Unilateral adrenal infarction in pregnancy.

A 25-year-old pregnant woman at 28 weeks gestational age presented with increasing abdominal pain and was found to have a unilateral adrenal infarction on a CT scan of the abdomen. Her medical history was unremarkable. There was no evidence of adrenal insufficiency with normal cortisol and adenocorticotropic hormone levels for pregnancy. Evaluation of thrombophilia disorders established the patient to be heterozygous for methylenetetrahydrofolatereductase C677T gene mutation as the only finding. The patient was anticoagulated to prevent contralateral thrombosis. At 32 weeks she experienced spontaneous rupture of membranes. One week later she delivered vaginally and remained anticoagulated for the puerperium.

Impact of PET staging in limited-stage small-cell lung cancer.

INTRODUCTION: Although positron emission tomography computed tomography (PET-CT) has been widely used for small-cell lung cancer (SCLC) staging, no study has examined the clinical impact of PET staging in limited-stage (LS) SCLC. METHODS: We identified patients with LS-SCLC treated definitively with concurrent chemoradiation. Outcomes were assessed using the Kaplan-Meier approach, Cox regression, and competing risks method. RESULTS: We treated 54 consecutive LS-SCLC patients with concurrent chemoradiation from January 2002 to August 2010. Forty underwent PET, 14 did not, and all underwent thoracoabdominopelvic CT and magnetic resonance imaging neuroimaging. Most patient characteristics were balanced between the comparison groups, including age, race, sex, bone scanning, median dosage, and performance status. More number of PET-staged patients presented with nodal metastases (p = 0.05). Median follow-up was similar for PET-staged and non-PET-staged patients (p = 0.59). Median overall survival from diagnosis in PET-staged patients was 32 versus 17 months in patients staged without PET (p = 0.03), and 3-year survival was 47% versus 19%. Median time-to-distant failure was 29 versus 12 months (p = 0.04); median time-to-local failure was not reached versus 16 months (p = 0.04). On multivariable analysis, PET staging (odds ratio [OR] = 0.24; p = 0.04), performance status (OR = 1.89; p = 0.05), and N-stage (OR = 4.94; p < 0.01) were associated with survival. CONCLUSION: LS-SCLC patients staged with PET exhibited improved disease control and survival when compared with non-PET-staged LS-SCLC patients. Improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in these patients.

Polycystic ovarian syndrome: role of imaging in diagnosis.

Polycystic ovarian syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age and carries with it significant health risks, including infertility, endometrial hyperplasia, diabetes, and cardiovascular disease. The workup of PCOS has evolved to include the use of pelvic ultrasonography (US). Ovarian imaging is crucial in the evaluation of patients with suspected PCOS. Although findings of polycystic ovaries are commonly seen at routine US and are frequently not associated with PCOS, awareness of the criteria and definitions used in the diagnosis of PCOS is important, especially in patients who are being evaluated for ovulatory dysfunction or hyperandrogenism. The imaging report should be specific and should include ovarian volumes and antral follicle counts, in addition to other pertinent findings (eg, the presence of a dominant follicle or corpus luteum). Because patients are frequently referred for radiologic imaging as a part of clinical workup, and polycystic ovaries are a common incidental finding in women undergoing US for other gynecologic complaints, radiologists should be aware of the current diagnostic criteria for PCOS, the role of imaging in workup for this abnormality, and the pertinent reporting parameters for pelvic US.