Cuenca-Gonzalez Concepcion, Berzal Cantalejo Maria Fernanda, Herranz-Torrubiano Ana Maria, Lucia Vaamonde Lorenzo
We report the case of a woman referred to our rehabilitation department who presented a soft tissue tumour, a proximal third tibia leiomyosarcoma. It’s analyzed how the diagnosis was made, the treatment for tumour and its sequelae and the follow up period, by doing an update of the scientific evidence in this tumour management. This tumour is a subtype in soft tissue sarcomas. These are rare tumours that arise mostly from mesenchymal tissues and leiomyosarcoma is the fourth in frequency (12%). Although they can appear in any location, 40% cases have their origin typically in extremities. Sarcomas in extremities are characterized by a painless mass, incidentally discovered by the patient, the doctor or by performing an ultrasound. Conservative surgery is considered the main treatment for this soft tissue sarcoma, avoiding radical surgeries which don’t achieve survival results. Radiotherapy and adjuvant chemotherapy are used both with surgery to prevent local recurrence and metastases. Pathology and imaging tests (ultrasounds, CT and MRI) will be fundamental for the staging, for therapeutic decisions to be made and for monitoring possible local recurrences or regional or systemic metastases. Correspondence to: Cuenca-González Concepción, Universidad Complutense, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Service, Hospital Clínico San Carlos, Madrid, Spain, Tel: +34 91 330 36 03; E-mail: cuchacuenca@gmail.com
{"title":"Management of lower limbs leiomyosarcoma: A case report","authors":"Cuenca-Gonzalez Concepcion, Berzal Cantalejo Maria Fernanda, Herranz-Torrubiano Ana Maria, Lucia Vaamonde Lorenzo","doi":"10.15761/RDI.1000119","DOIUrl":"https://doi.org/10.15761/RDI.1000119","url":null,"abstract":"We report the case of a woman referred to our rehabilitation department who presented a soft tissue tumour, a proximal third tibia leiomyosarcoma. It’s analyzed how the diagnosis was made, the treatment for tumour and its sequelae and the follow up period, by doing an update of the scientific evidence in this tumour management. This tumour is a subtype in soft tissue sarcomas. These are rare tumours that arise mostly from mesenchymal tissues and leiomyosarcoma is the fourth in frequency (12%). Although they can appear in any location, 40% cases have their origin typically in extremities. Sarcomas in extremities are characterized by a painless mass, incidentally discovered by the patient, the doctor or by performing an ultrasound. Conservative surgery is considered the main treatment for this soft tissue sarcoma, avoiding radical surgeries which don’t achieve survival results. Radiotherapy and adjuvant chemotherapy are used both with surgery to prevent local recurrence and metastases. Pathology and imaging tests (ultrasounds, CT and MRI) will be fundamental for the staging, for therapeutic decisions to be made and for monitoring possible local recurrences or regional or systemic metastases. Correspondence to: Cuenca-González Concepción, Universidad Complutense, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Service, Hospital Clínico San Carlos, Madrid, Spain, Tel: +34 91 330 36 03; E-mail: cuchacuenca@gmail.com","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77877027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alshehri Am, Srinivasan, Umair Khan, S. Wickremasena, Hui Jh, Lee Gs, A. Bhattacharya
Background: Pulmonary embolism (PE) is a life-threatening condition with overall mortality of up to 20 % when left untreated. CTPA is the preferred investigation for diagnosis of PE for patients with normal kidney function. Several studies showed this test is being over employed without using available predictive tools i.e. Wells score, Modified Geneva score & D-Dimer Methodology: A retrospective review of patients’ records who had CTPA for suspected pulmonary embolism from the period of 1st March 2015 to 28th Feb 2016. Patient’s demographics and components of different scoring system were obtained by manual review of patient’s electronic records. Result: A total of 249 CTPAs were done during this study period. In term of patient demographics, median age was 63 years and 48.6 % of patients were females. PE was diagnosed in 34 (13.7%) patients. Only 196 (76.6%) patients had a CXR as an initial investigation. Acute kidney injury was noted in 23 (14.0%) patients post CTPA. Revised Geneva score was calculated for all patients who had CTP for PE, only 10 (4 %) patients had a high probability on Revised Geneva score (score >11). Wells score could not be accurately calculated due to the retrospective nature of the study. Conclusion: The diagnostic yield of CTPA with a positive result for pulmonary embolism was 13.7%, which is below the recommended standards by the Royal College of Radiology (UK) (15.4% to 37.4%). Also, these findings were noted to be inferior compared with a similar study done in an Australian hospital. These findings may be attributed to the poor utilization of risk assessment tools (Geneva, Wells and D-Dimer) and not performing simple chest X-ray prior to CTPA. A protocol to request CTPAs is needed which is suited to the regional settings to avoid unnecessary CTPAs and its complications. Correspondence to: Al Alawi AM, Department of Medicine, Goulburn Valley Health, Australia, E-mail: dr.abdullahalalawi@gmail.com Received: March 03, 2018; Accepted: March 20, 2018; Published: March 24, 2018 Introduction Pulmonary embolism (PE) is a potentially fatal condition if left untreated. The annual crude incidence rate of PE in Australian was estimated to be 0.31 per 1000 in a community setting [1]. The 1-year case-fatality rate for PE is approximately 23% [2]. Efficient clinical evaluation and diagnostic testing is necessary to avoid delays in initiating therapy, which in turn reduces morbidity and mortality from PE [3]. Pulmonary angiography is the historical criterion standard for the diagnosis of PE, which has now been largely replaced by less invasive alternatives. CTPA is the investigation of choice for diagnosis of PE but requires the use of potentially nephrotoxic contrast agents and radiation [4,5]. Alternatively, as a result V/Q scans are commonly considered in patients with renal impairment, pregnant women and in young patients due to the lower dose of radiation [6]. Over the last decade, there has been a significant increase in CTPA
{"title":"The patterns of ordering Computed Tomography Pulmonary Angiogram (CTPA) for diagnosis of pulmonary embolism (PE) in a rural health setting","authors":"Alshehri Am, Srinivasan, Umair Khan, S. Wickremasena, Hui Jh, Lee Gs, A. Bhattacharya","doi":"10.15761/rdi.1000127","DOIUrl":"https://doi.org/10.15761/rdi.1000127","url":null,"abstract":"Background: Pulmonary embolism (PE) is a life-threatening condition with overall mortality of up to 20 % when left untreated. CTPA is the preferred investigation for diagnosis of PE for patients with normal kidney function. Several studies showed this test is being over employed without using available predictive tools i.e. Wells score, Modified Geneva score & D-Dimer Methodology: A retrospective review of patients’ records who had CTPA for suspected pulmonary embolism from the period of 1st March 2015 to 28th Feb 2016. Patient’s demographics and components of different scoring system were obtained by manual review of patient’s electronic records. Result: A total of 249 CTPAs were done during this study period. In term of patient demographics, median age was 63 years and 48.6 % of patients were females. PE was diagnosed in 34 (13.7%) patients. Only 196 (76.6%) patients had a CXR as an initial investigation. Acute kidney injury was noted in 23 (14.0%) patients post CTPA. Revised Geneva score was calculated for all patients who had CTP for PE, only 10 (4 %) patients had a high probability on Revised Geneva score (score >11). Wells score could not be accurately calculated due to the retrospective nature of the study. Conclusion: The diagnostic yield of CTPA with a positive result for pulmonary embolism was 13.7%, which is below the recommended standards by the Royal College of Radiology (UK) (15.4% to 37.4%). Also, these findings were noted to be inferior compared with a similar study done in an Australian hospital. These findings may be attributed to the poor utilization of risk assessment tools (Geneva, Wells and D-Dimer) and not performing simple chest X-ray prior to CTPA. A protocol to request CTPAs is needed which is suited to the regional settings to avoid unnecessary CTPAs and its complications. Correspondence to: Al Alawi AM, Department of Medicine, Goulburn Valley Health, Australia, E-mail: dr.abdullahalalawi@gmail.com Received: March 03, 2018; Accepted: March 20, 2018; Published: March 24, 2018 Introduction Pulmonary embolism (PE) is a potentially fatal condition if left untreated. The annual crude incidence rate of PE in Australian was estimated to be 0.31 per 1000 in a community setting [1]. The 1-year case-fatality rate for PE is approximately 23% [2]. Efficient clinical evaluation and diagnostic testing is necessary to avoid delays in initiating therapy, which in turn reduces morbidity and mortality from PE [3]. Pulmonary angiography is the historical criterion standard for the diagnosis of PE, which has now been largely replaced by less invasive alternatives. CTPA is the investigation of choice for diagnosis of PE but requires the use of potentially nephrotoxic contrast agents and radiation [4,5]. Alternatively, as a result V/Q scans are commonly considered in patients with renal impairment, pregnant women and in young patients due to the lower dose of radiation [6]. Over the last decade, there has been a significant increase in CTPA ","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87197712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abreu Montanaro Vv, Marinho Pb, Uchoa Cavalcanti Eb, Ferreira Martins Bja, C. Ap
The role of hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) gene mutation in the pathogenesis of ischemic stroke has been a topic of growing interest. Reports available in literature describe this association, primarily in cases of pediatric stroke. We report a case of a 23-year-old woman presented to the SARAH Network of Rehabilitation Hospitals with a history of recurrent ischemic strokes during infancy and an etiological diagnosis of Moyamoya syndrome. Evaluation revealed mild elevation of serum homocysteine levels and a homozygous MTHFR gene mutation, no other associated abnormalities were detected. There is evidence of the presence of these abnormalities in some cases of pediatric ischemic stroke in the clinical setting. Data are limited regarding the role of hyperhomocysteinemia and an MTHFR gene mutation in causing vascular lesions/damage. Further studies involving patients with ischemic stroke (primarily those with arterial occlusion), are warranted to better establish such a correlation. *Correspondence to: Abreu Montanaro VV, Neurological Rehabilitation Department, Sarah Hospital, Brasília Brazil, Tel: +55 61 33191111; E-mail: vinicius_montanaro@yahoo.com.br Received: March 05, 2018; Accepted: March 27, 2018; Published: March 31, 2018 Introduction Data available in literature describe an association between hyperhomocysteinemia and a methylenetetrahydrofolate reductase (MTHFR) gene mutation and vascular events [1]. A possible correlation is known to exist between 677TT MTHFR gene polymorphism and the presence of large-vessel lesions [2] and Moyamoya syndrome. However, the correlation between the 677TT gene polymorphism and Moyamoya syndrome is not conclusive [3]. In the present paper, we report the case of a patient who presented with Moyamoya syndrome associated with hyperhomocysteinemia and a MTHFR gene mutation.
{"title":"Moyamoya syndrome concomitant with hyperhomocysteinemia and a Methylenetetrahydrofolate reductase gene mutation: a case report and brief review","authors":"Abreu Montanaro Vv, Marinho Pb, Uchoa Cavalcanti Eb, Ferreira Martins Bja, C. Ap","doi":"10.15761/RDI.1000130","DOIUrl":"https://doi.org/10.15761/RDI.1000130","url":null,"abstract":"The role of hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) gene mutation in the pathogenesis of ischemic stroke has been a topic of growing interest. Reports available in literature describe this association, primarily in cases of pediatric stroke. We report a case of a 23-year-old woman presented to the SARAH Network of Rehabilitation Hospitals with a history of recurrent ischemic strokes during infancy and an etiological diagnosis of Moyamoya syndrome. Evaluation revealed mild elevation of serum homocysteine levels and a homozygous MTHFR gene mutation, no other associated abnormalities were detected. There is evidence of the presence of these abnormalities in some cases of pediatric ischemic stroke in the clinical setting. Data are limited regarding the role of hyperhomocysteinemia and an MTHFR gene mutation in causing vascular lesions/damage. Further studies involving patients with ischemic stroke (primarily those with arterial occlusion), are warranted to better establish such a correlation. *Correspondence to: Abreu Montanaro VV, Neurological Rehabilitation Department, Sarah Hospital, Brasília Brazil, Tel: +55 61 33191111; E-mail: vinicius_montanaro@yahoo.com.br Received: March 05, 2018; Accepted: March 27, 2018; Published: March 31, 2018 Introduction Data available in literature describe an association between hyperhomocysteinemia and a methylenetetrahydrofolate reductase (MTHFR) gene mutation and vascular events [1]. A possible correlation is known to exist between 677TT MTHFR gene polymorphism and the presence of large-vessel lesions [2] and Moyamoya syndrome. However, the correlation between the 677TT gene polymorphism and Moyamoya syndrome is not conclusive [3]. In the present paper, we report the case of a patient who presented with Moyamoya syndrome associated with hyperhomocysteinemia and a MTHFR gene mutation.","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86645992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Hamartomas are benign breast lesions. Radiologic and clinical evaluation has great importance in the diagnosis for reducing unnecessary procedures. We intend to investigate the contribution of magnetic resonance imaging (MRI) in the diagnosis of hamartomas Method: Our research has been conducted retsospectively, a total of 55 breast hamartomas were reassessed using mammography (MG) and MRI. In the detection of morphological features of hamartomas were compared efficacy of MG and MRI. ADC values were obtained corresponding to lesion localization and normal breast parenchyma. Result:MRI was significantly superior to MG in detecting pesudo-capsule and size(p<0,001). There was no significant difference between enhancement pattern and ADC values obtained from breast tissue and hamartoma. Conclusion: Conclusionally, we assume that MRI can provide more detailed information in difficult cases which have not classical mammographic appearances, so MRI can be considered as an alternative imaging for accurate diagnosis and prevent unnecessary biopsies and surgeries. *Correspondence to: Arslan FZ, Konya Training and Research Hospital, Department of Radiology, Haci Saban Mah, Meram New Road Avenue, Meram, Konya, Turkey, Tel: 05064382430; Fax: 03323236723; E-mail: Zeynep_a1002@hotmail.com
{"title":"Importance of magnetic resonance imaging in the diagnosis of breast hamartoma","authors":"A. A, Arslan Fz, Eryilmaz Ma, Oner O","doi":"10.15761/RDI.1000136","DOIUrl":"https://doi.org/10.15761/RDI.1000136","url":null,"abstract":"Aim: Hamartomas are benign breast lesions. Radiologic and clinical evaluation has great importance in the diagnosis for reducing unnecessary procedures. We intend to investigate the contribution of magnetic resonance imaging (MRI) in the diagnosis of hamartomas Method: Our research has been conducted retsospectively, a total of 55 breast hamartomas were reassessed using mammography (MG) and MRI. In the detection of morphological features of hamartomas were compared efficacy of MG and MRI. ADC values were obtained corresponding to lesion localization and normal breast parenchyma. Result:MRI was significantly superior to MG in detecting pesudo-capsule and size(p<0,001). There was no significant difference between enhancement pattern and ADC values obtained from breast tissue and hamartoma. Conclusion: Conclusionally, we assume that MRI can provide more detailed information in difficult cases which have not classical mammographic appearances, so MRI can be considered as an alternative imaging for accurate diagnosis and prevent unnecessary biopsies and surgeries. *Correspondence to: Arslan FZ, Konya Training and Research Hospital, Department of Radiology, Haci Saban Mah, Meram New Road Avenue, Meram, Konya, Turkey, Tel: 05064382430; Fax: 03323236723; E-mail: Zeynep_a1002@hotmail.com","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90352768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Simó, Ateba Jfb, Manyol En, Ndah Tn, Ndontchueng Mm, Njiki Cd
The use of X-Ray in medical radiology is always risky. In particular, when it comes to imaging pregnant women, the majority of foetus cells might be damaged. Despite all the requirements from international renowned organizations relating to imaging of pregnant women and newborns, the unintentional irradiations of the foetus are still common in radiology services. A case that occurred at the Gynaeco Obstetric and Paediatric Hospital of Douala (Cameroon) in September 2015, is instructive. A 46-year-old woman about six months pregnant was subject to an X-Ray of the pelvis requested by a medical doctor following a suspicion “of osteonecrosis”. Investigations have been conducted by the National Radiation Protection Agency (NRPA) by using Diavolt kVp meter. In addition, theoretical foetal dose estimation has been proceeded to evaluate accuracy of the technical estimation of the obtained result. The patient was irradiated with parameters of 20 mAs and 90 kV which lead to a dose to foetus of about 213 μGy. The lead apron that was used to protect the pelvis reduced the absorbed dose by a factor of 6. The hospital officials were advised to do more collaboration between referral medical doctors and radiologists as soon as the use of X-Ray on pregnant women is deemed necessary, to inform patients about the dangers of ionizing radiation on foetus, and to request information on their pregnancy status as well. Correspondence to: Beyala Ateba JF, National Radiation Protection Agency of Cameroon, Yaoundé, Cameroon, E-mail: bajeanfelix@yahoo.fr Received: March 03, 2018; Accepted: March 20, 2018; Published: March 24, 2018 Introduction The use of X-ray generators for diagnostic radiology in the medical sector in Cameroon, Central Africa, is wide spread and on the increase in recent times [1]. One of the most commonly asked questions in relation to the use of ionizing radiation in medicine concerns the management of the pregnant patient. Instinctively, one might want to avoid use of radiation with a pregnant patient; however, there are a number of situations in which the use of radiation for diagnosis or therapy is appropriate. In addition, there are many female physicians and technicians who are employed in medical settings involving radiation. Thousands of pregnant patients and radiation workers are exposed to ionizing radiation each year [2]. X rays have also been used for more than 50 years to assess the dimensions of the maternal pelvis in pregnancy [3]. For occupationally exposed pregnant women, the equivalent dose to the surface of the abdomen shall not exceed 2 mSv per year and the effective dose resulting from exposure shall not exceed 1 mSv from the time which the pregnancy is known until its term [4,5]. According to presidential decree N° 2002/250, issued on 31st October 2002, National Radiation Protection Agency (NRPA), was established as the only Regulatory Body in Cameroon [6]. It is the competent authority for radiation protection and waste management
{"title":"Medical radiation exposure of pregnant patients: case study of the gynaeco obstetric and paediatric hospital of douala, cameroon","authors":"A. Simó, Ateba Jfb, Manyol En, Ndah Tn, Ndontchueng Mm, Njiki Cd","doi":"10.15761/rdi.1000126","DOIUrl":"https://doi.org/10.15761/rdi.1000126","url":null,"abstract":"The use of X-Ray in medical radiology is always risky. In particular, when it comes to imaging pregnant women, the majority of foetus cells might be damaged. Despite all the requirements from international renowned organizations relating to imaging of pregnant women and newborns, the unintentional irradiations of the foetus are still common in radiology services. A case that occurred at the Gynaeco Obstetric and Paediatric Hospital of Douala (Cameroon) in September 2015, is instructive. A 46-year-old woman about six months pregnant was subject to an X-Ray of the pelvis requested by a medical doctor following a suspicion “of osteonecrosis”. Investigations have been conducted by the National Radiation Protection Agency (NRPA) by using Diavolt kVp meter. In addition, theoretical foetal dose estimation has been proceeded to evaluate accuracy of the technical estimation of the obtained result. The patient was irradiated with parameters of 20 mAs and 90 kV which lead to a dose to foetus of about 213 μGy. The lead apron that was used to protect the pelvis reduced the absorbed dose by a factor of 6. The hospital officials were advised to do more collaboration between referral medical doctors and radiologists as soon as the use of X-Ray on pregnant women is deemed necessary, to inform patients about the dangers of ionizing radiation on foetus, and to request information on their pregnancy status as well. Correspondence to: Beyala Ateba JF, National Radiation Protection Agency of Cameroon, Yaoundé, Cameroon, E-mail: bajeanfelix@yahoo.fr Received: March 03, 2018; Accepted: March 20, 2018; Published: March 24, 2018 Introduction The use of X-ray generators for diagnostic radiology in the medical sector in Cameroon, Central Africa, is wide spread and on the increase in recent times [1]. One of the most commonly asked questions in relation to the use of ionizing radiation in medicine concerns the management of the pregnant patient. Instinctively, one might want to avoid use of radiation with a pregnant patient; however, there are a number of situations in which the use of radiation for diagnosis or therapy is appropriate. In addition, there are many female physicians and technicians who are employed in medical settings involving radiation. Thousands of pregnant patients and radiation workers are exposed to ionizing radiation each year [2]. X rays have also been used for more than 50 years to assess the dimensions of the maternal pelvis in pregnancy [3]. For occupationally exposed pregnant women, the equivalent dose to the surface of the abdomen shall not exceed 2 mSv per year and the effective dose resulting from exposure shall not exceed 1 mSv from the time which the pregnancy is known until its term [4,5]. According to presidential decree N° 2002/250, issued on 31st October 2002, National Radiation Protection Agency (NRPA), was established as the only Regulatory Body in Cameroon [6]. It is the competent authority for radiation protection and waste management ","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"269 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77168679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Kosaka, Mariko Kikuchi, Norihiko Sengoku, Y. Tanaka, Mina Waraya, H. Katoh, K. Yamashita, Sabine Kajita, R. Woodhams, M. Watanabe
Background: The incidence of synchronous bilateral breast cancer is increasing each year. The applicability of contrast-enhanced magnetic resonance imaging (MRI) in the detection of multiple breast lesions has been reported in many studies. However, there have been no reports concerning the usefulness of preoperative MRI to evaluate synchronous bilateral breast cancer in Japan. We reviewed patients with synchronous bilateral breast cancer to investigate the applicability of contrastenhanced MRI in detecting contralateral breast cancer that was not visible by MMG or ultrasound. Methods: Synchronous bilateral breast cancer was found in 47 (3.2%) of the 1465 breast cancer patients who underwent surgery in our hospital between April 2006 and December 2012. Of those 47 patients, we enrolled 28 patients whose second lesions were non-palpable. The sensitivities of MMG, ultrasonography, and contrastenhanced MRI were compared for their ability to detect the malignancy of the second lesion. We also assessed the pathological characteristics of those lesions that were only visible by contrast-enhanced MRI. Results: In 28 patients whose second lesions were non-palpable,7% was DCIS in first lesions, and 39% was DCIS in second lesions. The median size of the invasive cancer was 2.3 cm (range, 0.5-9.5 cm) within the first lesions. The median size of the invasive cancer was 1.0 cm (range, 0.4-5.0 cm) within the second lesions. Of the 28 malignant lesions, 13 (46%) were positive by MMG, 18 (64%) were positive by ultrasonography, and 28 (100%) were positive by contrast-enhanced MRI. In six of the 28 patients (21%), the malignant lesions were found by contrast-enhanced MRI but not by MMG nor by ultrasonography. Conclusion: Contrast-enhanced MRI has the highest sensitivity and is therefore the most useful modality in identifying non-palpable breast abnormalities. It is especially useful in the detection of small contralateral lesions and lesions immediately under the nipple of the contralateral breast. Correspondence to: Yoshimasa Kosaka, Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan; Tel: +81 427788111, Fax: +81 427789556; E-mail: y-kosaka@med.kitasato-u.ac.jp
{"title":"The usefulness of preoperative MRI in synchronous bilateral breast cancer","authors":"Y. Kosaka, Mariko Kikuchi, Norihiko Sengoku, Y. Tanaka, Mina Waraya, H. Katoh, K. Yamashita, Sabine Kajita, R. Woodhams, M. Watanabe","doi":"10.15761/RDI.1000122","DOIUrl":"https://doi.org/10.15761/RDI.1000122","url":null,"abstract":"Background: The incidence of synchronous bilateral breast cancer is increasing each year. The applicability of contrast-enhanced magnetic resonance imaging (MRI) in the detection of multiple breast lesions has been reported in many studies. However, there have been no reports concerning the usefulness of preoperative MRI to evaluate synchronous bilateral breast cancer in Japan. We reviewed patients with synchronous bilateral breast cancer to investigate the applicability of contrastenhanced MRI in detecting contralateral breast cancer that was not visible by MMG or ultrasound. Methods: Synchronous bilateral breast cancer was found in 47 (3.2%) of the 1465 breast cancer patients who underwent surgery in our hospital between April 2006 and December 2012. Of those 47 patients, we enrolled 28 patients whose second lesions were non-palpable. The sensitivities of MMG, ultrasonography, and contrastenhanced MRI were compared for their ability to detect the malignancy of the second lesion. We also assessed the pathological characteristics of those lesions that were only visible by contrast-enhanced MRI. Results: In 28 patients whose second lesions were non-palpable,7% was DCIS in first lesions, and 39% was DCIS in second lesions. The median size of the invasive cancer was 2.3 cm (range, 0.5-9.5 cm) within the first lesions. The median size of the invasive cancer was 1.0 cm (range, 0.4-5.0 cm) within the second lesions. Of the 28 malignant lesions, 13 (46%) were positive by MMG, 18 (64%) were positive by ultrasonography, and 28 (100%) were positive by contrast-enhanced MRI. In six of the 28 patients (21%), the malignant lesions were found by contrast-enhanced MRI but not by MMG nor by ultrasonography. Conclusion: Contrast-enhanced MRI has the highest sensitivity and is therefore the most useful modality in identifying non-palpable breast abnormalities. It is especially useful in the detection of small contralateral lesions and lesions immediately under the nipple of the contralateral breast. Correspondence to: Yoshimasa Kosaka, Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, Japan; Tel: +81 427788111, Fax: +81 427789556; E-mail: y-kosaka@med.kitasato-u.ac.jp","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"268 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75778801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dual Energy CT - A diagnostic boon","authors":"ALMohammad Ma, H. Hao, L. Bo, Bin Sh","doi":"10.15761/RDI.1000125","DOIUrl":"https://doi.org/10.15761/RDI.1000125","url":null,"abstract":"","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"178 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77833517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Uccelli, A. Intelisano, D. Piccinali, A. Zanello, R. Meroni, L. Pedone, N. Gaffuri, O. Goletti
{"title":"Ameboma versus colorectal cancer: a case report","authors":"F. Uccelli, A. Intelisano, D. Piccinali, A. Zanello, R. Meroni, L. Pedone, N. Gaffuri, O. Goletti","doi":"10.15761/rdi.1000128","DOIUrl":"https://doi.org/10.15761/rdi.1000128","url":null,"abstract":"","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73642784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a case of significant lung herniation which was related to a relatively low acuity injury sustained while moving a small load of bricks. The patient was symptomatic with pain and dyspnea, and chest images revealed a large herniation of the right lower lobe through a defect in the intercostal muscles. Lung herniation is rare but is usually associated with significant trauma or surgery. This degree of injury occurred with minor provocation but caused significant morbidity. *Correspondence to: Carvalho AM, Queen’s University Belfast School of Medicine, UK, E-mail: Paula.Carvalho@med.va.gov Received: June 15, 2018 Accepted: June 25, 2018; Published: June 28, 2018 Case report A 62-year-old man presented to the emergency room with swelling and pain at his right lower costal margin. A sharp tearing pain was reported at the initial injury which occurred while moving bricks 2 days prior. Several hours later, the patient, who is a smoker, had a coughing episode with aggravation of the pain and subsequent development of a soft spongy bulge at the site. The bulge increased in size with subsequent coughing and became severely painful, preventing normal tidal breaths. The patient reduced the swelling by external compression with a broad belt which he wore in order continue working. Although compression was helpful, he was unable to continue work due to intractable pain. On physical exam, the patient was alert and in no immediate distress. He had a 30 pack-year history of cigarette smoking but was otherwise in good health and used no medications. Vital signs were normal, except for a respiratory rate at 22/minute with shallow breaths. The patient was holding his right side and had a leather belt tightly bound over his upper abdomen. He was unable to take deep breaths, but there were decreased breath sounds over the right lateral and posterior lung fields. Once the belt was removed, there was no apparent swelling, but a depression was palpated at the lateral aspect between the eighth ninth rib interspace. The patient reported that he could replicate the bulge beneath the skin if he coughed. A chest x-ray showed an indistinct right basilar density with a potential small effusion possibly related to atelectasis or pneumonia (Figures 1A and 1B). There were no evident rib fractures. While preparing for a chest CT, the patient coughed, and the bulge recurred. CT images showed a large herniation of the right lower lobe between the 9th and 10th rib interspace. The adjacent ribs were separated with interruption of the associated intercostal muscles (Figures 2A and 2B, Figure 3 and Figure 4). The patient subsequently underwent a right thoracotomy with placement of a Gore-Tex patch to close the defect. A sterile seroma cavity had formed in the chest wall and was excised. The patient has recovered well and has not experienced further pain or recurrence of herniation on follow-up CT (Figure 5). Pulmonary herniation is a rare condition characterized by protrusion
{"title":"A case of major lung herniation with minor trauma","authors":"Carvalho Am, Anderson Da","doi":"10.15761/RDI.1000140","DOIUrl":"https://doi.org/10.15761/RDI.1000140","url":null,"abstract":"We present a case of significant lung herniation which was related to a relatively low acuity injury sustained while moving a small load of bricks. The patient was symptomatic with pain and dyspnea, and chest images revealed a large herniation of the right lower lobe through a defect in the intercostal muscles. Lung herniation is rare but is usually associated with significant trauma or surgery. This degree of injury occurred with minor provocation but caused significant morbidity. *Correspondence to: Carvalho AM, Queen’s University Belfast School of Medicine, UK, E-mail: Paula.Carvalho@med.va.gov Received: June 15, 2018 Accepted: June 25, 2018; Published: June 28, 2018 Case report A 62-year-old man presented to the emergency room with swelling and pain at his right lower costal margin. A sharp tearing pain was reported at the initial injury which occurred while moving bricks 2 days prior. Several hours later, the patient, who is a smoker, had a coughing episode with aggravation of the pain and subsequent development of a soft spongy bulge at the site. The bulge increased in size with subsequent coughing and became severely painful, preventing normal tidal breaths. The patient reduced the swelling by external compression with a broad belt which he wore in order continue working. Although compression was helpful, he was unable to continue work due to intractable pain. On physical exam, the patient was alert and in no immediate distress. He had a 30 pack-year history of cigarette smoking but was otherwise in good health and used no medications. Vital signs were normal, except for a respiratory rate at 22/minute with shallow breaths. The patient was holding his right side and had a leather belt tightly bound over his upper abdomen. He was unable to take deep breaths, but there were decreased breath sounds over the right lateral and posterior lung fields. Once the belt was removed, there was no apparent swelling, but a depression was palpated at the lateral aspect between the eighth ninth rib interspace. The patient reported that he could replicate the bulge beneath the skin if he coughed. A chest x-ray showed an indistinct right basilar density with a potential small effusion possibly related to atelectasis or pneumonia (Figures 1A and 1B). There were no evident rib fractures. While preparing for a chest CT, the patient coughed, and the bulge recurred. CT images showed a large herniation of the right lower lobe between the 9th and 10th rib interspace. The adjacent ribs were separated with interruption of the associated intercostal muscles (Figures 2A and 2B, Figure 3 and Figure 4). The patient subsequently underwent a right thoracotomy with placement of a Gore-Tex patch to close the defect. A sterile seroma cavity had formed in the chest wall and was excised. The patient has recovered well and has not experienced further pain or recurrence of herniation on follow-up CT (Figure 5). Pulmonary herniation is a rare condition characterized by protrusion ","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89838674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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