Pitfalls in imaging of musculoskeletal infections.

In musculoskeletal infections, imaging helps in the diagnosis and identification of disease extent. Musculoskeletal infections have variable clinical presentations related to host immune responses and virulence of pathogens. Occasionally, infectious process may mimic other entities such as autoimmune inflammatory diseases, tumors, or traumatic injuries, both clinically and radiologically.

Clinics in diagnostic imaging (149). Bilateral testicular epidermoid cysts.

A 33-year-old man presented with a painless, non-growing left testicular mass for five years. Preoperative ultrasonography (US) of the scrotum showed a small, circumscribed calcific mass in the right testis and another well-defined heterogeneous echoic mass with a partially calcified wall in the left testis, with avascularity on colour Doppler US. These imaging findings in a clinical setting of non-growing testicular masses were highly suggestive of epidermoid cysts, thus leading to testis sparing surgery.

Congenital renal anomalies detected in adulthood.

Objective: To document the types of congenital renal anomalies detected in adulthood, the clinical presentation and complications of these renal anomalies, and the most useful imaging modality in detecting a renal anomaly.

Materials And Methods: This study was approved by the institutional review board and informed consent was waived. Between January 2007 and January 2011, the clinical data and imaging studies of 28 patients older than 18 years diagnosed with renal anomaly at the authors' institution were retrospectively reviewed.

Paget's disease of the breast: clinical, imaging and pathologic findings: a review of 16 patients.

Objectives: To determine the clinical, imaging and pathological findings of Paget's disease of the breast.

Materials And Methods: Approval by Institutional Review Board was granted and informed consent was waived. Retrospective review of the pathological diagnosis of 2,361 women with breast carcinoma between January 2004 and April 2010 revealed 27 patients with Paget's disease of the breast.

Musculoskeletal melioidosis.

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection.

Tuberculosis arthritis and tenosynovitis.

The incidence of extrapulmonary tuberculosis (TB) has been rising due to the increasing number of immunosuppressed patients. Musculoskeletal system accounts for 25% of extrapulmonary TB. Most of the musculoskeletal TB involves the spine.

Clinics in diagnostic imaging (135). Cystic renal cell carcinoma.

A 45-year-old man presented with right flank pain and haematuria for one month. Computed tomography showed a large, well-circumscribed exophytic complex cystic mass with enhanced, irregular thickened walls arising from the upper pole of the right kidney, which was associated with bilateral renal stones. Partial right nephrectomy with removal of the right renal stones was performed.

Clinics in diagnostic imaging (134). Testicular lymphoma.

A 55-year-old man presented with a painless right scrotal mass for the past three months. Scrotal ultrasonography showed a large circumscribed hypoechoic mass with marked hypervascularity occupying almost the entire right testis. The epididymis and scrotal skin were normal.

Breast calcifications: which are malignant?

Most calcifications depicted on mammograms are benign. However, calcifications are important because they can be the first and earliest sign of malignancy. For detection and analysis of microcalcifications, high-quality images and magnification views are required.

Can radiographic plain film be used to determine the depth of the tumour bed in the absence of surgical clips for breast boost planning.

Purpose: A number of studies have demonstrated the importance of using surgical clips to define the tumour bed in breast boost radiotherapy. In the absence of such clips, other techniques suggested to improve boost location have included CT and ultrasound (US). Determination of the depth of the tumour bed is important in the selection of electron energy.

Clinics in diagnostic imaging (125). Diagnosis: Suspicious right breast carcinoma with axillary node metastases.

A 61-year-old woman who had a known history of ovarian carcinoma presented with a palpable painless mass in the right axilla. Mammograms showed segmental-distributed pleomorphic microcalcifications in the upper outer quadrant of the right breast with marked enlargement of the right axillary nodes. The biggest node contained microcalcifications.

Role of ultrasonography in diagnosis of scrotal disorders: a review of 110 cases.

Objective: To determine the role of ultrasonography in diagnosis of scrotal disorders.

Materials And Methods: This study was carried out after institutional review board approval was granted, and informed consent was waived. Between January 2005 and January 2007, 144 patients aged 12 years and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed.

Spectrum of imaging findings in melioidosis.

This pictorial review aims to highlight the clinical and imaging features of melioidosis in various organ systems. The patients were from two centres: one in Thailand and one in Singapore. The annual average incidence of melioidosis is estimated to be 4.

Urachal abnormalities: clinical and imaging features.

Introduction: The clinical manifestation of urachal abnormalities may mimic many intraabdominal or pelvic diseases. We present clinical, imaging and pathological findings of a spectrum of complicated urachal abnormalities and determine whether imaging can be used to differentiate tumour from infection.

Methods: From January 1993 to December 2006, seven patients with surgically-proven complicated urachal abnormalities had their clinical, imaging and pathological features reviewed.

Spectrum of papillary lesions of the breast: clinical, imaging, and pathologic correlation.

Objective: Papillary lesions of the breast are a heterogeneous group of lesions that are difficult to diagnose as benign or malignant. The purpose of this article is to review clinical presentation, imaging features, and pathologic correlation of papillary lesions of the breast and to discuss the prognosis and management of these lesions.

Conclusion: Recognition of the variety of benign and malignant papillary lesions of the breast will facilitate diagnosis and proper management.

Imaging features of hepatic angiomyolipomas.

We review the imaging appearances of hepatic angiomyolipomas in patients with and without tuberous sclerosis. Sporadic hepatic angiomyolipomas have a varied appearance because of the inconstant proportion of fat, making confident imaging diagnosis difficult and necessitating biopsy in many cases. In patients with tuberous sclerosis, hepatic angiomyolipomas have a more consistent imaging appearance and, together with other features of the syndrome, can be more easily diagnosed.

Cystic echinococcosis in Thailand with a special note on detection by serology in one family.

Thailand is a nonendemic area of echinococcosis. We report, herein, 3 cases with a special note on the use of serology in detection of the disease in one family. All cases were Thais.

Benign breast lesions mimicking carcinoma at mammography.

Many benign breast lesions pose diagnostic challenges. These lesions include abscess, haematoma, radial scar, post surgical scar, diabetic mastopathy, focal fibrosis, sclerosing adenosis, granular cell tumour, extra-abdominal desmoid tumour, medial insertion of pectoralis muscle and sternalis muscle, and axillary lymphadenopathy (due to HIV infection, collagen vascular lesions, tuberculous and bacterial lymphadenitis). Radiologists should be familiar with the characteristic imaging features of these benign lesions, and should include these benign lesions in the differential diagnosis whenever malignant-appearing findings are encountered.

Clinics in diagnostic imaging (114). Rupture of the right testis.

A 22-year-old man, who was kicked in the scrotum during Thai kickboxing, presented with a painful swelling of the right hemiscrotum. Scrotal ultrasonography (US) showed an enlarged right testis with heterogeneous echogenicity and irregular contours. Colour Doppler US showed vascularity in the upper pole of the right testis and avascularity in the lower pole.

Breast carcinomas: why are they missed?

Introduction: Mammography has proven to be an effective modality for the detection of early breast carcinoma. However, 4-34 percent of breast cancers may be missed at mammography. Delayed diagnosis of breast carcinoma results in an unfavourable prognosis.

Artifacts in mammography: ways to identify and overcome them.

High-quality mammography images enhance a radiologist's ability to interpret mammograms because they have greater sensitivity and specificity. Artifacts may create pseudo-lesions or mask abnormalities leading to misinterpretation. Familiarity with the numerous artifacts encountered will enable radiologists to provide accurate diagnoses.

Mammographic changes related to different types of hormonal therapies.

Objectives: To determine the effects of different types of hormone therapies (HT) on mammographic breast density changes.

Material And Method: Between 1999 and 2002, mammograms obtained before and 12-18 months after different types of HT in 170 women were evaluated Estrogen alone (n = 66), or estrogen in cyclic (n = 59) or continuous (n = 45) combination with progesterone were used. The baseline mammographic density was classified according to the Breast Imaging Reporting and Data Systems (BI-RADS).