ABSTRACT Male breast cancer is rare, representing less than 1% of breast cancer cases, and is often diagnosed at a later stage due to a low index of clinical suspicion. This is the case of an invasive ductal carcinoma in a middle-aged man with a history of cardiac transplantation and long-term immunosuppressant use. The patient presented with a breast lump found on self-examination, which was then evaluated with diagnostic mammography and US. Imaging demonstrated a suspicious retroareolar mass with associated nipple retraction, and subsequent US-guided core biopsy confirmed moderately differentiated invasive ductal carcinoma (ER-positive, PR-positive, HER2-negative). This case highlights the importance of maintaining clinical suspicion for breast malignancy in male patients presenting with a new breast mass, even in the absence of traditional risk factors such as family history of breast cancer. Thorough clinical evaluation and appropriate diagnostic imaging can facilitate early detection and treatment of male breast cancer.
Abstract Cystic and cyst-like lesions of the mediastinum encompass a broad spectrum of entities ranging from benign congenital abnormalities to inflammatory or malignant processes with cystic components. These lesions are frequently encountered with cross-sectional imaging and may present a diagnostic challenge due to overlapping imaging appearances. Accurate characterization is critical, as misclassification can lead to unnecessary surgical intervention or delayed diagnosis of clinically significant disease. These lesions can be incidentally identified on routine chest radiographs as paramediastinal opacities. CT is typically the initial imaging modality for further evaluation of mediastinal lesions and provides essential information regarding lesion location, morphology, and relationship to adjacent structures. MRI offers superior soft-tissue characterization and plays a key role in problem-solving, particularly when CT findings are indeterminate. The use of T1- and T2-weighted sequences, along with diffusion-weighted imaging, facilitates differentiation of simple cysts from lesions containing solid, proteinaceous, or malignant components. Awareness of characteristic imaging features of common congenital cysts, acquired cystic lesions, and important mimics further improves diagnostic confidence. In conclusion, mediastinal cystic lesions require a structured imaging-based approach for accurate diagnosis. Integration of clinical context, anatomic location, and multimodality imaging findings, with particular emphasis on MRI, supports appropriate risk stratification and individualized patient management.
OBJECTIVE:To evaluate the association between the Rockwood Frailty Index (RFI) and survival across three populations in a Hospital-at-Home Unit (HaH): complex chronic patients, non-oncologic palliative patients (advanced organ failure, severe functional limitation and impaired physiological reserve) and oncologic palliative patients. DESIGN:Retrospective longitudinal observational cohort study. SITE: Hospital-at-Home Unit of the Hospital Universitari i Politècnic La Fe (Valencia, Spain). PARTICIPANTS:Patients aged 65 or older discharged between January 2021 and December 2024, with an RFI recorded at admission and follow-up in the Case Management programme. 2,610 patients were included (53.8% complex chronic; 34.0% non-oncologic palliative; 12.2% oncologic palliative). INTERVENTIONS:None; observational study with no intervention. MAIN: measurements Survival (time to death) using Kaplan-Meier curves, log-rank tests and multivariate Cox regression, adjusted for demographic (age, sex), clinical (Charlson and Barthel indices, diagnosis-related group, prior emergency admissions) and laboratory variables (albumin, C-reactive protein, glomerular filtration rate). RESULTS:Significant differences were observed between groups (χ2=231; P<.001), with median survival of 449, 248.5 and 125days. The RFI was independently associated with higher mortality (HR 2.50; 95%CI: 1.66-3.76), outperforming the Charlson index (HR 1.05). CONCLUSIONS:The RFI is a powerful independent prognostic predictor across all three populations, outperforming comorbidity and functional dependency. A threshold of ≥0.53 identifies non-oncologic patients with advanced organ failure and severe functional impairment -median survival below nine months- without a formal palliative designation. Its implementation in Primary Care electronic health records would enable early identification of this population and anticipate end-of-life palliative care, regardless of diagnosis.
OBJECTIVE:To identify and analyse determinants of hypertension self-care from a gender perspective, integrating the experiences of patients and primary care professionals. DESIGN:Descriptive qualitative study using focus groups and Giorgi's phenomenological approach. SETTING:Public primary care centre in Barcelona, Spain. PARTICIPANTS:Twenty-four participants distributed across four focus groups: 12 patients with hypertension (6 women, 6 men) and 12 professionals (10 women, 2 men; 8 nurses, 4 physicians), recruited through purposive sampling. METHODS:Sessions lasting 60-80min followed a semi-structured guide addressing knowledge, beliefs, diet, physical activity, self-monitoring, adherence, stress, social support, roles and gender influences. They were transcribed verbatim and analysed by three researchers using Giorgi's descriptive phenomenological method, with iterative consensus. Factors were subsequently categorised according to the PRECEDE model. RESULTS:Determinants common to both genders and determinants with gender-differentiated expression were identified. The belief that medication alone is sufficient acted as a cross-cutting determinant. Predominantly female determinants included caregiving-related guilt, subordination of self-care, time poverty, schedule incompatibility, asymmetry of intrafamilial support and family food management shaped by gender roles. Predominantly male determinants included low risk perception, symptom-guided help-seeking, reliance on partners for dietary management and triggers in masculinised social contexts. Professionals reported limited specific training and low confidence in applying a gender perspective. CONCLUSIONS:The identified determinants support the relevance of gender-sensitive educational interventions in hypertension care. Professional training in applying a gender perspective represents a priority for continuing professional development in primary care.
OBJECTIVE:Automating administrative tasks, such as compiling a patient's medical history, could help general practitioners in their daily work. AI performance has improved in recent decades, but skepticism among professionals limits its use in medical practice, due to fears of gaps and biases. This study attempts to evaluate the effectiveness of AI in recording patient histories compared to general practitioners. DESIGN:Cross-sectional study. SITE: Online study in France. PARTICIPANTS:French general practitioners recruited online. INTERVENTION:We compared the performance of a general practitioner with that of AI in collecting a patient's history during an initial consultation. MAIN MEASUREMENTS:Medical histories were classified into categories: long-term chronic diseases, medical, surgical, obstetric, occupational, drug allergies, other allergies, and family history of cancer. RESULTS:With 204 general practitioners, we obtained 942 patient histories. AI was more effective than traditional physicians in collecting patient histories, especially in older age groups and in categories such as allergies and family history. The relevance and reliability of those histories depend on the age and type of history reported. Older patients, obstetric history, and drug allergies were the most relevant factors. CONCLUSION:AI is expected to become a major player in the healthcare sector due to its efficiency and accuracy. However, there is still debate about its potential to replace doctors in tasks such as diagnosis, prevention, therapy, or patient information. The ethics of data collection and AI remain a subject of debate, with the importance of training healthcare professionals to ensure they respect medical and patient ethics. The study highlights the importance of integrating new technologies into general medicine and the doctor-patient relationship in the profession.
Abstract Renal medullary carcinoma (RMC) is a rare, aggressive renal malignancy affecting young individuals who have sickle cell hemoglobinopathy. Imaging shows an infiltrative central renal mass, often with distant metastases. Diagnosis is supported by renal biopsy. While the disease may be cured with early detection, RMC is often diagnosed at an advanced stage, making the overall prognosis poor.
Abstract Although Morgagni hernia is the rarest type of congenital diaphragmatic hernia, it is clinically important due to the potential for delayed diagnosis and associated complications. Its bimodal age distribution underscores the importance of recognizing this condition in both pediatric and adult populations, where symptoms can range from asymptomatic findings to severe pulmonary or gastrointestinal issues. Accurate diagnosis depends on imaging, with lateral chest x-rays often identifying initial signs, while advanced modalities like CT or MRI may provide definitive confirmation.
Abstract Pediatric achalasia is rare, with an average age at diagnosis of 7 years. Because symptoms overlap with gastroesophageal reflux disease (GERD), diagnosis is often delayed. Patients present with dysphagia with solids and liquids, regurgitation, and a history of failed treatment of GERD. On imaging, the proximal esophagus is dilated with smooth, tapered narrowing distally, forming the classic “bird’s beak” sign. A definitive diagnosis is made with the absence or markedly diminished contractility seen on HRM. Short-term management is performed endoscopically, whereas definitive treatment is surgical.
Abstract Meconium ileus is a mechanical obstruction of the small bowel and is often the first clinical manifestation of cystic fibrosis in the neonatal period. Affected neonates typically present with abdominal distention and failure to pass meconium within the first 48 hours of life. Diagnosis relies on a combination of imaging modalities, including radiographs and US, as well as confirmatory testing for cystic fibrosis through genetic and sweat chloride analysis. Management begins with hyperosmolar contrast enemas, which can be both diagnostic and therapeutic, while surgical intervention is reserved for complicated cases or when enema fails to resolve the obstruction.
Abstract Ureteropelvic junction obstruction is the most common cause of congenital hydronephrosis and typically presents with dilation of the renal pelvis and calyces without associated ureteral dilation. Although many cases are suspected prenatally as urinary tract dilation, definitive evaluation occurs postnatally through integration of US findings and functional assessment. US remains the primary imaging modality, with CT or MR urography used when additional anatomic detail is required, particularly to evaluate for extrinsic causes. Renal drainage and differential function are most assessed with mercaptoacetyltriglycine-3 diuretic renography. Management is individualized based on symptoms, severity of dilation, and renal function. While many children are managed conservatively, surgical pyeloplasty is indicated in patients with significant obstruction or declining function and is associated with favorable long-term outcomes.
Abstract Pediatric pulmonary embolism (PE) has become increasingly more common. It occurs most frequently in adolescent girls because of the effect of estrogen on blood coagulation. Prompt diagnosis is essential for lowering long-term complications and the mortality risk. However, this is challenging due to the varied and often asymptomatic clinical presentation of PE in children. On imaging, a filling defect within a pulmonary artery is the diagnostic finding. Imaging may also show signs of right ventricular strain, which helps inform treatment options. PE is treated based on risk and burden of disease. Potential treatments include anticoagulation, low-dose systemic thrombolysis, surgical embolectomy, or catheter-directed embolectomy.
Abstract Arteriovenous (AV) fistulas are rare vascular anomalies that can cause high-output cardiac failure due to significant AV shunting. We report a case of a middle-aged patient presenting with progressive heart failure and abdominal pain. The patient was initially suspected of having hydronephrosis on grayscale US. However, color Doppler imaging subsequently revealed extensive vascular flow within the renal pelvis, excluding obstruction. CTA confirmed a large AV fistula between the right renal artery and right renal vein, with marked dilation of the renal vasculature and inferior vena cava. This case highlights the importance of Doppler imaging in avoiding misdiagnosis and demonstrates the role of CTA in characterizing renal vascular pathology. Early recognition of renal AV fistulas is critical given their potential for severe hemodynamic consequences.
Abstract Talar dome osteochondritis dissecans is typically a traumatic rotational injury that is primarily found on the medial aspect of the talus. Those at the highest risk are teens aged 12-19, females, and those of non-Hispanic white descent. Conservative approaches, such as a cast and immobilization, are first attempted. However, if symptoms persist, surgical approaches are considered. The most successful surgical technique used for osteochondral lesion of the talar dome therapy is fixation.
Abstract Congenital chylothorax should be considered in neonates with symptoms and imaging consistent with pleural effusion, but analysis of the pleural effusion is necessary to confirm chylothorax. Lymphangiogram can identify a leak or highlight a structural lymphatic anomaly and is useful in guiding therapy. However, this case adds to the recent evidence in the literature that lymphangiography alone can resolve a lymphatic leak. Further research should be done on the efficacy of therapeutic lymphangiography to further elucidate its role in congenital chylothorax management.
