Rosai-Dorfman disease in a symptomatic elderly man.

An 81-year-old man presented with anemia, fatigue, weight loss, and recurrent urinary tract infections and was found to have diffuse large adenopathy and infiltrating renal masses. Surgical excision of a lymph node and histologic evaluation led to the diagnosis of Rosai-Dorfman disease, a rare histioproliferative condition that classically presents with enlarged cervical lymph nodes bilaterally. It also can involve additional nodal chains and/or have extranodal manifestations. The condition can self-resolve or have periods of remission and reactivation.

Use of 68Ga DOTATATE, a new molecular imaging agent, for neuroendocrine tumors.

Neuroendocrine tumors (NET), such as insulinomas and carcinoid tumors, can be challenging to diagnose since patients often present with vague symptoms. Adding to the challenge, these tumors are often occult on typical cross-sectional imaging modalities. Because of these challenges, there has been an increase in the utilization of radiopharmaceuticals that take advantage of specific receptors expressed by NET. Among the multiple radiopharmaceuticals that can be used, 68Ga DOTATATE is emerging as the most sensitive and specific imaging agent. We present a case where 68Ga DOTATATE was used to diagnose a well-differentiated neuroendocrine tumor.

Usefulness of positron emission tomography to detect cerebral amyloid as a means to diagnose neurodegenerative disease.

Alzheimer's disease is characterized histologically by the accumulation of a subtype of amyloid protein-beta amyloid-in the brain parenchyma in the form of amyloid plaques. In another neurodegenerative disorder, cerebral amyloid angiopathy, the accumulation of beta amyloid occurs within the walls of the cerebral vessels. With recent advances in imaging technology, we can not only image amyloid plaques in the brain parenchyma at an earlier stage of disease, but can also often correlate the presence of Alzheimer's disease with cerebral amyloid angiopathy. We present a case of suspected Alzheimer's disease and discuss the association in this patient between cerebral amyloid angiopathy and Alzheimer's disease, as well as the benefits of a unique nuclear imaging modality, amyloid positron emission tomography, in diagnosing dementia.

Unusual presentation of metastatic ovarian carcinoma as an enlarged intramammary lymph node.

Metastasis to the breast most commonly arises from a contralateral primary breast malignancy; however, metastatic disease can also result from extramammary malignancies by hematogenous or lymphatic dissemination. This case report reviews an unusual presentation of primary ovarian carcinoma with metastasis to an intramammary lymph node.

Optimal interpretative strategy for preoperative parathyroid scintigraphy.

PURPOSE: Our objective was to retrospectively compare various scintigraphic methods to determine their relative accuracies and interobserver variabilities in preoperative localization of single-gland disease in patients with primary hyperparathyroidism. PATIENTS AND METHODS: We studied 292 patients who underwent preoperative parathyroid scintigraphy and surgical resection between June 2002 and September 2008. Imaging included early and delayed pinhole Tc-MIBI imaging (including anterior oblique images), similar I imaging, and MIBI SPECT. Seven different imaging combinations were assessed as follows: early MIBI only, delayed MIBI only, comparison of dual-phase early and delayed MIBI, visual subtraction of early MIBI and I images, all planar images, SPECT only, and all planar and SPECT images (ALL). Each data set was reviewed by 2 of 4 experienced nuclear physicians without knowledge of clinical information or final diagnosis. Imaging results were compared with surgical outcomes. RESULTS: The accuracy of ALL imaging for delineating abnormal/normal parathyroid glands by quadrant was 96%, 93%, 95%, and 95% for the 4 readers. The accuracies of visual subtraction of early MIBI and I images and all planar images were not significantly different from ALL for all 4 readers. All planar and SPECT images were significantly more accurate than early MIBI only, delayed MIBI only, or SPECT only for all 4 readers and better than comparison of dual-phase early and delayed MIBI for 3 of 4 readers. CONCLUSIONS: A rigorous combination of multiple imaging approaches yielded high accuracies across multiple readers for localization of a single offending parathyroid gland, but a more limited technique using MIBI/I subtraction imaging with anterior and anterior oblique pinhole images provided similarly high accuracy and limited interobserver variation of accuracy.

Imaging HIV/AIDS. Body cavity-based lymphoma.

Non-Hodgkin's lymphoma (NHL) is an important and common AIDS-related neoplasm. AIDS-related NHL can be defined by its anatomic distribution as systemic (nodal and extranodal masses), primary central nervous system, and occasionally body cavity-based lymphomas (BCBL). Radiologic imaging plays an important role in differentiating the varied appearances of AIDS-related NHL, particularly regarding BCBL: patients' images demonstrate only fluid in the pleural, pericardial, and/or peritoneal spaces. Imaging of a case of BCBL is presented, including simultaneous pericardial, pleural, and peritoneal effusions.

Tuberculosis in renal transplant recipients: rifampicin sparing treatment protocol.

The reactivation of mycobacterium infection in renal transplant recipients in developing countries is a common therapeutic dilemma, especially in those patients receiving cyclosporin immunosuppression. The inclusion of rifampicin in the antituberculosis protocol increases the risk of precipitating acute allograft rejection due to its interaction with cyclosporin and also increases the financial burden. We successfully treated 16 patients who developed mycobacterial infection post renal transplant with a rifampicin sparing antituberculosis drug regimen. Pyrexia of unknown origin was the most common manifestation observed and a therapeutic trial with antituberculosis drugs is justified. De novo diabetes mellitus appears to be an added risk factor and increases the susceptibility to mycobacterial infection.

Painful periostitis in the setting of chronic voriconazole therapy.

A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis.

Unilateral absence of a pulmonary artery: a rare disorder with variable presentation.

Unilateral absence of a pulmonary artery (UAPA) is a rare condition with an estimated prevalence of 1 in 200,000 young adults. Most commonly, UAPA occurs in conjunction with cardiovascular abnormalities such as tetralogy of Fallot or cardiac septal defects, but it can also occur in an isolated manner. Patients with isolated UAPA can remain asymptomatic into late adulthood but usually report symptoms such as dyspnea or chest pain or suffer from hemoptysis or recurrent infections. Diagnosis can be difficult due to the rarity of the condition and its nonspecific presentation. We present a case of a 61-year-old man who presented for lung transplant evaluation and was found to have UAPA. Typical findings on chest radiograph, strategies for diagnosis, and available treatments are discussed.

Utility of pattern recognition in the detection of unsuspected additional primary malignancies on positron emission tomography-computed tomography.

Positron emission tomography-computed tomography (PET-CT) has been shown to detect unexpected synchronous malignancies in up to 4.8% of patients and has been shown to be more sensitive than conventional staging alone. Detection of an unsuspected synchronous malignancy on PET-CT will often affect both patient treatment and prognosis. This article reviews expected patterns of disease spread so that a synchronous malignancy can be more easily recognized.

Studying PPTCT Services, Interventions, Coverage and Utilization in India.

BACKGROUND AND OBJECTIVES: Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective PPTCT interventions. NACP III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, drop-outs, interventions efficacy with other determinants. MATERIALS AND METHODS: At ICTCs, registered ANCs are counseled and tested for HIV. HIV+ve ANCs are linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV+ve ANCs since 2004 subsequently delivered till December 2009 and their exposed children in PPTCT-VSGH constituted study cohort. RESULTS: 29281 ANCs registered, 69.7% were counseled pre-test, 100% of them tested, 94.9% were counseled post-test. 60.5% were detected in 3(rd) trimester. CD4 testing was carried out in 71.6% HIV+ve ANCs. 81 ANCs were detected HIV+ve inclusive of 11 unregistered cases. 72 pregnancy outcomes reported institutionally, 77.6% were caesarian sections. Out of 59 live births, 56 sdNVP-MB-Pair were given. 88.1% children were traced till 18 months, 76.3% of live births were alive, 40.7% of live births were tested. 1 was found HIV+ve with history of adherence to all prescribed PPTCT guidelines. CONCLUSIONS: PMTCT services - counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.