Suk-Ping Ng

Hyperdense gallbladder wall sign An overlooked sign of acute cholecystitis on unenhanced CT examination

We reviewed the unenhanced computer tomography (CT) scans of 53 patients with surgically proven acute cholecystitis, where 27 patients presented with hyperdense gallbladder wall. To our knowledge, this sign was never reported before. Because mucosa is highly sensitive to ischemia, early mucosal necrosis and hemorrhage may result in CT-detectable high density. Similar episode may also occur in acute cholecystitis. This sign also reflects high probability for acute gangrenous cholecystitis. We suggest that patients with this sign should have urgent treatment.

Small Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic carcinoma of the breast is a rare form of breast cancer and has a poorer prognosis than other breast malignancies. Preoperative diagnosis of this tumor by imaging is difficult because of its rarity. Sonography of this small neoplasm has not been reported previously. We describe a case of this rare tumor together with the preoperative mammographic and sonographic findings. When these images present in a lesion, metaplastic breast carcinoma should be included in the differential diagnosis.

Intraluminal Papillary Urinary Bladder Paraganglioma: case report and review of literatures

Urinary bladder paraganglioma is a very rare tumor, account for ＜0.05% of all bladder tumors. They are usually submucosal tumors most commonly located near the urinary bladder trigone. A deeply located urinary bladder paraganglioma may not be seen on cystocope, and pelvic sidewall paraganglioma may mimic urinary bladder paraganglioma. Here we present an extremely rare case of urinary bladder paraganglioma presenting as 39-year-old woman incidentally found to have an intraluminal papillary bladder tumor and it turned out to be a paraganglioma. Most of the paragangliomas are usually functional tumors, which frequently cause symptoms related to catecholamine release. In addition to systemic symptoms like other paragangliomas, bladder paraganglioma may cause specific symptoms during urination and sexual intercourse that warrant attention for diagnosis and management. Preoperative, correct diagnosis of such case with palliative medication using catecholamine antagonist may be crucial to prevent adverse complication.

Radial Scar of the Breast

Radial scar is a distinctive disease not only because of its similarity with breast cancer but also because of the controversy of diagnosing methods. Here we report two cases of radial scar with different clinical approaching strategies. We pose two questions based on the inconsistency between these two cases and review recent studies to come up with some reasonable answers. The first question is about the predictive values of several diagnostic methods. According to the recent studies, mammography and excisional biopsy are the most practical examinations. Ultrasonography only has some value in the biopsy procedure. MRI is still unreliable to confirm the final diagnosis but may be a promising tool to guarantee that a lesion is in fact a benign entity. Second question concerns the reasonable time to perform an excisional biopsy. Based on the results of current research, it seems rational to always carry out an excisional biopsy at the time when radial scar is noticed. The reason is because the only well-documented method until now to confirm the diagnosis of radial scar is excisional biopsy. AII other biopsy procedures including fine-needle aspiration biopsy, core biopsy and vacuum-assisted biopsy have variable degree of malignancy underestimation rate. However, more complex criteria may improve the strength of these three biopsy methods in the future.

Successful Treatment of Infected Lymphocele Following Major Gynecologic Surgery by Computed Tomographic-guided Drainage

Objective: Lymphocele is a well-known complication of major gynecological surgery. Most collections are asymptomatic and self-limited, but infected lymphoceles need further management. We evaluated the effectiveness of this minimally invasive procedure as an alternative to surgical treatment. Material(s) and method(s): From July 1998 through July 2003, 13 cases of infected lymphoceles were retrospectively reviewed. Location of the lymphoceles, size, and duration of drainage were recorded. Result(s): Fever and pain were the most common presenting symptoms. The interval between the initial surgical procedure and the presentation of an infected lymphocele ranged from 1 to 31 months (mean 5.8 months). CT-guided drainage resulted in relief of pain and defervesence in all 13 patients. The causative organisms included both gram positive and gram negative bacteria. The duration of catheter drainage ranged from 6 to 29 days (mean 12.9 days). All patients tolerated the procedure well, and there were no significant complications. Conclusion(s): While lymphoceles may form a few weeks after surgery, but we found that infected lymphoceles usually became clinically apparent a few months instead of weeks after operation. CT-guided percutaneous drainage is effective, safe, and well tolerated. It provides a good alternative to open surgery for infected lymphocele.