Breast Cancer Screening in the Intermediate-Risk Population: Falling Through the Cracks?

Breast cancer screening guidelines vary for women at intermediate risk (15%-20% lifetime risk) for developing breast cancer across jurisdictions. Currently available risk assessment models have differing strengths and weaknesses, creating difficulty and ambiguity in selecting the most appropriate model to utilize. Clarifying which model to utilize in individual circumstances may help determine the best screening guidelines to use for each individual.

The FIND Program: Improving Follow-up of Incidental Imaging Findings.

Incidental findings are findings identified on imaging which are unrelated to the original reason for examination and require follow-up. The Radiology Finding Incidental Disease (FIND) Program was designed to track and improve follow-up of incidental imaging findings. The purpose of this study was to determine the frequency of incidental findings on cross-sectional imaging and the adherence to suggested follow-up of incidental findings prior to and after implementation of a structured reporting and tracking system. A retrospective analysis of 2000 patients with computed tomographic cross-sectional imaging was performed: 1000 patients prior to implementation of the FIND Program and 1000 patients 1 year after establishment of the program. Data collected included the frequency of incidental findings, inclusion of follow-up recommendations in the radiology report, and adherence to suggested follow-up. There was a higher rate of completion of recommended follow-up imaging in the post-implementation group (34/67, 50.7%) compared to the pre-implementation (16/52, 30.8%) (p = 0.03). Implementation of an incidental findings tracking program resulted in improved follow-up of incidental imaging findings. This has the potential to reduce the burden of clinically significant incidental findings possibly resulting in later presentation of advanced disease.

Correlation Between Breast Arterial Calcifications and Higher Cardiovascular Risk: Awareness and Attitudes Amongst Canadian Radiologists Who Report Mammography.

Background: Breast arterial calcification (BAC) on mammography correlates with increased cardiovascular risk. Reporting BAC is not standard practice. Our study evaluates the awareness of Canadian radiologists who report mammography of the clinical significance of BAC and their attitudes towards reporting BAC compared to their European and American counterparts. Methods: Following local institutional ethics approval, a 25 question survey (SurveyMonkey) was disseminated to Canadian radiologists via provincial and national society email lists. Responses were collected over 5 weeks (April-June 2022). Results: One hundred and eighty-six complete responses were collected. Sixty percent (112/186) were aware of the association between BAC and cardiovascular risk and 16% (29/186) document its presence in mammogram reports. Thirty five percent (65/186) occasionally document BAC if severe or in a young patient. Four percent (7/186) had local departmental guidelines on BAC reporting and 82% (153/186) agreed there is a need for national BAC reporting guidelines. Fewer Canadian radiologists were aware of the association between BAC and cardiovascular risk compared to European radiologists (60% vs 81%), report the presence of BAC compared to both European (15% vs 62%) and American (15% vs 35%) radiologists, and inform the patient of the presence of BAC compared to European radiologists (1% vs 46%). Conclusion: Canadian radiologists who report mammography were less aware of the association between BAC and cardiovascular risk than their European and American counterparts and were less likely to document the presence of BAC. Given the correlation of BAC with increased cardiovascular event risk, there is increased need for awareness as well as national BAC reporting guidelines.

Internal pudendal artery embolization for management of a traumatic labial hematoma.

Non-obstetric perineal injuries often occur as a result of blunt trauma from sport or vehicular accidents. Due to the rich vascular supply of the vulva, this region is susceptible to hematoma formation. Traumatic arterial injury usually involves emergency embolization, typically utilizing coils or microspheres. This case describes an incidence of the utilization of gelfoam for temporary embolization to prevent vulvar and labial necrosis in a patient with an actively expanding hematoma.

Testicular cancer with extensive gonadal and renal vein tumor thrombus.

Tumor thrombus has been demonstrated to occur with hepatocellular and renal cell carcinoma, however, rarely occurs in testicular germ cell malignancies. Tumor thrombus results from the intravascular invasion of malignant cells, different from the hypercoagulable state induced by malignancy, and has significant implications with regards to prognosis and therapeutic options. We describe a case of an otherwise healthy 30-year-old patient with extensive gonadal and renal vein tumor thrombus from testicular germ cell cancer, as well as discuss the diagnosis and treatment options for this type of metastatic disease.

Idiopathic pyometra in a postmenopausal patient.

Pyometra is a rare gynecological condition most commonly seen in elderly, postmenopausal women. Malignancy should always be considered as the primary etiology until proven otherwise in the investigation of an intrauterine infection. Clinical signs and symptoms can be vague or nonexistent, and thorough investigation with ultrasound and cross-sectional imaging may be necessary to understand the extent of the disease and best course of treatment. We describe a case of idiopathic pyometra in a postmenopausal woman, as well as review the pathophysiology, investigation, and management of pyometra.

Superior mesenteric artery syndrome secondary to an abdominal aortic aneurysm.

Superior mesenteric artery (SMA) syndrome in association with abdominal aortic aneurysm (AAA) is exceedingly rare and has been noted to occur in patients with severe abdominal pain, bilious emesis, and a history of tobacco use. When symptoms of small bowel obstruction occur, it is imperative to investigate further with cross-sectional imaging to determine the etiology. Conservative management is preferred, but in cases of SMA syndrome with concomitant AAA, aneurysm repair should be considered, regardless of size, if initial treatment fails.

Spilled stones following pyelolithotomy: An unusual mimic of peritoneal carcinomatosis.

While spillage of intraperitoneal gallstones has been reported frequently in the literature, spilled renal stones after urologic intervention is rare. The dropped renal stones may mimic peritoneal carcinomatosis (PC) on imaging, causing concern and potentially leading to unnecessary diagnostic workup. Additionally, these dropped stones may cause surrounding inflammation, potentially leading to the formation of adhesions or an intra-abdominal abscess. Calcifications along the peritoneal lining are generally interpreted as peritoneal carcinomatosis until proven otherwise. However, this case highlights the importance of a detailed history and comparison with prior imaging. We describe a rare case of intraperitoneal spilled renal stones after pyelolithotomy initially mistaken for PC, in addition to a review of diagnostic pitfalls and radiologic mimics of PC.

Asymptomatic pneumoperitoneum in the setting of pneumatosis intestinalis: a benign entity or surgical emergency?

Pneumatosis intestinalis is a potential cause of asymptomatic pneumoperitoneum without peritonitis. The disease can be managed conservatively and presents a clinical scenario where pneumoperitoneum does not necessitate surgical management. This case illustrates the importance of acknowledging the condition and its variable presentation, allowing for increased awareness and avoidance of invasive procedures when not indicated.

Breast Arterial Calcifications: Reporting Preferences and Impact on Screening for Coronary Artery Disease.

OBJECTIVE: Breast arterial calcifications (BAC) have been shown to correlate with measures of coronary artery disease risk stratification, although reporting of BAC is optional by BI-RADS guidelines. The purpose of this study is to determine referring provider preferences in BAC reporting on mammography reports and if such reporting has any impact on patient management. METHODS: This study was approved by the local institutional review board. A voluntary eight-question survey regarding the preferences and outcomes of BAC reporting on mammography was distributed to 1085 primary care physicians, obstetrics and gynecologists, medical oncologists, and breast and general surgeons in our health system via a secure online platform. Data analysis including Pearson chi-square was performed with a P-value of <0.05 for significance. RESULTS: A response rate of 19.1% (207/1085) was attained, with 21/207 (10.1%) of respondents indicating they do not routinely order mammograms excluded from further analysis. A total of 62.4% (116/186) of ordering physicians indicated a preference for reporting of BAC in both the body and impression of the radiology report, with 82.3% (153/186) of respondents placing importance on the quantity of atherosclerotic calcifications. Most participants (148/186, 79.6%) reported that the presence of BAC would prompt further investigation for coronary artery disease and associated risk factors. CONCLUSION: The majority of responding physicians indicated a preference for detailed reporting of BAC and that such reporting would impact patient care. Understanding referring provider preferences regarding ancillary findings of BAC will allow for improved communication and value in mammography.

Atypical Mixed Variant of Pericallosal Lipoma With Splenial Dysgenesis.

Pericallosal lipomas are rare benign intracranial masses that arise during embryonic development, typically categorized into tubulonodular and curvilinear subtypes. A mixed variant of both tubulonodular and curvilinear subtypes is very rare. Patients with pericallosal lipomas may be asymptomatic or may have different presentations, such as headaches. Conservative medical management is the mainstay of therapy for those without epileptic seizures or associated vascular malformations. We present a case of a mixed variant pericallosal lipoma in a patient with chronic headaches that were diagnosed using head computed tomography (CT) and brain magnetic resonance imaging (MRI).