Radio-Frequency Identifier Devices (RFIDs): Our Experience With Wireless Localisation in Non-palpable Breast Masses at a UK Tertiary Breast Imaging Unit.

The aim of this report is to evaluate the impact of the percutaneous ultrasound-guided placement of wireless radio-frequency identifier devices (RFIDs; Hologic LOCalizer, Marlborough, Massachusett) and its impact in our practice of preoperative localisation of biopsy-proven breast cancers, post-vacuum assisted biopsy-site hematoma, and lymph nodes for targeted dissection pre-operatively. A single institutional retrospective analysis of RFID usage for preoperative localisation in screening and symptomatic patients with non-palpable biopsy-proven breast carcinoma was reviewed from the radiology information system at our tertiary breast imaging unit. Its impact on the radiological and surgical team practice was reviewed, including the number of appointments, the interval between scheduling image-guided localisation and intraoperative localisation, procedure failure, average deployment, and surgical time. Feedback from surgeons and pathologists practice was also taken into consideration. Fifty-nine RFID clips were placed for wireless localisation of breast cancers, lymph nodes, and post-vacuum-assisted biopsy hematoma over nine months. Seventy-three per cent (73%; n=43/59) of RFID devices were placed in biopsy-proven carcinomas under direct ultrasound guidance. The learning curve was small, as the delivery system was similar to the commonly used localisation clips. The pilot process involved RFID with radioisotope injections for the breast mass for the initial 28% (n=12 /43) cases, which were gradually transitioned into RFID only. Radioisotope was used for sentinel node purposes if required. For targeted node dissection, 3% (n=2/59) patients received RFID for biopsy-proven metastatic node localisation, with one of two with adjunct radioisotope injection. Post-vacuum-assisted biopsy (VAB) hematoma was localised in 24% (n=14/59) cases, four of which received adjunct radioisotope in the pilot phase. The average procedure time for RFID deployment was five minutes. The average time for surgery was 20 minutes. 1.6% (n=1/59) incidence of RFID slipping from the surface of the site through surgical exposure attributed to the superficial and immediate pre-operative placement of the RFID. This was salvageable with adjunct radioisotope injection within the pilot phase. There were no incidences of repeat localisation or repeat exploration surgeries. Planned pre-operative localisation with RFID allows for better planning and less pressured service delivery and a success rate of 98-99%. This ultimately avoids lost theatre time and patient demotivation. Surgeons have reported excellent intra-operative detectability in their approach. There has been no difficulty in the detection of the RFID within the surgical cavity despite hematoma. RFID localisers are expensive compared to our usual practice of radioisotope injection but this can be recuperated through uncoupled tariffs like gain in slots of one-stop clinics, flexibility for placement, and avoiding lost theatre time, as these can be placed up to 30 days before surgery.

Spontaneous Pneumomediastinum Associated With SARS-CoV-2: Infrequent Complication of the Novel Disease.

A 44-year-old male with no previous medical history or comorbidities presented with significantly increasing shortness of breath, myalgia, nausea, and fatigue. He had no diagnosed medical conditions and enjoyed good health prior to the episode of acute respiratory infection. There was no history of smoking, emphysema, or chronic lung diseases. CT revealed bilateral ground-glass opacities in predominantly peripheral distribution. Based on imaging spectrum and global pandemic of the novel coronavirus, typical SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection was suspected. Viral load was confirmed with biochemical data and laboratory results. Interestingly, despite intensive treatment, the patient developed sudden complications during the second week of his hospitalization. The symptoms started to resolve on pharmacological treatment and supplemental noninvasive oxygen supply over the next weeks. We illustrate and discuss the case of spontaneous pneumomediastinum as an uncommon manifestation of novel SARS-CoV2 chest infection. Even though our patient did not develop acute respiratory distress syndrome or further complications, the presented case highlights the importance of basic radiological monitoring of the disease in order to ensure prompt diagnosis of complications and appropriate subsequent management.

Isolated Vastus Intermedius Avulsion Injury: A Case Report with Imaging Spectrum of this Rare Incidence.

Isolated mid-tendon vastus intermedius avulsion injuries are rare, painful, and overuse-related changes with a wide spectrum of epidemiology often demonstrating an exceptional spectrum of imaging features, especially on conventional radiographs. Although they can be easily diagnosed on magnetic resonance imaging, it is pertinent to identify the features of conventional imaging as that forms the first line of investigation. Our case report emphasizes the significance of identifying early signs of vastus intermedius avulsions on plain radiographs which can avoid neglect and functional disability. Timely identification of conventional imaging can avoid months of excruciating pain and streamline the further course of the treatment.

Infantile Hemangioendothelioma of the Parotid Gland.

A 4-month-old infant presented with a painless swelling overlying the left angle of mandible. Ultrasound and magnetic resonance imaging (MRI) revealed a large lesion replacing the entire left parotid gland, with multiple enlarged vessels. Homogeneous enhancement of the lesion was seen on the postcontrast MRI scans. Based on the imaging features, a diagnosis of infantile hemangioendothelioma of the parotid gland was offered. This helped in avoiding any further invasive testing.