Adenomyoma With Pseudoinvasive Growth Pattern and Serosal Penetration Mimicking Endometrial Carcinoma.

We present a novel case of a 48-yr-old female with a uterine adenomyoma with an unusual pseudoinvasive growth pattern displaying full-thickness penetration beyond the serosal surface in association with a dehisced Caesarian scar. Before hysterectomy, magnetic resonance imaging findings showed an infiltrative lesion suggestive of endometrial carcinoma. An endometrial biopsy was benign but definitive operative management was pursued given the concerning imaging. Gross examination of the uterus demonstrated a 7.2 cm, relatively well-circumscribed polypoid neoplasm with pushing borders extending through the full thickness of the myometrium. A serosal defect with protruding red tissue was noted where the neoplasm penetrated the exterior surface of the uterus. Histologic examination demonstrated benign endometrial glands, associated endometrial stroma, thick-walled vessels, and a prominent smooth muscle component consistent with an adenomyoma. To our knowledge, this unique presentation of a pseudoinvasive adenomyoma extending beyond the serosa is extremely rare and is the first time reported in the literature.

Posterior chondrolabral cleft: clinical significance and associations with shoulder instability.

BACKGROUND: A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown. QUESTIONS/PURPOSES: The purposes of this study were to determine if posterior chondrolabral clefts are associated with variations in glenoid morphology, and to determine if they are associated with shoulder instability. PATIENTS AND METHODS: Shoulder MRI was performed in 1,264 shoulders, 1,135 male (89.8%), and 129 female (10.2%). A musculoskeletal radiologist blinded to history and outcomes evaluated the MR images for linear high signal intensity at the posterior chondrolabral junction and a rounded or truncated contour of the posterior glenoid. Glenoid version and depth were measured. Patients were followed prospectively for shoulder instability for 4 years. Univariate and multivariate statistical analysis were performed. RESULTS: Posterior chondrolabral cleft was present in 114/1,264. Posterior chondrolabral cleft was associated with a rounded or truncated posterior glenoid. There were 9.5° retroversion in shoulders with a posterior cleft, and 7.7° retroversion in shoulders without a cleft. Shoulders with a posterior chondrolabral cleft were more likely to develop shoulder instability. CONCLUSIONS: Posterior chondrolabral clefts are not uncommon on MRI. They are associated with a rounded or truncated posterior glenoid and a small but significant increase in glenoid retroversion. They are associated with shoulder instability.

CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed?

OBJECTIVE: The purpose of this study is to compare CT urography (CTU) with unenhanced CT in the evaluation of upper urinary tracts in adults younger than 50 years with asymptomatic microscopic hematuria. MATERIALS AND METHODS: In this study, 1516 CTU examinations were reviewed in adults younger than 50 years. Inclusion criteria were no significant prior urologic disease and asymptomatic microscopic hematuria with at least one urinalysis with greater than or equal to 3 RBCs/high-power field and less than or equal to 50 RBCs/high-power field. Upper urinary tract findings on CTU were classified as malignancy-related or non-malignancy-related hematuria and incidental non-hematuria-related findings. A blinded radiologist reviewed the unenhanced images, recording upper urinary tract findings and recommendations for further contrast-enhanced imaging. The modified Wald equation at a 95% CI, the "Rule of Threes" equation, and binomial distribution were used for malignancy-related findings. RESULTS: Four hundred forty-five examinations in 442 patients met inclusion criteria. CTU reports showed zero malignancy-related hematuria findings, 64 non-malignancy-related hematuria findings (62 renal calculi and two others), and 138 incidental non-hematuria-related findings. Unenhanced CT interpretation had a sensitivity of 100% (64/64) and a specificity of 89.2% (337/378). The theoretic risk of an upper urinary tract malignancy is 0-1.1%. CONCLUSION: CTU added no additional diagnostic benefit versus unenhanced CT in evaluating the upper urinary tracts of adults younger than 50 years with asymptomatic microscopic hematuria. Using only unenhanced CT can reduce radiation and minimize contrast agent-associated risk, with a less than 1.0% risk of missing upper urinary tract hematuria-related malignancy.

Magnetic resonance imaging appearance of a double anterior cruciate ligament associated with a displaced tear of the lateral meniscus.

The aim of this study is to report a novel description of a displaced tear of the lateral meniscus as a curvilinear low signal intensity band parallel and posteroinferior to the anterior cruciate ligament (ACL) on midline oblique sagittal magnetic resonance (MR) images, resulting in the appearance of a "double ACL." The appearance of a double ACL may potentially be a specific indicator for a lateral meniscal displaced tear. Increased awareness of this characteristic MR finding may increase accuracy in the diagnosis of displaced tears of the lateral meniscus.

Use of cardiopulmonary bypass for tracheal resection: a case report.

Although ventilatory support can be life-saving, it also has adverse effects, including postintubation tracheal stenosis caused by damage to the larynx and trachea. Cardiopulmonary bypass is generally not used for the surgical management of tracheal stenosis; however, we have found that the use of cardiopulmonary bypass can be advantageous during tracheal resection and reconstruction.