RESUMO
A bladder diverticulum (BD) is an abnormal pouch protruding from the bladder wall, which can be congenital or acquired. Acquired diverticula are more common, usually secondary to outflow obstruction or neurogenic bladder. Spontaneous rupture of a BD is rare, particularly in women. This report is about a female patient who develops abdominal pain and dysuria, progressing to an acute abdomen. The diagnosis of spontaneous rupture of a BD was suspected in pelvic ultrasound and confirmed in computed tomography (CT) cystography. The patient was submitted to diverticulectomy and bladder wall reconstruction. Although rare, this entity should be considered in patients with acute abdomen with unclear etiology, even in women with no evident risk factors for a BD or its rupture.
RESUMO
Background This study was conducted to evaluate the prevalence of imaging-detected silent breast cancer in females, with the hypothesis that the incidence of imaging-detected silent breast cancer in females is greater than the true disease incidence. The main purpose of this study is the attempt to prove whether breast imaging can identify silent breast cancers that apparently are common in serial histology analysis. Methodology A series of 217 consecutive medicolegal autopsies on fresh Portuguese cadavers were performed from July 2016 to December 2019 at the National Institute of Legal Medicine and Forensic Science, Lisbon, Portugal. The criteria for exclusion were age younger than 40 years, the autopsy performed in less than 48 hours after death, any major injury to one or both breasts, and known or clinically evident breast cancer. Once the eligibility criteria were met, and the sample collection authorization was obtained, a bilateral subcutaneous modi-fied radical mastectomy was performed in each fresh cadaver at the National Institute of Legal Medicine and Forensic Science. Mammography, ecography, and excisional biopsies of suspect areas were conducted on the collected samples. Results The indication for excisional biopsy by imaging was assigned in eight cases, and no breast cancer was discovered in the excised specimens. Conclusions In light of the findings, it cannot be concluded that the imaging-detected silent breast cancer prevalence is higher than the actual incidence of the disease, so the author's initial hypothesis was rejected. Mammography does not overdiagnose breast cancer. Benign breast alterations are common, accounting for 43.6% of the corpses collected, while low-suspicion alterations were discovered in 1.84% of breast samples. The objective examination, which included inspection and palpation, missed 37.5% of the biopsied breast changes. This finding indicated that an objective examination leads to a significant number of false-negative results which cannot be used as a screening method.
RESUMO
Traumatic diaphragmatic rupture is uncommon, life threatening and remains a diagnostic and radiographic challenge. Diagnosis is frequently delayed, which may result in a late intervention with a potential catastrophic outcome. We report a case of an acute diaphragmatic laceration in a 40-year-old woman, with a personal history of bipolar disease, admitted on the emergency department after falling from a nine-meter building. During initial evaluation, the plain chest radiograph showed multiple rib fractures associated with a significant left pneumothorax. It also showed an elevated left diaphragm with a suspicious gastric shadow in the left hemithorax. Computed tomography confirmed the diagnosis of a left-sided diaphragmatic laceration and the patient was advised surgical intervention. During laparoscopy, a 7 cm rupture of the left hemi-diaphragm with herniation of the stomach was identified. The hernia was reduced laparoscopically and the defect repaired with interrupted, non-absorbable, sutures. The patient had an uneventful recovery and remained well at a 3-month follow-up visit. Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. However, if the patient is hemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.
