Breast imaging case of the day. Intramammary and axillary lymph node metastases from infiltrating lobular carcinoma of the breast.
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Biomedical subjects
Publications and source records attributed to D Cyrlak.
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Increasing numbers of postmenopausal women are undergoing hormonal replacement therapy. In this pictorial essay, we present the spectrum of mammographic changes seen in these women. These changes include symmetric and asymmetric increase in breast density, increase in size of fibroadenomas, and development or increase in size of cysts. Our examples illustrate that differentiation of hormonal therapy changes from neoplasm can occasionally be problematic when a focal density or mass is seen on mammograms. Furthermore, reexamination of published reports and our cases suggests that treatment with estrogen alone promotes enlargement of cysts and fibroadenomas, whereas treatment with a combination of estrogen and progesterone is more likely to be associated with diffuse increase in density.
Telephone follow-up in a recent low-cost ($50) mammography screening project in Orange County, California, was done to determine the detection rate and the induced costs of detection of small breast cancers. Because 403 of 2,261 (18%) women screened required additional evaluation and the cost of evaluation per abnormal mammogram averaged $607, the actual cost per cancer detected was $25,500. At least five cancers were detected per 1,000 women screened, and only 17% of the cancers involved the axillary lymph nodes. The costs of screening mammograms accounted for less than one-third of total costs, with surgical consultations and biopsies for benign disease representing the major induced costs of screening.
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Chronic recurrent multifocal osteomyelitis was first described in 1972 and to date 33 cases have been reported, all but one from outside the United States. This unusual osteomyelitis is characteristically recurrent and multifocal with a predilection for the metaphyses. Cultures are persistently negative and antibiotics do not appear to affect the course of the disease, which may be as long as 15 years. Females are affected twice as frequently as males and half the cases are less than ten years old. Antistreptolysin 0 titers are elevated in a quarter of the patients, and there may be a history of previous throat infection. There is an association with pustulosis palmoplantaris. We present two additional cases from the United States.
Pneumomediastinum has numerous etiologies and its pathways of spread are multiple and well defined. Knowledge of these anatomic pathways and possible etiologies is important in order to avoid extensive and unnecessary evaluations. For example, if there is a known reason for pneumomediastinum, and pneumoperitoneum is present without associated abdominal findings, further evaluation for perforated viscus is unnecessary. In a patient who is an asthmatic or a diabetic, the presence of pneumomediastinum should not lead to work-up with contrast studies unless there are specific clinical reasons to do so. In critically ill infants and adults, pulmonary interstitial emphysema is an important warning sign for impending pneumothorax or pneumomediastinum and the patient's physicians should be alerted. There are occasional difficulties in differentiating pneumomediastinum from pneumopericardium and from a medial pneumothorax. Analysis of anatomic details and decubitus views are helpful in this regard.
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