Spectrum of Various Male Breast Lesions: Pictorial Review with Radiologic-Pathologic Correlation

Most men referred for breast imaging have palpable lumps. Most lesions that are evaluated are benign, and malignancy is less common. Although there are characteristic imaging features of malignancy, substantial overlap is presented between benign and malignancy. Therefore, other imaging modalities are increasingly being used for accurate evaluation. We report on various male breast lesions using ultrasonography, mammography, computed tomography, and positron emission tomography-computed tomography. Pathognomonic histologic findings of each case are also provided.

Pathologically Proven Hyperechoic Masses of the Breast on Ultrasound: Differentiation of Malignant and Benign Lesions

OBJECTIVE: The aim of this study was to evaluate the frequency of the characteristic sonographic findings of the pathologically confirmed hyperechoic masses on breast ultrasonography, and clinical and sonographic findings in differentiating the malignant from benign hyperechoic masses. METHODS: One hundred and ninety hyperechoic masses on breast ultrasonogram of which were pathologically confirmed were retrospectively analyzed. The clinical features were reviewed according to patient's age, size of mass, and palpability. The sonographic features were reviewed according to the Breast Imaging Reporting and Data System 4th lexicon: margin, orientation, shaped, and posterior acoustic features. The sonographic features of the benign and malignant masses were statistically analyzed using the chi-square test, the Fisher's exact test, and t-test. RESULTS: The benign masses were 42 cases (79.2%) and the malignant masses were 11 cases (20.8%). Patient age, size of mass, palpability were not significant difference between malignant and benign masses (P=0.684, P=0.377, P=0.746). Mixed hyperechoic, noncircumscribed margin, irregular shape, nonparallel orientation were significantly different for malignant and benign masses (P<0.001, P=0.01, P=0.003, P=0.025). But posterior acoustic features were not statistically different for malignant and benign masses. CONCLUSION: Malignant masses with hyperechogenicity were more likely than benign masses to have mixed hyperechoic, noncircumscribed margin, irregular shape, nonparallel orientation. Therefore, pathologically confirm should be performed hyperechoic masses with suspicious findings.

Angiolipoma of the Breast: A Case Report / 한국유방암학회지

An angiolipoma is a common mixed connective tissue tumor that commonly occurs in the trunk and extremities, and has been rarely reported in the breast. It is a benign variant of a lipoma that shows various appearances on mammography. It is usually seen with a well circumscribed homogeneously hyperechoic pattern on ultrasound. We report a rare case of an angiolipoma of the breast with no definite abnormality on mammography, appearing as an irregular homogeneously hyperechoic lesion on ultrasound.

Imaging Findings of Wirsungocele: A Report of Two Cases

Wirsungocele is defined as a cystic dilatation of the terminal portion of the main pancreatic duct, and this is an extremely rare malady. The pathophysiology of Wirsungocele has been proposed that a congenital or acquired weakness in the distal duct that's associated with functional obstruction may lead to the formation of Wirsungocele. In addition, mechanical obstruction of the distal duct has been considered as another mechanism of Wirsungocele. We report here on the imaging findings of two cases of Wirsungocele that seemed to occur by different pathophysiologic mechanisms.

Nontraumatic Subperiosteal Orbital Hematoma Associated with Ethmoid Sinusitis: A Case Report

Subperiosteal hematoma of the orbit is a rare disease and most of the cases occur in young adult males as a result of direct facial or orbital trauma. In the absence of direct facial or orbital trauma, nontranmatic subperiosteal orbital hematoma has rarely been reported in association with a sudden elevation of cranial venous pressure or venous congestion, systemic diseases associated with a bleeding diathesis and paranasal sinusitis. We report here on a rare case of subperiosteal orbital hematoma associated with ethmoid sinusitis, as was seen on CT imaging.

Cervical Thoracic Duct Cyst: A Case Report

Thoracic duct cysts are uncommon lesions that most commonly occur in the abdominal and thoracic portion of the thoracic duct: the cervical portion is the rarest location. The main causes of thoracic duct cyst are surgical injuries such as neck dissection and blunt trauma. We report here on a rare case of spontaneous cervical thoracic duct cyst that was noted on ultrasonography and CT. The thoracic duct cyst was confirmed by fine needle aspiration and it was treated by sclerotherapy.

The Usefulness of the Transabdominal Ultrasonography as a Screening Examination in the Evaluation of the Patient with Suspicious Gastric Disease

PURPOSE: To evaluate the usefulness of transabdominal ultrasonography as a screening examination in patients with suspicious gastric disease. MATERIALS AND METHODS: We selected 141 patients with epigastric pain and who were found to have antral gastric wall thickening of more than 5 mm in transabdominal ultrasonography, and who underwent gastroscopy immediately following the ultrasonography examination, because we suspected that these patients had gastric disease. We measured the full thickness of the five layers of the gastric wall and evaluated the preservation of this fivelayered structure. We respectively compared the gastric wall thickness and the preservation of gastric layers in 26 normal, 91 gastritis, 12 gastric ulcer, and 12 gastric cancer patients, who were classified based on the gastroscopy results. RESULTS: The mean thicknesses of the gastric wall in the normal, gastritis, gastric ulcer and gastric cancer patients were 5.13+/-0.14 mm, 6.71+/-1.33 mm, 8.08+/-2.80 mm, and 12.45+/-3.70 mm, respectively. The gastric walls in the gastritis, gastric ulcer and gastric cancer patients were significantly thicker than that in the normal patients (p 0.01). Except for two patients with gastritis and three patients with gastric ulcer, the stratification of the gastric wall was preserved in all of the normal, gastritis and gastric ulcer patients, whereas it was disrupted in all of the patients with gastric cancer. CONCLUSION: Transabdominal ultrasonography in the fasting state may be a helpful and convenient modality, which can serve as a screening examination in the evaluation of gastric disease. Therefore, careful attention and effort are needed to evaluate the gastric wall during transabdominal ultrasonography.

A Case of Hungry Bone Syndrome after Parathyroidectomy in Patient with Tertiary Hyperparathyroidism and Hemodialysis Patient / 대한내분비외과학회지

Hyperparathyroidism is a common finding in patients with chronic renal failure. Among the hyperparathyroidism, tertiary hyperparathyroidism, which is secreting parathyroid hormone autonomously in spite of hypercalcemia. Sometimes it requires surgical intervention due to not only symptomatic hypercalcemia, but also longstanding asymptomatic hypercalcemia. Hungry bone syndrome was known to be developed due to extensive re-mineralization of skeleton after parathyroidectomy. It is characteristic of persistent hypocalcemia, hypophosphatemia and often with tetany. The patient's condition improved without complication after the calcium chloride and calcium carbonate administration. We report a case of hungry bone syndrome developed after parathyroidectomy in patient with tertiary hyperparathyroidism and chronic renal failure.

Incidental Finding of a Precaval Right Renal Artery on CT: A Case Report

The right renal artery passing anterior to the inferior vena cava is a rare variant of the normal renal arterial anatomy, and identifying this anomaly is important for the planning of minimally invasive renal surgery. The presence of this precaval right renal artery was detected on the contrast-enhanced CT scan by identifying the right renal artery passing anterior to the inferior vena cava. We report here on a case of a precaval right renal artery as a main supplying artery, and this was incidentally found on CT.

Atypical Hepatic Hemangiomas with Multiple Calcifications Mimicking Hepatic Metastases: Case Report

Although hepatic hemangioma is the most common benign tumor of the liver, it is rarely associated with calcifications. We report on the case of an asymptomatic 58-year-old man in whom multiple hepatic masses containing calcifications were discovered incidentally at ultrasonography. The radiologic features mimicked those of multiple hepatic metastases.

Radiologic Findings and Follow-Up Evaluation

In esophageal perforation, fistulous tracts commonly occur between the esophagus and mediastinal or pleural spaces, but rarely between the esophagus and bronchi. The clinical manifestations and radiologic findings of esophageal perforation are nonspecific, and diagnosis is the often delayed; esophagography is the standard technique for evaluation of its location and degree. CT is useful in demonstrating the extraluminal manifestations of esophageal perforation and for follow-up after medical treatment, and may depict the various manifestations of perforation, according to the causes.

A Case of Malignant Melanoma Presenting as a Breast Mass / 한국유방암학회지

Malignant melanomas arising in the skin, buccal mucous membranes. and retina are encountered frequently. A malignant melanoma characteristically disseminates widely but infrequently metastasizes to the breast, and primary melanoma of the breast is even rarer. Primary melanomas can arise in the glandular tissue of the breast. We report a case of malignant melanoma either primary in the breast or metastatic from an unknown primary that presented initially as a left breast mass without a detectable cutaneous lesion.

CT Findings of Congenital Transmesenteric Hernia: Case Report

Transmesenteric hernia occurs usually in adult patients who had history of an abdominal surgery or blunt abdominal trauma. Congenital mesenteric defect is a relatively common cause of internal hernia in children. However, the report of CT findings of congenital transmesenteric hernia is relatively rare. Thus, we report a case of congenital transmesenteric hernia occurring in a 13-year-old girl with intestinal obstructive symptoms, and include the CT findings.

Peliosis Hepatis Mimicking Single Hepatic Mass: A Case Report

Peliosis hepatis is a rare disease characterized by cystic hepatic sinusoidal dilatation and the presence of multiple blood-filled spaces in the hepatic parenchyma. In most cases, multiple lesions and individual cysts not exceeding 1cm in diameter occur. We report a case in which the condition occurred in a 33-year-old woman who presented with general weakness and in whom a 3.5 cm-sized single hepatic mass was discovered incidentally at ultrasonography. The radiologic features mimicked those of a signle hepatic mass.

Follow-up HRCT Findings of Ground-Glass Attenuation in Usual Interstitial Pneumonia

PURPOSE: To evaluate changes in lesions, as shown by follow-up high-resolution CT (HRCT) in patients withusual interstitial pneumonia (UIP), and the significance of ground-glass attenuation. MATERIALS AND METHODS: HRCTfindings in 23 patients with UIP were retrospectively reviewed. We quantitatively analysed the pattern and extentof lesions, as seen on HRCT, initially and during the most recent follow-up. We also compared pattern changesbetween group I (n=12; less than 25% of the initial extent of GGA) and group II (n=11, more than 26% of thisinitial extent). RESULTS: Initial HRCT findings included GGA and irregular linear density in all patients,honeycombing in 21 (91%), and consolidation in two patients (9%). During the most recent follow-up, HRCT showedthat the extent of GGA had decreased (p0.05). CONCLUSION: The greater extent of GGA, as seen on HRCT, of a patient with UIP shows much less fibrosison follow-up HRCT. In UIP, evaluation of the extent of GGA, as seen on initial HRCT, is a helpful indicator ofprognosis.

Radiologic Findings of Malignant Retroperitoneal Fibrosis

PURPOSE: To evaluate the radioloic findings of malignant retroperitoneal fibrosis. MATERIALS AND METHODS: Post-contrast CT (n=9) and urographic (n=7) findings of nine patients with malignant retroperitoneal fibrosis were retrospectively analyzed. Primary tumors were found to be advanced gastric cancer (n=6), early gastric cancer (n=1), breast cancer (n=1), and cervical cancer (n=1). We analyzed CT findings with regard to the site of soft tissue lesion, ureteral involvement, the presence or absence of hydronephrosis, and distant metastasis. The level and length of ureteral involvement, presence or abscence of ureteral stenosis, and ureteral displacement as seen on urography, were analyzed. RESULTS: On CT scans, enhanced soft tissue lesions (mass, 5 cases; plaque, 4 cases) encircling the abdominal aorta and IVC were noted in all cases. Thickening of the ureteral wall (n=8), hydronephrosis (n=9), and enlarged lymph node (n=5) were also seen. On urography, irregular stenosis and medial displacement of ureters from level L2 to S2 were noted in all cases. The length of ureteral involvement was 4-6.5cm. CONCLUSION: The common CT findings of malignant retroperitoneal fibrosis were enhanced soft tissue lesion encircling the abdominal aorta and IVC, hydronephrosis, and thickening of the ureteral wall. On urography, ureteral stenosis and medial displacement were seen.

CT Finding of Transfusional Hemosiderosis in Patients with Chronic Renal Failure: Clinical Correlation

PURPOSE: To evaluate whether there is any correlation between the CT features of hemosiderosis and clinical findings in patients with chronic renal failure who have received multiple blood transfusions. MATERIALS AND METHODS: Among chronic renal failure patients who had undergone long-term dialysis and received multiple blood transfusions, CT findings in 16 cases in which increased liver attenuation was seen on images obtained for other purpose, were analyzed by three radiologic specialists. The attenuation values of liver, spleen and pancreas compared with that of back muscle were correlated with the amount and duration of transfusion, and blood ferritin level. RESULTS: In 15 of these 16 case, blood ferritin level was examined; 14 showed more than 300ng/ml. Increased attenuation of the spleen was noted in 11 cases, and of the pancreas, in six. All these six also showed increased value for the spleen; the amount of blood transfusion was less than 40 units in three case and more than 40 units in the other three. None showed glucose intolerance. Between the two groups, there were no statistically significant difference in the amount and duration of transfusion, or blood ferritin level. CONCLUSION: There is no correlation between the CT features of hemosiderosis and clinical findings. In patients with chronic renal failure and no clinical symptoms, the status of iron overload was relatively easily detected on CT. Close observation of CT findings is thus thought to prevent significant permanent functional deformity of organs in patients with chronic renal failure who have received multiple blood transfusions.