Urinoma: A Rare but Potential Differential of Acute Abdomen.

Urinoma is an encapsulated collection of extravasated urine in the retroperitoneal space. This rare and potentially dangerous event can occur spontaneously or iatrogenically varying from asymptomatic cases to acute abdomen. The initial diagnostic modality is ultrasound. Suspicious ultrasound findings are confirmed by CT or MRI. Treatment depends on the inciting factor and varies from conservative management to interventional drainage procedures. We report the case of a male patient with known urothelial carcinoma of the urinary bladder who presented acutely with a complaint of progressive painful swelling in the right lumbar region. Imaging revealed a breach in the right ureter leading to urinary extravasation and the formation of progressively enlarging urinoma extending to the contralateral lumbar region. Based on radiological diagnosis, the patient was urgently referred to a urologist. Spontaneous renal rupture should be one of the differentials of a patient presenting with acute abdomen as it can lead to a rare and potentially threatening condition of urinoma.

Cutaneous metastasis in hypopharyngeal carcinoma: a case report.

Background: Occurrence of cutaneous metastasis in hypopharyngeal carcinoma is an extremely rare event reported in the literature, with an incidence of only 0.8%-1.3%. Early diagnosis of cutaneous metastasis would have a positive impact on treatment response and disease prognosis with diagnosis mainly dependent on physical examination and radiological imaging (ultrasonography, computed tomography scan or PET-CT). Palliative care is, however, the mainstay of treatment for cutaneous metastasis. Case presentation: We report a middle-aged female patient, with known case of hypopharyngeal squamous cell carcinoma, who initially showed partial response to chemoradiotherapy but developed cutaneous nodules in the region of the right axilla and bilateral lateral chest wall posterior to the posterior axillary fold. Excision biopsy of one of these nodules showed metastatic squamous cell carcinoma. The patient was again referred to the Oncology Department of INMOL Hospital and her chemotherapy was planned for cutaneous metastasis. Conclusion: Being uncommon, the occurrence of cutaneous lesions in a patient with hypopharyngeal carcinoma should prompt detailed evaluation to rule out metastasis. Early detection will help in improving disease prognosis and median survival.

Peri-Renal Lymphangiomatosis: A Case Report Presenting a Rare Disease at a Rarer Location.

Renal lymphangiomatosis is a rare pathology wherein dilatation of perirenal, parapelvic, and intrarenal lymphatics is observed and can occur in both children and adults. It has no gender predilection and can present in unilateral and bilateral forms. Clinical symptomatology ranges from incidental findings to flank pain, hematuria, and abdominal swelling. Radiological appearances may mimic renal cysts, peripelvic cysts, perinephric abscesses, or collections. This emphasizes the importance of developing familiarity with the imaging characteristics of this rare entity. We present the case of an 11-year-old boy whose chief complaint was abdominal distension and bilateral flank pain. The radiological assessment revealed bilateral perinephric collections, which, along with clinical correlation, led to the diagnosis of bilateral peri-renal lymphangiomatosis.

Diagnostic value of strain elastography and shear wave elastography in differentiating benign and malignant breast lesions.

BACKGROUND: Conventional B-mode breast ultrasonography, though the primary modality to determine benign or malignant nature of a solid breast lesion, sometimes encounters overlapping sonographic morphological features in a single lesion. Elastography leads to improvement by evaluating the structural aspects and characterization of the lesion as benign or malignant on the basis of multi-parametric assessment. OBJECTIVE: Determine the role of strain elastography (SE) and shear wave elastography (SWE) in differentiating benign and malignant breast lesions. DESIGN: Cross sectional SETTING: Radiology department of hospital PATIENTS AND METHODS: Patients meeting inclusion criteria referred to our hospital for ultrasonography followed by biopsy or surgical excisions were examined with B-mode ultrasonography and by both strain and shear wave elastography. MAIN OUTCOME MEASURES: Mean values of SE and SWE in benign and malignant breast lesions, determination of cutoff using AUC curves and sensitivity and specificity of both techniques. SAMPLE SIZE: One hundred breast lesions from 95 consecutive patients. RESULTS: The mean (SD) strain elastography ratio in the overall patient population was 4.1 (2.0). Cutoff for benign vs. malignant lesions was 2.86 on the ROC curve. The AUC was 0.911 (95%CI; 0.835-0.988: SE, 0.039) with a sensitivity of 95.8% and a specificity of 89.3%. For the SWE kPa values, the ROC curve showed the AUC was 0.929 (95% CI, 0.870-0.988; SE: 0.030, P<.001). Assigning 45.3 as a cut off value provided a sensitivity of 95.8% with a specificity of 85.7%; the positive predictive value was 94.5% and the negative predictive value was 89.6%. The Breast Imaging Reporting and Data System (BI-RADS) category alone was able to differentiate between benign and malignant lesions with a sensitivity of 91.7% and a specificity 100% keeping the cut off value between 4a and 4b. The area under the ROC curve was 0.979. Combining the three (BI-RADS + SE + SWE) distinguished benign vs. malignant lesions with a sensitivity up to 100% and specificity up to 96.3%. CONCLUSION: Combining SE and SWE as a complementary tool with conventional B-mode ultrasonography has a significant potential for better characterization of solid breast lesions and decreasing unnecessary biopsies of BI-RADS IVa lesions. LIMITATIONS: Single institution study. CONFLICT OF INTEREST: None.