Emergency Breast Imaging, What Radiologists Need To Know

Awareness by the general radiologist of the various emergent conditions of the breast would enable a better management and appropriate referral, rather than postponing management till a breast radiologist is available for consultation. Early referrals are essential to prevent deterioration of complications including severe infection and even sepsis. There has been a lack of consensus in the past regarding appropriate management and delays in treatment have resulted in worse outcomes which could have been avoided.

Value of Ultrasound in Evaluation of Abnormal Axillary Lymph Node

Understanding of the various appearances of axillary lymph nodes (LNs) is essential for diagnosing and planning of breast cancer treatment. In this article, the role of ultrasound in detecting abnormal appearing metastatic LNs s is discussed, with emphasis on most of the ultrasonographic features and tools which might help improve detection of axillary LN pathology.

Sonography of Primary Cervical Neuroblastoma in the Infant

A palpable neck mass in a newborn or young child is overwhelmingly benign but can require additional evaluation to exclude the rare malignant etiology. We present a 10-month-old female with a non-tender, non-erythematous firm nodule in the left neck initially suspected to be enlarged lymph nodes. Sonographic imaging was concerning for a diagnosis of neuroblastoma confirmed by surgical resection and pathologic examination. The sonographic characteristics associated with neuroblastoma are important to recognize to accurately diagnose the neoplasm and improve patient management.

Sonographic Features of Chronic Kidney Disease in Agricultural Community in Sri Lanka

Objectives: The aim of this study was to use ultrasound-based kidney morphological features to classify chronic kidney disease (CKD) in an agricultural community in Sri Lanka where there is a high prevalence of CKD with unknown etiology. Materials and Methods: A cohort of CKD patients (n = 50) and healthy subjects (n = 26) underwent B-mode renal ultrasound. CKD patients were further categorized as those clinically diagnosed with diabetes mellitus, hypertension, and other known causes (n = 30) and those of unknown etiology (n = 20). Following kidney morphological features were calculated: Length (LEN), width (WDTH), cortical thickness, volume (VOL), and shape index. Results: CKD kidneys of both groups were significantly smaller than the healthy kidneys (P < 0.001). Based on a random forest procedure, the top three influential features that distinguished CKD kidneys from healthy kidneys were: VOL normalized to waist circumference (CKD = 0.6 ± 0.2 cm2, healthy = 0.9 ± 0.2 cm2), VOL normalized to body surface area (CKD = 36 ± 9 cm3/m2, healthy = 52 ± 13 cm3/m2), and WDTH (CKD = 3.6 ± 0.5 cm, healthy = 4.3 ± 0.6 cm). Patients with CKD of unknown etiology had higher kidney LEN and VOL normalized to height (HGHT) (LEN/HGHT = 0.58 ± 0.05 cm/m, VOL/HGHT = 0.40 ± 0.09 cm3/m, P < 0.05) compared to those of the known etiology group (LEN/HGHT = 0.51 ± 0.09 cm/m, VOL/HGHT = 0.30 ± 0.10 cm3/m). Conclusion: The study shows that ultrasound-based kidney volume can distinguish healthy versus diseased kidneys as well as CKD of known versus unknown etiology. Normalizing for height is required when comparing diseased groups.

Rare Cause of Painful Ejaculation – Zinner’s Syndrome: A Case Report

Zinner’s syndrome is a rare congenital abnormality consisting of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The mutual embryological origins of the seminal vesicle and the ureteral bud from the Wolffian duct result in both anomalous seminal vesicle and urinary tracts. Most cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. The usual presentation is between the third and fourth decades of life, with infertility being the most common complaint. Ultrasound and magnetic resonance imaging can easily detect this condition. We present here an extremely rare developmental anomaly involving the Wolffian ducts, which would remain undiagnosed but for radiologic imaging.

Sonographic Appearance of Testicular Hemangioma: A Case Report

Tumors of the testes are the most common solid organ malignancy in young men. The first modality of choice for intratesticular masses is high-resolution sonography. The majority of intratesticular masses are malignant and ultrasound (US) remains the first-line modality for evaluation of these masses. While rare, benign testicular masses are important to recognize to avoid unnecessary workup and surgery. We present the case of a 38-year-old male with a testicular hemangioma, a rare benign testicular tumor. US and pathologic findings of this tumor are discussed.

Early Prenatal Diagnosis of Congenital Ranula

Congenital ranula (CR) is a rare tumor. Few cases of prenatal diagnosis (PD) of CR have been reported in the literature and diagnosis usually is beyond 20 weeks of gestation. We report a case of a pregnant patient with 16 weeks of gestation, where ultrasound (US) visualized in her fetus, a cystic tumor protruding in his oral cavity. Basis and complementary studies, including fetal echocardiography, were normal. Serial two-dimensional (2D) and three-dimensional (3D) US studies monitored fetal growth, amniotic fluid, progressive changes in the cystic mass, and maxillary movements. At 38.5 weeks of gestation, a cesarean section was performed. At 17th neonate days old, the neonate was done the simple and complete excision. Early PD of CR is possible. In this case was done as early as at 16 weeks of gestation. This is the first CR reported case with the earliest PD (16 week of gestation). We recommend that during the first trimester US, the oral cavity must be well explored, to rule out tumors.

Sonography of Meconium Periorchitis in the Neonate

Occurrence of a scrotal mass in a newborn or young child often requires additional evaluation, the extent of which depends on the clinical scenario. We present a case of a newborn infant that presented with non-tender bilateral scrotal swelling that was prenatally suspected to be meconium periorchitis, a diagnosis confirmed by postnatal surgical exploration. Understanding the sonographic characteristics associated with meconium periorchitis help to allow for appropriate management of the patient and guide surgical evaluation.

Birt-Hogg-Dubé Syndrome: A Case Report Describing Sonographic Evaluation of Salivary Gland Oncocytomas

Birt-Hogg-Dubé (BHD) syndrome is a rare hereditary disorder associated with autosomal dominant hereditary epithelial carcinomas, in which patients have an increased incidence of renal cell carcinomas, scattered hamartomas, pulmonary cysts, and spontaneous pneumothoraces. Other less common findings include lipomas, parathyroid adenomas, salivary gland tumors, and colonic polyps/tumors. Early diagnosis of BHD can help establish renal screening and reduce mortality by early detection and more effective treatment of renal cell carcinoma. This case report describes the sonographic features of salivary gland oncocytomas found in a patient with BHD.

Acoustic Streaming: A Diagnostic Clue to Diagnosing Testicular Teratoma

Teratomatous tissue is commonly seen in a variety of malignant testicular tumors, and while the exact determination of testicular tumor subtypes heavily relies on pathologic diagnosis, ultrasound remains the gold standard in the initial evaluation of such entities. The major groups of testicular tumors may demonstrate characteristic features which can point the radiologist toward a more pruned differential diagnosis. While it is important for the interpreting physician to be aware of such features, it is of equal necessity that they are aware of potential visual phenomena, such as acoustic streaming in the diagnosis of testicular tumors. We present a case of a testicular teratoma with acoustic streaming. This testicular tumor was confirmed to be predominantly a teratoma with a minimal element of seminoma on histopathology.