Ultrasonographic features and clinical implications of benign palpable breast lesions in young women.

PURPOSE: The purpose of this study was to describe the breast ultrasonography (US) features and to investigate whether performing a core biopsy is warranted in young women having palpable solid breast masses. METHODS: A total of 76 solid palpable masses in 68 consecutive women (≤25 years old) underwent tissue diagnosis by percutaneous core biopsy. Two radiologists, who were blinded to the clinical history and histopathology, independently evaluated the US features according to Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The frequency of benign and malignant descriptor terms that were used to characterize the lesions were compared to the final pathology. RESULTS: All 76 palpable solid masses yielded benign pathology. On the US, the shape of the mass was described by radiologists 1 and 2 as oval or round (63.2% and 71.1%), margin as circumscribed (68.4% and 77.6%) and orientation as parallel (85.5% and 90.8%); the frequency of using all three benign descriptors was 61.8% and 68.5%, respectively. Suspicious descriptors were used less frequently by radiologists 1 and 2 including irregular shape (9.2% and 13.1%), non-circumscribed margin (31.6% and 22.4%) and non-parallel orientation (14.5% and 9.2%); the frequency of using all three suspicious descriptors was 9.2% and 11.8%, respectively. CONCLUSION: Despite the variable US features, breast malignancy seems extremely low in 25 years or younger women for palpable breast lesions. Using the BI-RADS lexicon, US accurately predicted benignity in about two thirds of our patients, supporting US surveillance as a safe alternative to invasive tissue sampling in this setting.

Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging.

Postpartum and posttermination complications are common causes of morbidity and mortality in women of reproductive age. These complications can be broadly categorized into vascular, infectious, surgical, and neoplastic etiologies, or are due to ectopic implantation of placental or endometrial tissue. Causes of postpartum vascular complications include retained products of conception, arteriovenous malformation, and pseudoaneurysm. Infectious entities include endometritis, abscess, wound cellulitis, and pelvic septic thrombophlebitis. Postsurgical complications include uterine scar dehiscence, bladder flap hematoma, and subfascial hematoma. Neoplastic complications include the spectrum of gestational trophoblastic neoplasms. Ectopic tissue implantation complications include abnormal placentation and uterine scar endometriosis. Imaging is essential for diagnosis, and radiologists must be familiar with and aware of these entities so that accurate treatment and management can be obtained. In this review, we illustrate the imaging findings of common postpartum and posttermination complications on ultrasound, computed tomography, and magnetic resonance imaging.

Prevalence and timing of bend relief disconnection in patients supported by the late version HeartMate II left ventricular assist device.

BACKGROUND: On April 4, 2012, the U.S. Food and Drug Administration issued a Class 1R recall of the HeartMate II (Thoratec Corporation, Pleasanton, CA) left ventricular assist device (LVAD) due to spontaneous detachment of the bend relief from its intended position in patients implanted with the most recent version of the HM II. This study examined the incidence and timing of outflow graft bend relief disconnection in patients implanted with the HM II LVAD. METHODS: All patients supported with the modified version of the HM II LVAD were asked to report for dedicated abdominal X-ray imaging to assess the position of the bend relief. Also performed was a retrospective review of X-ray images of all patients who had previously been supported with this version but had since received a transplant, undergone LVAD explant, or died. RESULTS: Between March 9, 2011, and April 9, 2012, 59 patients underwent primary implant with the modified version HM II. Follow up X-ray images were available for 56 patients (95%). The bend relief was found fully disconnected in 6 of 56 (11%) and partially disconnected in 13 (23%). Two of 6 patients (33%) with full bend relief disconnection and 1 of 13 of the initially partially disconnected patients (7.7%) required urgent surgical intervention due to symptoms of hemolysis and/or heart failure. CONCLUSIONS: Bend relief disconnection is common and may be observed immediately after implant but may also develop over time. Full bend relief disconnect may present with hemolysis and/or heart failure symptoms and often requires surgical revision. Surveillance abdominal X-ray imaging should be performed routinely on all patients who were implanted with the modified version HM II.

Ease of conversion from venovenous extracorporeal membrane oxygenation to cardiopulmonary bypass and venoarterial extracorporeal membrane oxygenation with a bicaval dual lumen catheter.

Extracorporeal circulatory support revolutionized the field of cardiothoracic surgery, initially in the form of cardiopulmonary bypass (CPB) and then in its modified form, extracorporeal membrane oxygenation (ECMO). Although initial cannulation techniques involved open intrathoracic approaches, the increased prevalence of reoperative sternotomies and the emergence of minimally invasive surgery encouraged the development of peripheral cannulation methods and configurations. The Avalon Elite Bicaval Dual Lumen catheter (Avalon Laboratories, LLC, CA) can be placed in the right internal jugular vein to provide venovenous (VV) ECMO. However, some patients on VV ECMO then develop compromised cardiac performance. We describe two ways in which the Avalon Elite was used, first for complete venous drainage through a single peripheral site for CPB and in the other to convert a patient on VV ECMO to axillary artery venoarterial (VA) ECMO.

The impact of obesity on the outcome of emergency intubation in trauma patients.

OBJECTIVE: Emergency intubation of trauma patients is a complex intervention, which can be safely and successfully performed in most trauma centers. This, however, has never been validated in the obese trauma population. Obese patients have anatomic and physiologic characteristics that make their intubation more challenging. We therefore hypothesize that obese trauma patients requiring emergency intubation are at increased risk for unsuccessful intubation and airway-related complications. METHODS: Retrospective review of prospectively collected data from an airway surveillance database at an urban Level I trauma center between 2001 and 2004 was analyzed. The study population included all adult patients admitted to the trauma center, who required urgent airway management. The patients were stratified into four groups according to their body mass index (BMI): lean (BMI < 25), overweight (25 < or = BMI < 30), obese (30 < or = BMI < or = 40), and morbid obesity (BMI > 40). Demographic parameters and outcome measures including field intubation success, airway complications, early respiratory complications, and mortality were collected. Logistic regression was performed to determine predictors of these outcome measures. RESULTS: Of the 9,980 patients evaluated during the three-year study period, 1,435 (14%) were emergently intubated and made up the study population. About 92% of ED intubations were performed by the anesthesia team. Of all emergently intubated patients, 46% were lean, 37% were overweight, 15% were obese, and 2% were morbidly obese. There were no significant differences in demographic parameters between the lean, overweight, and obese groups. The morbidly obese patients were however older, composed of more female patients and more likely to have suffered a blunt injury. Logistic regression analysis revealed that BMI was not an independent risk factor for failed intubations in the field or in the ED, postintubation airway complications, or death. Only early respiratory complications demonstrated a statistically significant (p = 0.02), but unlikely clinically relevant (OR = 1.04; 95% CI, 0.99-1.07) association with a higher BMI. CONCLUSION: Emergency intubation of obese trauma patients can be safely and successfully performed in a high volume Level I trauma center. Obesity is not a predictor of postintubation airway complications or mortality. Larger studies are needed to validate these finding in the morbidly obese patients.