Gynecomastoid hyperplasia: imaging findings in six patients.

This case series describes the radiologic appearances of gynecomastoid hyperplasia of the breast in our experience. The clinical histories, breast images, and histopathologic findings in six women were reviewed. At mammography, there was no abnormality in two women, an enlarging asymmetric density in three women, and a nodule in one woman. Breast ultrasonography showed a hypoechoic nodule in one woman. Gynecomastoid hyperplasia has a varied radiologic appearance.

Paraovarian cystadenomas and cystadenofibromas: sonographic characteristics in 14 cases.

PURPOSE: To describe the sonographic features of paraovarian cystadenomas. MATERIALS AND METHODS: We searched the computerized pathology and radiology databases for cases of histopathologically proved paraovarian cystadenomas from January 1993 through December 1996 in which preoperative sonography had also been performed. Fourteen paraovarian cystadenomas or cystadenofibromas were identified in 14 patients aged 20-57 years. Sonographic and pathologic findings were correlated. RESULTS: Three of the masses appeared as simple cysts sonographically. Of the remaining 11 masses, nine had solid nodular areas within the cyst; three had septations; and four had a thick wall, an irregular wall, or both at sonography. At sonography, four masses were thought to arise outside the ovary, four were erroneously thought to arise in the ovary, and the location was uncertain in six. CONCLUSION: Paraovarian cystadenomas are cystic masses that usually contain one or more small solid nodules and occasionally contain septations.

Placental implantation on the amniotic sheet: effect on pregnancy outcome.

PURPOSE: To assess pregnancy outcome in patients with amniotic sheets and to determine whether outcome is affected by placental implantation on the amniotic sheet. MATERIALS AND METHODS: Sonograms obtained during the 2nd and 3rd trimesters were reviewed in 157 patients with amniotic sheets to confirm the presence of an amniotic sheet and to determine the relationship of the placenta to the amniotic sheet. The cesarean section rate, gestational age at birth, birth weight, birth weight percentile, and Apgar score 1 minute after birth were recorded in patients in whom the postnatal follow-up data were available. Data were compared with overall data obtained at the authors' institution during the same period. RESULTS: The placenta appeared implanted on the amniotic sheet in 41 (26.1%) of the 157 patients. In the 120 patients with amniotic sheets and follow-up data, the cesarean section rate was 32.5% compared with 21.5% overall. The mean gestational age at birth was slightly lower than that overall (38.2 vs 39.0 weeks, P < .001), but the birth weight percentile was similar (48.6% vs 50.0%, P = .58). No statistically significant differences were found in postnatal follow-up data between pregnancies with placental implantation on and in those without implantation on the amniotic sheet. CONCLUSION: Pregnancy outcome is similar in patients with and in those without placental implantation on the amniotic sheet.

Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration.

PURPOSE: To evaluate the utility of cytologic analysis of fluid obtained from impalpable breast cysts by means of radiologically guided aspiration. MATERIALS AND METHODS: The authors retrospectively reviewed the reports of cytologic examinations of fluid obtained with sonographically or mammographically guided aspiration of 660 impalpable breast cysts in 583 women during 3 1/2 years. RESULTS: No malignant cells (541 cysts) or insufficient cellular material (86 cysts) was seen with cytologic examination of 95% of the aspirates. Atypical cells were seen with cytologic examination of fluid from 33 (5%) lesions. None of these 33 lesions were found to represent malignancy at the time of surgical excision (n = 9) or during clinical follow-up (n = 24). CONCLUSION: Routine cytologic examination is unnecessary if the fluid obtained with radiologically guided aspiration from impalpable breast cysts is not bloody.

Investigation of abnormal appearing thyroid glands on Tc-99m sestamibi breast scintimammography.

Of 507 breast scintimammograms performed using Tc-99m sestamibi, 34 patients were incidentally found to have abnormal appearing thyroid glands. The authors sought to investigate the clinical significance and/or ascertain an extraneous causative factor for these findings. One cold thyroid nodule was detected and was proven benign through biopsy. Two cases of subacute and chronic thyroiditis were proven, and it is possible that additional patients had this disease process. Focal areas of increased thyroid Tc-99m sestamibi uptake were observed in eight patients and probably represent parathyroid adenomas, nonautonomous hyperfunctioning thyroid nodules, or nontoxic multinodular goiter. The results did not yield an extraneous causative factor, underlying pathology, or clinically significant disease in all of the patients investigated, but the findings suggest a need for careful evaluation of any unusual uptake in the thyroid gland and the rest of the image. The authors do not recommend investigation of all abnormal appearing thyroid glands on Tc-99m sestamibi scintimammography. However, clinical correlation should be recommended.

Strut interlocking of titanium Greenfield vena cava filters and its effect on clot capturing: an in vitro study.

PURPOSE: To determine the influence of filter leg-interlocking on filtering efficiency of titanium Greenfield inferior vena cava filters in an in vitro model. METHODS: Titanium Greenfield filters (TGF) were placed in an inferior vena cava (IVC) flow phantom with no interlocking legs, or with one or two pairs of legs interlocked. Clot emboli of varying sizes were introduced into the stream of flow, and the frequency of successful captures by the deformed filters was recorded. RESULTS: Interlocking filter legs diminished the filtering efficiency of the TGF by up to 80% with the flow phantom in a horizontal position; no such compromise existed when the phantom was in a vertical position. CONCLUSION: When leg interlocking is verified radiographically, the filtering efficiency of the TGF is reduced, and placement of a second IVC filter may be indicated.

In vitro flow phantom analysis and clot-capturing ability of incompletely opened Vena Tech-LGM vena caval filters.

It has been shown recently that Vena Tech-LGM (B. Braun Vena Tech, Evanston, IL) filters inserted into the inferior vena cava via the jugular route may be deployed sometimes in an incompletely opened (IO) position. The flow characteristics and clot capturing ability of IO Vena Tech-LGM filters are not clearly understood. Using a vena cava flow phantom, the clot-capturing abilities of the IO and opened Vena Tech-LGM filters were assessed. For 5 x 5-mm clots, the IO Vena Tech-LGM filter captured only 40% of thrombi compared with a 90% capture rate for the opened filter. The capture rates were 90 and 100% for the IO and opened filter, respectively, for larger 5 x 15-mm clots. It was found that the IO filter could capture 2-7 x 25 mm thrombi prior to the development of a turbulent bypass channel which prevented subsequent clot capture. Using 5 x 15 mm clots, this same phenomenon occurred with the capture of 6 and 11 thrombi by the IO and opened Vena Tech-LGM filters, respectively. Our results suggest a significantly reduced filtering efficiency for the IO Vena Tech-LGM device. However, there is a high rate of clot capture with the opened Vena Tech-LGM filter.

Comparison of filters in an oversized vena caval phantom: intracaval placement of a bird's nest filter versus biiliac placement of Greenfield, Vena Tech-LGM, and Simon nitinol filters.

For patients with an oversized inferior vena cava (IVC) (diameter greater than 28 mm, corrected for magnification) who require vena caval filtration for prophylaxis against pulmonary emboli, the accepted treatment has been the biiliac venous placement of Greenfield filters. Because of its wide strut span, the Bird's Nest filter (BNF) has been successfully placed in patients having an oversized IVC. However, the effects of the BNF on caval blood flow and its clot-capturing ability in an oversized IVC are not clearly understood. The authors created a flow phantom simulating an oversized IVC with "iliac" tributaries of normal inner diameter to analyze flow turbulence, pressure gradients, and the clot-capturing ability of the BNF, tested within the "caval" segment of the phantom, and the Greenfield, Vena Tech-LGM, and Simon nitinol filters, tested in the "iliac" segments. All filters were tested for flow disturbances before and after clot capture. The authors' results demonstrate that within an oversized IVC, the BNF creates less flow disturbance and is less occlusive with clot capture than biiliac filters. The BNF displayed a clot-capturing ability equal to that of biiliac filters. Thus, for patients with an oversized IVC, these results suggest that placement of a single intracaval BNF is preferable to biiliac placement of filters.