Role of breast ultrasound and mammography in evaluating patients presenting with focal breast pain in the absence of a palpable lump.

To determine if ultrasound and/or mammography is helpful in detecting breast cancers in patients presenting with focal breast pain. Patients who presented between February 2008 and April 2011 with focal breast pain without a lump were included in the study. The mammographic and US findings were retrospectively reviewed. BIRADS 0, 4, and 5 were considered positive on mammogram while BIRADS 4 and 5 were considered positive on US. The efficacy of mammogram-alone, ultrasound-alone, and in combination to detect breast cancer was evaluated. The performance of mammography for detecting any mass lesions that were present on subsequent US was also evaluated. A total of 257 patients were evaluated with US and 206 (80.1%) of these also had mammograms prior to the US. Cancer incidence was 1.2% (n = 3). The sensitivity, specificity, PPV, and NPV of mammogram-alone and US-alone for detection of breast cancer in these patients were 100%, 87.6%, 10.7%, 100% and 100%, 92.5%, 13.6%, and 100%, respectively, while for combined mammogram and US was 100%, 83.7%, 8.3%, and 100%. The sensitivity, specificity, PPV, and NPV of mammogram for identifying an underlying suspicious mass lesion that was subsequently detected by US was 58%, 91%, 39%, and 95%. The NPV of a BIRADS 1 mammogram for any underlying mass lesion was 75%. Addition of an ultrasound to a mammogram did not detect additional cancers; likely due to low cancer incidence in these patients. However, US detected underlying mass lesions in 25% cases with a BIRADS 1 mammogram result.

A case report of adult colonic intussusception.

A 52-year-old man presented to the emergency department with abdominal pain, nausea, and vomiting. A computed tomographic scan showed findings consistent with colo-colonic intussusception and ischemic bowel with evolving infarction. The intussuscepted portion of the colon was immediately resected. Pathology demonstrated a transverse colo-colonic intussusception with an intraluminal focus of Burkitt's lymphoma as the lead point. Transverse colonic intussusception is very rare and often presents with nonspecific signs and symptoms and as such is often not considered based on clinical findings alone. Computed tomography is the key to diagnosis, and it is important to recognize the imaging findings so that the appropriate surgery can be performed quickly.