The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings. Patients' CT scans, follow-up examinations, and electronic medical records were reviewed. Final diagnoses of the causes of the masses were confirmed with imaging follow-up (83.9%), clinical follow-up (13.7%), and pathologic examination (2.4%). Results This study included 379 patients, 214 (56.5%) women and 165 (43.5%) men, with a mean age ± standard deviation of 59.3 years ± 15.3 (range, 21-97 years). There were 145 (38.3%) patients in the malignancy group, 29 (7.6%) patients in the symptomatic group, and 205 (54.1%) patients in the incidental group. The incidence of malignant splenic masses was 49 of 145 (33.8%) in the malignancy group, eight of 29 (27.6%) in the symptomatic group, and two of 205 (1.0%) in the incidental group (P < .0001). The incidental group consisted of new diagnoses of lymphoma in one (50%) patient and metastases from ovarian carcinoma in one (50%) patient. Malignant splenic masses in the incidental group were not indeterminate, because synchronous tumors in other organs were diagnostic of malignancy. Conclusion In an incidental splenic mass, the likelihood of malignancy is very low (1.0%). Therefore, follow-up of incidental splenic masses may not be indicated. © RSNA, 2018.

The Great Mimicker: Pseudo-Meig Syndrome in a Pregnant Patient. A Review.

Meig syndrome is the triad of benign ovarian tumor, ascites, and pleural effusion. Pseudo-Meig syndrome mimics the Meig syndrome triad; however, in pseudo-Meig syndrome, the ovarian tumor usually represents a primary malignancy or metastases. Differentiating Meig from pseudo-Meig syndrome is challenging both clinically and with diagnostic imaging but is important because prognoses for these distinct entities are drastically different. Evidence-based sonographic prediction models are valuable because they can aid in this distinction. Here, we present the first reported case of pseudo-Meig syndrome secondary to large, bilateral Krukenberg tumors of unknown origin, in a gravid 30-year-old woman at 24 weeks' gestation, discovered initially by ultrasound.

The "peripheral washout sign" in focal hepatic lesions: not always an MRI sign of malignancy.

The "peripheral washout sign" is a magnetic resonance imaging finding defined as an enhancing liver lesion with a peripheral rim of de-enhancement relative to its center and surrounding parenchyma on delayed contrast-enhanced images. The "peripheral washout sign" has been described solely in malignant liver lesions. We present a histologically proven benign hepatic angiomyolipoma showing the "peripheral washout sign". To the best of our knowledge, this is the first report on a benign hepatic lesion exhibiting this extremely specific imaging feature.

Mammary-type myofibroblastoma of the liver: multi-modality imaging features with histopathologic correlation.

A 46-year-old woman with an incidentally discovered hepatic mass at the time of echocardiography underwent additional imaging for characterization. Ultrasound demonstrated a 5.3 cm solid hyperechoic mass. Computed tomography and magnetic resonance imaging showed intratumoral fat and nodular foci of progressive enhancement. The patient underwent surgical resection, with the mass demonstrating histopathologic and immunohistochemical features diagnostic of a hepatic mammary-type myofibroblastoma. We present herein the clinical, imaging, and pathologic features in this unique case of hepatic mammary-type myofibroblastoma. Mammary-type myofibroblastoma is a benign spindle cell tumor typically composed of groups of myofibroblasts within bands of hyalinized collagenous stroma. Some tumors also have an adipocytic component. The tumor is nearly exclusively seen in the breast and although extramammary soft tissue locations have been described, to our knowledge, this is the first reported case in the liver or any visceral site. Although rare, radiologists and clinicians should, therefore, be aware of the possibility of a mammary-type myofibroblastoma when a solid, non-encapsulated, fat containing tumor in the liver is encountered.

Appropriateness of CT of the chest, abdomen, and pelvis in motorized blunt force trauma patients without signs of significant injury.

OBJECTIVE: The purpose of this article is to determine the frequency of clinically significant injuries detected on CT of the chest, abdomen, and pelvis in adult patients involved in motorized blunt force trauma with normal clinical examinations. MATERIALS AND METHODS: A retrospective review of the medical records of patients presenting with a triage history of motorized blunt force trauma who underwent CT of the chest, abdomen, and pelvis at the time of presentation was performed. Hemodynamically stable adult patients without abnormal physical examination findings to suggest injury of the trunk (e.g., tenderness, deformity, or bruising over the chest, abdomen, or pelvis) were included in the study. The formal report of the CT scan was reviewed and all acute injuries were recorded. Admission and discharge dates and surgical interventions were also recorded. RESULTS: Records for 542 patients were reviewed; 108 patients (74 men and 34 women; median age, 36 years) fulfilled the inclusion criteria. Eleven of the 108 patients (10%; 95% CI, 4.4-15.6%) had acute injuries detected on CT of the chest, abdomen, and pelvis. None of the injuries required direct medical intervention. Alcohol intoxication or distracting injuries were present in eight of these patients. The median time in hospital, from emergency department presentation to discharge, was 4.4 days (interquartile range, 2.5-8.5 days) for patients who were admitted and 6.7 hours (interquartile range, 4.8-10.3 hours) for those who were discharged. CONCLUSION: The clinical yield of performing CT of the chest, abdomen, and pelvis in motorized blunt trauma patients with normal clinical examinations in our study was minimal.

Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas.

Solid lesions of the pancreas represent a heterogeneous group of entities that can be broadly classified as either neoplastic or nonneoplastic. Neoplastic lesions include pancreatic adenocarcinoma, pancreatic neuroendocrine tumor, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, metastases to the pancreas, and rare miscellaneous neoplasms. Nonneoplastic lesions include focal pancreatitis, fatty infiltration-replacement, intrapancreatic accessory spleen, congenital anomalies such as prominent pancreatic lobulation and bifid pancreatic tail (pancreatic bifidum), and rare miscellaneous lesions (eg, pancreatic sarcoidosis, Castleman disease of the pancreas). A variety of imaging modalities are available for assessing these solid lesions, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging, endoscopic US, and hybrid nuclear imaging techniques such as single photon emission computed tomography-CT and positron emission tomography-CT, each of which has its own strengths and limitations. Accurate diagnosis can be challenging, and use of a multimodality imaging approach is often helpful in equivocal or complex cases. Knowledge of relevant clinical information and key radiologic features is essential for confident lesion characterization and differentiation.

Fibroids treated with uterine artery embolization: do imaging findings correlate with patient outcomes?

OBJECTIVE: To evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). MATERIALS AND METHODS: Sixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. RESULTS: Changes in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P > 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P < 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P < 0.05). CONCLUSION: We found poor correlation between imaging findings and patient- perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE.