ABSTRACT
Background: This study was performed to prospectively investigate the diagnostic reliability of the daily use of ACR-TIRADS classification system, in differentiating between a benign and a malignant lesion.Methods: In this prospective observational study, 50 patients with thyroid nodules underwent ultrasound examination and fine needle aspiration. The ultrasound studies were evaluated according to the ACR-TIRADS greyscale characteristics of composition, echogenicity, margins, shape, and echogenic foci. Each feature in a particular USG characteristic was scored and ACR-TIRADS categorization done from 1 to 5. This was compared to FNAC/histopathology findings and risk of malignancy was calculated for each feature and ACR-TIRADS category.Results: Of the 50 nodules included in the study, 38 were found to be benign and 12 were found to be malignant. Risk of malignancy for all ultrasound features showed an increasing trend with higher scored feature. Risk of malignancy for various features were as follows: Composition-cystic (0%), spongiform (0%), solid-cystic (0%) and solid (36%); echogenicity-anechoic(0%), hyperechoic (4%), isoechoic (11%), hypoechoic (47%) and markedly hypoechoic (100%); shape-wider-than-tall (21%) and taller-than-wide (66%); margins-smooth (18%), illdefined (0%), lobulated/irregular (38%) and extrathyroid extension (100%); echogenic foci-none (13%), large comet-tail artefacts (0%), macrocalcification (42%), rim calcification (50%) and punctate echogenic foci (50%). Amongst ACR-TIRADS(TR) categories TR1, TR2 and TR3 had 0% risk while TR4 had 30% and TR5 had 56% risk of malignancy with p value of 0.001.Conclusions: ACR-TIRADS is a high specific, accurate classification system for categorizing the thyroid nodules based on ultrasound features, for assessing the risk of malignancy.
ABSTRACT
Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by presence of widespread intraalveolar accumulation of innumerable minute calculi called microliths. It is caused by inactivating mutations in the gene “solute carrier family 34 member 2”, encoding a sodium-dependent phosphate co-transporter (SLC34A2) expressed primarily in alveolar epithelial type II cells. It is most frequently diagnosed from birth to 40 years of age with a mean age of 27-30 years at the time of diagnosis. Most of patients are asymptomatic or having mild symptoms and are usually diagnosed incidentally. Chest radiograph and high-resolution CT of thorax are nearly pathognomonic for diagnosing PAM and histopathological confirmation is required only in few cases. This disease has slow progressive course ultimately leading to death by causing pulmonary fibrosis and cor pulmonale. Currently, there is no medical or gene therapy capable of reducing disease progression. Lung transplantation remains the only possible treatment for end-stage disease. Herein,we report a case of PAM in a 60-year-old gentleman who presented with a 5-year history of shortness of breath on exertion and intermittent cough with expectoration. His sister had similar respiratory symptoms and died 10 years back of which no details are available. The rarity of this disease and late age of presentation prompted us to report this case.