Contemporary Multimodality Imaging of Primary Hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is a disorder characterized by hypercalcemia and an elevated or inappropriately normal parathyroid hormone level. Classic features include bone pain, fractures, renal impairment, nephrolithiasis, and mental disturbance. However, most cases of PHPT are now asymptomatic at diagnosis or associated with nonspecific neurocognitive changes. The most frequent cause of PHPT is a solitary adenoma that secretes parathyroid hormone without the normal suppressive effect of serum calcium. A smaller number of cases can be attributed to multigland disease. Parathyroidectomy is curative and is considered for nearly all affected patients. Although PHPT is primarily a clinical and biochemical diagnosis, imaging is key to the localization of adenomas, which can lie in conventional locations adjacent to the thyroid gland or less commonly at ectopic sites in the neck and mediastinum. In addition, accurate localization facilitates the use of a minimally invasive or targeted surgical approach. Frequently used localization techniques include US, parathyroid scintigraphy, and four-dimensional CT. Second- and third-line modalities such as MRI, PET/CT, and selective venous sampling with or without parathyroid arteriography can increase confidence before surgery. These localization techniques, along with the associated technical aspects, relative advantages, and drawbacks, are described. Local expertise, patient factors, and surgeon preference are important considerations when determining the type and sequence of investigation. A multimodality approach is ultimately desirable, particularly in challenging scenarios such as multigland disease, localization of ectopic adenomas, and persistent or recurrent PHPT. Online supplemental material is available for this article. ©RSNA, 2022.

Subhepatic caecal tumour in an adult with intestinal malrotation.

Intestinal malrotation is an abnormality that usually presents in infanthood. Following correction, complications are rare in adults. We describe a case of a 64-year-old woman with a history of malrotation who presented with anaemia and weight loss. Colonic cancer was apparently excluded by colonoscopy. In fact, endoscopy had only been performed up to the hepatic flexure, which was unexpectedly positioned in the right iliac fossa. The patient then underwent a CT pneumocolon study, which demonstrated a caecal tumour, unusually located subhepatically. Repeat colonoscopy was performed to the true caecum and the lesion was biopsied. The patient underwent uncomplicated open right hemicolectomy and made a full recovery. To avoid diagnostic delay and, at worst, missing pathology entirely, clinicians must always thoroughly review a patient's history. Adults with malrotation may have atypical presentations of abdominal disease and so it is pertinent that surgeons, endoscopists and general practitioners remain alert and cognisant of their patients' history.

Validation of the Spence Children's Anxiety Scale's obsessive compulsive subscale in a clinical and community sample.

This study describes the validation of the obsessive compulsive subscale on the Spence Children's Anxiety Scale (SCAS OCD) for use as a clinical assessment tool. Data from 196 anxious children (102 males, ages 7-18) and their parent collected during a diagnostic assessment were compared to data from 420 children (206 males, ages 8-13) from the community collected by mail. The validity of the SCAS OCD parent- and child-report forms were supported by correlations with the Children's Yale-Brown Obsessive Compulsive Scale and continuous OCD symptom variables from the Anxiety Disorders Interview Schedule: Child Version. In addition, children with OCD were found to have higher scores on the SCAS OCD subscale than patients without OCD and children from the community without a reported anxiety diagnosis. The sensitivity of the SCAS OCD to treatment effects was also demonstrated in a subset of the clinical sample that received exposure and response prevention therapy. Finally, cut-scores were identified that examine the sensitivity and predictive utility of the scales.