Imaging of carbon granulomas of the breast following carbon track localization.

Three cases of carbon granuloma are described following the instillation of carbon solution at the time of stereotactic fine needle aspiration for pre-operative localization of impalpable mammographic abnormalities. If the carbon track is not excised following carbon instillation the retained carbon may result in a granuloma. This may present as a new mass on subsequent clinical or mammographic follow-up.

Breast MRI: early experience with a 3-D fat-suppressed gradient echo sequence in the evaluation of breast lesions.

The early clinical experience with a 3-Dimensional Fourier Transform Gradient Echo sequence with fat suppression in the evaluation of breast masses is reported. Ten female patients with breast malignancies were pre-operatively evaluated with this sequence and the results compared with the pathological specimens. The scanning protocol included a non-contrast sequence followed by an immediate post-contrast sequence (completed 4.5 min after intravenous contrast injection) and a delayed sequence. Images were assessed for maximum lesion and parenchymal enhancement, lesion size and additional enhancing abnormalities. In six patients, malignant masses enhanced maximally on the immediate post-contrast sequence with parenchyma enhancing maximally on delayed images. In three cases, there was preferential enhancement of malignant lesions over normal parenchyma but to a similar degree on both post-contrast sequences. In one case, both the lesion and parenchyma enhanced maximally on the delayed sequence. Magnetic resonance assessed lesion size accurately and also detected satellite malignancies in one case. However, lesion grade, associated in situ carcinoma and lymphovascular invasion did not impact on lesion enhancement. In this small series, a contrast-enhanced, fat-suppressed 3-D Gradient Echo Sequence detected breast carcinoma with high sensitivity. The technique holds promise but further evaluation is required.

Ultrasonography of breast hamartomas.

The authors present the breast ultrasound findings of nine women with mammographic abnormalities typical of breast hamartomas. Two of the mammographically detected hamartomas could not be identified at breast ultrasound. Six hamartomas were well-circumscribed masses of heterogeneous echogenicity with no posterior acoustic shadowing. One lesion was a well-defined hypo-echoic mass with no posterior shadowing. We conclude that many mammographically and clinically detected hamartomas can be clearly identified at breast ultrasound. The breast sonographer should be aware of the spectrum of appearances that may occur. When a breast abnormality has the characteristic mammographic appearances of a hamartoma, it may be counterproductive to perform an additional breast ultrasound.

Bizarre parosteal osteochondromatous proliferation of the hands and feet.

Two adults with bizarre parosteal osteochondromatous proliferation of the hands and feet are presented. The preoperative diagnosis may be difficult to make and the correct diagnosis was not made in either case until pathological examination of recurrent tumour masses occurred. The radiological and pathological features of this lesion are discussed. The diagnostic features which differentiate this condition from other causes of new bone formation in the peripheries are described.

Mammographic appearances of mammary duct ectasia that mimic carcinoma in a screening programme.

The aim of this study is to demonstrate the spectrum of mammographic appearances of mammary duct ectasia that mimic carcinoma in a breast cancer screening programme. Between February 1989 and March 1993, 40,003 women underwent screening mammography as part of the Western Australia Women's Cancer Prevention Unit screening programme. Fine needle aspiration or excisional biopsy was performed on 1437 women, and 12 cases of cytologically or histologically confirmed mammary duct ectasia were detected. A total of 14 mammographic abnormalities from 12 asymptomatic female patients were biopsied, and confirmed to represent mammary duct ectasia. The mammographic spectrum included eight areas of microcalcification (two of which were extensive), three spiculated masses and three lobulated, partially smooth masses. Five of these women showed no other mammographic stigmata of mammary duct ectasia in either breast. Additional features of mammary duct ectasia, including nipple retraction, retro-areolar duct dilatation or macrocalcification were identified in seven women. Mammographic features of mammary duct ectasia are frequently detected in asymptomatic women undergoing screening mammography and cause no diagnostic dilemma. Occasionally mammary duct ectasia will have a mammographic appearance that is indistinguishable from carcinoma, necessitating breast biopsy. In this study 40% of those women with mammary duct ectasia that were submitted for biopsy had no other feature of mammary duct ectasia that could have suggested the pre-operative diagnosis.

Mammographic features of adenoid cystic carcinoma.

Adenoid cystic carcinoma of the breast accounts for < 1% of breast malignancies. This case report describes the mammographic features and the pathology. Adenoid cystic carcinoma is a well-circumscribed carcinoma that has a relatively good prognosis.

Iodide mumps following intravenous urography with iopamidol.

We report a case of bilateral submandibular and parotid sialadenitis subsequent to the injection of 100 ml of iopamidol (Niopam 370, Bracco) for an intravenous urogram. Iodide 'mumps' has previously been reported as a rare sequela of ionic contrast media injection. It is a mild and short lived condition, usually requiring no treatment.

Cranio-vertebral bony changes in a case of congenital lipomatosis.

Congenital lipomatosis may cause a fatty mass infiltrating muscle planes and extending into the epidural space. Adjacent structures are displaced: there is pressure erosion of the vertebrae and periosteal new bone formation.

Degenerative joint abnormalities in patients with paraplegia of duration greater than 20 years.

Radiographs and medical and surgical records of 51 patients following spinal injury have been reviewed. All the patients had been paraplegic for 20 years or more at the time of the survey. The reason for the survey was to assess the incidence of degenerative change of the hips, sacroiliac and shoulder joints in patients following spinal injury. Our review indicates that the number of paraplegic patients who develop degeneration of hip and sacroiliac joint changes is less significant than has been previously reported. Analysis of our figures has revealed certain important associations which predispose these patients to joint degeneration. The associations (anatomical level of injury, urinary tract infections, and the level of the patients' activity) with joint degeneration are described.

Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization.

To determine whether intraoperative urinary output was predictive of postoperative renal function, mean urinary output and lowest hourly urinary output were measured in 137 patients during operation for aortic reconstruction. Pulmonary capillary wedge pressure was kept within normal limits. If urinary output was less than 0.125 ml X kg-1 X hr-1, patients were given crystalloid solution, mannitol, furosemide (Lasix), or nothing. For each patient, serum creatinine and blood urea nitrogen (BUN) levels were assayed on postoperative days 1, 3, and 7. There was no significant correlation between intraoperative mean urinary output or lowest hourly urinary output and change from preoperative to postoperative levels of creatinine or BUN. Twenty-one patients had postoperative renal insufficiency; of these, 17 had had renal disease before operation. In these patients as well; mean urinary output and the lowest hourly urinary output did not correlate with change in BUN or creatinine levels. The position of the aortic cross-clamp did not affect these correlations. Therefore, intraoperative urinary output was not predictive of postoperative renal insufficiency in patients undergoing aortic reconstruction.

Relation of carotid stump pressure to safety of carotid artery ligation.

Twenty-four patients underwent ligation of the internal carotid artery for a variety of clinical indications. These included cerebral embolization from surgically inaccessible carotid lesions, carotid disruption and resultant hemorrhage, unreconstructible carotid endarterectomies, and inoperable intracranial carotid aneurysms. The relation of preoperative stump pressures to safety of ligation was evaluated. the data reflect that a systolic stump pressure in excess of 70 mm Hg (13 patients) indicates adequacy of collateral hemispheric blood flow to allow safe ligation of the carotid artery. Pressures of 55 mm Hg or less constitute an unacceptable vulnerability to stroke (two of three patients), and intermediate pressures of 55 to 68 mm Hg constitute a genuine hazard (four of eight patients). The mechanisms of stroke appear to be thromboembolic with late propagation of thrombus into an intracranial low-flow system. Postligation maintenance of appropriate systemic blood pressure is essential, and systemic heparinization is recommended to reduce the morbidity and mortality in patients in the intermediate pressure zone (55 to 68 mm Hg). It is concluded that whenever carotid ligation becomes a therapeutic consideration, the preoperative or preligation measurement of carotid stump pressure is presently the most reliable determinant of safety of the operation.

Carotid plaque hemorrhage. Its role in production of cerebral ischemia.

A prospective study of carotid endarterectomy specimens showed an acute or recent intraplaque hemorrhage in 49 of 53 plaques (92.5%) from symptomatic patients, compared with seven of 26 plaques (27%) from nonsymptomatic patients. Luminal stenosis of greater than 50% was noted in 46 of 53 symptomatic patients (75%), 43 of whose plaques had evidence of multiple hemorrhages. Intimal disruption (ulceration) occurred over protruding mounds of intraplaque hemorrhage and was associated with retinal cholesterol emboli and prolonged neurologic deficits. Mural recesses with the angiographic appearance of ulceration seldom showed intimal breakdown. Eighteen patients continued to have symptoms while receiving aspirin, 13 of whom had had multiple intraplaque hemorrhages. Angioneogenesis occurred within the plaques in response to hemorrhage, creating vascular lesions vulnerable to mechanical stress and capable of producing further hemorrhage or intimal disruption.