Randall L. Scott

Quality assurance review: Improving diagnostic accuracy of percutaneous needle biopsy

Adequate pathologic slide preparation of percutaneous fine-needle biopsy (PFNB) specimens is necessary to maximize sensitivity and yield a tissue diagnosis. We present a quality control review of our biopsy technique and results in 71 aspiration biopsies done in 59 patients. Immediate cytology slide preparation in the radiology suite enabled us to increase our diagnostic yield from 53% to 84%, and allowed us to preserve PFNB, rather than open biopsy, as the primary diagnostic modality. We recommend regular review of biopsy techniques to confirm adequate diagnostic yields of these procedures.

DUPLEX DOPPLER EXAMINATION OF A PERINEPHRIC ABSCESS IN A RENAL TRANSPLANT

Perinephric abscess has no characteristic ultrasonic appearance or location. Differentiation from urinoma, lymphocele, or hematoma depends on clinical and laboratory findings. Therapy consists of percutaneous catheter drainage, surgical drainage, and antibiotic therapy. Acute rejection is the most common cause of decreased diastolic flow during the immediate postoperative period. Acute tubular necrosis does not usually alter blood flow unless it is severe. Duplex doppler ultrasonic assessment of the renal transplant during the immediate postoperative period may provide a valuable baseline for comparison if complications develop. Baseline and follow-up ultrasonography to evaluate diastolic flow can help determine whether a posttransplant patient should receive emergency or conservative therapy for complications.

Pleural aspergillosis diagnosed by computerized tomography.

As shown by the case we have reported, patients with a chronic pneumothorax and nodular, thickened pleura may have pleural aspergillosis. We recommend that when such patients have CT of the chest, the examiner use the alternate dependent position to look for mobile pleural debris.

Tuberculous arthritis of the wrist: Differential diagnosis and case report

Tuberculous arthritis usually occurs in the spine, hip, or knee. Tuberculosis is not usually considered early in the evaluation of monoarticular arthritis of a non- weight-bearing joint. We wish to présent a case in which progressive destruction of the wrist occurred in a patient with minimal symptoms and no systemic complaints, thus emphasizing the insidious nature of the disease. A high index of suspicion is necessary if proper diagnosis and medical management are to be instituted.

Case report 129

Address reprint requests to: Randall L. Scott, M.D., Department of Diagnostic Radiology, University of Tennessee College of Medicine, Walter F. Chandler Building, 865 Jefferson Avenue, Memphis, TN 38163, USA multiple soft tissue masses of the face and chest wall. Physical examination at the time of admission showed an 8 x 9 cm smooth, hard, fixed, non-tender mass in the region of the right mandibular angle. A similar lesion was observed in the mid-forehead region. The laboratory data were normal. A complete skeletal survey, including studies of the skull and mandible, was obtained (Figs. 1, 2, and 3) as well as barium studies of the gastrointestinal tract (Fig. 4).