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Pediatric Radiology Sep 2022Pediatric chest wall lesions are varied in etiology ranging from normal and benign to aggressive and malignant. When palpable, these lesions can alarm parents and... (Review)
Review
Pediatric chest wall lesions are varied in etiology ranging from normal and benign to aggressive and malignant. When palpable, these lesions can alarm parents and clinicians alike. However, most palpable pediatric chest lesions are benign. Familiarity with the various entities, their incidences, and how to evaluate them with imaging is important for clinicians and radiologists. Here we review the most relevant palpable pediatric chest entities, their expected appearance and the specific clinical issues to aid in diagnosis and appropriate treatment.
Topics: Child; Humans; Magnetic Resonance Imaging; Thoracic Wall; Tomography, X-Ray Computed
PubMed: 35316339
DOI: 10.1007/s00247-022-05323-9 -
Przeglad Menopauzalny = Menopause Review Sep 2022Carcinoma of the accessory breast tissue (CABT) is an extremely rare occurrence, representing 0.3% of all breast malignancies. A 65-year-old, postmenopausal woman was...
Carcinoma of the accessory breast tissue (CABT) is an extremely rare occurrence, representing 0.3% of all breast malignancies. A 65-year-old, postmenopausal woman was referred to our Breast Clinic complaining of a palpable, growing, and painful mass in her right axilla. Physical examination revealed a palpable tender mass, approximately 3 cm in size, visibly infiltrating the overlying skin area, while physical examination of the breast revealed no palpable lesions. Core biopsy of the mass was promptly scheduled, and the histological report came back positive for Nottingham Grade II NST invasive carcinoma of the breast. The patient underwent breast-conserving surgery and concomitant axillary lymph node dissection (ALND) for removal of the malignant mass. Care was taken to preserve the axillary vein and the long thoracic nerve. Closure of the axillary incision required mobilization of skin flaps to ensure optimal cosmetic results. Despite the ectopic breast tissue being a largely benign and infrequent occurrence, the breast surgeon must remain vigilant for the possibility of CABT development. At any rate, further epidemiological studies incorporating as many patients as possible are required in order to formulate recommendations on the management and prognosis of CABT. Until such guidelines exist, excision of the carcinoma, along with ALND performance, is a reasonable and justified approach to the surgical treatment of CABT.
PubMed: 36254132
DOI: 10.5114/pm.2022.119528 -
Indian Journal of Dermatology 2022Several cutaneous diseases can present with annular lesions, making a distinction by physical appearance alone challenging. They can be distinguished into infectious and... (Review)
Review
Several cutaneous diseases can present with annular lesions, making a distinction by physical appearance alone challenging. They can be distinguished into infectious and non-infectious, and common and uncommon annular dermatoses. Common non-infectious diseases include granuloma annulare, urticaria, and subacute lupus erythematosus. In addition, there are rare non-infectious non-neoplastic annular dermatoses whose nosographic attribution is established, including annually recurring erythema annulare centrifugum (EAC) and annular erythema in Sjögren syndrome and others whose nosographic positioning is still debated. They are neutrophilic figurate erythema, palpable migratory arciform erythema, eosinophilic annular erythema, and annular lichenoid dermatitis of youth. Their etiopathogenesis is largely unknown, although immune-mediated mechanisms are likely involved. It is difficult to establish if they are variants of reaction patterns or separate clinic-pathological entities. In fact, EAC and annually recurring EAC may represent different aspects of the same disease. Palpable migratory arciform erythema is hardly distinguishable from EAC deep type, Jessner-Kanof disease, and lupus tumidus. Neutrophilic figurate erythema and eosinophilic figurate erythema are clinically very similar and differing only in the relative proportion of eosinophils and neutrophils.
PubMed: 36386081
DOI: 10.4103/ijd.ijd_743_21 -
Wilderness & Environmental Medicine Mar 2021
Topics: Exercise; Female; Humans; Middle Aged; Vasculitis
PubMed: 33423897
DOI: 10.1016/j.wem.2020.10.001 -
Radiologia 2022Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in...
Palpable tumors in children are a common reason for consulting a radiologist. The differential diagnosis is extensive and considerably different from that used in adults. Some of the etiologies of palpable tumors are little known outside of pediatrics. The most commonly used imaging test is ultrasonography, because in addition to being harmless and cost-effective, it is conclusive in most cases. Most palpable lesions in children are benign; it is estimated that only 1% are malignant. Knowing these lesions enables the correct diagnosis without the need to resort to unnecessary, sometimes invasive tests, thus avoiding delays in treatment when more severe disease is present. This article aims to review the clinical and radiological characteristics of the palpable lesions that are most common in pediatric patients, explaining the key features that enable accurate diagnosis.
Topics: Humans; Child; Adult; Neoplasms; Ultrasonography; Diagnosis, Differential; Radiology; Pediatrics
PubMed: 36402541
DOI: 10.1016/j.rxeng.2022.08.001 -
British Journal of Sports Medicine Mar 2017Gluteal tendinopathy (GT) is a source of lateral hip pain, yet common clinical diagnostic tests have limited validity. Patients with GT are often misdiagnosed, resulting...
PURPOSE
Gluteal tendinopathy (GT) is a source of lateral hip pain, yet common clinical diagnostic tests have limited validity. Patients with GT are often misdiagnosed, resulting in inappropriate management, including surgery. This study determined the diagnostic utility of clinical tests for GT, using MRI as the reference standard.
METHODS
65 participants with lateral hip pain were examined to evaluate the ability of clinical tests to detect MRI-determined GT (an increase in intratendinous signal intensity on T2-weighted images). Palpation of the greater trochanter and several clinical pain provocation tests applying compressive and tensile loads on the gluteal tendons were investigated. MRI of the painful hip was examined by a radiologist, blind to clinical findings.
RESULTS
Pain reported within 30 s of standing on the affected limb conclusively moves a (nominal) 50% pretest probability of GT presence on MRI to a post-test probability of 98% (specificity 100%, positive likelihood ratio ∼12), whereas no pain on palpation (80% sensitivity) would rule out its presence. 20 participants (31%) had GT on MRI but clinically negative (ie, not positive on palpation and another test).
CONCLUSIONS
Keeping in mind that the sample size was small (ie, possibly underpowered for indices of diagnostic utility with low precision), the results of this study indicate that a patient who reports lateral hip pain within 30 s of single-leg-standing is very likely to have GT. Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected GT.
Topics: Adult; Aged; Arthralgia; Female; Hip Joint; Humans; Isometric Contraction; Magnetic Resonance Imaging; Male; Middle Aged; Patient Positioning; Physical Examination; Sensitivity and Specificity; Tendinopathy
PubMed: 27633027
DOI: 10.1136/bjsports-2016-096175 -
Journal of Korean Medical Science Mar 2022Non-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric...
BACKGROUND
Non-palpable splenomegaly in patients with polycythemia vera (PV) has seldom been addressed. In this retrospective study, we evaluated non-palpable, volumetric splenomegaly defined based on age- and body surface area (BSA)-matched criteria in patients with PV diagnosed according to the 2016 World Health Organization diagnostic criteria.
METHODS
Patients with PV who underwent abdominal computed tomography (CT) and who had palpable splenomegaly at diagnosis from January 1991 to December 2020 at Chungnam National University Hospital were enrolled. The spleen volume of each patient was determined by volumetric analysis of abdominal CT and adjusted for the patient's age and BSA. Then the degree of splenomegaly was classified as no splenomegaly, borderline volumetric splenomegaly, overt volumetric splenomegaly, or palpable splenomegaly.
RESULTS
Of the 87 PV patients enrolled, 15 (17.2%) had no splenomegaly, whereas 17 (19.5%), 45 (51.7%), and 10 (11.5%) had borderline volumetric, overt volumetric, and palpable splenomegaly, respectively. The degree of splenomegaly did not affect the cumulative incidence of thrombotic vascular events (10-year incidence: 7.7%, 0%, 22.3%, and 50.7%, respectively, = 0.414). By contrast, splenomegaly tended to adversely affect myelofibrotic transformation (10-year cumulative incidence: 0%, 0%, 7.1%, and 30.3%, respectively, = 0.062). Moreover, the cumulative incidence of myelofibrotic transformation was significantly higher in patients with overt volumetric or palpable splenomegaly than those with no or borderline volumetric splenomegaly (10-year incidence: 0% vs. 10.3%, respectively; 15-year incidence: 0% vs. 26.3%, respectively, = 0.020). Overall survival (OS) differed among patients with different degrees of splenomegaly (15-year OS: 100%, 78.6%, 71.7%, and 51.9%, respectively, = 0.021).
CONCLUSION
The degree of splenomegaly, including volumetric splenomegaly, based on age- and BSA-matched reference spleen volumes at diagnosis reflects disease progression in PV patients. Therefore, volumetric splenomegaly should be evaluated at the time of diagnosis and taken into consideration when predicting the prognosis of patients with PV.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Polycythemia Vera; Predictive Value of Tests; Prognosis; Republic of Korea; Retrospective Studies; Splenomegaly; Young Adult
PubMed: 35315598
DOI: 10.3346/jkms.2022.37.e87 -
The Canadian Journal of Urology Aug 2017To characterize our contemporary clinical experience with cryptorchidism.
INTRODUCTION
To characterize our contemporary clinical experience with cryptorchidism.
MATERIALS AND METHODS
The records of boys referred for cryptorchidism were reviewed from 2001 to 2011. Data regarding the incidence of retractile testes, testicular ascent, surgical approach and outcomes were tabulated. Follow up was both early (< 12 weeks) and late (> 12 weeks).
RESULTS
A total of 1885 patients, or 2593 testes, were identified. Eight hundred and forty-one children (45%) or 1204 testes (46%) were retractile on initial exam-57% bilateral; 187 testes (7%) later 'ascended' on re-examination and underwent surgery--15% bilateral; 1340 (85%) testes were palpable in the inguinal canal and underwent inguinal orchidopexy--98% were successful; 69 (4%) of initially palpable testes were found to be atrophic and removed; 167 (11%) testes were non-palpable and underwent laparoscopy-46 were atrophic and removed; 31 were vanishing; 33 were brought down using an inguinal approach at the same sitting with 97% success; 47 underwent staged Fowler-Stephens orchidopexy (FSO) and 10 underwent non-staged FSO, with 82% and 78% success respectively. All second stages were performed open.
CONCLUSIONS
Almost half of children referred for cryptorchidism had retractile testes. Surgery for later ascent was required in 16% of testes judged to be retractile at a median age of 8 years, emphasizing the need for repeat examination. High success rates with inguinal orchidopexy were achieved, even in non-palpable testes. Testes requiring FSO were uncommonly encountered-approximately 5 testes/year or 4% of testes undergoing surgery-and success was achieved in approximately 80%.
Topics: Child, Preschool; Cryptorchidism; Humans; Male; Retrospective Studies
PubMed: 28832317
DOI: No ID Found -
AJR. American Journal of Roentgenology Nov 2014Women commonly present to imaging departments with a palpable breast abnormality. However, widespread confusion remains regarding the most appropriate sequence and... (Review)
Review
OBJECTIVE
Women commonly present to imaging departments with a palpable breast abnormality. However, widespread confusion remains regarding the most appropriate sequence and extent of imaging required. The purpose of this article is to discuss the evidence informing current management guidelines for the care of patients with palpable breast abnormalities.
CONCLUSION
Ultrasound is a highly effective imaging tool for guiding effective evaluation of women with palpable breast abnormalities and should be used for all women with suspicious findings at clinical breast examination. The exception is cases in which mammography shows a clearly benign correlate or a normal, fatty area of breast tissue in the location of the palpable finding. Breast ultrasound should be the primary imaging tool for women with palpable lumps who are pregnant, lactating, or younger than 30 years. For women 40 years old and older, mammography, followed in most cases by ultrasound, is recommended. For women 30-39 years old, ultrasound or mammography may be performed first at the discretion of the radiologist or referring provider. There is little to no role for breast MRI or other advanced imaging technologies in the routine diagnostic evaluation of palpable breast abnormalities.
Topics: Adult; Breast Diseases; Diagnosis, Differential; Female; Humans; Middle Aged; Palpation; Ultrasonography, Mammary; Young Adult
PubMed: 25341156
DOI: 10.2214/AJR.14.12725 -
The Journal of Hand Surgery... Apr 2024
Topics: Humans; Wrist; Wrist Joint; Upper Extremity
PubMed: 38553850
DOI: 10.1142/S2424835524710024