Cotton-ball granuloma mimicking axillary lymphadenopathy in a breast cancer patient.

Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.

Moving into the digital era: a novel experience with the first full-field digital mammography system in Malaysia.

INTRODUCTION: Breast cancer is the commonest cancer in women and represents a significant problem from the clinical and public health perspectives. The aim of this paper is to report our experience of transitioning from screen-film mammography (SFM) to computed radiography mammography (CRM), and finally to full-field digital mammography (FFDM), and to evaluate the performance of these three different types of mammographic systems. METHODS: A total of 2,734 mammograms using the three different systems were carried out at the University of Malaya Medical Centre. These examinations were evaluated based on time from start of examination to reporting, image quality, archiving, reject and repeat rates and overall diagnostic accuracy for SFM, CRM and FFDM. RESULTS: The time taken from the start of the examination to the radiologist interpretation and reporting were faster in both FFDM and CRM, compared to SFM. Image contrast with better contrast detail was almost equivocal for both CRM and FFDM, but lower for SFM. Easier image storage and archiving were available for CRM and FFDM in the form of magnetic optical discs, rather than hard copy storage as in SFM. The reject rate for FFDM was zero percent, compared to CRM and SFM which were two percent and two percent, respectively. The repeat rate for FFDM, CRM and SSFM was zero percent, 0.1 percent and 1.5 percent, respectively. Overall diagnostic accuracy of FFDM, CRM and SFM were comparable as no cancers were missed on all three systems as double blinded reporting was done. CONCLUSION: FFDM does improve quality of mammography service by providing better workflow time and archiving system, with good diagnostic accuracy.

Spiral CT angiography in an infant with a hypoplastic aortic arch.

The advent of multislice computed tomography (CT) has revolutionised the performance of body CT and allowed the development of CT angiography (CTA). CTA is a robust and minimally invasive method of visualizing the arterial vascular system. The newer generation of multidetector scans has allowed for shorter scanning times with no respiratory misregistration at peak vascular opacification following peripheral contrast injection. The volume of data obtained from these scans can be further manipulated to generate two-dimensional (2D) and three-dimensional (3D) images with no increase in radiation to the patient. Hence, CTA has gained popularity and importance as the alternative diagnostic tool especially for ill patients in which conventional angiography is inadvisable.We present an infant with coarctation of the aorta and hypoplastic aortic arch, in which CT angiography was used to pinpoint the diagnosis. The CT findings were subsequently confirmed at surgery.

Improved fracture detection using the mammographic film-screen combination.

AIM: The single emulsion or single screen system is usually reserved for mammography since its use in general radiography is limited. The purpose of this study is to compare the mammographic film-screen combination (MFC) and the standard film-screen combination (SFC) in terms of fracture and soft tissue injuries detection. PATIENTS, METHODS AND MATERIALS: In this prospective study, 41 patients from Accident and Emergency suspected of having injury in the hands, wrists, ankles and feet regions were radiographed using both MFC and SFC. These were compared in terms of image quality, presence of fractures and soft tissue injuries. The two different film-screen combinations were also compared in terms of detection of bony fragments, film characteristics such as film speed, contrast and spatial resolution, dose and cost. RESULTS: The MFC gives statistically better image quality compared to SFC. In 10% of patients, fractures were detected only in the MFC, which also detects tiny bone fragments that may not be resolved by the SFC. The spatial resolution of the MFC is greater than the SFC. The film speed and contrast of the MFC are lower than that of the SFC. The doses of MFC were higher compared to SFC. CONCLUSIONS: The MFC detects fractures better compared with SFC. However, the entrance skin dose for the mammographic film-screen combination was about 35% to 55% higher than the standard film-screen combination.

Non-Hodgkin's lymphoma with left suprascapular neuropathy on magnetic resonance imaging.

Magnetic resonance imaging is gaining importance in the diagnosis of nerve and muscular disorders. The ability of magnetic resonance imaging to delineate the different muscles and the nerve in any plane has made the differentiation between the changes of neuropathy, denervation, and nerve entrapment possible. Although findings on magnetic resonance imaging are non-specific, their use, coupled with clinical symptoms and electromyographic findings, allow an accurate diagnosis to be made without resorting to invasive biopsies.