Does left ventricular diastolic function deteriorate earlier than left ventricular systolic function in anthracycline cardiotoxicity?

Cardiotoxicity is the most important complication in patients receiving anthracycline chemotherapy. We studied the left ventricular diastolic function (LVDF) and systolic function (LVSF) in these patients and assessed whether LVDF deteriorates earlier than LVSF. We prospectively studied 58 patients (mean age 48.02 ± 13.87; 32 female, 26 male) on anthracycline treatment, before chemotherapy (S0) and after cumulative doses of 139 ± 12 mg/m(2) (S1) and 308 ± 14 mg/m(2) (S2). The LVSF was computed in terms of left ventricular ejection fraction (LVEF) from equilibrium radionuclide angiography (ERNA). The peak ejection rate (PER), peak filling rate (PFR), time to peak ejection rate (TPER), time to peak filling rate (TPFR), 1/3rd filling fraction and ratio of PFR and PER were calculated from ERNA and were also standardized using 150 baseline ERNA studies. Statistical analysis was done by repeated measures analysis of variance (ANOVA). We found significant decrease in LVEF (P<0.001) and PER (P<0.001) between the S1 and S2 studies and PFR (P<0.007) between the S0 and S1 studies. In conclusion in patients receiving anthracycline treatment, LVDF deteriorates earlier than left ventricular systolic function (LVSF).

Disseminated tuberculosis masquerading as metastatic breast carcinoma on PET-CT.

PET has an established role in the management of breast cancer. However, F-18 FDG uptake sometimes has been associated with benign disease leading to false positive results. We present a case of a 37-year-old woman who presented with a 3-month history of a left breast lump and palpable left axillary lymph nodes. Whole-body PET-CT scan demonstrated multiple focal areas of intense FDG uptake in the left breast and multiple axillary, cervical, and mediastinal lymph nodes. PET-CT findings mimicked metastatic breast cancer, which was subsequently confirmed as disseminated tuberculosis by mammotome-guided biopsy of the breast lesion and fine needle aspiration biopsy of lymph nodes.

Hepatobiliary scintigraphy in detecting lesser sac bile leak in postcholecystectomy patients: the need to recognize as a separate entity.

Cholecystectomy is one of the most commonly performed abdominal surgeries in which bile duct injury and bile leaks are the most important complications. Imaging plays an important role in the prompt diagnosis and management of bile leaks. The more common sites of bile leak are the gallbladder bed, subhepatic, in a bilioma, right paracolic gutter, or diffusely in the peritoneal cavity. Bile leak into the lesser sac (LS) is uncommon but is a special entity posing difficult problems in management. We have described in this study the clinical presentation, imaging findings, and management of 6 patients with biliary leakage into the LS postcholecystectomy. The clinical presentation of this condition was varied, ranging from patients with asymptomatic or with vague complaints resulting in difficulties in clinical suspicion or symptomatic but minimal enough not to be detected by ultrasonogram. Hepatobiliary scintigraphy played an important role in the diagnosis and management, and all patients required definitive therapeutic drainage procedures. Any persistent focal radiotracer activity in the anatomy of the LS, increasing with time and not diffusing into the general peritoneal cavity is diagnostic of bile leak into the LS.