Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade.

CONTEXT: Assessment of individual sonographic features provides vital clues about the biological behavior of breast masses and can assist in determining histological grade of malignancy and thereby prognosis. AIMS: Assessment of individual sonographic features of biopsy proven invasive ductal breast carcinomas as predictors of malignancy grade. SETTINGS AND DESIGN: A retrospective analysis of sonographic findings of 103 biopsy proven invasive ductal breast carcinomas. MATERIALS AND METHODS: Tumor characteristics on gray-scale ultrasound and color flow were assessed using American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) Atlas Fifth Edition. The sonographic findings of masses were individually correlated with their histopathologic grades. STATISTICAL ANALYSIS USED: Chi square test, ordinal regression, and Goodman and Kruskal tau test. RESULTS: Breast mass showing reversal/lack of diastolic flow has a high probability of belonging to histological high grade tumor (ß 1.566, P 0.0001). The masses with abrupt interface boundary are more likely grade 3 (ß 1.524, P 0.001) in comparison to masses with echogenic halos. The suspicious calcifications present in and outside the mass is a finding associated with histologically high grade tumors. The invasive ductal carcinomas (IDCs) with complex solid and cystic echotexture are more likely to be of high histological grade (ß 1.146, P 0.04) as compared to masses with hypoechoic echotexture. CONCLUSIONS: Certain ultrasound features are associated with tumor grade on histopathology. If the radiologist is cognizant of these sonographic features, ultrasound can be a potent modality for predicting histopathological grade of IDCs of the breast, especially in settings where advanced tests such as receptor and molecular analyses are limited.

CHAOS: Prenatal imaging findings with post mortem contrast radiographic correlation.

Congenital high airway obstruction syndrome is a rare fetal anomaly with characteristic constellation of prenatal findings on ultrasound and MRI. The typical triad of imaging features are enlarged and echogenic lungs, flattening or inversion of diaphragm and fetal hydrops. Early prenatal recognition of congenital high airway obstruction syndrome by ultrasound and/or MRI is mandatory for the appropriate perinatal management. We report a case of a male fetus with typical imaging findings of congenital high airway obstruction syndrome on ultrasound and MRI at 19 weeks of gestation. The role of contrast radiographs of fetal airways, including retrograde laryngogram, in confirming the postnatal diagnosis of this fetal condition is demonstrated. The prenatal imaging findings were correlated with contrast radiographs of upper airways, sonography of aborted fetus and fetal autopsy findings.

Amniotic band syndrome with sacral agenesis and umbilical cord entrapment: A case report emphasizing the value of evaluation of umbilical cord.

Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts by fibrous amniotic bands in utero. The congenital anomalies seen in this syndrome vary widely and defects may be isolated or multiple and do not follow a specific pattern. Asymmetric distribution of defects is the hallmark of this syndrome. The diagnosis is difficult to make on ultrasound and relies on identification of amniotic bands. We report a case of amniotic band syndrome with sacral agenesis diagnosed on routine antenatal ultrasound scan in the second offspring of a recently diagnosed diabetic mother. The associated features were entrapment of umbilical cord, caudal adhesions and lower limb anomalies. Medical termination of pregnancy was done and all the fetal anomalies as well as umbilical cord abnormalities were confirmed. The importance of meticulous scanning to evaluate for amniotic bands and the umbilical cord in addition to the fetal structures is emphasized.

Recurrent sigmoid volvulus associated with eventration of diaphragm in a twenty-six-year-old man.

Recurrent sigmoid volvulus is a clinical entity characterized by recurrent episodes of partial or complete sigmoid volvulus. Although it is commonly seen in the elderly, it can be occasionally seen in younger patients. Patients with recurrent partial sigmoid volvulus are relatively asymptomatic or present with mild abdominal pain. Early diagnosis and treatment is essential to prevent conversion to acute gangrenous volvulus. We present a case of recurrent partial sigmoid volvulus in association with eventration of diaphragm in a 26-year-old man.

Early Detection by Ultrasound of Partial Hydatidiform Mole With a Coexistent Live Fetus.

INTRODUCTION: Twin pregnancy with hydatidiform mole and coexistent live fetus is a rare condition with severe maternal and fetal complications such as preeclampsia, vaginal bleeding, persistent gestational trophoblastic tumor, and fetal death. CASE PRESENTATION: We report a case of a twin pregnancy with histopathologically proven hydatidiform mole and a coexistent live fetus in a 30-year-old Indian woman diagnosed by first trimester ultrasound. DISCUSSION: Our case emphasizes the role of ultrasound in diagnosing this condition in early pregnancy. A succinct overview of etiological mechanisms, possible complications, and clinical management is provided. CONCLUSION: Ultrasound is an effective diagnostic tool to diagnose hydatidiform mole with coexistent live fetus. Early diagnosis of this condition is important for risk stratification and facilitates an informed decision by the patient whether to terminate the pregnancy or to continue until full term with close monitoring after delivery.

Pulmonary Langerhans cell histiocytosis in children: a spectrum of radiologic findings.

Pulmonary Langerhans cell histiocytosis (PLCH) is a well known entity in adults but is exceedingly rare in children. It is better described in adults than in children. We describe the current understanding of PLCH in children and a spectrum of radiological findings of PLCH in the paediatric population. On high resolution computed tomography (HRCT), PLCH may have variable appearance depending on the stage of disease, ranging from small interstitial nodular opacities to multiple thin/thick walled cysts (often bizarre in shape), eventually leading to marked parenchymal fibrosis and honeycomb pattern. CT finding of PLCH is similar in adult and paediatric populations with the exception that lung base near the costophrenic angle is spared in adults but almost always involved in children.

Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed.

AIM: The purpose of this study was to assess the value of Doppler evaluation of left gastric vein hemodynamics when monitoring portal hypertension patients, by correlating Doppler ultrasonography (USG) parameters with the severity of esophageal varices and occurrence of variceal bleeding. METHODS: This study was carried out on 100 patients using Doppler USG and endoscopy. Forty-seven of these were patients with cirrhosis with portal hypertension, who had not had a recent variceal bleed (group 1) and 26 were patients with cirrhosis with portal hypertension, with a recent history of bleeding (group 2). The control group comprised of 27 subjects who did not have liver disease or varices on endoscopy (group 3). The hemodynamic parameters, namely the diameter of the left gastric vein and the direction and flow velocity in the vessel, were compared in these groups, with the grade of esophageal varices. RESULTS: Hepatofugal flow velocity in the left gastric vein was higher in patients with large-sized varices compared to those patients with small-sized varices (P < 0.001). The left gastric vein hepatofugal flow velocity was higher in patients with a recent variceal bleed than in those patients without a history of a recent variceal bleed (P < 0.0149). Large-sized varices were more commonly found in patients with a history of a recent variceal bleed (P < 0.0124). CONCLUSION: Left gastric vein hemodynamics were found to correlate with the severity of the varices and the occurrence of recent variceal bleed in patients with cirrhosis with portal hypertension. Evaluation of the left gastric vein portal dynamics could be helpful in monitoring the progress of the disease in these patients.

Expectant and medical management of placenta increta in a primiparous woman presenting with postpartum haemorrhage: The role of Imaging.

We report a case of postpartum hemorrhage due to adherent placenta. A 28 year old primiparous woman who underwent manual removal of placenta for primary postpartum haemorrhage soon after delivery was referred to our Institute on her third postnatal day because of persistent tachycardia and low grade fever. Placenta accreta was suspected on initial ultrasonographic examination. MRI examination confirmed the diagnosis of placenta accreta in few areas and revealed increta in other areas. On expectant management she developed genital tract sepsis and hence she was treated with intravenous Methotrexate after controlling infection with appropriate antibiotics. Doppler Imaging showed decreased blood flow to the placental mass and increased echogenecity on gray scale USG after Methotrexate administration. She expelled the whole placental mass on 35th postnatal day and MRI performed the next day showed empty uterine cavity. Morbid adhesion of placenta should be suspected even in primiparous women without any risk factors when there is history of post-partum hemorrhage. MRI is the best modality for evaluation of adherent placenta.

Biliary cystadenocarcinoma of the gall bladder: a case report.

INTRODUCTION: While biliary cystadenoma and biliary cystadenocarcinoma involving the liver are not uncommon, biliary cystadenocarcinoma of the gall bladder is an extremely rare lesion and can be very difficult to diagnose. CASE PRESENTATION: A 50-year-old Indian woman presented with pain and swelling in the right hypochondrium. An ultrasonography revealed a cystic lesion arising from the gallbladder fossa. This lesion was initially managed with aspiration and antibiotics by the treating physician. The patient was referred for surgical management because the abscess was not resolved through conservative treatment. A diagnosis of an infected nonparasitic cyst was made and deroofing of the cyst was performed. A histopathological examination of the excised cyst wall showed cystadenocarcinoma. The patient subsequently underwent a successful surgical excision of the lesion. CONCLUSION: Infective lesions of the liver are common in developing countries and are usually managed through aspiration and antibiotics. Cystadenocarcinoma of the gallbladder needs to be considered in the differential diagnosis of cystic lesions arising from the gallbladder fossa. A high index of suspicion and cytological examination from the wall of such complex lesions will help in the timely management of such lesions.