Intussusception in a child with COVID-19 in the USA.

COVID-19, caused by the novel coronavirus strain SARS-CoV-2 that emerged in late 2019, has resulted in a global pandemic. COVID-19 was initially believed to occur less frequently in children with relatively mild disease. However, severe disease and varied presentations have been reported in infected children, one of such being intussusception. There have only been three reported cases of intussusception in the pediatric population infected with COVID-19. In this paper, we will discuss the management and treatment of a novel fourth case of COVID-19-associated intussusception. This case is the first reported in the USA and suggests that COVID-19 may be implicated in the development of intussusception. Pediatricians should consider the possibility of intussusception when a child with COVID-19 presents with abdominal pain.

Torsion of the Epididymal Appendage in a Child.

The epididymal appendage, or the appendix epididymis, is a developmental remnant of the mesonephric duct that sprouts from the head of the epididymis. Due to its pedunculated anatomical configuration, the epididymal appendage is prone to torsion and can become a rare cause of an acute scrotum. Given its often challenging and atypical presentation, high clinical suspicion and Doppler ultrasonography are needed to guide diagnosis. We report a challenging case of epididymal appendage torsion that required prompt surgical exploration to accurately diagnose. Awareness of this condition and its radiological findings can play an important role in reaching an accurate diagnosis and avoiding surgical intervention.

Current Available Computer-Aided Detection Catches Cancer but Requires a Human Operator.

INTRODUCTION: This study intends to show that the current widely used computer-aided detection (CAD) may be helpful, but it is not an adequate replacement for the human input required to interpret mammograms accurately. However, this is not to discredit CAD's ability but to further encourage the adoption of artificial intelligence-based algorithms into the toolset of radiologists. METHODS: This study will use Hologic (Marlborough, MA, USA) and General Electric (Boston, MA, USA) CAD read images provided by patients found to be Breast Imaging Reporting and Data System (BI-RADS) 6 from 2019 to 2020. In addition, patient information will be pulled from our institution's emergency medical record to confirm the findings seen in the pathologist report and the radiology read. RESULTS: Data from a total of 24 female breast cancer patients from January 31st 2019 to April 31st 2020, was gathered from our institution's emergency medical record with restrictions in patient numbers due to coronavirus disease 2019 (COVID-19). Within our patient population, CAD imaging was shown to be statistically significant in misidentifying breast cancer, while radiologist interpretation still proves to be the most effective tool. CONCLUSION: Despite a low sample size due to COVID-19, this study found that CAD did have significant difficulty in differentiating benign vs. malignant lesions. CAD should not be ignored, but it is not specific enough. Although CAD often marks cancer, it also marks several areas that are not cancer. CAD is currently best used as an additional tool for the radiologist.

Granulomatosis With Polyangiitis in a Pediatric Male.

Significant eosinophilia is a prominent feature in Churg-Strauss syndrome but has not been described in granulomatosis with polyangiitis (GPA) in a pediatric patient. We present a biopsy case that confirmed granulomatosis with polyangiitis with significant eosinophilia > 30% on the initial presentation. Etiologies that could account for eosinophilia were excluded during workup. The patient's presentation of pulmonary alveolar hemorrhage, conjunctivitis arthritis, high-titer cytoplasmic antineutrophil, PR3-ANCA antibodies, and cytoplasmic antibodies (cANCA) was consistent with a clinical picture of atypical GPA in a pediatric patient. This case presents a rare opportunity not only due to GPA's low incidence in the pediatric population but due to the unusual nature of significant eosinophilia in GPA.

A Case of Male Breast Cancer Patient with CHEK2*1100delC Mutation.

Male breast cancer (MBC) is a rare disease that accounts for less than one percent of all breast cancers. The association between BRCA1 and BRCA2 mutations and MBC has been well-established; recent data suggest that CHEK2 1100delC heterozygosity is also associated with an increased risk of MBC. Herein, we present the case of a 47-year-old male who was initially diagnosed with bilateral symmetric gynecomastia on a diagnostic mammogram performed for right breast palpable lump. Sixteen months after his diagnosis of gynecomastia, he presented with enlarging right breast palpable lumps and underwent a diagnostic mammogram and breast ultrasound. Ultrasound-guided biopsies were performed on the right breast mass and axillary lymphadenopathy. Pathology revealed right breast invasive ductal carcinoma (IDC) and right axillary metastatic lymphadenopathy. Subsequent genetic testing found CHEK2*1100delC mutation. This case report focuses on the presentation, diagnosis, and management of breast cancer, as well as long-term cancer screening in the setting of CHEK2 mutation in a relatively young male patient.