Caroline Judy Westerhout

Shearwave Elastography Increases Diagnostic Accuracy in Characterization of Breast Lesions.

AbstractThe purpose of this study was to investigate the diagnostic efficacy of shearwave elastography (SWE) in differentiating between benign and malignant breast lesions.One hundred and fifty-nine lesions were assessed using B-mode ultrasound (US) and SWE parameters were recorded (Emax, Emean, Emin, Eratio, SD). SWE measurements were then correlated with histopathological diagnosis.The final sample contained 85 benign and 74 malignant lesions. The maximum stiffness (Emax) with a cutoff point of ≥ 56.0 kPa (based on ROC curves) provided sensitivity of 100.0%, specificity of 97.6%, positive predictive value (PPV) of 97.4%, and negative predictive value (NPV) of 100% in detecting malignant lesions. A cutoff of ≥80 kPa managed to downgrade 95.5% of the Breast Imaging-Reporting and Data System (BI-RADS) 4a lesions to BI-RADS 3, negating the need for biopsy. Using a combination of BI-RADS and SWE, the authors managed to improve the PPV from 2.3% to 50% in BI-RADS 4a lesions.SWE of the breast provides highly specific and sensitive quantitative values that are beneficial in the characterization of breast lesions. Our results showed that Emax is the most accurate value for differentiating benign from malignant lesions.

Clinical Risk Factors for Life-Threatening Lower Respiratory Tract Infections in Children: A Retrospective Study in an Urban City in Malaysia

Aim Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia. Methods This retrospective study included children aged less than 18 years admitted for LRTIs over 13 months in a tertiary referral centre in Kuala Lumpur, Malaysia. Neonates, children with asthma and those with either no or a normal chest radiograph were excluded. Life-threatening infection was defined as that needing non-invasive ventilation or admission to the paediatric intensive care unit. Routine blood investigations and nasopharyngeal secretion results (bacterial and viral) were obtained. Chest radiographs were reviewed by a designated radiologist. Environmental data (rainfall, particulate matter ≤10 µm [PM10] and air pollution index [API]) was obtained from the respective government departments. Results Three hundred and ninety-one episodes of LRTIs were included. Viruses were implicated in 48.5% of LRTIs, with respiratory syncytial virus (RSV) being detected in 44% of viral LRTIs. Forty-six (11.8%) children had life-threatening disease and the overall mortality rate was 1.3% (5 children). RSV was detected in 26% of children with life-threatening LRTIs. In multivariate logistic regression, chronic lung disease, presenting history of apnoea and signs of hypoxia, was associated with life threatening LRTIs. Increased LRTI admissions were associated with low rainfall but not PM10 nor API. Of those on follow-up, 39% had persistent respiratory symptoms. Conclusion One in nine children admitted with LRTI had a life-threatening LRTI. The aetiology was viral in almost half of admitted children. RSV was detected in a quarter of children with life-threatening LRTIs. Children who present with LRTIs and either have chronic lung disease, presenting history of apnoea or signs of hypoxia, should be observed carefully as the risk of deterioration to life-threatening illness is high.

Education and imaging. Hepatobiliary and pancreatic: A huge liver paraganglioma.

A 48-year-old woman was investigated because of a 6-month history of pain in the upper abdomen and progressive abdominal distension. On examination, she had a large mass in the right upper quadrant that extended to the umbilicus. Routine blood tests including liver function tests and a serum level of alpha fetoprotein were within the reference range. A computerized tomography (CT) scan of the abdomen revealed a large mass in the right upper quadrant, approximately 12 ¥ 18 ¥ 18 cm in size. There was contrast enhancement at the periphery of the mass consistent with a cavernous hemangioma. A coronal view of the mass is shown in Figure 1. As a major liver resection was proposed, she underwent embolization of the right portal vein. A repeat CT scan did not demonstrate any reduction in the size of the tumor or hypertrophy of the left lobe of the liver. At laparotomy, she had a huge pedunculated mass arising from the inferior surface of segments 5 and 6 of the liver (Figure 2). Histological features were consistent with a paraganglioma and this was supported by immunohistochemical studies which showed positive staining for neuronspecific enolase, synaptophysin and glial fibrillary acidic protein. However, S100 was equivocal and immunohistochemical staining was negative for chromogranin, MNF 116, vimentin, actin and CD68. Paragangliomas are neoplasms of the sympatho-adrenal neuroendocrine system. The most common site for these neoplasms is the adrenal medulla (pheochromocytoma). Extra-adrenal paragangliomas are unusual and mostly follow the distribution of the sympathetic nervous system. Paragangliomas in abdominal organs are rare but have been reported in a number of sites including the bladder and gallbladder. Atypical features in the above case included the site of the tumor (liver) and the size of the tumor (many are relatively small). Clinical features of excess catecholamine secretion have been reported in 20–80% of patients. Only a minority undergo malignant change as determined by the development of metastases. Another notable feature in the above case was the presence of centripetal contrast enhancement that is normally thought to be a typical feature of a cavernous hemangioma.

Hepatobiliary and pancreatic:A huge liver paraganglioma

A 48-year-old woman was investigated because of a 6-month history of pain in the upper abdomen and progressive abdominal distension. On examination, she had a large mass in the right upper quadrant that extended to the umbilicus. Routine blood tests including liver function tests and a serum level of alpha fetoprotein were within the reference range. A computerized tomography (CT) scan of the abdomen revealed a large mass in the right upper quadrant, approximately 12 ¥ 18 ¥ 18 cm in size. There was contrast enhancement at the periphery of the mass consistent with a cavernous hemangioma. A coronal view of the mass is shown in Figure 1. As a major liver resection was proposed, she underwent embolization of the right portal vein. A repeat CT scan did not demonstrate any reduction in the size of the tumor or hypertrophy of the left lobe of the liver. At laparotomy, she had a huge pedunculated mass arising from the inferior surface of segments 5 and 6 of the liver (Figure 2). Histological features were consistent with a paraganglioma and this was supported by immunohistochemical studies which showed positive staining for neuronspecific enolase, synaptophysin and glial fibrillary acidic protein. However, S100 was equivocal and immunohistochemical staining was negative for chromogranin, MNF 116, vimentin, actin and CD68. Paragangliomas are neoplasms of the sympatho-adrenal neuroendocrine system. The most common site for these neoplasms is the adrenal medulla (pheochromocytoma). Extra-adrenal paragangliomas are unusual and mostly follow the distribution of the sympathetic nervous system. Paragangliomas in abdominal organs are rare but have been reported in a number of sites including the bladder and gallbladder. Atypical features in the above case included the site of the tumor (liver) and the size of the tumor (many are relatively small). Clinical features of excess catecholamine secretion have been reported in 20–80% of patients. Only a minority undergo malignant change as determined by the development of metastases. Another notable feature in the above case was the presence of centripetal contrast enhancement that is normally thought to be a typical feature of a cavernous hemangioma.

Advanced MRI applications and findings of malignant phyllodes tumour: review of two cases.

Phyllodes tumour or cystosarcoma phyllodes is a rare stromal breast tumour that is usually benign but on rare occasions can turn malignant. Non-specificity of the imaging features on sonography and mammography makes it difficult to distinguish malignant from benign counterparts solely based on imaging. The final diagnosis is still highly dependent on histopathological assessment. Herein, we describe two cases of malignant phyllodes tumour with emphasis on magnetic resonance (MR) imaging features using advanced MR applications.

Hepatobiliary and Pancreatic: A huge liver paraganglioma: Education and Imaging

A 48-year-old woman was investigated because of a 6-month history of pain in the upper abdomen and progressive abdominal distension. On examination, she had a large mass in the right upper quadrant that extended to the umbilicus. Routine blood tests including liver function tests and a serum level of alpha fetoprotein were within the reference range. A computerized tomography (CT) scan of the abdomen revealed a large mass in the right upper quadrant, approximately 12 ¥ 18 ¥ 18 cm in size. There was contrast enhancement at the periphery of the mass consistent with a cavernous hemangioma. A coronal view of the mass is shown in Figure 1. As a major liver resection was proposed, she underwent embolization of the right portal vein. A repeat CT scan did not demonstrate any reduction in the size of the tumor or hypertrophy of the left lobe of the liver. At laparotomy, she had a huge pedunculated mass arising from the inferior surface of segments 5 and 6 of the liver (Figure 2). Histological features were consistent with a paraganglioma and this was supported by immunohistochemical studies which showed positive staining for neuronspecific enolase, synaptophysin and glial fibrillary acidic protein. However, S100 was equivocal and immunohistochemical staining was negative for chromogranin, MNF 116, vimentin, actin and CD68. Paragangliomas are neoplasms of the sympatho-adrenal neuroendocrine system. The most common site for these neoplasms is the adrenal medulla (pheochromocytoma). Extra-adrenal paragangliomas are unusual and mostly follow the distribution of the sympathetic nervous system. Paragangliomas in abdominal organs are rare but have been reported in a number of sites including the bladder and gallbladder. Atypical features in the above case included the site of the tumor (liver) and the size of the tumor (many are relatively small). Clinical features of excess catecholamine secretion have been reported in 20–80% of patients. Only a minority undergo malignant change as determined by the development of metastases. Another notable feature in the above case was the presence of centripetal contrast enhancement that is normally thought to be a typical feature of a cavernous hemangioma.