Acute incarcerated intrathoracic sleeve herniation after laparoscopic sleeve gastrectomy: an uncommon yet urgent complication-a comprehensive case report and literature review.

Laparoscopic sleeve gastrectomy (LSG) stands as one of the most frequently performed bariatric procedures in the USA. While hiatal hernia or intrathoracic migration of the staple line is frequently described as a chronic complication, this review article sheds light on the seldom-discussed acute presentation of this alarming complication. We present a compelling case of a young female who experienced sudden and intractable vomiting shortly after LSG. Utilizing a multidisciplinary approach, upper gastrointestinal imaging (UGI) and computed tomography (CT) scans unequivocally confirmed incarcerated intrathoracic migration of the gastric sleeve, necessitating immediate surgical intervention. Radiologists must be equipped with the knowledge to recognize subtle yet crucial imaging findings from UGI and CT scans to ensure timely intervention, thus mitigating the risks associated with this underreported acute complication of LSG and ultimately improving patient outcomes and safety.

COVID-19-associated Pulmonary Cryptococcosis: A Rare Case Presentation.

Multiple case reports and case series report a surge in opportunistic infections like aspergillosis, mucormycosis, and reactivation of cytomegalovirus infection in coronavirus disease-2019 (COVID-19) patients. We hereby report the first case to the best of our knowledge of pulmonary cryptococcosis in a patient who had successfully recovered from severe COVID-19 illness. The pulmonary cryptococcosis spectrum ranges from asymptomatic infection to frank acute respiratory distress syndrome leading to respiratory failure. Pulmonary cryptococcosis is often underdiagnosed because its clinical presentation, radiographic features, and serologic laboratory investigations are generally inconclusive. The saprophytic colonization of fungus as opposed to invasive disease cannot be assessed from either culture of sputum or currently available serologic tests. Pulmonary cryptococcosis close association with COVID-19 can be further established with reporting of more cases. Hereby, we propose the term CAPC (COVID-19-associated pulmonary cryptococcosis) for such cases. How to cite this article: Sharma S, Agrawal G, Das S. COVID-19-associated Pulmonary Cryptococcosis: A Rare Case Presentation. Indian J Crit Care Med 2022;26(1):129-132.

Magnetic Resonance Imaging, the Virtual Biopsy of Mesenteric Masses.

ABSTRACT: The mesentery may be affected by multiple disease processes. Magnetic resonance imaging aids as a virtual pathological biopsy tool in the assessment of mesenteric masses because of superior soft tissue contrast and characterization. In this comprehensive review, we describe in detail the magnetic resonance imaging features of some solid and cystic mesenteric masses, with an emphasis on lesion-specific signal characteristics on T1- and T2-weighted images, diffusion-weighted imaging, and enhancement features on the dynamic postcontrast phase that aid in narrowing the differential diagnosis.

Iatrogenic breast pseudoaneurysm in a lactating female: A rare breast emergency treated with ultrasound guided thrombin administration.

Pseudoaneurysm development is a well-recognized consequence of arterial injury, frequently observed in procedures involving arterial groin access. Breast emergencies are infrequent but need prompt attention. We present a notable case of breast pseudoaneurysm postcore needle biopsy, incidentally, identified through subsequent magnetic resonance imaging. Remarkably, the patient's lactating status emerged as a unique risk factor. Our report thoroughly explores the pathogenesis, etiology, preventive measures, and treatment strategies specific to breast pseudoaneurysms. A comprehensive understanding of this phenomenon is essential for radiologists at large, with particular importance for specialists in breast imaging.

A case of bilateral male breast cancer- What does it teach us?

Male breast cancer is rare, with a lifetime risk of 1 in 833 males, with bilateral male breast cancer being extremely uncommon. This report describes a rare case of bilateral breast cancer in a 74-year-old male who presented with a breast lump and incidental calcifications in the contralateral breast. This case highlights the similarities, as well as differences, in presentation and imaging features of breast cancer in males and females. It also demonstrates how Magnetic Resonance Imaging can be a useful tool for pre-treatment planning of certain male breast cancers, especially to evaluate disease extent and to identify contralateral tumor.

A Rare Case of Fallopian Tube Metastasis Presenting as a Solitary Breast Mass.

Metastases to the breast from a nonmammary primary are rare. Primary fallopian tube carcinoma is one of the rarest malignancies of the female genital tract. Therefore, breast metastases from primary fallopian tube carcinoma are considered extremely rare. In this article, we shared the case of serous carcinoma of fallopian tube with metastasis to an intramammary lymph node, presenting as a solitary breast mass. On initial staging 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography for this patient with serous carcinoma of fallopian tube, a solitary FDG avid breast mass was found, along with FDG avid multistation nodes. The breast mass was evaluated with diagnostic mammogram and ultrasound and eventually biopsy of this mass revealed metastatic lymph node from carcinoma of fallopian tube origin.

Can COVID-19 worsen racial disparities in breast cancer screening and diagnosis?

Background: Health disparities among minority groups, especially African Americans, can limit their access to quality medical care and lead to disproportionate medical management and disease outcomes. The aim of this study was to compare the COVID-19-related change in mammogram volumes and cancer detection at two affiliated academic breast centers, one that serves a predominantly African American patient population and one that serves a predominantly non-African American patient population. Materials and methods: For the purpose of anonymity, racial demographics were collected and the center with a higher African American patient population was designated as institution A, while the center with a higher non-African American patient population was designated as institution B. Careful selection of the two breast centers was instituted in order to limit the impact of potential confounders other than race.An Institutional Review Board (IRB) exemption was obtained and two Mammography Quality Standards Act (MQSA) reports were generated; one for March 2020 through September 2020, during the height of the COVID-19 pandemic, and one for March 2019 through September 2019 to serve as the pre-pandemic control group. The i2b2 Query Analysis Tool® was used to obtain racial demographic data and compare the percent change in screening and diagnostic mammograms, image-guided biopsies, total cancers diagnosed by imaging, and percent of minimal cancers for both institutions. Results: Screening mammograms and breast cancer detection decreased in 2020 compared to 2019 at both institutions. However, the percent change from 2019 to 2020 was greater at institution A than at institution B. Percent minimal cancers, an indicator of early-stage breast cancer also decreased more drastically at institution A than at institution B. Interestingly, the total number of diagnostic exams and image-guided biopsies increased in 2020 at institution B, whereas both decreased at institution A. Conclusion: The COVID-19 pandemic may lead to worsening racial disparities in breast cancer screening. In an effort to narrow future disparity, it is crucial for radiologists and other health care providers to be aware of this inequality and educate all women on the importance of obtaining routine screening mammography. More studies are needed.

A rare complication of pyogenic hepatic abscess after laparoscopic sleeve gastrectomy-case report and literature review emphasizing the role of imaging.

A pyogenic hepatic abscess is an uncommon complication after laparoscopic sleeve gastrectomy (LSG) that can develop secondary to an infected hematoma or a staple line leak due to bacterial seeding. Appropriate screening for and management of a pyogenic hepatic abscess are essential in patients with clinical suspicion for complications after LSG. Early diagnosis is essential as pyogenic hepatic abscess can be fatal if not treated early. Only five cases have been reported in the literature so far. We present a case of pyogenic hepatic abscess that occurred two weeks after LSG in a 46-year-old female without immunosuppressive conditions or early postoperative leak. The abscess was diagnosed by computed tomography (CT) and was successfully treated with antibiotics and CT-guided drainage.

Mimics and Pitfalls of Primary Ovarian Malignancy Imaging.

The complex anatomy and similarity of imaging features of various pathologies in the pelvis can make accurate radiology interpretation difficult. While prompt recognition of ovarian cancer remains essential, awareness of processes that mimic ovarian tumors can avoid potential misdiagnosis and unnecessary surgery. This article details the female pelvic anatomy and highlights relevant imaging features that mimic extra-ovarian tumors, to help the radiologists accurately build a differential diagnosis of a lesion occupying the adnexa.

Expanded subpopulation of FoxP3+ T regulatory cells in renal cell carcinoma co-express Helios, indicating they could be derived from natural but not induced Tregs.

Conversion of conventional T cells into T regulatory cells (Tregs) has been proposed as a potential mechanism for Treg expansion in cancer. However, this evidence is supported by in vitro or mouse model studies with no data from in vivo or human studies to support its role in enriching peripheral and tumor-infiltrating Tregs. Recent work has shown that induced FoxP3+ Tregs (iTregs) do not express Helios; an Ikaros family transcription factor. We analyzed peripheral blood samples from untreated renal cell carcinoma (RCC) patients and following interleukin (IL)-2 treatment for the expression of FoxP3 and Helios. Our work shows that expanded peripheral FoxP3+ Tregs in untreated RCC patients co-express Helios. Interestingly, IL-2 administration results in expansion of FoxP3+ Helios+ natural Tregs (nTregs) significantly more than FoxP3+ Helios- iTregs. Our work shows that the increased FoxP3+ Treg subpopulation in RCC patients co-express Helios, indicating that they could be derived from natural but not induced Tregs.

A Practical Technique to Improve Visualization of Sentinel Nodes in Axillary Region on Breast Lymphoscintigraphy: Medial Breast Traction by Patient.

A standard method of performing breast lymphoscintigraphy is anterior and lateral views after periareolar intradermal injection of a radiotracer. However, a sentinel lymph node may be obscured by the activity at injection site, especially on anterior view. Also, breast tissue may cause attenuation to prevent sentinel node visualization. Repeat images during medial traction of breast by patient is an effective technique to improve visualization of sentinel lymph nodes in axillary region.

Role of MRI in Breast Cancer Staging: A Case-Based Review.

Breast cancer is the most commonly diagnosed cancer in women in the United States and is also the second leading cause of cancer deaths in women. The five-year survival rate and overall prognosis are largely dependent on the stage at diagnosis. Our article highlights the role of magnetic resonance imaging (MRI) in breast cancer staging and updates to the American Joint Committee on Cancer (AJCC) 8th edition guidelines regarding breast cancer staging that are relevant to radiologists. It provides a case-based approach to emphasize the key findings that the radiologist should report on a breast MRI to aid the clinicians in staging and management.

It's Not Always Gynecomastia: A Case of Diffuse Large B-Cell Lymphoma Presenting as Breast Mass in a Male Patient.

We report a case of diffuse large B-cell breast lymphoma that presented as a palpable breast lump in a male patient evaluated with digital mammography and targeted breast ultrasound (US) but ultimately confirmed by US-guided core needle biopsy. We will discuss the appropriate workup algorithm for a palpable breast lump in a male patient as outlined by the American College of Radiology (ACR) Appropriateness Criteria. While gynecomastia is the most common reason for a new palpable breast lump in a male patient, male breast cancer (including lymphoma and metastasis) can have a similar appearance on imaging. Our goal is to provide clarity on proper radiographic assessment protocols and imaging features of palpable breast masses in men by emphasizing the role of anatomical location and symmetry in distinguishing it from more common causes, such as gynecomastia, in future diagnostic imaging scenarios.

MRI Virtual Biopsy of T2 Hyperintense Breast Lesions.

A wide variety of benign and malignant breast processes may generate hyperintense signal at T2-weighted magnetic resonance imaging (MRI). MRI has been traditionally used in the pre-treatment planning of breast cancer, in assessing treatment response and detecting recurrence. In this comprehensive review, we describe and illustrate the MRI features of a few common and uncommon T2 hyperintense breast lesions, with an emphasis on MRI features that help to characterize lesions based on morphological features, specific appearances on T1-and T2-weighted imaging, and enhancement characteristics on the dynamic post-contrast phase that are either diagnostic or aid in narrowing the differential diagnosis.

Effectiveness of UV-C equipped vacuum at reducing culturable surface-bound microorganisms on carpets.

Carpets are both sinks and sources for exposure to chemicals, allergens, and microbes and consequently influence health, including asthma, allergies, and infectious diseases. Asthmatics, children, and the immune-compromised are particularly vulnerable to health risks resulting from exposure to carpet contaminants. To address this risk, a commercial upright vacuum cleaner with an ultraviolet germicidal lamp (λ=253.7 nm, UVC) has been developed for residential and commercial uses. However, its effectiveness in reducing microbial load on real-world carpets has not been previously demonstrated. Accordingly, the purpose of the current study was to evaluate the effectiveness of a UVC-equipped vacuum in reducing the carpet surface-bound microbial load. This was accomplished by comparing the carpet microbial surface load from pre- to post-treatment of 9 ft(2) in-use carpet sections under three treatment scenarios: 1) UVC alone (UV), 2) the beater-bar plus vacuum (BB+Vac), or 3) a combination of all three (COMB). Each treatment was two minutes in duration. Microbial surface loads were measured by pressing contact plates containing Sabourauds Dextrose agar onto the carpet surface. In-use carpets from three locations were tested in place. The treatment effect was evaluated at two levels. First, we considered the mean reduction in CFU from pre- to post-treatment for each 9 ft(2) carpet grid (n = 4 for each treatment). The second level considered each 1 ft(2) section using a paired analysis (n = 40 to 49 for each treatment). A total of 125 pre/post-sample pairs were collected across the three treatments. Results showed that all three treatments were associated with a reduction in carpet microbial load (p < 0.0001). The COMB yielded the largest reduction of 13 CFU/plate (87% reduction) and was approximately the sum of the individual effects of either UVC (6.6 CFU/plate, 60% reduction, p = 0.009) or BB+Vac (7.3 CFU/plate, 78% reduction, p < 0.0001). We therefore conclude that a UVC-equipped vacuum approximately doubles the unit's effectiveness in reducing surface-bound microbial load, thereby holding promise as a means for decreasing indoor infectious disease risk.

Metastatic melanoma presenting as a breast mass - role of radiologist as a clinician.

Breast tissue can be the host of not only many benign and malignant tumors but can also be a metastatic site for various tumors such as leukemia, lung cancer, and melanoma. This report describes an unusual case of a 43-year-old female who presented with a new palpable breast lump and several similar extramammary lumps on her skin. A melanoma panel, consisting of S100, HMB45, and Melan-A stains, was included in the pathology evaluation due to diagnostic suspicion of the radiologist and revealed metastatic melanoma. This case highlights the importance of detailed history and relevant physical exam as well as clinical and imaging correlation. It serves as a reminder to radiologists to include metastatic melanoma in the differential of suspicious subcutaneous breast masses, especially in patients with multiple subcutaneous lumps in the body or abnormal skin findings.

A Case of Asymmetric Nipple Enhancement as an Imaging Precursor to Invasive Ductal Carcinoma.

On multidetector computed tomography (CT), it is important to scrutinize the imaged portions of the breasts. In recent years, the dramatic rise in CT imaging has led to the increased detection of incidental breast lesions. We describe a case of invasive ductal carcinoma that presented as stage IV cancer, and retrospective review of prior imaging study revealed asymmetric nipple enhancement on a trauma protocol CT chest acquired three years earlier. This report highlights the importance of being attentive to breast abnormalities on CT performed for indications other than breast disease and additionally focuses on the approach to address abnormal enhancement of the nipple areolar complex (NAC).

Bracketed Radioactive Seed Localization for Breast Conservation Surgery.

We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of the area of concern. All patients had originally presented with calcifications identified on screening mammogram that were subsequently diagnosed as ductal carcinoma in situ and/or invasive ductal carcinoma by image-guided biopsy performed at our institution. Eight patients had one positive margin on final surgical pathology and required re-excision (32%). One patient was converted to mastectomy. Of the patients requiring re-excision, the average maximum linear extent of calcifications was 3.4 cm (SD 0.97), whereas it was 3.1 cm (SD 1.2) in patients with negative surgical margins (P = 0.5). Bracketing calcifications with radioactive seeds can potentially allow more patients to undergo breast conservation surgery.