Multiple Intramyocardial Masses in an Otherwise Healthy 35-Year-Old Woman.

Sarcoidosis with manifest cardiac involvement typically presents with heart failure, conduction abnormalities, or ventricular arrhythmias. Here, we present a case of a young woman whose presentation raised suspicion for metastatic cardiac disease of unknown primary origin. Further investigation revealed cardiac sarcoidosis with multiple intramyocardial granulomatous masses in the absence of significant enlargement of hilar or mediastinal nodes. This case highlights the following: (i) sarcoidosis can mimic metastatic cardiac tumours; and (ii) hilar and mediastinal lymph nodes can be metabolically active in cardiac sarcoidosis in the absence of significant enlargement.

La sarcoïdose avec atteinte cardiaque patente se manifeste typiquement par une insuffisance cardiaque, des troubles de la conduction ou des arythmies ventriculaires. Nous présentons ici le cas d'une jeune femme dont le tableau clinique évoquait une pathologie cardiaque métastatique d'origine primitive inconnue. Des examens supplémentaires ont révélé une sarcoïdose cardiaque associée à de multiples granulomes intramyocardiques, en l'absence d'hypertrophie importante des ganglions hilaires ou médiastinaux. Ce cas illustre les points suivants : (i) les symptômes de la sarcoïdose peuvent imiter ceux de tumeurs cardiaques métastatiques; et (ii) les ganglions lymphatiques hilaires et médiastinaux associés à une sarcoïdose cardiaque peuvent présenter une activité métabolique en l'absence d'hypertrophie importante.

Colorectal Cancer Outcomes in a Large Negative Computed Tomography Colonography Screening Cohort.

INTRODUCTION: At our institution, the most common cohort of individuals having computed tomography colonography (CTC) are those that require primary screening for colorectal cancer and were unable to tolerate or failed optical colonoscopy (OC). CTC is an efficient method for detecting polyps, masses, flat-lesions, and overt colorectal cancer, serving as a viable alternative to colonoscopy. This study follows patients with negative CTC results to evaluate the number of clinically significant lesions that may have been potentially missed by CTC. We suspect this number will be exceedingly low given the high sensitivity of this technique. METHODS: All patients with negative CTC screening (n = 509) in the Eastern Health Medical Health Region, located in Newfoundland and Labrador, Canada were included. An electronic medical record review was undertaken, encompassing provider, colonoscopy, imaging, and histopathology reports. Subjects were also checked through the Newfoundland Cancer Clinic Registry Database. All incidents of colorectal cancer were recorded. RESULTS: The study cohort comprised 509 subjects. These subjects were followed for an average of 7.88 years. Two colorectal adenocarcinomas in this cohort were identified representing a crude cancer incidence rate of 0.49 cancers per 1000 patient years, and a rate of 0.39% following a normal CTC. CONCLUSIONS: Colorectal cancer presenting clinically is rare in the 7.88 years following a negative CTC, suggesting CTC is equally effective for colorectal screening compared to OC. Furthermore, current guidelines that recommend interval CTC screening every 5 years is conservative, and interval screening can likely be recommended over a longer time frame.

The Accuracy of Single Photon Emission Computed Tomography/Computed Tomography Arthrography in Evaluating Aseptic Loosening of Hip and Knee Prostheses.

Aseptic loosening represents the most common complication associated with hip and knee arthroplasty and is a common indication for surgical revision in the post-arthroplasty population. The optimal imaging methodology in evaluating clinical suspected loosening is not well-defined. Our study retrospectively evaluated nuclear medicine arthrography with hybrid single photon emission computed tomography/computed tomography (SPECT/CT) in 38 patients (21 hip, 17 knee) compared with reference standards of surgical evaluation, spontaneous resolution of symptoms without revision, or a minimum of 1 year clinical and radiographic follow-up. Our study demonstrated a sensitivity of 100%, specificity of 96.0%, PPV of 92.9%, NPV of 100%, and accuracy of 97.4% with this imaging technique suggesting utility of nuclear medicine arthrography with SPECT/CT in the clinical evaluation of suspected aseptic loosening.