Review of the Sonographic Features of Interpectoral (Rotter) Lymph Nodes in Breast Cancer Staging.

ABSTRACT: This article reviews the ultrasound evaluation and staging of breast cancer with respect to the involvement of interpectoral (Rotter) lymph nodes. The primary objective is to demonstrate and assess the characteristic sonographic findings of interpectoral (Rotter) lymph nodes to help provide accurate nodal staging information. We aim to provide a comprehensive review and serve as an imaging guide for the identification and evaluation of Rotter lymph nodes. The detection of abnormalities and pathologic features of metastatic axillary nodal disease in the interpectoral region is reviewed, and the impact on clinical management and treatment is discussed. In the radiology literature, there is no comprehensive review of the sonographic appearance and evaluation of Rotter lymph nodes.

Higher plasma IL-6 and PTX3 are associated with worse survival in left heart failure with pulmonary hypertension.

Introduction: Left heart failure (LHF) is commonly complicated by pulmonary hypertension (PH), increasing morbidity and mortality. The present study aimed to evaluate the prognostic value of inflammatory proteins in LHF with PH (LHF-PH). Materials and methods: The levels of 65 plasma proteins, analysed with proximity extension assay, were compared between healthy controls (n = 20), patients with LHF-PH (n = 67) comprising both HFpEF-PH (n = 31) and HFrEF-PH (n = 36), and in a LHF subpopulation before and after heart transplantation (HT, n = 19). Haemodynamic parameters were measured using right heart catheterization. Results: Plasma levels of Interleukin 6 (IL-6) and Pentraxin related protein PTX3 (PTX3) were elevated in LHF-PH vs. controls (p < 0.001), and these decreased after HT compared to before HT (p < 0.001). Plasma IL-6 and PTX3 correlated to elevated NT-proBNP (r = 0.44, p = 0.0002 and r = 0.4, p = 0.0009, respectively). Additionally, IL-6 correlated with mean pulmonary arterial pressure (r = 0.4, p = 0.0009) and mean right atrial pressure (r = 0.51, p < 0.0001). Higher levels of IL-6 and PTX3 were associated with worse survival rates in patients with LHF-PH (Log rank p < 0.01). Discussion: In patients with LHF-PH, higher plasma levels of IL-6 and PTX3 were associated with worse survival rates. Future larger studies to validate and investigate the direct clinical applicability of IL-6 and PTX3 as potential prognostic biomarkers are encouraged.

Recurrent Shoulder Posteroinferior Subluxation Status Post Reverse Remplissage.

Posterior shoulder dislocation is an uncommon injury that typically follows intense contraction of the external rotator muscles, such as from seizure activity, high-velocity trauma, or intense electrical shock. The diagnosis is often missed or delayed, leading to complications such as functional deficits or osteonecrosis of the humeral head. Closed reduction can be utilized following an initial occurrence, however, repeated insult to the glenohumeral joint may lead to posterior instability. A reverse Hill-Sachs lesion, a vertical impacted fracture of the anteromedial aspect of the humeral head, can occur. Surgical treatment options for posterior instability include the modified McLaughlin procedure also known as the reverse remplissage procedure. Unfortunately, the success rates of this procedure are controversial.

The use of ocular ultrasound to diagnose retinal detachment: a case demonstrating the sonographic findings.

Retinal detachment is an ophthalmologic emergency that requires immediate medical attention as it can potentially lead to permanent vision loss. The gold standard for diagnosing retinal detachment is dilated funduscopic exam. However, when this exam is not feasible such as in an emergency room setting or if visualization of the posterior portion of the eye is not possible due to vitreous hemorrhage or dense cataracts, ocular ultrasound provides a readily available and effective alternative. We present the sonographic appearance of chronic retinal detachment in a 24-year-old female with a longstanding history of poorly controlled type 1 diabetes who could not undergo dilated funduscopic exam due to intra-ocular hemorrhage. While retinal detachment is more likely to be detected by radiologists on computed tomography (CT) or magnetic resonance imaging (MRI), radiologists should be aware of the ultrasound findings as well, especially as it becomes a more frequently utilized method for diagnosing retinal detachment in an emergency room setting.

Tuberculosis of the cervical spine.

A 25-year-old male state-prisoner presented with altered mental status, right neck pain, and uncontrolled hypertension.