Multiple renal angiomyolipomas with asymptomatic nontraumatic pulmonary fat embolus: A case report.

Although retroperitoneal bleeding and massive hematuria are potential complications of angiomyolipoma (AML), the pulmonary embolism as a presenting symptom is extremely rare. It is important to be aware that benign AMLs can present with pulmonary fat embolism.

Decreased Pulmonary Artery Bifurcation Angle: A Novel Imaging Criterion for the Diagnosis of Chronic Pulmonary Thromboembolism.

Background: Chronic pulmonary thromboembolism (CTEPH) is an unusual complication of acute pulmonary embolism (PE), which is now considered to be treatable. In modern multi-detector scanners, a detailed evaluation of pulmonary artery geometry is currently possible. This study aimed to evaluate the changes in pulmonary artery bifurcation angle (PABA) in the follow-up computed tomography angiography (CTA) of patients with acute PE. Methods: In this cross-sectional study, the records of two tertiary-level academic hospitals were gathered from 2012 to 2019. Pulmonary artery (PA) bifurcation angle and diameter were measured. Chi square test, independent samples t test, Mann-Whitney, and Pearson's tests were employed to compare data. To evaluate the cut-off point, we utilized receiver operating characteristic (ROC) curve analysis. The accuracy, sensitivity, and specificity of pulmonary artery bifurcation angle changes were calculated. A P value <0.05 was considered to be significant. Results: Forty-six patients were included in the study. No significant differences were found between patients with and without CTEPH, and PABA in the dimeters of PA trunk, right PA, and left PA in the first CTA images (P values of 0.151, 0.142, 0.891, and 0.483, respectively), while in the secondary CTA, the mean PABA was significantly smaller in patients with CTEPH (P=0.011). In the receiver operating characteristic (ROC) analysis, delta angle revealed an area under the curve of 0.745 and an optimal cutoff of 0, leading to a sensitivity of 64%, specificity of 87%, and accuracy of 76% for diagnosing CTEPH. Conclusion: We showed a significant decrease in PABA in patients developing CTEPH. This parameter can be easily measured in lung CTA.

Evaluation of the relationship between inpatient COVID-19 mortality and chest CT severity score.

OBJECTIVES: There is scarce data available on the prognostic application of chest CT. The main purpose of this study was to evaluate the performance of a semi-quantitative CT severity score in identifying the risk of mortality in COVID-19 patients. METHODS: This retrospective cohort study was performed on 262 hospitalized COVID-19 patients. The CT severity score was assessed by two independent radiologists using a method previously used to score the severity of acute respiratory distress syndrome on thin slice lung CT. RESULTS: Multivariate regression analysis showed increasing odds of in-hospital death associated with older age, and the presence of coronary artery disease at the time of admission. The mean CT severity score was 7.5 in the survivor group and 14.5 in the deceased group. Overall, the lower zones were the most frequently affected sites in COVID-19. There was significant difference between the survivor and deceased groups regarding CT severity scores. Multivariate regression analysis showed increasing odds of in-hospital death associated with higher CT severity score at admission. CONCLUSIONS: Our results show that mortality was significantly higher in patients with higher CT severity score even after adjustment for clinical, demographics and laboratory parameters. However, this study is performed retrospectively and needs to be validated in a prospective study.

Evaluation of Diagnostic Precision of Ultrasound for Rotator Cuff Disorders in Patients with Shoulder Pain.

BACKGROUND: Rotator cuff disorders are a leading cause of shoulder symptoms. Accurate imaging, detecting the type of the involved muscle, and severity of the injury have important effects on the choice of treatment. Accordingly, the current study was conducted to evaluate the diagnostic accuracy of ultrasound for rotator cuff disorders in patients suffering from shoulder pain and to explore the precision of ultrasound in determining the exact dimensions of a tear in comparison with magnetic resonance imaging (MRI). METHODS: This prospective research was performed on patients clinically suspected of rotator cuff tendinopathy. An ultrasound of the shoulder was initially performed for the candidates. In this study, MRI was regarded as the modality of choice for examining the images of shoulder disorders. The European Society of Musculoskeletal Radiology (ESSR) guidelines were used to design the protocols and implement imaging measures. Based on the reference standard of MRI, the specificity and sensitivity as well as positive and negative predictive values of ultrasound in detection of rotator cuff disorders were calculated. RESULTS: A total of48 patients (22 women, 23 dominant right hands) with an average age of 51.6±8.3 years were enrolled in this study. Based on MRI findings, rotator cuff disorders were detected in 43 patients (89.5%). The most commonly observed disorders were partial-thickness rotator cuff tear (n=17, 35.4%), full-thickness rotator cuff tear (n=16, 33.3%), and tendinopathy (n=10, 20.8%). Among rotator cuff disorders, the highest sensitivity of ultrasound was observed in the detection of full-thickness tear (93.7%) and rotator cuff tendinopathy (90%). The highest specificity was found in the detection of full-thickness rotator cuff tear (100%) and partial-thickness rotator cuff tear (96.7%). CONCLUSION: Based on our findings, ultrasound could be considered as a high-quality diagnostic tool to rule in partial and full-thickness rotator cuff tears and rule out the rotator cuff pathologies.

The burden and predisposing factors of non-communicable diseases in Mashhad University of Medical Sciences personnel: a prospective 15-year organizational cohort study protocol and baseline assessment.

BACKGROUND: The rising burden of premature mortality for Non-Communicable Diseases (NCDs) in developing countries necessitates the institutionalization of a comprehensive surveillance framework to track trends and provide evidence to design, implement, and evaluate preventive strategies. This study aims to conduct an organization-based prospective cohort study on the NCDs and NCD-related secondary outcomes in adult personnel of the Mashhad University of Medical Sciences (MUMS) as main target population. METHODS: This study was designed to recruit 12,000 adults aged between 30 and 70 years for 15 years. Baseline assessment includes a wide range of established NCD risk factors obtaining by face-to-face interview or examination. The questionnaires consist of demographic and socioeconomic characteristics, lifestyle pattern, fuel consumption and pesticide exposures, occupational history and hazards, personal and familial medical history, medication profile, oral hygiene, reproduction history, dietary intake, and psychological conditions. Examinations include body size and composition test, abdominopelvic and thyroid ultrasonography, orthopedic evaluation, pulse wave velocity test, electrocardiography, blood pressure measurement, smell-taste evaluation, spirometry, mammography, and preferred tea temperature assessment. Routine biochemical, cell count, and fecal occult blood tests are also performed, and the biological samples (i.e., blood, urine, hair, and nail) are stored in preserving temperature. Annual telephone interviews and repeated examinations at 5-year intervals are planned to update information on health status and its determinants. RESULTS: A total of 5287 individuals (mean age of 43.9 ± 7.6 and 45.9% male) were included in the study thus far. About 18.5% were nurses and midwives and 44.2% had at least bachelor's degree. Fatty liver (15.4%), thyroid disorders (11.2%), hypertension (8.8%), and diabetes (4.9%) were the most prevalent NCDs. A large proportion of the population had some degree of anxiety (64.2%). Low physical activity (13 ± 22.4 min per day), high calorie intake (3079 ± 1252), and poor pulse-wave velocity (7.2 ± 1.6 m/s) highlight the need for strategies to improve lifestyle behaviors. CONCLUSION: The PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences is the first organizational cohort study in a metropolitan city of Iran aiming to provide a large data repository on the prevalence and risk factors of the NCDs in a developing country for future national and international research cooperation.

ESR1 gene variants, haplotypes and diplotypes may influence the risk of breast cancer and mammographic density.

Breast cancer as the most common cancer worldwide is influenced by genetic and physiological factors. Based on some evidence indicating the role of estrogen receptor 1 gene (ESR1) in breast cancer development, in this study, the association of three common variations in ESR1 gene with breast cancer and density in an Iranian population was evaluated. In a case-control study, 400 blood samples were collected for DNA extraction and genotyping. Breast density was assessed using mammography. ESR1 rs6915267 (G/A), rs2077647 (C/T) and rs1801132 (C/G) were genotyped using ARMS-PCR method. PHASE program was used to estimate the haplotypes frequencies. Our data analysis showed rs6915267 GA genotype in the heterozygous (GA) as well as co-dominant models was associated with lower mammographic density. None of the three variations were associated with the breast cancer risk. Haplotype analysis indicated G-T-C haplotype of rs6915267, rs2077647 and rs1801132 [OR = 0.54, 95% CI (0.31-0.92), p = 0.025] and G-T/G-T diplotype of rs6915267-rs2077647 [OR = 0.38, 95% CI (0.17-0.86), p = 0.019] were associated with a decreased risk of breast cancer. ESR1 may affect density of the breast and its haplotypes may modulate breast cancer risk.

Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis.

Acute cerebral vein thrombosis is usually seen as increased attenuation in brain non-contrast computed tomography. It is so helpful to define measurable parameters for subjective evaluation of sinus thrombosis in non-enhanced brain computed tomography, especially where advanced neuroimaging techniques are not available. The purpose of this study is to evaluate the diagnostic value of venobasilar attenuation ratio and venobasilar attenuation difference in the evaluation of acute cerebral venous sinuous thrombosis in non-enhanced brain CT scan. Fifty confirmed cases of acute cerebral vein thrombosis were sex- and age-matched with 73 subjects who did not have the condition. Average venous sinus attenuation, Hounsfield to hematocrit ratio, basilar artery density, venobasilar attenuation ratio and venobasilar attenuation difference were measured. Mean attenuation was 65.8 in thrombosed and 44.9 in non-thrombosed sinuses (P < 0.0001). A cutoff absolute sinus attentuaion of 61 HU led to a sensitivity of 82%, specificity of 100% and accuracy of 92%. A cutoff ratio of 1.4 for venobasilar ratio led to a sensitivity of 100%, specificity of 78% and accuracy of 87%. A cut-off value of 24 for venobasilar difference resulted in the sensitivity of 80%, specificity of 100% and accuracy of 92%. The additional measurement of venous sinus and basilar artery attenuations and calculation of venobasilar ratio and difference can increase the sensitivity and specificity of NCCT in the diagnosis of acute CVST.

Tuberculous mastitis: A review of 32 cases.

BACKGROUND: Breast tuberculosis (TB) is a rare disease, still present in endemic areas. The significance of breast TB is due to its rare occurrence and its resemblance to malignant breast lesions. The objective of this study was to study various clinical presentations and imaging features of different forms of tuberculous mastitis. METHODS: A retrospective study was conducted over a 10-year period. Thirty-two consecutive patients diagnosed with tuberculous mastitis were included. RESULTS: There was only one male patient in this series. The patients ranged in age from 25 to 60 years (mean age was 33.69 years). A solitary breast mass was the most common clinical presentation, which was associated with inflammatory findings in the majority of cases. The most common mammographic finding was diffusely increased density and the most common pathological finding was solitary mass. The most common appearance on ultrasound was of multiple intercommunicating breast masses with axillary lymphadenopathy. CONCLUSIONS: Breast TB should be considered in the differential diagnosis in the presence of a painful breast mass, discharging sinuses, mastitis, or a breast abscess that does not respond to conventional medical treatment. A multidisciplinary approach is required to aid timely diagnosis and to provide appropriate management and treatment in order to avoid complications.

Local recurrence of renal cell carcinoma presented with massive gastrointestinal bleeding: management with renal artery embolization.

BACKGROUND: Gastrointestinal bleeding from renal cell carcinoma metastasis is an uncommon manifestation of tumor recurrence and is usually difficult to control. Palliative trans-catheter embolization to control the bleeding has been used and described in the literature. CASE PRESENTATION: The present report describes a 62- years-old male with local recurrence of RCC who presented with upper GI bleeding as the primary manifestation 10 years after right-sided partial nephrectomy. A pseudoaneurysm of renal artery with erosion into the duodenal lumen was responsible for the massive bleeding and was controlled with coil embolization. CONCLUSION: This case report highlights the importance of high index suspicion in post-nephrectomy patients for RCC, presenting with new symptoms. Aggressive gastrointestinal workup and adequate awareness of available minimally-invasive endovascular options for controlling GIB in these patients, are of paramount importance.

Relationship among mammographic findings with histopathologic type of breast cancer and human epidermal growth factor receptor 2 (HER2) in young women.

INTRODUCTION: Radiological measures to diagnose breast cancer, including mammographic and ultrasound assessments in young women, are associated with restrictions affecting the use of this tool. No adequate information is available on mammography view in young people with breast cancer and its relationship with pathologic type and epidermal growth factor receptor 2 (HER2) as a prognostic marker, especially in the Iranian race. This study was conducted to examine the relationship between mammographic findings of young women with breast cancer with diagnosed histopathologic type and HER2 marker status. METHODS: This retrospective cross-sectional study was carried out on women with breast cancer referred to Omid Hospital in Mashhad, Iran. Inclusion criteria were age less than 45 years and definitive diagnosis of breast cancer documented in the patient record. Information on mammographic findings such as mass, asymmetry, microcalcification, tissue distortion, nipple retraction, and skin thickening was collected from patient medical records. In addition, the type of pathology diagnosed based on biopsy samples and HER2 examination results were collected. The chi-square test and SPSS software were used to analyze the relationship among qualitative variables. RESULTS: This study was performed on 153 patients with a mean age of 39.3±2.5 years (minimum 20 years and maximum 45 years). The mammographic finding was reported normal in 41 patients (26.7%). The evidence of malignant mass was observed in 48 patients (31.3%). The microcalcification was found in 31 patients (20.3%). The retraction or thickening of breast tissue was seen in 39 patients (25.5%). The distortion of breast stroma was found in 41 patients (26.8%). The HER2 marker in 76 patients (49.7%) was positive in study subjects. There was no statistically significant association between mammographic findings and pathologic type. Among the mammographic findings, only the presence of microcalcification had significant association with HER2 results (p=0.008). CONCLUSION: It seems that a significant relationship could not be found between mammographic features in patients with breast cancer and type of pathology diagnosed. However, the presence of calcification in mammography is associated with positive HER2.

Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound.

Galactoceles are the most common benign breast lesions during breastfeeding period that can mimic carcinomas. We report a galactocele with malignant appearance on ultrasound in the accessory breast. The patient was a 32-year-old lactating woman presented to our hospital for considerable swelling in the left axilla. Ultrasound examination revealed a hypoechoic mass with heterogeneous echogenicity and irregular shape and margins. Sonography-guided aspiration was performed. Aspiration of milky fluid and resolution of the axillary lump after aspiration confirmed the diagnosis of galactocele. Galactocele can present as a suspicious tumoral lesion in the axillary accessory breast and diagnostic aspiration can help in correct diagnosis of this rare lesion in the accessory breast.

Hemorrhagic Colloid Cyst Presenting with Acute Hydrocephaly.

Colloid cysts are benign slow-growing cystic lesions located on the roof of the third ventricle that usually present with symptoms related to gradual rise of intracranial pressure. They mostly remain asymptomatic and sometimes grow progressively and cause diverse symptoms associated with increased intracranial pressure such as headache, diplopia, and sixth cranial nerve palsy. Here we report a 47-year-old female who presented to the emergency department with acute severe headache and nausea/vomiting. On MRI examination acute hydrocephaly due to hemorrhagic colloid cyst was detected. Acute hemorrhage in colloid cysts is extremely rare and may present with symptoms of acute increase in the intracranial pressure. Intracystic hemorrhage is very rarely reported as a complication of colloid cyst presenting with paroxysmal symptoms of acute hydrocephaly.

Breast Angiosarcoma with Exophytic Growth.

Primary angiosarcoma of the breast is a rare malignant tumor. Diagnostic breast imaging includes mammography and ultrasound, which are usually nonspecific. A 42-year-old woman with angiosarcoma of the breast is presented. Physical findings showed a hard exophytic mass in the upper part of the left breast, with skin discoloration overlaying the mass. Mammography revealed a high density well defined mass in the left breast, without any micro-calcification and speculation. On ultrasound examination, a hypoechoic mass with a well-defined margin and heterogenous echogenicity was detected. A core needle biopsy and excisional biopsy were performed, and histological examination confirmed the diagnosis of angiosarcoma. The patient underwent simple mastectomy. We present the mammographic and ultrasonographic features of a case of primary breast angiosarcoma with exophytic growth.

Multiple bilateral pulmonary nodules masquerading as pulmonary metastasis; a case of nodular sarcoidosis.

Sarcoidosis is a multi-system inflammatory disorder of unknown etiology that is manifested by the presence of non-caseating granulomas. Multiple pulmonary nodules are rare presentations of sarcoidosis. We report a case of nodular sarcoidosis in a young male of Middle-East origin who had initially presented with bilateral painful ankle edema. His chest X-ray showed multiple bilateral pulmonary nodules. A high resolution computed tomography scan of the chest demonstrated multiple pulmonary nodular lesions and also mediastinal and hilar lymphadenopathy. Subsequent biopsies revealed non-necrotizing granuloma with multi-nucleated giant cells indicative of sarcoidosis. An appropriate work-up was done to confirm the true nature of the nodules and facilitate treatment.