Diagnosing ovarian torsion with computed tomography. A case report.

BACKGROUND: The diagnosis of adnexal torsion is difficult to make on the basis of symptoms, physical findings or radiologic techniques. Unfortunately, delayed intervention can lead to irreversible damage and loss of the adnexa. This report describes a finding seen on computed tomography (CT) that may increase suspicion of the diagnosis of ovarian torsion. CASE: A 21-year-old woman was admitted with constant abdominal pain and a tender retrouterine mass. Ultrasound failed to provide a definitive diagnosis. CT showed a central, hypodense area consistent with fat and surrounded by a shell of intermediate density. At laparotomy the patient was found to have a necrotic left adnexa due to torsion. Bisection of the adnexal mass confirmed a dermoid cyst with overlying edematous ovarian cortex. CONCLUSION: The observation of a round, hypodense central lesion (dermoid cyst) surrounded by thickened, edematous ovarian cortex on CT is a finding that may aid in the diagnosis of adnexal torsion. The finding is a thickened shell of ovarian cortex surrounding a central mass that has caused the torsion; in this case it was a dermoid cyst.

Breast cancer diagnosis in women with subglandular silicone gel-filled augmentation implants.

PURPOSE: To determine whether breast augmentation implants interfere with detection of breast cancer and to characterize the projections that offer an improvement in the detection of disease. MATERIALS AND METHODS: The mammographic examinations, clinical presentation, and pathologic findings were retrospectively reviewed in 18 patients who underwent breast augmentation with silicone gel-filled implants. RESULTS: At diagnosis, 16 patients (89%) had palpable abnormalities. Standard mammographic views were negative in 17 patients (94%). Modified implant compression views (used with implant displacement) showed abnormalities in 12 patients (67%). Sixteen (89%) of the 18 patients had invasive carcinomas, and seven (39%) had positive axillary lymph nodes. CONCLUSION: Standard mammographic views are inadequate for breast cancer screening in patients with silicone gel-filled implants. Although additional modified compression views offer a moderate improvement in breast cancer detection, imaging with tangential mammographic views, sonography of palpable areas, and breast physical examination in conjunction with mammography will offer additional benefit in breast cancer detection.

Financial and emotional cost of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) in infants with neonatal respiratory disease significantly increases the duration of hospitalization and cost of medical care. Early discharge on home oxygen therapy results in cost savings for third-party payers and the hospital, but adds financial and emotional burdens for the family. The median cost of initial hospitalization for 59 infants was $173,160 each. The median duration of home oxygen therapy was 92 days; the median cost was $5,195, compared with a projected cost of $46,920 for hospitalization for the same period. Two thirds of the 59 families experienced increased financial stress associated with marital status, reduced income, type of health insurance, and/or lack of respite or nursing help. Emotional stress was assessed in 26 (44%) of the families; one half coped well. Parents' perception of adequate insurance and stable income was significantly associated with positive coping. Providing home care for an infant with BPD on oxygen therapy is rewarding in many respects, but success requires appreciating its financial and emotional impact on families and providing them with social and financial support.