Nonpuerperal mastitis and subareolar abscess of the breast.

OBJECTIVE: The purpose of this article is to show radiologists how to readily recognize nonpuerperal subareolar abscess and its complications in order to help reduce the time to definitive therapy and improve patient care. To achieve this purpose, the various theories of pathogenesis and the associated histopathologic features are reviewed; the typical clinical characteristics are detailed in contrast to those seen in lactational abscess and inflammatory breast cancer; the common imaging findings are described with emphasis on the sonographic features; correlative pathologic findings are presented to reinforce the imaging findings as they pertain to disease origins; and the various treatment options are reviewed. CONCLUSION: Nonpuerperal subareolar mastitis and abscess is a benign breast entity often associated with prolonged morbidity. Through better understanding of the underlying disease process the imaging, physical, and clinical findings of this rare process can be more readily recognized and treatment options expedited, improving patient care.

The value of training technologists for adverse reactions to contrast.

PURPOSE: To design, implement, and measure outcomes of a technologist education program about anaphylactoid reactions to contrast media. METHODS: Radiologic technologists viewed a 45-minute presentation and completed a pretest, posttest, and self-assessment. These steps were repeated 14 months later with different test questions. Statistical analysis included participants' t test to assess significant differences (P < .05) between pretests and posttests. RESULTS: Seventeen computed tomography (CT) technologists participated in the first educational program, and 19 CT technologists participated in the second session. A statistically significant improvement (P < .05) was found between pretest and posttest mean test scores. However, the pretest scores were lower before the second session. Using a Likert scale (1 = completely agree vs 5 = completely disagree), technologists indicated the session improved their knowledge (mean score 1.1), made them more comfortable managing a reaction (mean score 1.1), and fostered confidence in recognizing symptoms of a reaction (mean score 1.4). DISCUSSION: A didactic curriculum of managing anaphylactoid reactions to contrast media offers subjective benefits and short-term objective knowledge gain for CT technologists. After the training, technologists had increased knowledge of and comfort with managing an emergency situation and recognizing symptoms, which help to prevent morbidity and mortality. However, the results indicate that frequent repetition of the material is necessary for long-term gains. CONCLUSION: A dedicated educational program for technologists helps prevent and manage adverse reactions to contrast media through improved knowledge, increased comfort and confidence, and teamwork development. At a minimum, semiannual training sessions should occur for all technologists to retain knowledge.

Pediatric and adolescent breast masses: a review of pathophysiology, imaging, diagnosis, and treatment.

OBJECTIVE: Pediatric breast masses are relatively rare and most are benign. Most are either secondary to normal developmental changes or neoplastic processes with a relatively benign behavior. To fully understand pediatric breast disease, it is important to have a firm comprehension of normal development and of the various tumors that can arise. Physical examination and targeted history (including family history) are key to appropriate patient management. When indicated, ultrasound is the imaging modality of choice. The purpose of this article is to review the benign breast conditions that arise as part of the spectrum of normal breast development, as well as the usually benign but neoplastic process that may develop within an otherwise normal breast. Rare primary carcinomas and metastatic lesions to the pediatric breast will also be addressed. The associated imaging findings will be reviewed, as well as treatment strategies for clinical management of the pediatric patient with signs or symptoms of breast disease. CONCLUSION: The majority of breast abnormalities in the pediatric patient are benign, but malignancies do occur. Careful attention to patient presentation, history, and clinical findings will help guide appropriate imaging and therapeutic decisions.

Malformations of dorsal induction.

Dorsal induction includes the formation and closure of neural tube, occurs during 3-5 weeks of gestation. Neurulation occurs in two phases, primary neurulation (formation of the neural plate and subsequently neural tube) and secondary neurulation (formation of distal cord and sacral and coccygeal segments). Failure of dorsal induction leads to anencephaly, exencephaly, cephaloceles, Chiari malformation and spinal dysraphism. In this article we discuss the relevant embryology, etiopathology and detail imaging appearances of these malformations.