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Patel AH, Amin R, Abdelsayed G. Congenital Riedel's lobe of the liver: A case report. Hepatol Forum 2024; 5:87-89. [PMID: 38487741 PMCID: PMC10936122 DOI: 10.14744/hf.2023.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 03/17/2024]
Abstract
Riedel's lobe of the liver is a rare anatomical variant often incidentally found on imaging or through the presence of hepatomegaly on physical examination. While patients are usually asymptomatic, the presentation of this condition can vary, ranging from nonspecific symptoms to more severe issues such as torsion, obstruction, rupture, and bleeding. We present a case of a patient with asymptomatic hepatomegaly who was incidentally found to have Riedel's lobe of the liver, accompanied by an elevated IgG mitochondrial antibody. The range of symptoms associated with this rare anatomical variation underscores its importance in diagnosis and surveillance within this patient population.
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Affiliation(s)
- Ankoor H Patel
- Department of Internal Medicine, Robert Wood Johnson School of Medicine, Rutgers Biomedical and Health Sciences (RBHS), Rutgers University, New Jersey, USA
| | - Rajan Amin
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Jersey, USA
| | - George Abdelsayed
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Jersey, USA
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2
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Kotadia ID, O'Dowling R, Aboagye A, Crawley RJ, Bodagh N, Gharaviri A, O'Hare D, Solis-Lemus JA, Roney CH, Sim I, Ramsey D, Newby D, Chiribiri A, Plein S, Sztriha L, Scott P, Masci PG, Harrison J, Williams MC, Birns J, Somerville P, Bhalla A, Niederer S, O'Neill M, Williams SE. High Prevalence of New Clinically Significant Findings in Patients With Embolic Stroke of Unknown Source Evaluated by Cardiac Magnetic Resonance Imaging. J Am Heart Assoc 2024; 13:e031489. [PMID: 38240222 DOI: 10.1161/jaha.123.031489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Embolic stroke of unknown source (ESUS) accounts for 1 in 6 ischemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS, and beyond the identification of cardioembolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and noncardiac findings and to determine their impact on clinical care in patients with ESUS. METHODS AND RESULTS In this prospective, multicenter, observational study, CMR imaging was performed within 3 months of ESUS. All scans were reported according to standard clinical practice. A new clinical finding was defined as one not previously identified through prior clinical evaluation. A clinically significant finding was defined as one resulting in further investigation, follow-up, or treatment. A change in patient care was defined as initiation of medical, interventional, surgical, or palliative care. From 102 patients recruited, 96 underwent CMR imaging. One or more new clinical findings were observed in 59 patients (61%). New findings were clinically significant in 48 (81%) of these patients. Of 40 patients with a new clinically significant cardiac finding, 21 (53%) experienced a change in care (medical therapy, n=15; interventional/surgical procedure, n=6). In 12 patients with a new clinically significant extracardiac finding, 6 (50%) experienced a change in care (medical therapy, n=4; palliative care, n=2). CONCLUSIONS CMR imaging identifies new clinically significant cardiac and noncardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04555538.
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Affiliation(s)
- Irum D Kotadia
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Robert O'Dowling
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Akosua Aboagye
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Richard J Crawley
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Neil Bodagh
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Ali Gharaviri
- Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
| | - Daniel O'Hare
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Jose Alonso Solis-Lemus
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Deborah Ramsey
- Princess Royal University Hospital London United Kingdom
| | - David Newby
- Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | | | - Paul Scott
- King's College Hospital London United Kingdom
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - James Harrison
- Princess Royal University Hospital London United Kingdom
| | - Michelle C Williams
- Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
| | - Jonathan Birns
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Peter Somerville
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Ajay Bhalla
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
- Guy's and St Thomas' National Health Service Foundation Trust London United Kingdom
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College London London United Kingdom
- Centre for Cardiovascular Science, The University of Edinburgh Edinburgh United Kingdom
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Matthews S, Kyi M, Nasimudeen A, Marusic A, Johns CS, Page J. Targeted Lung Health Check: breast related incidental findings-imaging appearances and lessons learned. Br J Radiol 2024; 97:371-376. [PMID: 38268227 PMCID: PMC11027243 DOI: 10.1093/bjr/tqad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/24/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE The introduction of Targeted Lung Health Checks (TLHC) to screen for lung cancer has highlighted that incidental findings are common and require management strategies. This study analyses retrospectively, incidentally detected breast lesions reported as part of the TLHC referred to the Breast Cancer clinicians. METHODS All participants with incidental breast nodules referred to the Breast Cancer team in the first year of screening were reviewed. RESULTS Fifty-two participants (48 female; 92.3%) were referred to the Breast Multidisciplinary Team Meeting for assessment of 43 breast nodules, 8 breast asymmetry/dense breasts, and 2 likely breast related metastatic disease. One participant declined breast team referral. For the 42 breast nodules investigated, the final diagnoses were 5 breast carcinomas, 10 normal breast tissue, and 27 benign nodules. One male patient was diagnosed with breast carcinoma. The 29 breast nodules classified as smooth and well defined were all benign. No malignancy was demonstrated in the group with asymmetric or dense breast tissue. Metastatic breast carcinoma was confirmed in two participants. Twenty-six out of thirty-seven (54%) females had prior breast screening mammograms precluding further investigation. CONCLUSION Incidental breast nodules are common on THLC scans. Smooth, sharply defined breast nodules are likely to be benign but low-dose CT is poor at accurately assessing breast nodules. Agreed breast referral pathways prior to starting the Lung Cancer Screening programme are recommended. Access to screening mammograms can reduce referrals to the Breast clinic. ADVANCES IN KNOWLEDGE Lessons learned from TLHC pilot studies can be useful to sites commencing national TLHC programme.
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Affiliation(s)
- Suzanne Matthews
- Main Radiology Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, United Kingdom
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
| | - Moe Kyi
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
| | - Abdul Nasimudeen
- NHS Doncaster CCG, Doncaster DN4 5HZ, United Kingdom
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
| | - Ante Marusic
- Telemedicine Clinic, Reading RG1 3EU, United Kingdom
| | - Christopher S Johns
- Main Radiology Department, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S5 7AU, United Kingdom
| | - Jason Page
- Doncaster and Bassetlaw Hospitals NHS Trust, Doncaster DN2 5LT, United Kingdom
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Walker N, Okafor C, Gandhi N, Sharma S. Spindle Cell Malignancy and Asbestos Exposure: A Case Report. Cureus 2024; 16:e54382. [PMID: 38505454 PMCID: PMC10948944 DOI: 10.7759/cureus.54382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/21/2024] Open
Abstract
We outline the presentation of a 68-year-old woman who received a chest radiograph due to her insurance requirements, resulting in the discovery of a left-sided pleural effusion. The effusion was further characterized as loculated on subsequent imaging. Thoracentesis yielded exudative fluid, leading to the patient undergoing video-assisted thoracoscopic surgery (VATS). During this procedure, a cystic mass was visualized, with the conversion of the operation to an open thoracotomy and left lower lobe lobectomy. Pathology was positive for spindle cell sarcoma. A thorough history of the patient revealed a decades-long occupational exposure to asbestos. The significance of this report is to illustrate the clinical presentation, immunohistochemical characteristics, and management of a rare spindle cell malignancy. Our case also raises the importance of screening patients on an individualized, shared decision-making basis.
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Affiliation(s)
- Nakoma Walker
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Chinedum Okafor
- Pathology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Nitesh Gandhi
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shivani Sharma
- Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
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Shehab M, Kosykh S, Wolf A, Haddad M, Fajer S, Hoffman RS, Bachar AR. Aberrant Right Subclavian Artery: Demographics, Morphological Features and Follow up CT Scans Dynamics. Vasc Endovascular Surg 2024; 58:172-177. [PMID: 37766474 DOI: 10.1177/15385744231203754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Introduction: Aberrant right subclavian artery (ARSA) is the most common of the aortic arch anomalies, occurring in .5% to 1% of the population. There is no standardized follow up protocol, especially in the asymptomatic cases. The purpose of the present study was to evaluate the natural history of ARSA and the role of serial CT scans. Methods: This is a single-center retrospective study of patients with ARSA depicted on chest computed tomography (CT) scans between February 2013 and July 2022. Data were collected from their medical records. Measurements of the aorta at different segments including the aortic diameter at the orifice of ARSA, and ARSA at ostium followed by 1 cm intervals were collected, as well as for follow-up CT scans. Results: 65 patients were diagnosed with ARSA, 70.8% of whom were women. The average age for the cohort was 58.569 ± 16.99 years. The median follow up time was 4 years (range 0-10 years), KM estimated survival after ARSA diagnosis at 1 and 5 years as 97% and 93%, respectively. Nineteen patients had a second CT scan and were included in the morphological CT dynamic analysis, on average of 29 ± 27 months apart (range 7-108). The mean ARSA diameter at origin was larger in the second scan 16.91 ± 4.31 mm compared to the initial scan 16.31 ± 4.96 mm, (P = .04).The mean aortic arch diameter in the first and second CT were 28.54 ± 4.24 and 29.64 ± 5.14 (P = .10), respectively. All other measurements did not disclose any significant enlargement over time. Conclusions: Our cohort demonstrate a benign natural history of ARSA with slow growth rates. However, due to our small sample size we can't draw a clinically sound recommendation on the need for imaging follow up, and further larger cohort with longer follow up interval are required.
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Affiliation(s)
- Maysam Shehab
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Stanislav Kosykh
- Radiology Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Ammie Wolf
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Menashe Haddad
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Simone Fajer
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Roetm Sivan Hoffman
- Radiology Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Adi R Bachar
- Vascular Surgery Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba, Israel
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Brooks JK, Alshami H, Younis RH, Jang H, Yousef N, Altajjar H, Zhou CQ, Price JB. Diminutive compound odontoma in a child: a case report with emphasis on early detection. Gen Dent 2024; 72:43-45. [PMID: 38117640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The odontoma is regarded as a hamartomatous process of the jaws. Most are discovered as an incidental radiographic finding, averaging 15 mm in size. This report describes a case of a diminutive odontoma that was surgically removed before the onset of eruptive and pathologic consequences. A compilation of documented complications and syndromes associated with odontomas is also presented.
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Sarin EL, Belani K. Unexpected TEE Findings During Rheumatic Triple-Valve Surgery: Incidental, Yet Impactful. J Cardiothorac Vasc Anesth 2023; 37:2391-2396. [PMID: 37419755 DOI: 10.1053/j.jvca.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
This E-Challenge highlights an incidental prebypass transesophageal echocardiographic (TEE) finding of a right atrial membrane that impacted cardiac surgical management during triple-valve surgery. Two-dimensional and advanced 3-dimensional (3D) TEE were used in real-time to assist intraoperative decision-making. The findings, clinical course, discussion of the differential diagnosis, final diagnosis, and patient management are detailed here.
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Affiliation(s)
- Eric L Sarin
- Inova Fairfax Hospital, Inova Heart and Vascular Institute, University of Virginia School of Medicine Affiliate, Department of Cardiac Surgery, Falls Church, VA
| | - Kiran Belani
- Northwestern Memorial Hospital, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Department of Anesthesiology, Chicago, IL.
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Brooks JK, Kumar V, Parsa A, Price JB. Pseudopathologic findings on panoramic radiographs and utility of follow-up cone beam computed tomographic scans: a case series. Gen Dent 2023; 71:34-37. [PMID: 37595081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Conventional radiography is the mainstay for evaluation of developmental and pathologic disorders of oral and maxillofacial structures. Occasionally, clinicians may experience diagnostic pitfalls during interpretation of these imaging modalities. The aim of this article is to present 4 cases of pseudopathologic disorders found on intraoral and panoramic radiographs. Subsequent use of cone beam computed tomographic (CBCT) imaging determined that the initial concerning findings represented anatomical or radiographic anomalies rather than pathologic processes. Supplemental use of CBCT scans may enhance diagnostic assessment, possibly reducing the need for surgical intervention, and elucidate structurally compromised regions of the jaw that could predispose it to fracture.
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Al-Qaysi A, Sayeh N, Al-Qaysi Z, Al Ghoul Y, Elhouni E. Quadricuspid Aortic Valve: A Case Report of an Asymptomatic Middle-Aged Man. Cureus 2023; 15:e45262. [PMID: 37846259 PMCID: PMC10576656 DOI: 10.7759/cureus.45262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/18/2023] Open
Abstract
A quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by the presence of four leaflets in the aortic valve. We are reporting a case of a 59-year-old male who presented to the emergency department with non-cardiac chest pain. The discovery of QAV during the evaluation highlights the importance of considering cardiac causes, even in cases where the presenting symptoms may not appear directly related to the heart.
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Affiliation(s)
| | - Naser Sayeh
- Cardiology, University of British Columbia, Vancouver, CAN
| | - Zainab Al-Qaysi
- Internal Medicine/Mountain Vista Medical Centre, Avalon University School of Medicine, Mesa, USA
| | - Yussef Al Ghoul
- Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, USA
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Lepage M, Uhrhammer N, Privat M, Ponelle-Chachuat F, Kossai M, Scanzi J, Ouedraogo ZG, Gay-Bellile M, Bidet Y, Cavaillé M. Case Series of 11 CDH1 Families (47 Carriers) Including Incidental Findings, Signet Ring Cell Colon Cancer and Review of the Literature. Genes (Basel) 2023; 14:1677. [PMID: 37761816 PMCID: PMC10530895 DOI: 10.3390/genes14091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Germline pathogenic variants in E-cadherin (CDH1) confer high risk of developing lobular breast cancer and diffuse gastric cancer (DGC). The cumulative risk of DGC in CDH1 carriers has been recently reassessed (from 40-83% by age 80 to 25-42%) and varies according to the presence and number of gastric cancers in the family. As there is no accurate estimate of the risk of gastric cancer in families without DGC, the International Gastric Cancer Linkage Consortium recommendation is not straightforward: prophylactic gastrectomy or endoscopic surveillance should be proposed for these families. The inclusion of CDH1 in constitutional gene panels for hereditary breast and ovarian cancer and for gastrointestinal cancers, recommended by the French Genetic and Cancer Consortium in 2018 and 2020, leads to the identification of families with lobular cancer without DGC but also to incidental findings of pathogenic variants. Management of CDH1 carriers in case of incidental findings is complex and causes dilemmas for both patients and providers. We report eleven families (47 CDH1 carriers) from our oncogenetic department specialized in breast and ovarian cancer, including four incidental findings. We confirmed that six families did not have diffuse gastric cancer in their medical records. We discuss the management of the risk of diffuse gastric cancer in Hereditary Lobular Breast Cancer (HLBC) through a family of 11 CDH1 carriers where foci were identified in endoscopic surveillance. We also report a new colon signet ring cancer case in a CDH1 carrier, a rare aggressive cancer included in CDH1-related malignancies.
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Affiliation(s)
- Mathis Lepage
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Nancy Uhrhammer
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Maud Privat
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Flora Ponelle-Chachuat
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Myriam Kossai
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, 63011 Clermont-Ferrand, France
| | | | - Zangbéwendé Guy Ouedraogo
- Service de Biochimie et Génétique Moléculaire, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
- CNRS, INSERM, iGReD, Université Clermont Auvergne, 63001 Clermont-Ferrand, France
| | - Mathilde Gay-Bellile
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Yannick Bidet
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
| | - Mathias Cavaillé
- Département d’Oncogénétique, Centre Jean Perrin, 63011 Clermont-Ferrand, France; (N.U.); (M.P.); (F.P.-C.); (M.G.-B.); (M.C.)
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, 63000 Clermont-Ferrand, France; (M.K.); (Y.B.)
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Del Chicca F, Puccinelli C, Petrini D, Citi S. Incidental Findings in Computed Tomography Examination of the Head in Rabbits and Guinea Pigs. Vet Sci 2023; 10:504. [PMID: 37624291 PMCID: PMC10459266 DOI: 10.3390/vetsci10080504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Rabbits and guinea pigs are popular pet animals and often undergo computed tomography (CT) examination for assessment of pathologies of the head. The goal of the study was to review CT examinations of the heads of rabbits and guinea pigs to identify and classify incidental findings. (2) Methods: 60 CT studies of the heads of rabbits and 65 of guinea pigs presented at 2 Institutions were reviewed and the indications for the study recorded. (3) Results: The presence of CT findings not directly related to the reason for the CT examination was present in 40/60 (66.7%) studies of rabbits and in 42/65 (64.4%) studies of guinea pigs. Most commonly, the incidental findings involved the ears, in 24/60 studies in rabbits and in 29/65 studies in guinea pigs. Incidental findings involved the nasal cavities, respectively, in 9 and 7 rabbits and guinea pigs. Soft tissue mineralization was present in 11 rabbits and 17 guinea pigs. (4) Conclusions: Based on the present study, incidental findings detected on CT studies are often present in rabbits and guinea pigs. Veterinarians should be aware of the possible clinical impact of these findings.
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Affiliation(s)
- Francesca Del Chicca
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 258c, 8057 Zurich, Switzerland
- Department of Veterinary Sciences, University of Pisa, Via Livornese, San Piero a Grado, 56122 Pisa, Italy
| | - Caterina Puccinelli
- Department of Veterinary Sciences, University of Pisa, Via Livornese, San Piero a Grado, 56122 Pisa, Italy
| | - Daniele Petrini
- Department of Veterinary Sciences, University of Pisa, Via Livornese, San Piero a Grado, 56122 Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, University of Pisa, Via Livornese, San Piero a Grado, 56122 Pisa, Italy
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Manyak A, Seaburg L, Bohreer K, Kirtland SH, Hubka M, Gerbino AJ. Invasive Procedures Associated With Lung Cancer Screening in Clinical Practice. Chest 2023; 164:544-555. [PMID: 36781101 DOI: 10.1016/j.chest.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/26/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The harm associated with imaging abnormalities related to lung cancer screening (LCS) is not well documented, especially outside the clinical trial and academic setting. RESEARCH QUESTION What is the frequency of invasive procedures and complications associated with a community based LCS program, including procedures for false-positive and benign, but clinically important, incidental findings? STUDY DESIGN AND METHODS We performed a single-center retrospective study of an LCS program at a nonuniversity teaching hospital from 2016 through 2019 to identify invasive procedures prompted by LCS results, including their indication and complications. RESULTS Among 2,003 LCS participants, 58 patients (2.9%) received a diagnosis of lung cancer and 71 patients (3.5%) received a diagnosis of any malignancy. Invasive procedures were performed 160 times in 103 participants (5.1%), including 1.7% of those without malignancy. Eight invasive procedures (0.4% of participants), including four surgeries (12% of diagnostic lung resections), were performed for false-positive lung nodules. Only 1% of Lung Imaging Reporting and Data System category 4A nodules that proved benign were subject to an invasive procedure. Among those without malignancy, an invasive procedure was performed in eight participants for extrapulmonary false-positive findings (0.4%) and in 19 participants (0.9%) to evaluate incidental findings considered benign but clinically important. Procedures for the latter indication resulted in treatment, change in management, or diagnosis in 79% of individuals. Invasive procedures in those without malignancy resulted in three complications (0.15%). Seventy nonsurgical procedures (6% complication rate) and 48 thoracic surgeries (4% major complication rate) were performed in those with malignancy. INTERPRETATION The use of invasive procedures to resolve false-positive findings was uncommon in the clinical practice of a nonuniversity LCS program that adhered to a nodule management algorithm and used a multidisciplinary approach. Incidental findings considered benign but clinically important resulted in invasive procedure rates that were similar to those for false-positive findings and frequently had clinical value.
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Affiliation(s)
- Anton Manyak
- Section of Graduate Medical Education, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA; Department of Graduate Medical Education, Loma Linda University, Loma Linda, CA
| | - Luke Seaburg
- Section of Pulmonary Medicine, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA
| | - Kristin Bohreer
- Section of Pulmonary Medicine, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA
| | - Steve H Kirtland
- Section of Pulmonary Medicine, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA
| | - Michal Hubka
- Section of Thoracic Surgery, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA
| | - Anthony J Gerbino
- Section of Pulmonary Medicine, Virginia Mason Medical Center, Virginia Mason Franciscan Health, Seattle, WA.
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Akouh N, Karich N, Haloui A, Bennani A. An Incidental Finding of Endocervical Melanosis in a Polymyomatous Uterus. Cureus 2023; 15:e41969. [PMID: 37593317 PMCID: PMC10431688 DOI: 10.7759/cureus.41969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/19/2023] Open
Abstract
Melanocytic lesions, whether benign or malignant, are extremely rare in the cervix and, more particularly, in the endocervical mucosa. Cervical melanosis is a benign entity, most often discovered by incidental findings on a histological study of a surgical specimen resected for another reason. The microscopic examination allows the diagnosis with certainty after ruling out any potential malignancies. The etiopathogenesis remains poorly understood; however, a number of theories have been put forward, such as excessive migration of pigmented cells from the neural crest, trauma, or chronic irritation situations. We report the case of a 40-year-old female patient followed in the gynecology department for a polymyomatous uterus. She underwent a total hysterectomy. The histological and immunohistochemical examinations concluded an incidental finding of cervical melanosis lesions associated with leiomyomas.
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Affiliation(s)
- Nada Akouh
- Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed I University, Oujda, MAR
| | - Nassira Karich
- Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed I University, Oujda, MAR
| | - Anass Haloui
- Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed I University, Oujda, MAR
| | - Amal Bennani
- Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed I University, Oujda, MAR
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14
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Dao V, Mallya SM, Markovic D, Tetradis S, Chugal N. Reprint of: Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:692-702. [PMID: 37315998 DOI: 10.1016/j.joen.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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Affiliation(s)
- Vi Dao
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California
| | - Sanjay M Mallya
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Daniela Markovic
- David Geffen School of Medicine, Division of General Internal Medicine and Health Sciences Research, Los Angeles, California
| | - Sotirios Tetradis
- UCLA School of Dentistry, Section of Oral and Maxillofacial Radiology, Los Angeles, California
| | - Nadia Chugal
- UCLA School of Dentistry, Section of Endodontics, Los Angeles, California.
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15
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Kwon SS, Cho YK, Hahn S, Oh J, Won D, Shin S, Kang JM, Ahn JG, Lee ST, Choi JR. Genetic diagnosis of inborn errors of immunity using clinical exome sequencing. Front Immunol 2023; 14:1178582. [PMID: 37325673 PMCID: PMC10264570 DOI: 10.3389/fimmu.2023.1178582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Inborn errors of immunity (IEI) include a variety of heterogeneous genetic disorders in which defects in the immune system lead to an increased susceptibility to infections and other complications. Accurate, prompt diagnosis of IEI is crucial for treatment plan and prognostication. In this study, clinical utility of clinical exome sequencing (CES) for diagnosis of IEI was evaluated. For 37 Korean patients with suspected symptoms, signs, or laboratory abnormalities associated with IEI, CES that covers 4,894 genes including genes related to IEI was performed. Their clinical diagnosis, clinical characteristics, family history of infection, and laboratory results, as well as detected variants, were reviewed. With CES, genetic diagnosis of IEI was made in 15 out of 37 patients (40.5%). Seventeen pathogenic variants were detected from IEI-related genes, BTK, UNC13D, STAT3, IL2RG, IL10RA, NRAS, SH2D1A, GATA2, TET2, PRF1, and UBA1, of which four variants were previously unreported. Among them, somatic causative variants were identified from GATA2, TET2, and UBA1. In addition, we identified two patients incidentally diagnosed IEI by CES, which was performed to diagnose other diseases of patients with unrecognized IEI. Taken together, these results demonstrate the utility of CES for the diagnosis of IEI, which contributes to accurate diagnosis and proper treatments.
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Affiliation(s)
- Soon Sung Kwon
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Youn Keong Cho
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungmin Hahn
- Department of Pediatric Hemato-oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Oh
- Division of Clinical Genetics, Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongju Won
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Saeam Shin
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Dxome, Seoul, Republic of Korea
| | - Jong Rak Choi
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Dxome, Seoul, Republic of Korea
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16
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Maunula A, Martola J, Atula S, Laakso SM, Tienari PJ. Incidental demyelination in magnetic resonance imaging and 10-year risk of multiple sclerosis: a data lake cohort study. Eur J Neurol 2023. [PMID: 37158298 DOI: 10.1111/ene.15849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is an absence of data from large population-based cohort studies on the incidence of radiologically isolated syndrome (RIS). We investigated the incidence of RIS and the subsequent risk for multiple sclerosis (MS). METHODS We conducted a population-based, retrospective cohort study using a data lake-based analysis of digitalized radiology reports. We screened all brain and spinal cord MRIs in people aged 16-70 during the years 2005-2010 (n=102 224) using optimized search terms to detect cases with RIS. The subjects with RIS were followed up until January 2022. RESULTS The cumulative incidence of RIS was 0.03% when all MRI modalities were included and 0.06% when only brain MRI was included according to MAGNIMS 2018 recommendation criteria. With the Okuda 2009 criteria, the respective figures were 0.03% and 0.05% (86% concordance). The overall risk for MS after RIS was similar 32% by using the MAGNIMS and 32% by using the Okuda definition of RIS. Individuals aged < 35.5 years exhibited the most significant predisposition to MS (80%), while those > 35.5 years had less than 10% risk of MS. MS diagnosed after RIS constituted 0.8% of the incident MS cases in the population during 2005-2010. CONCLUSIONS We provide a population-wide context for the incidence of RIS and its relationship to MS. MAGNIMS recommendations were only slightly more sensitive to detect RIS compared to Okuda criteria. RIS has a subtle effect on the overall incidence of MS, yet the risk for MS in individuals under the age of 35.5 years is substantial.
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Affiliation(s)
- Anna Maunula
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- HUS Brain Center, Department of Neurology, Hyvinkää Hospital, Hyvinkää, Finland
| | - Juha Martola
- Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Sari Atula
- HUS Brain Center, Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Sini M Laakso
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- HUS Brain Center, Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Pentti J Tienari
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- HUS Brain Center, Department of Neurology, Helsinki University Hospital, Helsinki, Finland
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17
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Canatan MO, Canatan MF, Canatan AN. An Incidental Tornwaldt Cyst Finding on the Postoperative Assessment of a Nasal Septum Deviation: A Case Report. Cureus 2023; 15:e39606. [PMID: 37384086 PMCID: PMC10299751 DOI: 10.7759/cureus.39606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
Tornwaldt cysts are rare, benign lesions that typically reside along the posterior wall of the nasopharynx. They are often discovered incidentally during routine imaging studies and can pose a diagnostic challenge due to their asymptomatic nature. This case report presents the incidental finding of a Tornwaldt cyst on a CT in an asymptomatic patient and highlights the lack of intervention required. The patient, a 28-year-old male, underwent a postoperative CT scan following septoplasty for a nasal septum deviation, revealing a well-defined cystic lesion in the midline of the nasopharynx consistent with a Tornwaldt cyst. Despite the presence of the cyst, the patient did not exhibit any associated symptoms such as nasal obstruction, headache, or recurrent infections. This case emphasizes the importance of recognizing and differentiating Tornwaldt cysts from other pathologies, as misdiagnosis and unnecessary interventions can lead to potential complications. Asymptomatic Tornwaldt cysts generally do not necessitate active intervention, but ongoing vigilance and individualized patient care remain vital to ensure optimal outcomes.
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18
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Joshi PH, Nasir K, Navar AM. When Opportunity Knocks: Capitalizing on Incidental Coronary Arterial Calcification. Circulation 2023; 147:715-717. [PMID: 36848409 DOI: 10.1161/circulationaha.122.063207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.H.J., A.M.N.)
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, TX (K.N.).,Center for Cardiovascular Computational and Precision Health (C3-PH), Houston Methodist, TX (K.N.)
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.H.J., A.M.N.)
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19
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Miraldi Utz V, Ebert JJ, Brightman DS, Simpson BN, Benoit S, Sisk RA. Dual phenotype: co-occurring Leber congenital amaurosis and familial exudative vitreoretinopathy: a case report. Ophthalmic Genet 2023; 44:89-92. [PMID: 36426739 DOI: 10.1080/13816810.2022.2090011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the concurrent presentation and management of IQCB1-associated Leber Congenital Amaurosis and NDP-associated Familial Exudative Vitreoretinopathy (FEVR). MATERIALS AND METHODS A 6-month-old Caucasian infant presented with poor visual response, high hypermetropia, and infantile-nystagmus with a provisional diagnosis of Leber Congenital Amaurosis based on clinical findings. Genetic counseling and testing were performed with a 285 gene retinal dystrophy panel (Blueprint Genetics). Clinical characteristics, presentation, ancillary testing results, and management are described. RESULTS Two previously reported heterozygous pathogenic variants in ICQB1 were identified (c.1518_1519del (p.His506Glnfs*13) and c.1381C>T, p.Arg461*) segregating in trans. In addition, a variation of uncertain significance (VUS) was found in NDP (c.280C>T; p.His94Tyr). Fluorescein angiography was performed demonstrating peripheral avascularity and retinal telangiectasia without frank neovascularization. Peripheral ablative laser was applied to the avascular zone. CONCLUSIONS The NDP VUS likely represents a pathogenic variant given the FEVR phenotype in addition to retinal degeneration, creating a rare dual phenotype. The combination of low oxygen demand from the IQCB1-associated retinal degeneration and NDP variant may have led to a more attenuated FEVR presentation with uncertain prognosis. A molecular diagnosis informed ocular and renal surveillance, as well as the recurrence risk for future offspring.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jared J Ebert
- Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Diana S Brightman
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Brittany N Simpson
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Stefanie Benoit
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert A Sisk
- Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA.,Cincinnati Eye Institute, Cincinnati, Ohio, USA
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20
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Dao V, Mallya SM, Markovic D, Tetradis S, Chugal N. Prevalence and Characteristics of Root Resorption Identified in Cone-Beam Computed Tomography Scans. J Endod 2023; 49:144-54. [PMID: 36509167 DOI: 10.1016/j.joen.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Root resorption is a destructive process that compromises tooth structure and can result in tooth loss. Often it remains asymptomatic and is an incidental finding on radiographic examinations. The purpose of this study was to determine prevalence and characteristics of root resorption in patients referred for cone-beam computed tomography (CBCT) imaging for a variety of indications. METHODS The study included CBCT scans of 1086 consecutive patients referred for CBCT imaging over an 18-month period. A total of 1148 scans were acquired. Data were abstracted from radiology reports, and prevalence estimates of resorption were computed for the aggregate sample and also across specific indications. RESULTS Resorption was identified in 171 patients (15.7%, 95% CI: 13.6%-17.9%) and in 249 teeth with a prevalence range of 2.6%-92.3% across specific indications. An 18.7% of the patients had 2 resorption sites whereas 8.8% had 3 or more resorption sites. The majority of affected teeth were anteriors (43.8%), followed by molars (40.6%) and premolars (14.5%). The most prevalent resorption types were external (29.3%), cervical (22.5%), infection-induced apical resorption (13.7%), internal (9.6%), and impacted tooth induced (8.8%). The majority of teeth with resorption did not have prior endodontic treatment (73.9%) and had radiographically normal periapex (69.5%). Of 249 teeth with resorption, 31% presented as incidental finding. The prevalence of incidental findings of resorption increased with age, P < .05, and was significantly lower for anterior teeth (20.2%) as compared to premolars (41.7%) and molars (36.6%), (P < .05). CONCLUSION The high proportion of incidental findings of resorption detected by CBCT suggests that resorption is not recognized/detected by conventional radiography and therefore remains underdiagnosed.
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Abstract
Incidental imaging findings are common and analogous to the results of screening tests when screening is performed of unselected, low-risk patients. Approximately 15-30% of all diagnostic imaging and 20-40% of CT examinations contain at least one incidental finding. Patients with incidental findings but low risk for disease are likely to experience length bias, lead-time bias, overdiagnosis, and overtreatment that create an illusion of benefit while conferring harm. This includes incidental detection of many types of cancers that, although malignant, would have been unlikely to affect a patient's health had the cancer not been detected. Detection of some incidental findings can improve health, but most do not. Greater patient- and disease-related risk increase the likelihood an incidental finding is important. Clinical guidelines for incidental findings should more deeply integrate patient risk factors and disease aggressiveness to inform management. Lack of outcome and cost-effectiveness data have led to reflexive management strategies for incidental findings that promote low-value and sometimes harmful care.
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22
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Muacevic A, Adler JR. Trifurcated Mental Foramina: A Cone-Beam Computed Tomography Incidental Finding During the Implant Treatment Planning. Cureus 2023; 15:e33828. [PMID: 36819370 PMCID: PMC9930873 DOI: 10.7759/cureus.33828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The mental foramen is a known skull anatomical structure located bilaterally on the mandible along the buccal cortical plate. It is located approximately between the roots of premolars in the anteroposterior dimension, and its supero-inferior level on the alveolar height varies in every individual. The position of the mental foramen is very crucial when surgical interventions are planned in the area. An accessory mental foramina can be very well detected in the three-dimensional (3D) imaging modality, especially in 3D volume rendering images. It can still be appreciated in two-dimensional (2D) imaging modalities such as a panoramic; however, at times it can be confused with periapical pathology, especially in cases where caries are present in the teeth. Three-dimensional imaging modality plays a critical role in identifying such anatomical variation, and hence, it is important to evaluate any surgical site in three dimensions prior to surgical intervention.
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23
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Důra M, Štork J, Felšöová A, Sticová E. Diagnostic Pitfalls in Dermatopathology. Cesk Patol 2023; 59:96-103. [PMID: 37805266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Dermatopathology is a distinct part of pathology revealing the rich association with soft tissue pathology and hematopathology. Regarding the number and diversity of the skin disorders, dermatopathology is a broad specialty encompassing hundreds of diseases. The diagnostics in dermatopathology contains a range of specific features. The article summarizes several practically important pitfalls in dermatopathology. The adequate timing and locality selection for proper sampling are emphasized. The influence of the topical therapy on the histopathological picture is debated. The frequently used surgical procedures in the skin biopsy are presented. The most frequent incidental findings and artifacts in cutaneous pathology are discussed. Problematics of the alopecia examination and direct immunofluorescence are added. Clinical-pathological correlation performed by the pathologist, and subsequently by the dermatologist, is the essential step in the diagnostic process. The knowledge transcending to the other specialty and reciprocal communication are prerequisite for the right diagnosis.
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Zgheib O, Trombetti A, Juillerat A, Fokstuen S. Odyssey of a Misclassified Genomic Variant: Insight from an Incidental Finding Assessment. Child Neurol Open 2023; 10:2329048X231199327. [PMID: 37664540 PMCID: PMC10472820 DOI: 10.1177/2329048x231199327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Genetic evaluation of a teenager with seizure found no pathogenic variant in a large gene panel, but an incidental likely pathogenic HNF4A variant, deemed to cause MODY1 diabetes. Diabetes history was absent and glycated hemoglobin normal, but serum calcium was severely low, with abnormally high parathyroid hormone. Thus, pseudohypoparathyroidism was suspected and confirmed by molecular genetic testing. Calcium and calcitriol supplementation led to calcium normalization and neurological symptom improvement. Given the absence of personal or family diabetes history, the HNF4A variant was reassessed and found to encode an alternative transcript with poor expression and activity levels, hence downgraded on expert advice from 'likely pathogenic' to 'likely benign'. Besides illustrating the importance of structured medical workup before launching extensive targeted exome sequencing, this case highlights the need for caution in incidental finding interpretation in patients lacking compatible phenotype or family history, and the value of expert advice in such variant interpretation.
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Affiliation(s)
- Omar Zgheib
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - André Juillerat
- Division of Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Siv Fokstuen
- Division of Genetic Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
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Muacevic A, Adler JR, Alkhathami AA, Alhati M. Incidental Finding of Venous Air Embolism: A Case Report. Cureus 2023; 15:e33896. [PMID: 36819379 PMCID: PMC9935085 DOI: 10.7759/cureus.33896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Venous air embolism (VAE) is a rare but potentially lethal condition. It has numerous clinical and physiological causes. We present a case report of a 72-year-old Saudi male, known case of diabetes mellitus (DM), hypertension, and ischemic heart disease. The patient came to the emergency room (ER) complaining of the heaviness of the tongue that resolved spontaneously within a few hours. He underwent percutaneous coronary angiography three months ago. The patient with the previously mentioned neurological symptoms, who had been misdiagnosed as having transient cerebral ischemia, was, after a computerized tomography (CT) scan result, diagnosed with venous air embolism. Venous air embolism can occur in situations other than those in which patients are traditionally thought to be at risk, making diagnosis difficult. Any sudden change in mental status and hemodynamic alterations during minimally invasive procedures should raise the physician's suspicion of VAE. Because VAE is an uncommon complication, few cases have been recorded in Saudi Arabia.
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26
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Muacevic A, Adler JR, Belisario C, Dalal SS, Zhang Y. Renal Mass Found on Imaging of Spine for Back Pain: An Incidental Finding. Cureus 2022; 14:e31267. [PMID: 36505156 PMCID: PMC9731809 DOI: 10.7759/cureus.31267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/10/2022] Open
Abstract
A middle-aged female patient who presented with back pain was found incidentally to have a renal mass by magnetic resonance imaging (MRI). Further imaging, including computerized tomography (CT) with contrast, suggested a high likelihood of malignancy. Following surgical resection, the tumor was found to be a rare benign lesion on subsequent pathological examination. The patient had conservative treatment for her presenting spine issues and is doing very well. Prompt work-up and treatment of incidental findings by the team of primary care, physical medicine and rehabilitation physicians, radiologists, pathologists, and surgeons helped to ensure a good outcome. Residents had a learning opportunity about the disease and on timely management of incidental findings.
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Yang Q, Berkman AM, Ezekian JE, Rosamilia M, Rosenfeld JA, Liu P, Landstrom AP. Determining the Likelihood of Disease Pathogenicity Among Incidentally Identified Genetic Variants in Rare Dilated Cardiomyopathy-Associated Genes. J Am Heart Assoc 2022; 11:e025257. [PMID: 36129056 DOI: 10.1161/jaha.122.025257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background As utilization of clinical exome sequencing (ES) has expanded, criteria for evaluating the diagnostic weight of incidentally identified variants are critical to guide clinicians and researchers. This is particularly important in genes associated with dilated cardiomyopathy (DCM), which can cause heart failure and sudden death. We sought to compare the frequency and distribution of incidentally identified variants in DCM-associated genes between a clinical referral cohort with those in control and known case cohorts to determine the likelihood of pathogenicity among those undergoing genetic testing for non-DCM indications. Methods and Results A total of 39 rare, non-TTN DCM-associated genes were identified and evaluated from a clinical ES testing referral cohort (n=14 005, Baylor Genetic Laboratories) and compared with a DCM case cohort (n=9442) as well as a control cohort of population variants (n=141 456) derived from the gnomAD database. Variant frequencies in each cohort were compared. Signal-to-noise ratios were calculated comparing the DCM and ES cohort with the gnomAD cohort. The likely pathogenic/pathogenic variant yield in the DCM cohort (8.2%) was significantly higher than in the ES cohort (1.9%). Based on signal-to-noise and correlation analysis, incidental variants found in FLNC, RBM20, MYH6, DSP, ABCC9, JPH2, and NEXN had the greatest chance of being DCM-associated. Conclusions The distribution of pathogenic variants between the ES cohort and the DCM case cohort was gene specific, and variants found in the ES cohort were similar to variants found in the control cohort. Incidentally identified variants in specific genes are more associated with DCM than others.
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Affiliation(s)
- Qixin Yang
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC.,Department of Cardiology The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou China
| | - Amy M Berkman
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Jordan E Ezekian
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Michael Rosamilia
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics Baylor College of Medicine and Baylor Genetics Laboratories Houston TX
| | - Pengfei Liu
- Department of Molecular and Human Genetics Baylor College of Medicine and Baylor Genetics Laboratories Houston TX
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology Duke University School of Medicine Durham NC.,Department of Cell Biology Duke University School of Medicine Durham NC
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Variability of pulmonary nodule volumetry on coronary CT angiograms. Medicine (Baltimore) 2022; 101:e30332. [PMID: 36107569 PMCID: PMC9439735 DOI: 10.1097/md.0000000000030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA). Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules' diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs. Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed. A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([-47.0%; 52.3%]), software packages ([-50.2%; 68.2%]), and observers ([-14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [-13.6%; 31.4%] and [-13.9%; 19.7%], respectively. Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
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Affiliation(s)
- Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- *Correspondence: Erique Pinto, MD, EBIR, Rua Luís DE Camões, nº 102, lt 8, 3º esq, 1300—356 Lisbon, Portugal. (e-mail: )
| | - Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio DE Janeiro, RJ, Brazil
- Universidade Federal Fluminense Faculdade de Medicina, Niteroi, RJ, Brazil
| | | | - Klaus Irion
- Imaging Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Rizwan S, Huang TC, Koong B, Bynevelt M, Stamatis J, Goonewardene R. Incidental finding of juvenile angiofibroma from pre-orthodontic radiographs: two case reports and a literature review. Aust Dent J 2022; 67:281-285. [PMID: 35152431 PMCID: PMC9790401 DOI: 10.1111/adj.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/20/2021] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
This case series presents two asymptomatic cases of juvenile angiofibroma which were initially incidentally identified in pre-orthodontic radiographs. Juvenile angiofibroma is an uncommon, locally aggressive benign, vascular neoplasm with invasive growth patterns. Due to the hypervascularity of these tumours, there are biopsy associated risks and multi-slice computed tomography, magnetic resonance imaging and angiography are usually employed for diagnosis. Early pre-symptomatic identification of this lesion facilitates early management and limiting potential life-threatening complications. This highlights the importance of thorough interpretation of dental radiographs, including the evaluation of structures which are not in the primary region of interest. © 2022 Australian Dental Association.
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Affiliation(s)
- S Rizwan
- School of DentistryThe University of QueenslandHerstonQueenslandAustralia
| | - TC Huang
- Private PracticePerthWestern AustraliaAustralia
| | - B Koong
- Private PracticePerthWestern AustraliaAustralia,School of Human Science, Faculty of ScienceThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - M Bynevelt
- The Neurological Intervention & Imaging Service of Western Australia at Sir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - J Stamatis
- Private PracticePerthWestern AustraliaAustralia
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Jiang S. A Scoping Review of Global Guidelines for the Disclosure of Secondary Genomic Findings to Inform the Establishment of Guidelines in China. China CDC Wkly 2022; 4:697-705. [PMID: 36060441 PMCID: PMC9433757 DOI: 10.46234/ccdcw2022.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2022] [Indexed: 11/21/2022] Open
Abstract
The detection and disclosure of secondary findings (SFs) is a preventive strategy for medically-actionable hereditary health conditions. Some countries have guidelines on management and disclosure of SFs, while others avoid detection and disclosure of SFs. This study is a review of clinical guidelines from six countries and the European Union to identify similarities and differences among SF guidelines. Evidence from this review supports harmonization of guidelines across countries to promote broad international collaborations on genomics and to benefit precision medicine. This study can serve as a reference for development of SF management guidelines in China by contributing evidence from other countries to the ethical and methodological challenges under debate.
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Affiliation(s)
- Shan Jiang
- School of Population and Public Health, the University of British Columbia, Vancouver, BC, Canada
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31
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Heremans R, Van Den Bosch T, Valentin L, Wynants L, Pascual MA, Fruscio R, Testa AC, Buonomo F, Guerriero S, Epstein E, Bourne T, Timmerman D, Leone FPG. Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3). Ultrasound Obstet Gynecol 2022; 60:243-255. [PMID: 35385178 DOI: 10.1002/uog.24910] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. METHODS This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. RESULTS In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. CONCLUSIONS We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Heremans
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - T Van Den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - L Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitatio A. Gemelli, IRCCS, Rome, Italy
| | - F Buonomo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute Luigi Sacco, Milan, Italy
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Chimusa ER, Alosaimi S, Bope CD. Dissecting Generalizability and Actionability of Disease-Associated Genes From 20 Worldwide Ethnolinguistic Cultural Groups. Front Genet 2022; 13:835713. [PMID: 35812734 PMCID: PMC9263835 DOI: 10.3389/fgene.2022.835713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
Findings resulting from whole-genome sequencing (WGS) have markedly increased due to the massive evolvement of sequencing methods and have led to further investigations such as clinical actionability of genes, as documented by the American College of Medical Genetics and Genomics (ACMG). ACMG's actionable genes (ACGs) may not necessarily be clinically actionable across all populations worldwide. It is critical to examine the actionability of these genes in different populations. Here, we have leveraged a combined WES from the African Genome Variation and 1000 Genomes Project to examine the generalizability of ACG and potential actionable genes from four diseases: high-burden malaria, TB, HIV/AIDS, and sickle cell disease. Our results suggest that ethnolinguistic cultural groups from Africa, particularly Bantu and Khoesan, have high genetic diversity, high proportion of derived alleles at low minor allele frequency (0.0-0.1), and the highest proportion of pathogenic variants within HIV, TB, malaria, and sickle cell diseases. In contrast, ethnolinguistic cultural groups from the non-Africa continent, including Latin American, Afro-related, and European-related groups, have a high proportion of pathogenic variants within ACG than most of the ethnolinguistic cultural groups from Africa. Overall, our results show high genetic diversity in the present actionable and known disease-associated genes of four African high-burden diseases, suggesting the limitation of transferability or generalizability of ACG. This supports the use of personalized medicine as beneficial to the worldwide population as well as actionable gene list recommendation to further foster equitable global healthcare. The results point out the bias in the knowledge about the frequency distribution of these phenotypes and genetic variants associated with some diseases, especially in African and African ancestry populations.
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Affiliation(s)
- Emile R Chimusa
- Division of Human Genetics, Department of Pathology, University of Cape Town, Medical School Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Shatha Alosaimi
- Division of Human Genetics, Department of Pathology, University of Cape Town, Medical School Cape Town, Cape Town, South Africa
| | - Christian D Bope
- Division of Human Genetics, Department of Pathology, University of Cape Town, Medical School Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Mathematics and Computer Science, University of Kinshasa, Kinshasa, Congo
- Centre for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
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Thomas SA, Siriruchatanon M, Albert SL, Bjurlin M, Hoffmann JC, Langford A, Braithwaite RS, Makarov DV, Fagerlin A, Kang SK. Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses. J Am Coll Radiol 2022:S1546-1440(22)00412-4. [PMID: 35714722 DOI: 10.1016/j.jacr.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop and pilot test a patient decision aid (DA) describing small kidney masses and risks and benefits of treatment for the masses. METHODS An expert committee iteratively designed a small kidney mass DA, incorporating evidence-based risk communication and informational needs for treatment options and shared decision making. After literature review and drafting content with the feedback of urologists, radiologists, and an internist, a rapid qualitative assessment was conducted using two patient focus groups to inform user-centered design. In a pilot study, 30 patients were randomized at the initial urologic consultation to receive the DA or existing institutional patient educational material (PEM). Preconsultation questionnaires captured patient knowledge and shared decision-making preferences. After review of the DA and subsequent clinician consultation, patients completed questionnaires on discussion content and satisfaction. Proportions between arms were compared using Fisher exact tests, and decision measures were compared using Mann-Whitney tests. RESULTS Patient informational needs included risk of tumor growth during active surveillance and ablation, significance of comorbidities, and posttreatment recovery. For the DA, 84% of patients viewed all content, and mean viewing time was 20 min. Significant improvements in knowledge about small mass risks and treatments were observed (mean total scores: 52.6% DA versus 22.3% PEM, P < .001). DA use also increased the proportion of patients discussing ablation (66.7% DA versus 18.2% PEM, P = .02). Decision satisfaction measures were similar in both arms. DISCUSSION Patients receiving a small kidney mass DA are likely to gain knowledge and preparedness to discuss all treatment options over standard educational materials.
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Erinç R, Topuz ÖV, Tamam MO. A case of soft tissue hematoma detected incidentally on 99m TC-labelled RBC gastrointestinal bleeding SPECT/CT. ULUS TRAVMA ACIL CER 2022; 28:113-115. [PMID: 34967438 PMCID: PMC10443159 DOI: 10.14744/tjtes.2020.90376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
Abstract
We report an incidental finding on 99mTc-labelled RBC gastrointestinal bleeding scintigraphy of a 49-year-old female patient referred to our clinic in order to localize the bleeding site. The patient has also been suffering from chronic renal insufficiency and received several interventions of femoral catheterization. During the follow-up, an intense uptake was observed at the right inguinofemoral area which is evaluated as a large soft tissue hematoma and confirmed by SPECT/CT subsequently. On the 24th h delayed image an activity accumulation along the bowel trace on the right side of the abdomen was seen as evidence of lower gastrointestinal bleeding.
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Affiliation(s)
- Rüya Erinç
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, İstanbul-Turkey
| | - Özge Vural Topuz
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, İstanbul-Turkey
| | - Muge Oner Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, İstanbul-Turkey
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Bagga B, Fansiwala K, Thomas S, Chung R, Moore WH, Babb JS, Horwitz LI, Blecker S, Kang SK. Outcomes of Incidental Lung Nodules With Structured Recommendations and Electronic Tracking. J Am Coll Radiol 2021; 19:407-414. [PMID: 34896068 DOI: 10.1016/j.jacr.2021.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of structured recommendations on follow-up completion for incidental lung nodules (ILNs). METHODS Patients with ILNs before and after implementation of structured Fleischner recommendations and electronic tracking were sampled randomly. The cohorts were compared for imaging follow-up. Multivariable logistic regression was used to assess appropriate follow-up and loss to follow-up, with independent variables including use of structured recommendations or tracking, age, gender, race, ethnicity, setting of the index test (inpatient, outpatient, emergency department), smoking history, and nodule features. RESULTS In all, 1,301 patients met final inclusion criteria, including 255 patients before and 1,046 patients after structured recommendations or tracking. Baseline differences were found in the pre- and postintervention groups, with smaller ILNs and younger age after implementing structured recommendations. Comparing pre- versus postintervention outcomes, 40.0% (100 of 250) versus 29.5% (309 of 1,046) of patients had no follow-up despite Fleischner indications for imaging (P = .002), and among the remaining patients, 56.6% (82 of 145) versus 75.0% (553 of 737) followed up on time (P < .001). Delayed follow-up was more frequent before intervention. Differences postintervention were mostly accounted for by nodules ≤ 8 mm in the outpatient setting (P < .001). In multivariable analysis, younger age, White race, outpatient setting, and larger nodule size showed significant association with appropriate follow-up completion (P < .015), but structured recommendations did not. Similar results applied for loss to follow-up. DISCUSSION Consistent use of structured reporting is likely key to mitigate selection bias when benchmarking rates of appropriate follow-up of ILN. Emergency department patients and inpatients are at high risk of missed or delayed follow-up despite structured recommendations.
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Affiliation(s)
- Barun Bagga
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | | | | | - Ryan Chung
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - James S Babb
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Leora I Horwitz
- Department of Population Health, NYU Grossman School of Medicine, New York, New York; Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Saul Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, New York; Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Stella K Kang
- Department of Population Health, NYU Grossman School of Medicine, New York, New York; Associate Professor, Department of Radiology, Department of Population Health, NYU Grossman School of Medicine, New York, New York.
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Petterino C, Caffull AL, Chuchu DB, Hartness ME. What is your diagnosis? A flag for platelet clumping in the peripheral blood of a female Crl:CD-1 mouse on an ADVIA hematology analyzer. Vet Clin Pathol 2021; 50:611-614. [PMID: 34476831 DOI: 10.1111/vcp.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
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Smith WC, Khatri G, Dunn SH, Zeidan N, Browning TG, Kubiliun N, Mansour JC, Minter RM, Vu L, Coleman VL, Pedrosa I, Leyendecker JR. Facilitating Surveillance of Incidental Findings Using a Novel Reporting Template: Proof of Concept in Patients With Pancreatic Abnormalities. J Am Coll Radiol 2021; 18:1246-57. [PMID: 34283988 DOI: 10.1016/j.jacr.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the surveillance impact of utilizing a discrete field in structured radiology reports in patients with incidental pancreatic findings. METHODS We implemented a dictation template containing a discrete structured field element to auto-trigger listing of patients with incidental pancreatic findings on a pancreas clinic registry in the electronic health record. We isolated CT and MRI reports with incidental pancreatic findings over a 24-month period. We stratified patients by presence or absence of the discrete field element in reports (flagged versus unflagged) and evaluated the impact of report flagging on likelihood of clinic follow-up, follow-up imaging, endoscopic ultrasound, surgical intervention, genetics referral, obtaining pathologic diagnosis, and time interval between index imaging to various outcomes. RESULTS Patients with flagged reports were more likely to be seen or discussed in a pancreas clinic compared with those with unflagged reports (189 of 376, 50.3% versus 79 of 474, 16.7%; P <. 001). Patients with flagged reports were more likely to get follow-up imaging than patients with unflagged reports (188 of 376, 50.0% versus 121 of 474, 25.5%; P < .001) and were more likely to undergo appropriate management of actionable findings compared with patients in the unflagged group (23 of 62, 37.1% versus 28 of 129, 21.7%; P = .036). DISCUSSION Implementation of a structured discrete field element for reporting of patients with incidental pancreatic findings had positive impact on surveillance measures and can be applied in other organ systems with established surveillance guidelines to standardize patient care.
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Emekli E, Gündoğdu E. A Case of Incidentally Detected Bladder Lipoma and a Review of the Literature. Curr Med Imaging 2021; 18:86-90. [PMID: 34931985 DOI: 10.2174/1573405617666210712122127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lipomas are benign fatty tumors made of fat tissue. Bladder lipomas are extremely rare. For this reason, it is necessary to be aware of the imaging features when incidentally detected in imaging. CASE REPORT In the abdominal computed tomography (CT) performed as part of the follow-up examination of a 43-year-old patient, who had undergone surgery for adrenal adenoma five years earlier, a 14x9x8 mm smoothly marginated, ovoid-shaped, hypodense mass lesion with a homogeneous internal structure was detected in the anterior bladder wall. The pre-contrast density of the lesion was measured as -105 HU. The magnetic resonance imaging performed one year after the CT examination revealed a 14x9x8 intramural mass in the bladder wall, showing protrusion toward the lumen. The group was observed to be markedly hypointense on fat-suppressed T1 and T2-weighted images and considered consistent with a bladder lipoma. DISCUSSION Bladder lipomas are benign lesions that can vary in clinical presentations but usually cause hematuria. The differential diagnosis of bladder lipomas includes other mesenchymal rare benign tumors that can arise from the urinary bladder submucosal layer, including leiomyoma, hemangioma, plasmacytoma, fibroma, and neurofibroma, in imaging bladder lipomas present as homogeneous lesions containing macroscopic fat. Only the liposarcoma and pelvic lipomatosis could also show similar features. The less differentiated liposarcomas tend to present more heterogeneous enhancement, irregular-shaped margins, and infiltrative behavior. Also, appropriate multiplanar reconstructions may allow the radiologist to determine it is an extravesical pelvic lipomatosis. CONCLUSION Using CT and MRI, these lesions rich in adipose tissue can be distinguished from other lesions, and their diagnosis can be made to a great extent. However, a histopathological examination is required for a definitive diagnosis.
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Affiliation(s)
- Emre Emekli
- Department of Radiology, Etimegut State Hospital, Department of Radiology, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
| | - Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University, Faculty of Medicine, Turkey
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Cuartas KN, Wilson NR, Kala J. Lymphoma Masquerading as an Ear Mass. Cureus 2021; 13:e14180. [PMID: 33936891 PMCID: PMC8081646 DOI: 10.7759/cureus.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Due to the infrequently reported location, malignancies of the ear are usually misdiagnosed at the time of first presentation. To the best of our knowledge, there have been no reports in literature regarding diffuse large B-cell lymphoma (DLBCL) presenting as an ear mass, as was seen in our patient. We describe a case of a 38-year-old gentleman who presented with four months of worsening dyspnea on exertion and nonproductive cough. On exam there was a 4 cm x 5 cm erythematous, non-tender, and immobile mass on the right lower ear in the intertragic notch, sparing the lobe. CT of the neck and chest revealed prominent cervical lymph nodes and a diffusely spread circumferential soft tissue mediastinal mass involving the lungs, pleura, and pericardium. Malignancy was suspected, so the right ear mass was biopsied. Findings were consistent with DLBCL, germinal center B-type. This case provides a rare example of DLBCL presenting as an ear mass in a 38-year-old male with a chronic cough. We believe that prompt radiological evaluation of the chronic nonresolving cough may have helped in timely diagnosis of the malignancy, possibly halting the extensive infiltrative spread of disease, and thereby reducing the morbidity that the patient eventually suffered.
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Affiliation(s)
- Karen N Cuartas
- Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Nathaniel R Wilson
- Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Jaya Kala
- Internal Medicine, University of Texas Health Science Center at Houston, Houston, USA
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Walker FO, Cartwright MS, Hunt CH. Managing uncommon and unexpected findings during neuromuscular ultrasound. Muscle Nerve 2020; 63:793-806. [PMID: 33325071 DOI: 10.1002/mus.27128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
One barrier to widespread adoption of neuromuscular ultrasound by clinical neurophysiologists is concern over how to identify and manage non-neuromuscular findings. This review addresses this concern by describing the sonographic appearance of a variety of commonly observed pathologies and anatomic variants in dermal, subcutaneous, bony, glandular, lymphatic, vascular, and other superficial tissues. Additionally, it outlines techniques to ensure proper clinical and ultrasound evaluation of unexpected or uncommon findings. Finally, it highlights strategies to manage unexpected findings, including how to best communicate findings to patients and referring clinicians to avoid unnecessary testing and ensure appropriate follow-up. Ultrasound extends the ability of the neuromuscular sonographer-clinician to contribute to patient care.
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Affiliation(s)
- Francis O Walker
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest Medical School, Medical Center Blvd, Winston-Salem, NC, 27157-1078, USA
| | - Michael S Cartwright
- Division of Neuromuscular Disorders, Department of Neurology, Wake Forest Medical School, Medical Center Blvd, Winston-Salem, NC, 27157-1078, USA
| | - Christopher H Hunt
- Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Atreya A, Shrestha R, Nepal B, Nepal S, Shrestha D, Mahato S. When sexual offence is an unexpected diagnosis - exploration of medical, legal and social aspects in Nepalese scenario. Med Leg J 2020; 88:192-195. [PMID: 32716259 DOI: 10.1177/0025817220935878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In Nepal, following allegations of sexual assault, the survivor is taken by the police to a Government Hospital for medical examination and sample collection. To provide an integrated service to survivors of gender-based violence, a One-Stop Crisis Management Centre (OCMC) is established in many Government Hospitals. However, paediatric survivors of sexual abuse frequently seek initial care at the emergency department, as most present with a medical complaint rather than for sexual abuse. It is therefore important to train emergency physicians with the skills required to identify the features and diagnose a case of sexual assault. We present a case where the diagnosis of sexual assault of a child was an incidental finding and discuss the challenges faced in dealing with such cases in non-OCMC Hospital.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal
| | - Rijen Shrestha
- Department of Forensic Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | | | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Nepal
| | - Deepak Shrestha
- Department of Obstetrics and Gynecology, Lumbini Medical College, Palpa, Nepal
| | - Sweta Mahato
- Department of Obstetrics and Gynecology, Lumbini Medical College, Palpa, Nepal
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Drukker L, Cavallaro A, Salim I, Ioannou C, Impey L, Papageorghiou AT. How often do we incidentally find a fetal abnormality at the routine third-trimester growth scan? A population-based study. Am J Obstet Gynecol 2020; 223:919.e1-919.e13. [PMID: 32504567 DOI: 10.1016/j.ajog.2020.05.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Third-trimester scans are increasingly used to try to prevent adverse outcomes associated with abnormalities of fetal growth. Unexpected fetal malformations detected at third-trimester growth scans are rarely reported. OBJECTIVE To determine the incidence and type of fetal malformations detected in women attending a routine third-trimester growth scan. STUDY DESIGN This was a population-based study of all women with singleton pregnancy attending antenatal care over a 2-year period in Oxfordshire, UK. Women who had a viable singleton pregnancy at dating scan were included. Women had standard obstetrical care including the offer of a routine dating scan and combined screening for trisomies; a routine anomaly scan at 18 to 22 weeks; and a routine third-trimester growth scan at 36 weeks. The third-trimester scan comprises assessment of fetal presentation, amniotic fluid, biometry, umbilical and middle cerebral artery Dopplers, but no formal anatomic assessment is undertaken. Scans are performed by certified sonographers or clinical fellows (n=54), and any suspected abnormalities are evaluated by a team of fetal medicine specialists. We assessed the frequency and type of incidental congenital malformations identified for the first time at this third-trimester scan. All babies were followed-up after birth for a minimum of 6 months. RESULTS There were 15,244 women attending routine antenatal care. Anomalies were detected in 474 (3.1%) fetuses as follows: 103 (21.7%) were detected before the anomaly scan, 174 (36.7%) at the anomaly scan, 11 (2.3%) after the anomaly scan and before the third-trimester scan, 43 (9.1%) at the third-trimester scan and 143 (30.2%) after birth. The 43 abnormalities were found in a total of 13,023 women who had a 36 weeks scan, suggesting that in 1 out of 303 (95% confidence interval, 233-432) women attending such a scan, a new malformation was detected. Anomalies detected at the routine third-trimester scan were of the urinary tract (n=30), central nervous system (5), simple ovarian cysts (4), chromosomal (1), splenic cyst (1), skeletal dysplasia (1), and cutaneous lymphangioma (1). Most urinary tract anomalies were renal pelvic dilatation, which showed spontaneous resolution in 57% of the cases. CONCLUSION When undertaking a program of routine third-trimester growth scans in women who have had previous screening scans, an unexpected congenital malformation is detected in approximately 1 in 300 women.
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Votto M, Castagnoli R, Prevedoni Gorone MS, Marseglia GL, Licari A. An asymptomatic mediastinal cyst in a young child: Case report and summary of the literature. Clin Case Rep 2020; 8:2163-2165. [PMID: 33235751 PMCID: PMC7669405 DOI: 10.1002/ccr3.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/29/2020] [Accepted: 06/06/2020] [Indexed: 11/12/2022] Open
Abstract
Bronchogenic cyst is a rare congenital chest malformation that mainly presents with wheeze and feeding issues in early life. A multidisciplinary approach and follow-up are pivotal for the improvement of lung function, mostly in cases of mediastinal complications.
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Affiliation(s)
- Martina Votto
- Department of PediatricsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Riccardo Castagnoli
- Department of PediatricsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Maria Sole Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and NeuroradiologyIRCCS San Matteo University Hospital FoundationPaviaItaly
| | - Gian Luigi Marseglia
- Department of PediatricsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Amelia Licari
- Department of PediatricsFondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
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Vandyck-Sey P, Amoh G, Essuman A, Lawson H. Incidental finding of COVID-19 infection amongst staff at a primary care facility in Ghana. Afr J Prim Health Care Fam Med 2020; 12:e1-e4. [PMID: 33054267 PMCID: PMC7564848 DOI: 10.4102/phcfm.v12i1.2669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has affected nearly every country worldwide and all African countries. The issue of healthcare workers (HCWs) contracting the disease is a growing concern in Ghana, because of the risk of spreading infections amongst themselves and to vulnerable patients in their care. This article illustrates how 14 staff at the Korle Bu Polyclinic/Family Medicine Department were incidentally found to be Covid-19 positive with most of them being asymptomatic. This observation led to a modification of the personal protective equipment (PPE) used by clinical staff when attending to patients. Furthermore, this finding suggests that a different criteria or guideline may be needed for testing of HCWs during a pandemic where a significant proportion of infected people are asymptomatic. We conclude that in the primary care setting HCWs must be ready to see all the following cases safely: routine patients, asymptomatic COVID-19 patients and suspected COVID-19 patients.
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Affiliation(s)
- Priscilla Vandyck-Sey
- Faculty of Family Medicine, Korle Bu Polyclinic and Family Medicine Centre, Korle Bu Teaching Hospital, Accra.
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Drukker L, Bradburn E, Rodriguez GB, Roberts NW, Impey L, Papageorghiou AT. How often do we identify fetal abnormalities during routine third-trimester ultrasound? A systematic review and meta-analysis. BJOG 2020; 128:259-269. [PMID: 32790134 DOI: 10.1111/1471-0528.16468] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Routine third-trimester ultrasound is frequently offered to pregnant women to identify fetuses with abnormal growth. Infrequently, a congenital anomaly is incidentally detected. OBJECTIVE To establish the prevalence and type of fetal anomalies detected during routine third-trimester scans using a systematic review and meta-analysis. SEARCH STRATEGY Electronic databases (MEDLINE, Embase and the Cochrane library) from inception until August 2019. SELECTION CRITERIA Population-based studies (randomised control trials, prospective and retrospective cohorts) reporting abnormalities detected at the routine third-trimester ultrasound performed in unselected populations with prior screening. Case reports, case series, case-control studies and reviews without original data were excluded. DATA COLLECTION AND ANALYSIS Prevalence and type of anomalies detected in the third trimester. We calculated pooled prevalence as the number of anomalies per 1000 scans with 95% confidence intervals. Publication bias was assessed. MAIN RESULTS The literature search identified 9594 citations: 13 studies were eligible representing 141 717 women; 643 were diagnosed with an unexpected abnormality. The pooled prevalence of a new abnormality diagnosed was 3.68 per 1000 women scanned (95% CI 2.72-4.78). The largest groups of abnormalities were urogenital (55%), central nervous system abnormalities (18%) and cardiac abnormalities (14%). CONCLUSION Combining data from 13 studies and over 140 000 women, we show that during routine third-trimester ultrasound, an incidental fetal anomaly will be found in about 1 in 300 scanned women. This information should be taken into account when taking consent from women for third-trimester ultrasound and when designing and assessing cost of third-trimester ultrasound screening programmes. TWEETABLE ABSTRACT One in 300 women attending a third-trimester scan will have a finding of a fetal abnormality.
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Affiliation(s)
- L Drukker
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Center, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Bradburn
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - G B Rodriguez
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - N W Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - L Impey
- Fetal Medicine Unit, Department of Maternal and Fetal Medicine, Women's Center, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Vijayan S, Potluri A. Case of Mönckeberg arteriosclerosis in the carotid, facial, and lingual arteries: a potentially serious incidental finding in CBCT. Gen Dent 2020; 68:47-50. [PMID: 32857048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Calcifications in the tunica media (middle layer of the arterial wall), classified as Mönckeberg arteriosclerosis, are more prevalent in older patients and patients with diabetes and/or chronic kidney disease. Mönckeberg arteriosclerosis has prevalence rates of 13.3% and 6.9% in men and women, respectively, and can be observed as a railroad track pattern on imaging studies. With the advent of cone beam computed tomography in dentistry, Mönckeberg arteriosclerosis is usually observed as an incidental finding. This case report describes a unique presentation of Mönckeberg arteriosclerosis in the carotid, facial, and lingual arteries of a 66-year-old man.
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Yahyaoui R, Blasco-Alonso J, Gonzalo-Marín M, Benito C, Serrano-Nieto J, González-Gallego I, Ruiz-Sala P, Pérez B, González-Lamuño D. Metabolic Serendipities of Expanded Newborn Screening. Genes (Basel) 2020; 11:genes11091018. [PMID: 32872442 PMCID: PMC7565434 DOI: 10.3390/genes11091018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023] Open
Abstract
Incidental findings on newborn screening (NBS) are results that are not the target of screening within a given NBS program, but rather are found as a result of the screening and resulting diagnostic workup for that target. These findings may not have an immediate clinical impact on the newborn, but are sometimes an additional benefit of NBS programs and may be considered secondary targets of NBS programs. This work describes four case reports that had incidental findings on the NBS, which eventually led to the diagnosis of another metabolic disease instead of the one that was initially suspected. The first case was a new defect in the cationic amino acid transporter-2 (CAT-2), which was oriented as an arginase-1 deficiency in the newborn. The second case was a maternal glutaric aciduria type 1 (GA-1) that mimicked a carnitine transporter deficiency in the newborn. The third report was a case of lysinuric protein intolerance (LPI), which appeared as high levels of citrulline on the NBS. The fourth case was a mother with homocystinuria that was diagnosed during the biochemical study of vitamin B12 status. All cases provide new or interesting data that will help guide differential diagnosis in the future.
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Affiliation(s)
- Raquel Yahyaoui
- Laboratory of Metabolic Disorders, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Correspondence: ; Tel.: +34-687806035
| | - Javier Blasco-Alonso
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Montserrat Gonzalo-Marín
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Endocrinology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain
| | - Carmen Benito
- Department of Genetics, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Juliana Serrano-Nieto
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Inmaculada González-Gallego
- Unit of Metabolic Disorders, Centro de Bioquímica y Genética Clínica, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Pedro Ruiz-Sala
- Centro Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, 28049 Madrid, Spain; (P.R.-S.); (B.P.)
| | - Belén Pérez
- Centro Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, 28049 Madrid, Spain; (P.R.-S.); (B.P.)
| | - Domingo González-Lamuño
- Department of Pediatrics, University of Cantabria-University Hospital Marqués de Valdecilla, 39008 Santander, Spain;
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Kuo C, Hwu W, Chien Y, Hsu C, Hung M, Lin I, Lai F, Lee N. Frequency and spectrum of actionable pathogenic secondary findings in Taiwanese exomes. Mol Genet Genomic Med 2020; 8:e1455. [PMID: 32794656 PMCID: PMC7549563 DOI: 10.1002/mgg3.1455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/29/2020] [Accepted: 07/27/2020] [Indexed: 01/29/2023] Open
Abstract
Background Exome sequencing has recently become more readily available, and more information about incidental findings has been disclosed. However, data from East Asia are scarce. We studied the application of exome sequencing to the identification of pathogenic/likely pathogenic variants in the ACMG 59 gene list and the frequency of these variants in the Taiwanese population. Methods This study screened 161 Taiwanese exomes for variants from the ACMG 59 gene list. The identified variants were reviewed based on information from different databases and the available literature and classified according to the ACMG standard guidelines. Results We identified seven pathogenic/likely pathogenic variants in eight individuals, with five participants with autosomal recessive variants in one allele and three participants with autosomal dominant variants. Approximately 1.86% (3/161) of the Taiwanese individuals had a reportable pathogenic/likely pathogenic variant as determined by whole‐exome sequencing (WES), which was comparable to the proportions published previously in other countries. We further investigated the high carrier rate of rare variants in the ATP7B gene, which might indicate a founder effect in our population. Conclusion This study was the first to provide Taiwanese population data of incidental findings and emphasized a high carrier rate of candidate pathogenic/likely pathogenic variants in the ATP7B gene.
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Affiliation(s)
- Chieh‐Wen Kuo
- College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Wuh‐Liang Hwu
- Department of PediatricsNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- Department of Medical GeneticsNational Taiwan University HospitalTaipeiTaiwan
| | - Yin‐Hsiu Chien
- Department of PediatricsNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- Department of Medical GeneticsNational Taiwan University HospitalTaipeiTaiwan
| | - Ching Hsu
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
| | - Miao‐Zi Hung
- Department of Medical GeneticsNational Taiwan University HospitalTaipeiTaiwan
| | - I‐Lin Lin
- Department of Medical GeneticsNational Taiwan University HospitalTaipeiTaiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
| | - Ni‐Chung Lee
- Department of PediatricsNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- Department of Medical GeneticsNational Taiwan University HospitalTaipeiTaiwan
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Jäckel K, Knechtle B. [Migraine? Arnold Chiari Malformation? Or Just a Migraine?]. Praxis (Bern 1994) 2020; 109:806-811. [PMID: 32752959 DOI: 10.1024/1661-8157/a003506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Migraine? Arnold Chiari Malformation? Or Just a Migraine? Abstract. In a young woman with a long-time headache in the sense of a migraine, a neurological reassessment including new findings of the existing MRI images of the skull resulted in the diagnosis of a Chiari malformation type 1. After successful operation of the MRI findings, the headache decreased significantly. However, since minor headaches of a different quality persist, a migraine plus malformation as an incidental finding are most likely.
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Kurtuldu E, Alkis HT, Yesiltepe S, Sumbullu MA. Incidental findings in patients who underwent cone beam computed tomography for implant treatment planning. Niger J Clin Pract 2020; 23:329-336. [PMID: 32134031 DOI: 10.4103/njcp.njcp_309_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives The aim of this study is to determine the type, frequency, and location of incidental findings in the maxillofacial region in patients undergoing cone beam computed tomography (CBCT) scan for implant treatment.[5]. Methods In this study, 300 patients who underwent CBCT imaging for implant treatment planning were evaluated retrospectively. Patients were evaluated in four different categories, namely, maxillary sinus pathologies, temporomandibular joint (TMJ) findings, dentoalveolar findings, and soft-tissue calcifications. In maxillary sinus pathologies, we categorized patients by mucosal thickening, polypoidal lesion, air-liquid level, total opacification, oroantral fistula, periapical lesion related with maxillary sinus, antrolith, hypoplasia, and foreign body presence. In the TMJ findings category, we evaluated patients for erosion, osteophyte, sclerosis, flattening, and bifid condyle. For dentoalveolar findings, we looked for the residual root and impacted tooth. In soft-tissue calcifications, we examined patients for tonsillolith, sialolith, lymph node calcification, styloid ligament calcification, carotid artery calcifications, and osteoma cutis. Results Mucosal thickening was mostly seen in maxillary sinus pathology. One hundred and forty-eight (49.3%) of the patients had at least one TMJ incidental finding. We detected at least one impacted tooth in 17 (5.7%) patients' maxilla and 14 (4.7%) patients' mandibles. The most frequently seen calcification was styloid ligament calcification. There was no statistically significant relationship between the age groups and incidental findings (P > 0.05). Conclusions Oral radiologists should be aware of incidental findings and evaluate the possibilities of underlying diseases in a comprehensive way, and if there is a concern about the finding, they should refer the patient to the relevant specialist.
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Affiliation(s)
- E Kurtuldu
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Biruni University, Zip 34010, İstanbul, Turkey
| | - H T Alkis
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Dumlupinar Avenue, Zip 07058, Campus, Antalya, Turkey
| | - S Yesiltepe
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
| | - M A Sumbullu
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ataturk University, Zip 25340, Erzurum, Turkey
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