Biomedical subjects
Publications and source records attributed to E S McCrea.
We reviewed 27 biopsy-proven cases of inflammatory disease of the breast. Mammographic features of acute and chronic breast inflammation and abscess included focal increased density (68%), a spiculated mass (56%), skin thickening (48%), skin retraction (28%), and microcalcification (8%). We found considerable similarity between inflammation and malignancy.
We present four cases of cystosarcoma phyllodes in which mammograms revealed a small or large lobulated mass occupying the entire breast. Preoperative diagnosis was a benign lesion with a low probability of nodular carcinoma. Histologically, all tumors were classified as malignant. Although uncommon, cystosarcoma should be considered in the differential diagnosis of these masses, since local recurrence is frequent unless wide wedge resection or simple mastectomy is done.
Current recommendations for the plain radiographic evaluation of abdominal pain suggest a minimum three-film series including an erect and supine abdominal view and an erect chest study. Three film radiographic abdominal "series" were obtained in 252 consecutive emergency-room patients who presented with abdominal pain. The views were analyzed independently for their relative diagnostic value. Radiologic pathologic findings were present in 20% of the abdominal films and in 13% of the chest radiographs. The supine abdominal view and the erect chest study diagnosed normality or abnormality in 98% of these patients. The elimination of the erect abdominal view from the routine abdominal series could result in financial savings, decreased radiation exposure, and a more efficient use of technician time, without significant loss of diagnostic information.
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Computed tomography (CT) of the chest was performed as part of the initial and subsequent staging evaluations in 33 patients with small cell lung carcinoma. In 25 of the 33 patients, CT demonstrated findings not observed on standard radiography. Eleven of the 33 would have been staged higher using CT. Before treatment, CT revealed more mediastinal and nodal involvement than conventional films. After chemotherapy, CT demonstrated areas of residual or early recurrent disease in nine of 28 patients that were not apparent on chest films. Initially thickened pericardium in patients with limited disease and persistent bronchial narrowing after chemotherapy were demonstrated to be associated with early relapse in the chest and short survival. These initial data suggest that the CT scan, in addition to more accurately assessing the extent of disease, can provide a new risk classification for early chest relapse. Initial thickened pericardium in limited disease and continued bronchial narrowing after chemotherapy may allow patient selection for future treatment trials with radiation as an adjuvant to chemotherapy.
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Emphysematous lung cysts in rare instances are associated with bronchial asthma, as evidenced by our patient and possibly another. Particularly in young patients, a trial period of steroid therapy should be instituted to confirm this possible association, to avoid unwarranted surgery and its attendant morbidity.
Metastases to the breast are uncommon, with about 250 cases reported from clinical and autopsy series. The mammographic findings in 16 new cases revealed a spectrum of changes that included solitary or multiple lesions, well demarcated or poorly marginated masses, and diffuse involvement of skin or parenchyma or both. Diffuse disease was seen more frequently in this series (4/16), at times simulating inflammatory breast cancer. Although diagnosis of a primary malignancy usually preceded detection of the breast lesion, 40% (6/16) had no history of malignancy. Prognosis remains poor; however, it has improved in the lymphoma-leukemia group due to improved immunotherapeutic and chemotherapeutic regimens. The clinical, radiologic, and pathologic features are discussed. Some of the lesions encountered can be confused with a primary breast malignancy or a benign lesion, necessitating prompt and accurate biopsy to preclude unnecessary major surgery and to improve survival in cancers amenable to current therapy.
A 52-year-old woman with a history of myasthenia presented with an anterior mediastinal mass and three other apparent pleural-based lesions on the side of the mediastinal lesion. These masses were confirmed by computed tomography and believed to represent distant intrathoracic implants from the presumed mediastinal thymoma. This knowledge directed proper surgical approach and clinical management in this patient, now free of disease four years later.
Pulmonary nodules may develop following bleomycin therapy, a previously undescribed entity that may simulate metastatic disease. Two asymptomatic patients are reported with nodules that developed following low dose bleomycin treatment for testicular tumors. One patient had previously documented pulmonary metastases that had resolved after chemotherapy. The other patient had nodular-appearing densities on routine chest examination without a history of previous metastatic lung involvement.
Fourteen consecutive patients with the clinical diagnosis of primary hyperparathyroidism had computed tomography (CT) preoperatively to evaluate the use of CT in localizing parathyroid adenomas. The patients were scanned from above the level of the thyroid cartilage to the bifurcation of the trachea. Computed tomography correctly identified, prospectively, the site of the adenoma in 7 of 14 patients, including one adenoma that was ectopic in location. Nine of these patients also had barium esophagrams, and this study was accurate in only three of the nine. Our study suggests that CT may be beneficial in the preoperative localization of parathyroid adenomas, particularly those in ectopic locations.
Hemorrhage into the breast is an unusual complication following anticoagulant therapy. A review has revealed only 20 examples. We wish to report the mammographic features not previously described in the radiologic literature.
Colonic diverticulitis may result in single or multiple fistulae communicating either internally or externally. We report an unusual case of fistulous communication between the colon and the left hip joint secondary to diverticulitis, with subsequent septic arthritis and osteomyelitis of the proximal femur.
Diphenylhydantoin (Dilantin) is a well known anticonvulsant with well documented effectiveness. The complications, unfortunately, are multiple and well recognized clinically. This paper deals with the roentgenographic changes encountered in long-term diphenylhydantoin use. Some of these changes, which are not clinically readily apparent, may alert unwary physicians in the recognition of diphenylhydantoin-induced disease.
Stercoraceous perforation of the colon is most often unsuspected and is usually diagnosed at operation or autopsy. Abdominal radiographs show large fecal masses in the rectum and sigmoid colon, and occasionally lying free in the peritoneal cavity. Free intraperitoneal air is present. We have reported a single case, with a discussion of the pathophysiology.
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