complication of pneumonia and subpleural abscess eroding into the pleural space. We present a case of tension pyopneumothorax in a drug addict. Successful treatment consisted of pleural drainage and parenteral antibiotics. The presence of an air-fluid level accompanying tension pneumothorax on chest radiograph should alert the physician to the possibility of this emergency condition.

We report the case of a 9.5-year-old boy who underwent sonographic and radiographic examinations because of knee pain. Two fibrous cortical defects were discovered, in his right femur and left tibia; the femoral lesion was seen more easily on sonography than on radiography. On gray-scale sonography, the lesions were characterized as a scalloped indentation of the cortical surface containing hypoechoic soft tissue. On color Doppler sonography, discrete vessels were found at the periphery and within the substance of the lesions, and on spectral Doppler analysis, low-resistance arterial flow was detected in those vessels. Follow-up examinations performed 10 and 19 months after our initial examination showed signs that the lesions were healing. The diagnosis of fibrous cortical defect was suggested by the gray-scale and Doppler sonographic characteristics and confirmed on radiography. Although radiography is required to document these lesions if found incidentally on sonography, follow-up examinations using only sonography may be feasible.

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Patients whose gallbladders are completely contracted after overnight fasting and cannot be adequately evaluated on sonography should be given a fatty meal and re-examined sonographically. This technique is efficient in preventing unnecessary additional patient visits for the evaluation of cholelithiasis.