scholarly journals The role of image in the diagnosis of pseudotumor lesions: a pictorial essay

2021 ◽  
Author(s):  
Angelo Chelotti Duarte ◽  
Lucas Ghisleri ◽  
Isabella Colla Maia ◽  
Antônio Carlos Martins Maia Junior
Keyword(s):  
Invasive Procedure ◽  
Final Diagnosis ◽  
Warning Signs ◽  
High Signal ◽  
Pictorial Review ◽  
Peripheral Ring ◽  
Pictorial Essay ◽  
Imaging Service ◽  
Expansive Lesion

Introduction: The clinical-radiological differentiation between neoplastic and pseudotumoral lesions has an important role in therapeutic approach, with repercussions on the conduct to be taken. When facing an expansive lesion, in addition to neoplasms, a list of differential diagnoses must be considered, including inflammatory, infectious, hemorrhagic lesions, among others. In this context, the role of imaging methods is highlighted in order to anticipate surgical management in the presumption of an aggressive neoplasm or, on the other hand, avoid an unnecessary invasive procedure. Objectives: To identify the warning signs of pseudotumor lesions in imaging studies. Methodology: Retrospective pictorial review of the archives of Diagnostic Imaging service of Santa Casa de São Paulo, between 2010 and 2020. Results: The warning signs that indicate a probable pseudotumoral lesion include spontaneous hypersignal in T1, marked hyposignal in T2, absence of significant expansive effect, cavitated lesion with high signal in diffusion, incomplete ring impregnation, restricted peripheral ring diffusion and spectral relations (choline / creatine) lower than 2. Each of these distinguishing features is discussed and exemplified. Conclusions: Although the distinction between expansive neoplastic and pseudotumoral lesions is not always direct, the systematic use of the exposed criteria allows greater assertiveness in the differential diagnosis. If the diagnostic doubt persists, therapeutic proof tests have a fundamental role in this context and, unfortunately, in some cases the final diagnosis will only be possible with biopsy.

scholarly journals The Utility of Rapid On-Site Evaluation during Bronchoscopic Biopsy: A 2-Year Respiratory Endoscopy Central Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Hansheng Wang ◽  
Na Wei ◽  
Yijun Tang ◽  
Yunyun Wang ◽  
Guoshi Luo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
International Association ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
European Respiratory Society ◽  
Macroscopic Appearance ◽  
Visible Lesion ◽  
Bronchoscopic Biopsy ◽  
Site Evaluation

Background. Rapid on-site evaluation (ROSE) is commonly used to evaluate the adequacy of biopsy materials in fine-needle aspiration; however, the diagnostic performance of ROSE during fiber optic bronchoscopy (FOB) biopsy under direct vision is rarely reported. Here, we evaluated the role of ROSE during FOB biopsy of visible lesion in trachea or bronchi. Methods. The role of ROSE was prospectively evaluated in consecutive bronchoscopy specimens obtained between January 2016 and January 2018. The agreement and accuracy between ROSE and final histopathological interpretation were assessed. The frequency and possible reasons for discrepancy between ROSE and definitive histopathology results were identified. Histological and cytological classification was performed according to the International Association for the Study of Lung Cancer, the American Thoracic Society, and the European Respiratory Society (IASLC/ATS/ERS) criteria of lung ADCs classification. Results. The study enrolled 651 patients, of which 33 were excluded because of insufficient cells. Final diagnosis of malignancy was achieved in 462 cases (74.8%), whereas 156 cases (25.2%) were nonmalignant. ROSE and pathology were well correlated for the diagnosis of squamous cell carcinoma (SCC) (Kappa = 0.718, p<0.05), adenocarcinoma (AdC) (Kappa = 0.662; p<0.05) and small cell lung cancer (SCLC) (Kappa = 0.955; p<0.05). In 24 cases diagnosed as malignant by ROSE and nonmalignant by pathology, the lesion tissues were surgically excised and re-analyzed, and the 24 cases were finally confirmed as malignant by pathology. Conclusions. ROSE technique allows bronchoscopists to obtain viable and adequate material for the diagnosis of histopathology, and provides them with an onsite preliminary diagnosis especially in cases with inconclusive macroscopic appearance. ROSE and pathology should be used in combination to increase the accuracy of diagnosis.

scholarly journals Large multicystic spinal lesion in a young African migrant: a problem of differential diagnosis

2021 ◽  
Vol 14 (7) ◽  
pp. e242690
Author(s):  
Tamara Ursini ◽  
Paola Rodari ◽  
Geraldo Badona Monteiro ◽  
Valeria Barresi ◽  
Carmelo Cicciò ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cystic Echinococcosis ◽  
Bone Cyst ◽  
Spinal Tuberculosis ◽  
Final Diagnosis ◽  
Lower Limbs ◽  
Migration Flow ◽  
Spinal Lesion ◽  
African Migrant ◽  
Expansive Lesion

We describe a rare case of large, fully cystic spinal schwannoma in a young adult from The Gambia. The initial clinical suspicion was spinal cystic echinococcosis. He came to our attention reporting progressive walking impairment and neurological symptoms in the lower limbs. An expansive lesion extending from L2 to S1 was shown by imaging (ie, CT scan and MRI). Differential diagnoses included aneurysmal bone cyst and spinal tuberculosis and abscess; the initial suggested diagnosis of spinal cystic echinococcosis was discarded based on contrast enhancement results. The final diagnosis of cystic schwannoma was obtained by histopathology of the excised mass. Cystic spinal lesions are rare and their differential diagnosis is challenging. Awareness of autochthonous and tropical infectious diseases is important, especially in countries experiencing consistent migration flow; however, it must be kept in mind that migrants may also present with ‘non-tropical’ pathologies.

scholarly journals Significance and Impact of the Intersphincteric Plane Sepsis in the Management of the Perianal Sepsis: Ultrasound Study

2021 ◽  
Author(s):  
Ashraf Talaat Youssef
Keyword(s):  
Digital Rectal Examination ◽  
Perianal Fistula ◽  
Final Diagnosis ◽  
Abscess Formation ◽  
Study Group ◽  
Potential Space ◽  
Anal Glands ◽  
Ultrasound Study ◽  
Perianal Sepsis

Abstract Background The intersphincteric plane (ISP) is a potential space between the external and the internal anal sphincters. About 90% of the perianal sepsis is caused by an obstruction of the ducts of anal glands with subsequent secondary bacterial infection. The imaging modalities used to diagnose perianal sepsis are the ultrasound via endoanal and transperineal routes and magnetic resonance imaging. Objective  The study aimed to identify the various patterns of the ISP sepsis and their incidence among our study group and to clarify the significance of ISP in the pathogenesis of anorectal abscesses and various types of perianal fistula tracts, to optimize the surgical management. Methods Retrospective descriptive study in which 57 patients with an ISP sepsis were evaluated with full medical history, clinical exam, and ultrasound; the final diagnosis was based on combining the results of ultrasound, digital rectal examination under anesthesia, and the operative results. Results The current study showed many patterns of the ISP sepsis and estimated the incidence of each pattern among our study group; such patterns could be fistula tracts, sinus tracts, abscesses, intersphincteric abscess with supralevator extension, sinus with abscess formation, fistula with abscess formation, distension of the ISP with free pus, and other complex patterns like horse abscess, abscess with transsphincteric sinus, and ISP fistula/sinus with transsphincteric branches. Conclusion Understanding the role of the ISP in the pathogenesis of anorectal abscesses and perianal fistula tracts can help in reaching the optimum way of management.

scholarly journals Hepatic epithelioid hemangioendothelioma: a report from three university centers

2016 ◽  
Vol 49 (5) ◽  
pp. 288-294 ◽  
Author(s):  
Antonello Giardino ◽  
Frank H. Miller ◽  
Bobby Kalb ◽  
Miguel Ramalho ◽  
Diego R. Martin ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epithelioid Hemangioendothelioma ◽  
Magnetic Resonance Images ◽  
Central Core ◽  
Magnetic Resonance Imaging Examination ◽  
High Signal ◽  
Resonance Imaging ◽  
Peripheral Ring ◽  
Venous Phase

Abstract Objective: To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images. Materials and Methods: A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination. Results: Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this. Conclusion: The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.

Memory and identity: intergenerational narratives of violence among refugees in Serbia

2013 ◽  
Vol 41 (6) ◽  
pp. 1065-1082 ◽  
Author(s):  
Mila Dragojević
Keyword(s):  
Identity Formation ◽  
Crucial Role ◽  
Political Mobilization ◽  
Second World War ◽  
Warning Signs ◽  
Cycle Of Violence ◽  
World War ◽  
Political Leaders ◽  
Second World

This article examines the role of the intergenerational memory of the Second World War (WWII) in identity formation and political mobilization. An existing explanation in the ethnic-conflict literature is that strategic political leaders play a crucial role in constructing and mobilizing ethnic identities. However, based on 114 open-ended interviews with individuals born in Serbia, Bosnia and Herzegovina, and Croatia, conducted in Serbia during 2008–2011, nearly a third of the respondents make spontaneous references to WWII in their statements, usually drawing parallels between the cycle of violence in the 1990s and that in the 1940s. The question this article asks, then, is why some respondents make references to WWII spontaneously while others do not. It is argued that intergenerational narratives of past cycles of violence also constitute a process of identity formation, in addition to, or apart from, other processes of identity formation. The respondents mention WWII violence in the context of the 1990s events because they “recognize” elements, such as symbols, discourse or patterns of violence, similar to those in the intergenerational narratives and interpret them as warning signs. Hence, individuals who had previously been exposed to intergenerational narratives may be subsequently more susceptible to political mobilization efforts.

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

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