Many patients presenting with extrapulmonary tuberculosis (TB) have urogenital TB. Urogenital TB can easily be overlooked owing to non-specific symptoms, chronic and cryptic or protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Although the definitive diagnosis of urogenital TB is established by culturing Mycobacterium tuberculosis or by DNA identification, the diagnosis is often difficult and delayed. Abnormal abdominal or chest radiographs are useful as the initial diagnostic investigation in a large proportion of infected patients. Intravenous urography and hysterosalpingography, the standard imaging modalities for the evaluation of urogenital TB in the past, are infrequently used nowadays in the era of cross-sectional imaging. Computed tomography, magnetic resonance imaging, and ultrasound imaging are useful, depending on which urogenital organs are investigated. Imaging features of TB affecting the adrenal gland and breast are also addressed. Awareness of the imaging findings enables the radiologist to raise the diagnostic suspicion in a timely manner, for initiation of prompt treatment and prevention of complications. Imaging can aid in localizing the site, extent, and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring the response to treatment.

Objective: To review the clinical presentation and imaging features of testicular lymphoma.Methods: We retrospectively reviewed the clinical data, and grey-scale and colour Doppler ultrasound features of 11 patients with proven testicular lymphoma between January 2000 and September 2013. The patients were aged 35 to 84 years (mean, 59 years). The diagnosis was established by orchidectomy in eight patients, by compelling evidence including bone marrow and lymph node biopsy in two, and autopsy in one.Results: Of the 11 patients, seven presented with painless scrotal mass(es), three presented with an afebrile painful scrotal mass, and one presented with a febrile painful scrotal mass. Disease was unilateral in nine patients and bilateral in two. Primary testicular lymphoma was diagnosed in six patients and secondary testicular lymphoma in five, of which nine were non-Hodgkin's lymphoma with diffuse large B-cell lymphoma (DLBCL) and two were T-cell lymphoma. Ultrasonography revealed diffuse hypoechoic involvement in seven patients, a solitary hypoechoic mass in two patients, and bilateral multiple hypoechoic masses in two patients. All lesions showed hypervascularity. Enlarged epididymis with hypervascularity was present in two patients mimicking epididymoorchitis.Conclusion: Testicular lymphoma is predominantly DLBCL. Patients may present with painless or painful scrotal mass(es). Lymphoma should be considered in a man older than 50 years who presents with testicular mass regardless of pain with focal or diffuse hypervascular hypoechoic testicular lesion(s) on ultrasound. The associated hypervascular enlarged epididymis does not exclude the diagnosis of testicular lymphoma.

Tumours or disorders affecting the breasts in pregnant or lactating women are usually similar to those occurring in non-pregnant women, but some lesions are unique to pregnancy and lactation such as lactating adenomas and galactoceles. During pregnancy and lactation, breasts change due to increasing hormone levels, which may make breast evaluation difficult. It is crucial to differentiate malignancy from benign breast lesions for proper management. Therefore, the appropriate investigation of breast complaints, and knowledge of breast disorders and their imaging spectrum during pregnancy and lactation are essential to provide the correct diagnosis.

In musculoskeletal infections, imaging helps in the diagnosis and identification of disease extent. Musculoskeletal infections have variable clinical presentations related to host immune responses and virulence of pathogens. Occasionally, infectious process may mimic other entities such as autoimmune inflammatory diseases, tumors, or traumatic injuries, both clinically and radiologically. Identification of the disease extent is sometimes difficult, particularly when infection occurs in the damaged tissue. The key imaging feature of infection is formation of abscesses. Familiarity of the imaging patterns of the infectious process leads to correct diagnosis and appropriate treatment.

A 33-year-old man presented with a painless, non-growing left testicular mass for five years. Preoperative ultrasonography (US) of the scrotum showed a small, circumscribed calcific mass in the right testis and another well-defined heterogeneous echoic mass with a partially calcified wall in the left testis, with avascularity on colour Doppler US. These imaging findings in a clinical setting of non-growing testicular masses were highly suggestive of epidermoid cysts, thus leading to testis sparing surgery. Histopathology confirmed bilateral epidermoid cysts. To the best of our knowledge, only 15 cases of bilateral epidermoid cysts have been reported. We discuss the US features of epidermoid cyst and its surgical management, as well as various cases of testicular masses.

A 33-year-old man presented with a painless, non-growing left testicular mass for five years. Preoperative ultrasonography (US) of the scrotum showed a small, circumscribed calcific mass in the right testis and another well-defined heterogeneous echoic mass with a partially calcified wall in the left testis, with avascularity on colour Doppler US. These imaging findings in a clinical setting of non-growing testicular masses were highly suggestive of epidermoid cysts, thus leading to testis sparing surgery. Histopathology confirmed bilateral epidermoid cysts. To the best of our knowledge, only 15 cases of bilateral epidermoid cysts have been reported. We discuss the US features of epidermoid cyst and its surgical management, as well as various cases of testicular masses.

Cholcscintigraphy by Tc 99 m-IDA derivatives and pin hole collimator with analog motion correction was presented. This technique could visualize shape and patterns of normal gallbladder and gallbladder diseases e.g. gall stone, carcinoma of gallbladder. Thc sensitivity for gall stones is 63.16 % and for carcinoma of gallbladder is 100 %. Its specificity is 93.06 %. The advantages and disadvantages of this technique were discussed. Cholescintigraphy by Tc 99 m-IDA derivatives and pin hole collimator with analog motion correction is useful for diagnosis of gall stones or gallbladder tumors in the patients whose gallbladder is not visualized by ultrasonography or oral cholecystography.

Purpose To determine the role of mammography and ultrasonography (US) in the early detection of bilateral breast cancer and ascertain its clinical, imaging, and pathologic features. Materials and methods The pathologic and breast imaging records were searched from Maharaj Nakorn Chiang Mai Hospital between January 2009 and December 2011 to identify patients diagnosed with bilateral breast cancer. The clinical features, method of diagnosis, time interval between development of the fi rst and second breast cancer, histologic type, staging of the tumor, mammography, and US findings of patients diagnosed bilateral breast cancer were analyzed. Results Seven hundred and seventy one patients were pathologically diagnosed breast cancer. Of these, 20 (2.6%) had bilateral breast carcinoma. However, only 19 patients aged 35-76 years (mean, 56.6 years) had imaging studies that constituted the basis of this study. Among them, seven had synchronous and 12 metachronous bilateral breast cancer. The interval to detection of the second cancer ranged from 17 to 324 months (mean, 111.7 months). Of the seven patients with synchronous cancer, five contralateral cancers were presented with a palpable mass detected from physical examination, mammography and US, with one cancer detected by both mammography and US, and the other by US alone. Of the 12 patients with metachronous carcinoma, one had pathologically proved multicentric contralateral breast cancer. Thus, there were 13 contralateral cancers in this group. Of the 12 patients with metachronous cancer, six presented with a palpable mass and six came to the hospital for mammographic screening. Six of the 13 cases of contralateral cancers were detected by physical examination, mammography and US, six by both mammography and US, and one by US alone. Pathologic findings of the lesions were ductal carcinoma in situ in 4, invasive ductal carcinoma in 14, invasive papillary carcinoma in 1 and invasive lobular carcinoma in 1. Stages of tumors in asymptomatic patients were stage 0 in 3, stage I in 4 and stage III in 1, and in patients with a palpable mass; stage I in 4, stage II in 4 and stage III in 3. Conclusion Contralateral breast cancers in bilateral breast cancer detected by mammography and US were less advanced than those found by physical examination.

A benign substermal thyroid goiter which represented an unusual cause of superior vena caval obstruction in a 72 year old female patient was reported.The condition was documented bt a simple and safe radionuclide superior vena cavography.

OBJECTIVE:To document the types of congenital renal anomalies detected in adulthood, the clinical presentation and complications of these renal anomalies, and the most useful imaging modality in detecting a renal anomaly. MATERIALS AND METHODS:This study was approved by the institutional review board and informed consent was waived. Between January 2007 and January 2011, the clinical data and imaging studies of 28 patients older than 18 years diagnosed with renal anomaly at the authors' institution were retrospectively reviewed. Renal anomalies in this study included only those with abnormality in position and in form. RESULTS:Of these 28 patients, 22 underwent imaging studies and their results constituted the material of this study. Of the 22 patients, 14 had horseshoe kidneys (HSK), four had crossed renal ectopia and four had malrotation. Sixteen patients were men and six were women. The patients ranged in age from 19 to 74 years (mean age 51.1 years). Clinical presentations were abdominal pain (13), fever (13), haematuria (4), palpable mass (2), asymptomatic (2), polyuria (1) dysuria (1), blurred vision (1), and headache with weakness of left extremities (1). Imaging studies included abdominal radiograph (15), intravenous pyelography (IVP) (8), retrograde pyelography (RP) (4), ultrasonography (US) (7), and computed tomography (CT) (9). Associated complications included urinary tract stones (17), urinary tract infection (16), hydronephrosis (12), and tumours (2). Abdominal radiograph suggested renal anomalies in nine out of 15 studies. IVP, RP, US and CT suggested anomalies in all patients who had these studies performed. However, CT was the best imaging modality to evaluate anatomy, function and complications of patients with renal anomalies. CONCLUSION:HSK was the most common renal anomaly, with abdominal pain and fever being the most common presentations. UTI and stones were the most common complications. IVP, RP, US and CT can be used to diagnose renal anomalies but CT is the best imaging modality to evaluate renal anatomy, function and its complications.

A 55-year-old man presented with a painless right scrotal mass for the past three months. Scrotal ultrasonography showed a large circumscribed hypoechoic mass with marked hypervascularity occupying almost the entire right testis. The epididymis and scrotal skin were normal. Right radical orchiectomy was performed. Histopathology revealed lymphoma, diffuse large B-cell type confined within the tunica albuginea. The patient made a good postoperative recovery. No evidence of lymphoma in other organs was demonstrated. We discuss the differential diagnosis of ultrasonographic intratesticular masses and highlight various cases of intratesticular

A 55-year-old man presented with a painless right scrotal mass for the past three months. Scrotal ultrasonography showed a large circumscribed hypoechoic mass with marked hypervascularity occupying almost the entire right testis. The epididymis and scrotal skin were normal. Right radical orchiectomy was performed. Histopathology revealed lymphoma, diffuse large B-cell type confined within the tunica albuginea. The patient made a good postoperative recovery. No evidence of lymphoma in other organs was demonstrated. We discuss the differential diagnosis of ultrasonographic intratesticular masses and highlight various cases of intratesticular lesions in this article.

OBJECTIVES:To determine the clinical, imaging and pathological findings of Paget's disease of the breast.MATERIALS AND METHODS:Approval by Institutional Review Board was granted and informed consent was waived. Retrospective review of the pathological diagnosis of 2,361 women with breast carcinoma between January 2004 and April 2010 revealed 27 patients with Paget's disease of the breast. The clinical, mammographic and ultrasonographic images were retrospectively reviewed.RESULTS:The prevalence of Paget's disease of the breast was 1.14% of all breast carcinoma at this institution. Of the 27 patients with Paget's disease, only 16 had imaging studies and this group constituted the basis of this study. All 16 patients were women, with ages ranging from 36-68 years (mean age 50.31 years). Eleven patients presented with clinical findings suggestive of Paget's disease of the breast. Seven of these 11 patients also had associated palpable mass(es). Four patients presented with a palpable mass alone and one presented with bloody nipple discharge alone. Mammography was performed in all 16 patients and ultrasonography (US) in 15 patients. Of the 16 mammographic studies, two were negative. Of the 15 US studies, three were negative. Of these three negative US studies, two also had negative mammography and one had pleomorphic microcalcifications on mammogram. US was helpful in detecting multifocality in two patients. Mammography was 100% positive in patients who presented with palpable breast mass(es) and bloody nipple discharge, but 50% positive in patients who had clinically suggestive Paget's disease alone. Almost all patients (15/16) had underlying breast malignancies. Seven patients had multifocality or multicentricity. Modified radical mastectomy was performed in 13 patients, simple mastectomy in two, and wide local excision in one patient. Pathological findings were ductal carcinoma in situ (DCIS) (n = 3), invasive ductal carcinoma (IDC) (n = 10), metaplastic carcinoma (n = 1), invasive lobular carcinoma (ILC) (n = 1), and only Paget's disease of the nipple without underlying breast carcinoma (n = 1).CONCLUSION:Patients with Paget's disease of the breast have a high incidence of an underlying breast carcinoma. Most of the patients in this study presented late and were more likely to have positive mammograms. Mammography should be performed to identify the underlying breast carcinoma. Those who have only nipple areolar changes and no palpable mass have less positive mammography and less invasive carcinoma.

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed.

A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed. Histopathology revealed papillary cell carcinoma confined to the kidney. The patient made good postoperative recovery. The Bosniak classification system of renal cystic lesions and cystic renal cell carcinoma are discussed. Various cases of renal cystic lesions and cystic renal cell carcinoma are shown.

A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed. Histopathology revealed papillary cell carcinoma confined to the kidney. The patient made good postoperative recovery. The Bosniak classification system of renal cystic lesions and cystic renal cell carcinoma are discussed. Various cases of renal cystic lesions and cystic renal cell carcinoma are shown.