Actinomycosis of the breast and lungs.

Actinomycosis is a chronic, progressive, and often relapsing granulomatous infection that characteristically crosses tissue planes and forms abscesses and sinus tracts. We report a unique case of a woman with actinomycosis presenting with a breast abscess, a sinus tract spontaneously exiting the sternum, and miliary lung lesions.

Cardiac Metastases from Malignant Melanoma: The "Charcoal Heart".

The column in this issue is supplied by Herbert L. Fred, M.D., M.A.C.P., and Hendrik A. van Dijk, both from McGovern Medical School-UT Health, Houston, Texas. Dr. Fred is emeritus professor of medicine and a well-known medical educator and diagnostician. A graduate of Johns Hopkins University School of Medicine, he has authored just under 500 publications including six books. Mr. van Dijk, former director of the University of Texas Health Science Center Medical School's Graphic Communications Group, has devoted 50 years to biomedical communications and is a national expert in that field.

Unsuspected pulmonary thromboemboli: a continuing clinical challenge.

The multidetector computed tomographic scanner has greatly improved our ability to quickly, safely, and adequately visualize the pulmonary arteries down to and including the subsegmental branches. But this sophisticated machine has also created new problems for clinicians who must care for patients who have what we now variously call incidental, asymptomatic, or unsuspected pulmonary thromboemboli­emboli that are clinically silent and detected unexpectedly. At this stage of our knowledge, we can say with certainty that these thromboemboli are common in all parts of the pulmonary arterial tree, are most often found in patients with cancer, carry a poor prognosis for patients with cancer, and are frequently missed during the initial CT reading. Their natural history and optimal management await definitive studies.