An unusual artifact observed on screening mammography in a patient with an LVAD.

PURPOSE: Screening mammography and digital breast tomosynthesis consist of high-resolution x-ray images to identify findings that are potentially indicative of breast cancer, enabling early detection and reduction of breast cancer mortality. Imaging artifacts can occasionally occur, sometimes due to patient-related medical devices. Because of continuous evolution of new technologies, there is potential for novel artifacts to be encountered. In this technical note, we report an unusual artifact in the screening mammogram of a patient with an Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS: A 72-year-old patient with a HeartMate 3 LVAD presented to our breast imaging facility for a standard screening exam with digital breast tomosynthesis (Selenia Dimensions, Hologic Inc., Bedford, MA) and synthetic 2D images (C-view, Hologic Inc., Bedford, MA). RESULTS: Linear artifacts oriented in the anteroposterior dimension demonstrating a spatial periodicity of ∼1.4 mm were seen on all left breast images, whereas concurrent right breast images did not demonstrate any artifacts. Repeat attempts using two identical digital breast tomosynthesis units demonstrated the same artifacts. No other exam at our imaging center that day demonstrated any such artifacts. Mammogram exams performed on this patient prior to her LVAD placement did not exhibit any similar artifacts. CONCLUSION: Findings support the patient's LVAD as the underlying source of linear artifacts observed on left breast images, particularly given the proximity of the LVAD to the left breast. With the number of patients receiving LVAD placement on the rise, as well as increasing median survival rates status post LVAD implantation, recognition of this LVAD related artifact on mammography may be important.

Seroprevalence data at a private teaching hospital in Kenya: An examination of Toxoplasma gondii, cytomegalovirus, rubella, hepatitis A, and Entamoeba histolytica.

BACKGROUND: Relevant seroprevalence data for endemic pathogens in a given region provide insight not only into a population's susceptibility to acute infection or risk for reactivation disease but also into the potential need for policy initiatives aimed at reducing these risks. Data from sub-Saharan Africa are sparse and since Aga Khan University Hospital Nairobi is an internationally accredited hospital equipped with a laboratory electronic medical record system, analysis of pertinent local seroprevalence data has been made possible. METHODS: We have analyzed serology data from laboratory electronic records at a 300 bed tertiary private teaching hospital in Kenya for the dates, 2008 to 2017 for Toxoplasma gondii, cytomegalovirus, and rubella, which were used primarily for antenatal screening. We also analyzed the data from hepatitis A and amebiasis serologies, which were used primarily for diagnostic purposes. RESULTS: For T. gondii, cytomegalovirus, and rubella, we used IgG serology to determine seroprevalence, finding rates of 32%, 86%, and 89%, respectively. There was no significant age-related difference in the 20 to 49 year old age range for any of these three pathogens. Of the Hepatitis A IgM tests that were ordered, 33% were positive with a peak positive rate of 70% in the five to nine year old age range. The seroprevalence of amebiasis was 4% and all cases of seropositivity were accompanied by compatible clinical illness (hepatic abscess). CONCLUSIONS: These data provide insight into seroprevalence rates of selected pathogens that can be used to guide screening and diagnostic laboratory testing as well as private and public immunization practices.