Abstract Breast fibromatosis (BF) is a rare disease of monoclonal fibroblast proliferation, accounting for only 0.2% of all breast tumors. It behaves unpredictably, in some cases becoming locally aggressive and therefore can be a source of significant morbidity. Fibromatosis cannot reliably be distinguished with imaging from more aggressive malignancies such as spindle cell-type metaplastic carcinoma, and therefore, core needle biopsies are integral to definitive diagnosis. Appropriate management of BF is an evolving topic. Historically, BF was treated with extensive surgical resection. However, newer management guidelines recommend initiating a 1- to 2-year period of active surveillance before resorting to systemic medical therapy, surgical resection, and/or radiotherapy. Radiologists play an integral role in arriving at diagnosis, determining concordance, and triaging affected patients for treatment. This article aims to review the current literature on the diagnosis and management of fibromatosis of the breast, with a focus on imaging features and the latest therapeutic options.
ABSTRACT Submucosal laryngeal and tracheal masses are a less common etiology for hoarseness, stridor, or dysphagia. Endoscopy may be insufficient for diagnosis or to guide sampling, given overlying intact mucosa. Computerized tomography (CT) or magnetic resonance imaging (MRI) of the neck can improve diagnostic accuracy; therefore, recognizing normal laryngotracheal anatomy, along with common radiological findings associated with submucosal masses, is imperative for guiding biopsy and refining a differential diagnosis. Treatment of submucosal laryngeal and tracheal processes can range from debulking, excision, sclerotherapy, or systemic therapy, emphasizing the importance of a proper diagnosis.
The postpartum period has been called the "fourth trimester." The physiological changes that occur during this period are similar to, but still differ from, those of pregnancy. In particular, the cardiovascular system undergoes marked changes, predisposing postpartum patients to a unique and rarely potentially fatal array of cardiovascular pathologies. Disorders include the relatively common conditions, such as pulmonary edema and pulmonary embolism, and the less common conditions, such as spontaneous coronary artery dissections and acute aortic pathologies. A thorough understanding and recognition of these pathologies in postpartum patients can allow for accurate diagnosis and appropriate imaging recommendations. The postpartum/peripartum period, which has recently been referred to as the fourth trimester, comprises a unique spectrum of physiological states that are similar to, but still differ from, those of pregnancy as well as from those of the nonpregnant state. Due to this, the fourth trimester not only shares many common conditions and potential complications with pregnancy, but also has its own unique set of potential complications. The purpose of this review article is to provide an overview of the imaging appearance of the more common, and not so common, clinical conditions associated with the postpartum period, as well as suggest appropriate diagnostic imaging algorithms and treatments. Focus will be placed on the cardiovascular system since it is the number one cause of maternal morbidity and mortality in the United States.
Extracorporeal membrane oxygenation (ECMO) is an advanced therapy used to support critically ill patients with severe respiratory and/or cardiovascular dysfunction that has failed conventional management. Cannulas used, and their insertion sites, have different radiographic appearances. The patient on ECMO requires multiple radiologic studies to ensure optimal cannula position and to monitor complications. Most complications related to ECMO use pertain to cannula malpositioning or use of anticoagulants. We describe modalities used to identify and monitor unexpected life-threatening ECMO-related complications.
Focal nodular hyperplasia (FNH) is a benign lesion occurring in a background of normal liver, often in younger women. It is thought to be secondary to hepatocyte hyperplastic growth response around a localized vascular malformation. While the typical features of FNH are well known, those with atypical appearances could pose a diagnostic challenge. Since FNH is rarely symptomatic and carries no risk for malignant transformation or life-threatening complications, it is essential to distinguish it from other lesions such as hepatocellular adenoma (HCA), hepatocellular carcinoma (HCC), and hypervascular liver metastases to avoid unnecessary interventions. Some of the atypical features to be aware of include presence of microscopic/macroscopic fat, calcification, changes in T2 signal, unusual patterns of hepatobiliary phase contrast uptake, as well as abnormal growth and enhancement. Lesions histologically identical to FNH arising in an abnormal liver are called FNH-like lesions and usually result from conditions affecting the vascular supply of the liver such as Budd-Chiari disease, sinusoidal obstruction syndrome, chronic portal vein thrombosis, and others.
Arthroplasty refers to the replacement, or resurfacing, of a joint with the goal of restoring function and relieving pain. Joint replacement procedures are extremely common, with greater than one million knee and hip replacements alone performed in the United States each year. Frequent indications for arthroplasty include arthritis, trauma, osteonecrosis, and treatment of congenital abnormalities. The most commonly replaced joints include the knee, hip, and shoulder, although ankle, elbow, and various digit arthroplasties are also encountered with considerable frequency. Patients with joint replacements are imaged frequently, at routine postoperative intervals, for symptoms related to the replaced joint, and for unrelated reasons in which the arthroplasty is incidentally visualized. Because of the high prevalence of joint replacements, complications are also common, and radiologists should be comfortable recognizing the appearance of potentially clinically significant pathologic processes affecting arthroplasties.
Use of extra corporeal membrane oxygenation (ECMO) has been increasing, especially in adults, since 2000 and accentuated by the viral epidemics of H1N1 and COVID-19. The number of hospitals offering adult ECMO also has increased. Expanded use requires expanded knowledge, as the ECMO cannulas are imaged incidentally on studies performed for other reasons or on planned cannula imaging. Radiologists must be able to recognize the type of ECMO, evaluate cannula positioning, and assess complications. The purpose of this article is to review and illustrate the various types of adult ECMO, associated complications, and the best imaging choices.
Gamma imaging encompasses a broad range of studies spanning multiple organ systems. The myriad of radiotracers and radiopharmaceuticals, the dynamic nature of imaging protocols, and the complexity of image interpretation render early mastery of this topic a source of great challenge. This 2-part manuscript provides an educational resource that introduces the basic concepts of gamma nuclear imaging with a focus on the most encountered studies across institutions. For each type of study presented, we describe the typical indications, the radiotracer used, standard institutional imaging protocols, the interpretation of the images, and correlation with other imaging modalities where applicable. The information is presented in the context of illustrative cases to expose readers to many of the pathologic entities associated with the several types of studies encountered in the clinical setting. In Part 1, we introduce basic concepts of radiotracer decay and the physics of gamma imaging. Head-to-toe studies subsequently presented in this part include brain imaging, thyroid imaging, and lung ventilation and perfusion imaging.
Dementia is an increasing health issue with a high prevalence among elderly individuals. Because a heterogeneous group of underlying disease processes may present clinically as dementia, structural brain magnetic resonance imaging is commonly performed for the workup of patients presenting with new cognitive impairment to aid in differentiation and diagnosis of various neurodegenerative diseases and dementia pathologies. Appropriate detection and recognition of characteristic structural brain MRI features may facilitate diagnostic decision making in dementia workup.
Abdominal radiographs play a fundamental role in emergency and in-patient settings in the assessment of adult patients presenting with abdominal pain. Despite the inherent limitations associated with this modality, plain films can provide valuable information in the evaluation of both acute and chronic abdominal pain. For example, analysis of bowel gas patterns can reveal bowel obstructions, secondary findings of bowel ischemia, or visceral perforation. Findings related to solid organ, soft tissue, or vascular pathologies may also be detected on plain film. In this paper, we review the proper radiographic technique for abdominal radiographs, including different projections and patient factors, and discuss the use of enteric contrast media. We will also outline an approach to interpreting abdominal radiographs, with a review of several cases.
This part 2 in a 2-part series illustrates the complications of acute necrotizing pancreatitis, including near-complete necrosis of pancreatic parenchyma and emphysematous pancreatitis, and uncommon locations of pancreatic pseudocysts are discussed.
Due to the nonspecific clinical presentation and limited evaluation by radiographs, diagnosis of tracheal abnormalities is often delayed. However, computed tomography, volumetric acquisitions, and multiplanar 3-dimensional formats have helped to improve assessment of tracheal abnormalities and their related parenchymal changes. The primary aim of this pictorial essay is to display the range of focal and diffuse tracheal abnormalities detectable via computed tomography and its diagnostic accuracy in comparison with histopathologic findings.
Breast augmentation with implants is a widely performed procedure for cosmetic, reconstructive, and congenital correction purposes. As a result, breast implants frequently appear on chest CT scans conducted for various clinical indications, including recent emphasis on COVID-19 pneumonia. Radiologists are presented with opportunities to incidentally identify findings related to breast implants, some of which are clinically significant. Although MRI is the preferred method for evaluating breast implants due to its high sensitivity, CT scans can detect several implant-related findings and should not be overlooked. Radiologists must be adept at recognizing and assessing breast implants, distinguishing normal appearances from abnormal findings in routine chest CT scans, and contributing to timely intervention and patient management when complications are depicted.
This part 1 in a 2-part series illustrates vascular complications such as pseudoaneurysms, splanchnic venous thrombosis, and subscapular hematoma of the liver and spleen. Complications associated with fistulous formation, including pancreatico-psoas and pancreatico-pleural fistulas, are discussed.
Congenital aortic arch variants and anomalies are frequently encountered in radiology practice. Some of these malformations are symptomatic, while others may have surgical or interventional implications. CTA and MRA provide a comprehensive evaluation of the abnormalities. This article briefly describes the embryologic development of the aortic arch and focuses on a multi-modality review of common and uncommon variants and anomalies of the aortic arch including variant branching and vascular ring.
Ultrasound-guided injections are safe and effective meth-ods to achieve intra-articular and/or bursal access. This paper reviews common approaches for targeting the hip, knee, ankle, and subtalar joints, as well as the iliopsoas and greater trochanteric bursae. The discussion highlights the critical periarticular and juxta-bursal anatomy to be aware of to optimize the approach and minimize the risk of complications. Tactics to employ during complex and/or technically challenging cases are shared.
Pulmonary masses are a commonly identified in thoracic imaging. In any clinical scenario a lung mass should raise suspicion for a malignant neoplasm. However, there are multiple non-neoplastic diseases that can also manifest as pulmonary masses. Therefore, certain risk factors, imaging findings, and clinical features should lean the scale to favor the diagnosis of specific benign diseases. Differentiation between malignant and benign disorders is critical to avoid unnecessary interventions. This article (the first part of a two-part series) focuses on infectious and congenital disorders. Vascular and miscellaneous entities will be discussed in the second part.
This article reviews the radiologic findings of recreational drug abuse. Patients with drug abuse often present with a spectrum of related multisystem abnormalities that can range from soft tissue or vascular injury via direct needle penetration to septic emboli, abscesses, septic arthritis, infarct, and hemorrhage. After providing a brief overview of popular routes of administration, we emphasize common and uncommon imaging findings of drug abuse in a system-by-system fashion. A case-based review of multisystem complications from recreational drug use is provided. In this second article of a 2-part series, emphasis is placed on thoracic and body effects.
Pulmonary masses are regularly found in thoracic imaging. A lung mass should raise suspicion for a malignant neoplasm, however, there are multiple nonneoplastic diseases that can also appear as masses. Therefore, certain risk factors, imaging, and clinical features should lean the scale to favor the diagnosis of specific benign diseases. Differentiation between a malignant and a benign lesion is critical to avoid unnecessary interventions. This article (the second part of a 2-part series) focuses on vascular and miscellaneous disorders.
