Elastrography used in addition to grey scale sonography increases its specificity. Elasticity contrast index (ECI) is based on strain elastrography and being a quantitative parameter, maybe more easy ...to obtain and reproducible while researches has been done in ECI in thyroid lesions, this is the first study, to the best of our knowledge to evaluate in breast lesions. This study was done to evaluate the diagnostic accuracy of Elasticity Contrast Index (ECI) in differentiating benign from malignant lesions of breast and to determine its cutoff value.
This is a descriptive cross-sectional study done at tertiary health care centre, which involved retrospective evaluation of data collected from September 2016 to March 2017. Conventional sonography was done followed by elastography on commercially available ultrasound machine. ECI was calculated in thyroid protocol available in the unit. Histopathological diagnosis was obtained for all the lesions and taken as gold standard.
A total of 89 breast lumps were evaluated, of which was 61 (69.3%) were benign and 27 (30.7%) malignant on histopathology. Independent t test revealed the average ECI value of benign lesions was 2.48 and malignant 5.1. Receiver operating curve showed ECI value of 3.25 as the cutoff, above which the lesions were malignant.
ECI is a quantitative elastography technique which can be easily used as an adjunct during breast sonography and can increase its specificity for diagnosing a lesion as malignant. This could reduce the number of false positive biopsies.
Tuberculosis is endemic in our part of the world and may have uncommon presentations like pancreatic involvement. A young male presented to the OPD with recent history of pain in epigastric region ...and was subsequently diagnosed with a multi-loculated cystic neoplasm in pancreatic head region on ultrasonography and CT scan. The pancreatic origin was confirmed on surgery while the histopathological study revealed tuberculous nature. This case report highlights the importance of considering tuberculosis in the differential diagnosis in pancreatic masses, especially, with atypical appearances, in young patients or with background predisposing to TB and the need for histological diagnosis.
Breast cancer is the leading female cancer worldwide with a high mortality rate. Early detection of the suspicious lesion is crucial for better prognosis. Higher breast density decreases the ...sensitivity of mammogram. Ultrasound can differentiate between cystic and solid masses and further characterize these as benign or possibly malignant. Our objective was to compare the findings of sonography with diagnostic mammography.BACKGROUNDBreast cancer is the leading female cancer worldwide with a high mortality rate. Early detection of the suspicious lesion is crucial for better prognosis. Higher breast density decreases the sensitivity of mammogram. Ultrasound can differentiate between cystic and solid masses and further characterize these as benign or possibly malignant. Our objective was to compare the findings of sonography with diagnostic mammography.This was a cross sectional study including 125 females who underwent diagnostic mammogram in a tertiary care center. The mammograms were evaluated and the patients were scanned by ultrasound and categorized as per ACR- BIRADS category. The findings of diagnostic mammography were compared with that of ultrasonography using SPSS version 25.METHODSThis was a cross sectional study including 125 females who underwent diagnostic mammogram in a tertiary care center. The mammograms were evaluated and the patients were scanned by ultrasound and categorized as per ACR- BIRADS category. The findings of diagnostic mammography were compared with that of ultrasonography using SPSS version 25.The heterogeneously dense breast in diagnostic mammography corresponded to the heterogenous- fibroglandular breast in ultrasonography. In majority, ultrasound increased the BIRADS category for the lesion than designated by the diagnostic mammography. It was particularly useful for category 0 and 3 lesions which were indeterminate and required further imaging.RESULTSThe heterogeneously dense breast in diagnostic mammography corresponded to the heterogenous- fibroglandular breast in ultrasonography. In majority, ultrasound increased the BIRADS category for the lesion than designated by the diagnostic mammography. It was particularly useful for category 0 and 3 lesions which were indeterminate and required further imaging.Ultrasound was useful in evaluation of dense breasts with ACR-BIRADS 0 and 3 in diagnostic mammogram. For category 3 and 4 in diagnostic mammogram, ultrasound showed category 1 or 2 lesions which aided to alleviate patient anxiety and avoid unnecessary biopsies. With emerging technological advances in ultrasound, it can used as a powerful tool for breast lesion detection and patient management.CONCLUSIONSUltrasound was useful in evaluation of dense breasts with ACR-BIRADS 0 and 3 in diagnostic mammogram. For category 3 and 4 in diagnostic mammogram, ultrasound showed category 1 or 2 lesions which aided to alleviate patient anxiety and avoid unnecessary biopsies. With emerging technological advances in ultrasound, it can used as a powerful tool for breast lesion detection and patient management.
IMPORTANCE: Sensitive outcome measures for disease progression are needed for treatment trials of Stargardt disease. OBJECTIVE: To describe the yearly progression rate of atrophic lesions in the ...retrospective Progression of Stargardt Disease study. DESIGN, SETTING, AND PARTICIPANTS: A multicenter retrospective cohort study was conducted at tertiary referral centers in the United States and Europe. A total of 251 patients aged 6 years or older at baseline, harboring disease-causing variants in ABCA4 (OMIM 601691), enrolled in the study from 9 centers between August 2, 2013, and December 12, 2014; of these patients, 215 had at least 2 gradable fundus autofluorescence images with atrophic lesion(s) present in at least 1 eye. EXPOSURES: Areas of definitely decreased autofluorescence (DDAF) and questionably decreased autofluorescence were quantified by a reading center. Progression rates were estimated from linear mixed models with time as the independent variable. MAIN OUTCOMES AND MEASURES: Yearly rate of progression using the growth of atrophic lesions measured by fundus autofluorescence. RESULTS: A total of 251 participants (458 study eyes) were enrolled. Images from 386 eyes of 215 participants (126 females and 89 males; mean SD age, 29.9 14.7 years; mean SD age of onset of symptoms, 21.9 13.3 years) showed atrophic lesions present on at least 2 visits and were graded for 2 (156 eyes), 3 (174 eyes), or 4 (57 eyes) visits. A subset of 224 eyes (123 female participants and 101 male participants; mean SD age, 33.0 15.1 years) had areas of DDAF present on at least 2 visits; these eyes were included in the estimation of the progression of the area of DDAF. At the first visit, DDAF was present in 224 eyes (58.0%), with a mean (SD) lesion size of 2.2 (2.7) mm2. The total mean (SD) area of decreased autofluorescence (DDAF and questionably decreased autofluorescence) at first visit was 2.6 (2.8) mm2. Mean progression of DDAF was 0.51 mm2/y (95% CI, 0.42-0.61 mm2/y), and of total decreased fundus autofluorescence was 0.35 mm2/y (95% CI, 0.28-0.43 mm2/y). Rates of progression depended on the initial size of the lesion. CONCLUSIONS AND RELEVANCE: In Stargardt disease with DDAF lesions, fundus autofluorescence may serve as a monitoring tool for interventional clinical trials that aim to slow disease progression. Rates of progression depended mainly on initial lesion size.
Mammography is an established screening tool for early detection of breast cancer, with several protocols used worldwide. Such screening programs and related data are lacking in less developed ...countries. We documented and analyzed the mammographic trends at Tribhuvan University Teaching Hospital, a tertiary care referral center, in Kathmandu, Nepal, to develop baseline data which may be helpful in further researches.
In this descriptive study, imaging findings of consecutive patients who had undergone mammography between July 2016 and March 2018 were reviewed after obtaining ethical clearance from the Institutional Review Committee. Ultrasonography and histopathological examination were done as needed. Demographics, presenting complaints, breast density, Breast Imaging, Reporting, Assessment and Data System category and final diagnosis were recorded and analyzed using appropriate statistical methods.
There were more diagnostic mammograms (62%) than screening with mastalgia the most common presenting complaint. Breast density was less in screening group. Overall, there were more benign lesions with incidence of breast cancer being 4.4% more in the diagnostic group. The age range varied from 22 to 86 years, with 15% (n=219) below 40 years age accounting for one-third of the cases of extremely dense breast and one-fourth of the suspicious lesions. Nearly 50% of breast cancers were seen in patients less than 50 years of age.
The study showed greater number of diagnostic than screening mammograms, with malignancies detected more often in the diagnostic group and younger age. Fewer screening studies suggest a lack of breast cancer awareness in our population who seek medical help only when symptomatic.
Paragonimiasis, or Oriental lung fluke is a parasitic infestation seen in Asia, Africa and South America which is spread by the consumption of crabs and crayfish. To date four cases have been ...reported from Nepal. Here, we report a case of paragonimiasis in a young male from Kathmandu valley who presented with symptoms of fever, on and off for 1 month, shortness of breath and cough. He was found to have pleural effusion. Sputum examination did not reveal acid fast bacilli, However, based on clinical features, he was started on antitubercular treatment. There was initial improvement, but later, he continued to have cough and hemoptysis over the next 2 years and on subsequent High-Resolution Computerized Tomography (HRCT) he was found to have a cavitary lung lesion in the superior segment of lower lobe of left lung. A possibility of aspergillosis was considered for which he underwent a lobectomy. The gross examination of the lung showed a small cavity measuring 5 mm which revealed on histology a parasitic structure with serous glands within it. In addition, there were many foreign body granulomas with ova within them. A diagnosis of paragonimiasis was made and the patient was started on Praziquantal. He recovered well and is currently asymptomatic. We can learn from this case that the signs and symptoms of paragonimiasis mimic that of tuberculosis and the mistaken diagnosis can lead to unnecessary treatment, prolonged morbidity and loss of time and resources.
Abstract
When faced with eczematous lesions involving the nipple–areolar complex (NAC), Paget's disease is assumed to be the diagnosis, anything else being considered a “Zebra” necessitating its ...exclusion on pathology. A middle-aged lady presented with synchronous asymmetrical ulceration of bilateral NAC with pleomorphic calcifications on mammography and simultaneous extensive vascular calcification in bilateral breasts that suggested systemic cause. Calciphylaxis is a rare diagnosis occurring usually due to underlying end-stage renal disease or hyperparathyroidism. There are very few case reports of calciphylaxis due to alcoholic liver disease and no cases to the best of our knowledge involving NAC. We report an extremely rare case of breast and NAC calciphylaxis due to alcoholic liver disease, highlighting need to consider benign etiology when bilateral involvement is present.
Gliomatosis peritonei is an extremely rare condition usually associated with either immature teratoma or, less commonly, mature teratoma. We present a case of a young female with long-standing ...progressive abdominal distension, who was diagnosed with mature ovarian teratoma with gliomatosis peritonei and gross ascites. The final diagnosis in this case was determined through the correlation of imaging, operative, and histopathological findings. The presence of enhancing peritoneal nodules usually leads to a suspicion of peritoneal carcinomatosis or abdominal tuberculosis, especially in endemic regions; however, gliomatosis peritonei should always be considered in the differential diagnosis, particularly when associated with teratomas. Radiological findings combined with histopathological reports are valuable in reaching the final diagnosis in these cases.
Female genital tract tuberculosis presents a diagnostic challenge because of its variable clinical presentation and radiological manifestation. Most patients are present with history of infertility, ...pain in the abdomen, vaginal discharge, and bleeding. These symptoms mimic those of gynecological cancer, such as endometrial carcinoma. Endometrial cancer typically manifests with vaginal bleeding in the post-menopausal age group; however, in less than 10% to 20% patients, it can occur in perimenopausal age groups, which makes it difficult to distinguish between malignancy and tuberculosis. We present a case report of a 40-year-old woman who complained of vaginal bleeding and lower abdominal pain. Her imaging findings favored the diagnosis of endometrial carcinoma but histopathology revealed tuberculosis.
Organophosphate-induced delayed neuropathy, a central-distal axonopathy, passes through latent, progressive, static and improvement phases. During the improvement phase, the peripheral nerves ...regenerate unmasking the spinal cord lesion with myelopathic features. We report a case of a 16-year-old male who developed myelopathy 6 weeks following chlorpyrifos poisoning. He had a motor weakness of 4/5 in bilateral hips and 3/5 in bilateral knees and ankles. Spasticity and exaggerated reflexes with ankle clonus were present in the lower limbs. Sensory and the upper limb motor examinations were all normal. Pertinent blood, cerebrospinal fluid and nerve conduction tests were normal. Magnetic resonance imaging of the spine showed features of cord atrophy. Three months following physiotherapy, his power improved to 5/5 in bilateral knee and hip joints and 4/5 in bilateral ankles with spasticity. Organophosphate-induced delayed neuropathy can present as earlier as 6 weeks with myelopathy. Previous history of organophosphorous exposure is important in myelopathy or peripheral neuropathy.
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