Role of 3D Ultrasound and Doppler in Differentiating Clinically Suspected Cases of Leiomyoma and Adenomyosis of Uterus.

INTRODUCTION: Adenomyosis and Leiomyoma are common disorders affecting females in their reproductive age. They mimic each other in clinical presentation. Due to similarities in clinical symptoms and signs, missing one diagnosis in favour of the other is not very uncommon. Accurate diagnosis of these two conditions is important for their management. In this study we evaluated role of 3D Ultrasound and Doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. MATERIALS AND METHODS: A total of 100 patients with symptoms of abnormal uterine bleeding (with or without dysmenorrhoea), lump abdomen, chronic pelvic pain or dysparaunia who were clinically diagnosed as leiomyoma of uterus and/or adenomyosis were enrolled in to the study. These patients underwent transvaginal sonography (TVS), trans abdominal sonography (TAS) along with color and spectral Doppler sonography. Scanning was done in follicular phase of the menstrual cycle to avoid bias due high vascularity of endometrium in secretory phase. The morphology of the lesion, its vascularity, and Pulsality Index (PI), Resistive Index (RI) and Vmax (maximum velocity) were measured. Only those patients who were chosen for operative treatment were included in the study. Radiological diagnosis was then correlated with intra-operative and histopathological diagnosis. RESULTS: On imaging, while using morphological criteria and Doppler for diagnosing leiomyoma, it was found that "peripheral vascularity" was seen in 52 (89%) cases, which was the highest. Similarly while diagnosing adenomyosis it was, the criteria "central vascularity" was seen in 28 cases (93%) and "ill defined junctional zone in 3D ultrasound" was seen in 26 cases (86%), which was also observed to be highest. With the cut off values taken for PI,RI and Vmax, diagnosis of leiomyoma was found to be 93.4% sensitive, 95.6% specific and with a positive predictive value of 97.6% and negative predictive value of 88.6%. Diagnosis of adenomyosis showed a sensitivity of 95.6%, specificity of 93.4% and a positive predictive value of 88.6% and negative predictive value of 97.6%. Imaging dignosed the co-existence of both the conditions correctly in 8 (66%) cases. CONCLUSION: The parameters of blood flow impedance (that is PI, RI, and Vmax) of arteries within or around the uterine lesions revealed a consistent and significant difference between leiomyoma and adenomyosis. So apart from morphological criteria used in 3D TAS and TVS, aid of color Doppler can more accurately differentiate and diagnose these conditions.

Role of trans vaginal ultrasound and Doppler in diagnosis of pelvic congestion syndrome.

Pelvic congestion syndrome (PCS) is a cause of chronic pelvic pain in women and is defined as pelvic pain lasting for more than six months.The diagnosis of PCS is a challenging task for the gynaecologist. It can be due to many varied causes like endometriosis, adhesions, chronic pelvic inflammatory disease (PID), ovarian cyst, fibroids, pelvic varicosities. Radiology plays an important role in the diagnosis and management of PCS. Pelvic UltraSonography (PUS),transvaginal sonography (TVS) with doppler, Magnetic resonance imaging (MRI), computed tomography (CT) and ovarian venography are usually used in the diagnosis of this condition. We report a case of a 35-year-old multiparous patient with history of pain in lower abdomen, vaginal discharge and general lethargy for past three years who was diagnosed as a case of PCS based on typical TVS and Doppler findings.

Internal Jugular Phlebectasia: Diagnosis by Ultrasonography, Doppler and Contrast CT.

Jugular phlebectasia is an isolated saccular or fusiform dilation of a vein without tortuosity. Its aetiology remains controversial. It is infradiagnosed, as it is generally asymptomatic. However, it has been increasingly recognized in recent years due to the better imaging techniques which are available. Phlebectasia of the Internal Jugular Vein (IJV) is a rare disease. It is mostly unilateral and it involves only the right side. It is usually a childhood disease which is diagnosed during the study of an intermittent neck mass. Its treatment is controversial. Presently, a conservative approach to unilateral or bilateral asymptomatic phlebectasia is recommended. Symptomatic phlebectasia requires surgery. The diagnosis is suggested by clinical features which can be confirmed by noninvasive radiology. This paper is reporting a case of unilateral right internal jugular phlebectasia in a 12 year old female patient who complained of an intermittent, right sided neck swelling, where we used UltraSonoGraphy(USG) with Doppler and Contrast enhanced CT(CECT) to evaluate the lesion.

An ectopic breast tissue presenting with fibroadenoma in axilla.

Introduction. The congenital anomalies of breast, especially the polymastia (supernumerary breast) and polythelia (supernumerary nipple), always do not fail to amuse the clinicians because of their varied presentations, associated renal anomalies, and pathologies arising from them. The axillary polymastia is a variant of ectopic breast tissue (EBT). Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma. Case Presentation. A 31-year-old Dravidian female presented with a lump of 4 cm in the right axilla for the past year which gradually increased in size, giving discomfort. Our initial differential diagnosis was fibroadenoma, lipoma, and lymphadenopathy. Further investigation and histopathological report of excision biopsy confirmed it as a fibroadenoma on ectopic breast tissue in the axilla. Patient has no associated urological or cardiac anomaly. Conclusion. This case has been reported for its rarity and to reemphasise the importance of screening of EBT for any pathology during routine screening of breast.

Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient.

Bronchial carcinoids are uncommon, slow growing, low-grade malignant neoplasms comprising 1-2% of all primary lung cancers. They are thought to arise from neuroendocrine/Kulchitsky's cells of bronchial epithelium. Histological features range from low-grade typical to more aggressive atypical carcinoids. Clinically they may be asymptomatic, present with nonresolving recurrent pneumonitis, hemoptysis, or with paraneoplastic syndromes. Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodule or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion due to its smaller size as is in our case. Contrast-enhanced computerized tomography (CECT) remains a highly sensitive examination which shows an intensely enhancing small rounded endobronchial nodule. We present a case of recurrent pneumonitis and hemoptysis in a young patient who showed features of typical central bronchial carcinoid in CECT and later confirmed with histopathological examination (HPE).