Jelena Popić Ramač

Image quality of mammography in Croatian nationwide screening program: Comparison between various types of facilities

PURPOSE The study was aimed to provide objective evidence about the mammographic image quality in Croatia, to compare it between different types of MG facilities and to identify the most common deficiencies and possible reasons as well as the steps needed to improve image quality. MATERIALS AND METHODS A total of 420 mammographic examinations collected from 84 mammographic units participating in the Croatian nationwide breast cancer screening program were reviewed in terms of four image quality categories: identification of patient and examination, breast positioning and compression, exposure and contrast, and artifacts. Those were rated using image evaluating system based on American College of Radiology and European Commission proposals. The results were compared among different types of mammographic units, and common image quality deficiencies were identified. RESULTS Total image quality scores of 12.8, 16.1, 13.0 and 13.7 were found for general hospitals, university hospitals, private clinics and public healthcare centres, respectively. Average score for all mammographic units was 13.5 (out of 25 points). University hospitals were significantly better than all other mammography units in overall image quality, which was mostly contributed by better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts. CONCLUSIONS Serious deficiencies in identification and breast positioning, which might compromise breast cancer screening outcome, were detected in our material. They occur mainly due to subjective reasons and could be corrected through additional staff training and improvement of working discipline.

Sporadic giant intra-abdominal desmoid tumor: A radiological case report

Desmoid tumor (DT) is a locally invasive form of fibromatosis, comprising only 0.03% of all tumors. DTs occur more frequently in patients with familial adenomatous polyposis and Gardners syndrome, as intra-abdominal or anterior abdominal wall tumors, whereas sporadic DTs are more likely to be extra-abdominal (only 5% of sporadic DTs are intra-abdominal). There is also an association of DTs with prior trauma, surgery, estrogen exposure and childbirth. Imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI) are used for preoperative diagnosis and for the planning of the surgery. Following surgery, CT and MRI are used to detect recurrence and to monitor the tumors response to radiotherapy or medical therapy for unresectable or recurrent tumors. We herein report a rare case of a sporadic giant intra-abdominal DT in a 28-year-old female patient without any predisposing factors, and highlight the importance of including DT in the differential diagnosis of huge intra-abdominal masses.

Transcatheter ovarian vein embolisation without renal vein stenting for pelvic venous congestion and nutcracker anatomy

The diagnosis of a nutcracker syndrome can be aggravated by overlap of a nutcracker phenomenon with other pathologies. In patients with nutcracker anatomy and predominantly pelvic congestion symptoms, ovarian vein embolization without left renal vein stenting could be considered a first line therapy.

Endovascular Treatment of Symptomatic Intrahepatic Portosystemic Venous ShuntUsing Amplatzer Vascular Plug II

Endovascular Treatment of Symptomatic Intrahepatic Portosystemic Venous Shunt Using Amplatzer Vascular Plug II Spontaneous intrahepatic portosystemic venous shunt (IPSVS) is a rare condition that implies abnormal communication between portal and systemic venous system within the liver parenchyma. It can be asymptomatic or present with symptoms of hepatic encephalopathy. We show a case of 74-year-old female patient with symptomatic IPSVS and successful endovascular treatment using Amplatzer Vascular Plug (AVP) II.

Azygos vein aneurysm as incidental finding.

A 47 year old female patient underwent computed tomography (CT) of the thorax as part of standard pretransplantation screening protocol. The patient suffered from decompensated liver cirrhosis and multifocal hepatocellular carcinoma (HCC). Patient underwent series of chemoembolisations for HCC and was subsequently placed on the transplantation list. Thoracic CT examination is a routine pretransplantatation examination in our hospital, because metastatic spread would be considered a contraindication for liver transplantation according to current guidelines. The study was performed in two phases, the standard unenhanced and the venous post-contrast phase. An oval mass in the upper paratracheal lymph node region was immediately noticed on the unenhanced scan and was initially thought to be an enlarged lymph node. On the post-contrast series the lesion displayed marked contrast uptake (> 100 HU) and it was clearly in connection with the azygos vein (Figure 1). Subsequent oblique multi-planar reconstructions (MPR) clearly displayed a fusiform aneurysmatic dilatation of the azygos vein, located at the junction of the azygos vein and the superior vena cava, measuring up to 25 × 16 × 18 mm (Figure 2). This incidental finding was not considered a contraindication to proceed with the liver transplantation and the patient was successfully operated several days after this study was performed.

Pseudoaneurysm of the abdominal aorta in pregnancy

We present a rare case of a successfully recognized and treated pseudoaneurysm of the abdominal aorta in a 42-year-old G6 P6 woman. Until admission the patient had had no major health problems. There had been no record of hypertensive disorders during the previous pregnancies, or during the reported pregnancy. The pseudoaneurysm occurred in the third trimester and it had a favourable outcome for the mother and her baby.