In recent years, the use of elastography in addition to sonography has become a routine clinical tool for the characterization of breast masses. Studies have investigated the improvement of specificity in differentiating benign from malignant breast masses. Therefore, additional use of elastography could help reduce the number of unnecessary biopsies in benign breast lesions especially in category IV lesions of the ultrasound breast imaging reporting data system. Ultrasound elastography is a cheap, readily available, useful, quick, noninvasive method, but it needs specific training as well as acknowledging technical and pathological factors, which may influence it. Both strain and acoustic radiation force impulse (ARFI) methods have been evaluated in breast lesions. Whereas strain elastography results in qualitative imaging of tissue stiffness due to induced compression, ARFI elastography displays quantitative and qualitative information of tissue displacement. A standardized imaging protocol is essential for an adequate and effective examination, also helping reduce the dependence from operators. Furthermore, knowledge of pitfalls that can be encountered when ultrasound elastography is performed may help avoid erroneous image interpretation. In this article, we describe a practical examination protocol for both strain and ARFI elastography and demonstrate the elastographic imaging findings in benign and malignant breast lesions. Short video clips displaying the technique are included as supplementary material.

Lymphomas constitute approximately 0.15% of malignant mammary neoplasms. Less than 0.5% of all malignant lymphomas involve the breast primarily. Primary non-Hodgkin breast lymphoma is usually right sided. The combined therapy approach, with chemotherapy and radiotherapy, is the most successful treatment. Mastectomy offers no benefit in the treatment of primary non-Hodgkin breast lymphoma. To the author's knowledge, this is the first published case of primary non-Hodgkin breast lymphoma reported with conventional ultrasonography, elastography (both freehand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 45-year-old woman presented with a lump in the right breast for 2 months. There was no evidence of systemic lymphoma or leukemia when the breast lesion was detected. Imaging findings were negative for lymphoma. Ipsilateral lymph nodes were not palpable. The mass was resected, and histopathology findings were diagnostic of non-Hodgkin lymphoma. Immunohistochemistry was confirmatory of non-Hodgkin lymphoma, diffuse large cell type of B-cell lineage. Although primary and secondary lymphomas of the breast are rare entities, they should be considered in the differential diagnosis of breast malignancies.

Breast adenomyoepithelioma is considered as an uncommon breast tumor. It is evaluated as a variant of intraductal papilloma. The treatment of choice is local resection with free margins. It is the first case of breast adenomyoepithelioma reported with conventional ultrasonography, elastography (both free-hand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 35-year-old white woman presented with a painless lump of the left breast. Treatment was local resection with free margins. There has been no recurrence for 6 months. Although breast adenomyoepithelioma is an uncommon breast tumor, its awareness is imperative because the differential diagnosis from other breast tumors is quite extensive.

Breast adenomyoepithelioma is considered as an uncommon breast tumor. It is evaluated as a variant of intraductal papilloma. The treatment of choice is local resection with free margins. It is the first case of breast adenomyoepithelioma reported with conventional ultrasonography, elastography (both free-hand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 35-year-old white woman presented with a painless lump of the left breast. Treatment was local resection with free margins. There has been no recurrence for 6 months. Although breast adenomyoepithelioma is an uncommon breast tumor, its awareness is imperative because the differential diagnosis from other breast tumors is quite extensive.

Lymphomas constitute approximately 0.15% of malignant mammary neoplasms. Less than 0.5% of all malignant lymphomas involve the breast primarily. Primary non-Hodgkin breast lymphoma is usually right sided. The combined therapy approach, with chemotherapy and radiotherapy, is the most successful treatment. Mastectomy offers no benefit in the treatment of primary non-Hodgkin breast lymphoma. To the author's knowledge, this is the first published case of primary non-Hodgkin breast lymphoma reported with conventional ultrasonography, elastography (both freehand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 45-year-old woman presented with a lump in the right breast for 2 months. There was no evidence of systemic lymphoma or leukemia when the breast lesion was detected. Imaging findings were negative for lymphoma. Ipsilateral lymph nodes were not palpable. The mass was resected, and histopathology findings were diagnostic of non-Hodgkin lymphoma. Immunohistochemistry was confirmatory of non-Hodgkin lymphoma, diffuse large cell type of B-cell lineage. Although primary and secondary lymphomas of the breast are rare entities, they should be considered in the differential diagnosis of breast malignancies.

BACKGROUND:Hughes-Stovin syndrome is a rare entity. The aetiology of Hughes-Stovin syndrome is still unknown and the natural course of the illness is usually fatal; however it is supposed to be a clinical variant manifestation of Behçet disease.CASE PRESENTATION:We report the case of an 18 years old, greek male patient with Hughes-Stovin syndrome, who initially presented with deep vein thrombosis. There were no findings consistent with Behçet disease and the haemoptysis was treated successfully with methylprednisolone. Pathogenesis, imaging investigation and treatment of this syndrome are also briefly discussed.CONCLUSION:In young men presenting with venous thrombosis as revealed on imaging examination, with platelet count and coagulation tests within normal and hemoptysis the eventuality of Hughes-Stovin syndrome is to be considered.

Hysterosalpingography (HSG) remains an important radiologic procedure in the investigation of infertility and has become a commonly performed examination due to recent advances of reproductive medicine. HSG demonstrates the morphology of the uterine cavity, the lumina, and the patency of the fallopian tubes. In this review article, we present the technical parameters of the examination, indications, contraindications, and possible complications of HSG. We also illustrate a variety of abnormalities of the uterus and fallopian tubes that can be detected accurately with HSG. We believe that, with the increased demand for HSG, radiologists should be familiar with HSG technique and the interpretation of HSG images.

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non-Hodgkin's lymphoma of the esophagus in a 77-year-old man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.

Lower extremity's venous pathology was traditionally investigated by intravenous venography. Nowadays Color Doppler flow imaging is widely accepted as a well established, noninvasive method for the evaluation of deep pelvic and lower extremity's venous system. The vast majority of authors conclude that the method can safely replace diagnostic venography in all patients with venous thrombosis, thrombophlebitis and valve or communicating veins insuffciency. Optimal performance of Color Doppler flow imaging as a diagnostic tool for the whole lower limb veins requires: Proper equipment specifications and settings. Knowledge of regional venous anatomy. Established examination protocols. Evaluation of morphological and functional findings. Documentation of the findings. All these steps are described as a sequence of guidelines, photographs and multiple ultrasonographic images. Our paper can be useful to all physicians or sonographers involved with color Doppler studies for the evaluation of lower limb venous diseases and abnormalities.

Acute lower gastrointestinal bleeding, is often a dramatic situation, associated with mortality rate up to 28%. Currently transcatheter alternatives have found their place in the therapeutic spectrum of this situation. An interesting question is when should this procedure be performed and which are the difficulties when performing it. We present the case of a 75-year old woman with acute massive lower gastrointestinal bleeding on the tenth post-operative day of a colic and partial ileal resection. Superselective angiography of the superior mesenteric artery was obtained that disclosed marked contrast extravasation of distal branches of the left colic artery as well as from a small branch feeding the distal enteric anastomoses. Clinical success was achieved after superselective embolization which was accomplished by using polyvinyl alcohol particles. The patient was discharged 5 days later and there were no procedure-related complications during 6-month follow-up period. So, especially in post-operative patients who are considered to be poor candidates for surgical treatment, arterial embolotherapy should be established not only as treatment option, but also as first line therapy for LGI bleeding.

Appendicitis is the most common abdominal emergency occurring in 7%-12% of the population. The aim of this article was to pictorially present the spectrum of appendix and acute appendicitis appearances on computed tomography (CT). The various appearances on CT of the normal appendix are shown as well as the CT criteria for the differentiation of perforated and non-perforated appendicitis.

Pancreas divisum is a common congenital abnormality of the pancreas that results from the lack of fusion between the dorsal and ventral pancreatic ducts during foetal development. In these cases, the dorsal duct becomes the main pancreatic duct and drains most of the pancreas. Pancreas divisum is mainly asymptomatic, but the prevalence of pancreas divisum is higher in patients with chronic abdominal pain and idiopathic pancreatitis. A study of 20 patients with pancreas divisum (12 men and eight women; aged 19-77 years; mean age 39 years) and who underwent magnetic resonance cholangiopancreatography (MRCP), was performed. In our series, pancreas divisum was clinically manifested as unexplained episodes of abdominal pain (mean duration 3.2 years) (60 percent), mild pancreatitis (30 percent) or incidentally (ten percent). MRCP demonstrated non-communicating dorsal and ventral ducts, independent drainage sites, a dominant dorsal pancreatic duct, and a small cystic dilatation of the dorsal duct at minor papilla (santorinocoele). In this pictorial essay, we review the most common MRCP features of pancreas divisum.

* Department of Radiology; “Hippocration” General Hospital, Athens; **First Regional Transfusion and Haemophilia Centre, “Hippocration” General Hospital, Athens; ***Department of Radiology, “Alexandras” General Hospital, Athens; ****Department of Radiology, “IASO” General Hospital, Athens; *****Department of Familiar Medicine, “Saint Panteleimon” General State Hospital of Nikaia Piraeus, Greece.

In the past few years the popularity of e-learning as a new educational method has increased considerably, allowing the implementation of new strategies and methods of teaching and learning. The decreased cost of computers and software, the increased use of computers, the spread of use of the internet, the progress of technology in general, time pressures and finally the conviction of teachers and instructors that education with the help of the computer is as effective as other conventional or traditional forms of instruction are the main reasons of this popularity. Education of this type supports the process of learning with the incorporation of images, diagrams, forms, video and sound, designed in multimedia modules, thus enhancing interaction between the teacher and the student. Computer based education constitutes a successful educational tool that involves the students as active participating members in the process of learning. Specially developed and completed training units of educational models of different content could have a much wider use in the continuing education of younger doctors and could be used for brief educational programs of knowledge revision for senior doctors. They could also be included in university pre- and postgraduate programs. This paper, apart from presenting the basic terms that specify the significance of electronic learning, also describes an actual project applying a distance-learning model of education targeted at radiologists and radiation technologists, concerning an instructional package on the physics of magnetic resonance imaging.