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Idiopathic granulomatous mastitis (IGM) is an inflammatory-mediated rare disease that can be linked to rare manifestations. Erythema nodosum (EN) and polyarthritis, seen in a multitude of autoinflammatory and autoimmune diseases, have been rarely linked to IGM. Despite the cause of IGM being unclear, Corynebacterium infections are thought to play a role in the pathophysiology of IGM. Unusually, IGM has a relapsing and remitting course, which also applies to its systemic manifestations. As such, we present a case of IGM in a middle-aged lady who was initially thought to have Corynebacterium-containing unilateral abscesses for which drainage was performed. However, several abscesses devoid of bacterial growth started recurring, and the disease course was complicated by EN and polyarthritis. IGM, EN, and polyarthritis eventually resolved and were managed with symptomatic treatment., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s) 2024.)

Various muscles can be involved in idiopathic eosinophilic myositis (IEM), with the ocular muscles being notably affected. Ocular eosinophilic myositis is a rare condition that typically affects the rectus muscles. A tissue biopsy stands as the gold standard for diagnosis. Different subtypes exist based on the extent of eosinophilic infiltration. Limited data is available about treatment, although glucocorticoids have shown successful outcomes. We present the case of a 60-year-old man who, a few years after being diagnosed with ocular myasthenia gravis, was diagnosed through a tissue biopsy with ocular eosinophilic myositis. Treatment with oral glucocorticoids significantly improved his symptoms., Competing Interests: The authors declare no conflict of interest., (© 2024 The Mediterranean Journal of Rheumatology (MJR).)

Introduction: This study aims to investigate the association between epi- and pericardial adipose tissue deposits around the heart against patient body habitus when using cardiac computed tomography (CT)., Methods: Ninety-two consecutive patients with suspected coronary artery disease underwent coronary CT angiography with quantitative cardiac and adipose tissue volume measurements. Body mass index (BMI), body surface area (BSA), thoracic circumference, anteroposterior diameter, cardiac and adipose tissue volumes were compared between genders by employing Pearson's correlation and results were considered statistically significant if p ≤ 0.05., Results: Statistically significant differences between genders were observed with males having a greater height (males 1.72 ± 0.11), BMI (30.76 ± 7.87 kg/m 2 ), BSA (2.06 ± 0.21 m 2 ), thoracic circumference (1022.12 ± 97.90 mm 2 ), and pericardial adipose tissue volume (46.72 ± 36.62 mm 3 ) (p < 0.05). For men, for Group 1 (BMI ≤ 27) each of the measured volumes showed moderate correlation between pericardial adipose tissue and AP chest-diameter (r = 0.429, p <0.05), whereas in Group 2 (27 < BMI ≤ 31.1), coronary artery volume had a strong association with the AP chest-diameter (r = 0.453, p < 0.05)., Conclusion: BMI and thoracic circumference are closely related to variable epi- and pericardial adipose tissue volumes in both males and females during cardiac CT., Implications for Practice: Quantification of epi- and pericardial adipose tissue deposits between males and females during cardiac CT may help further categorise coronary artery disease risk when including BMI and thoracic circumference for males and females., Competing Interests: Conflict of interest statement None., (Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

A 58-year-old male patient, previously healthy, presented with right flank pain of few hours duration. Initial workup showed an elevated creatinine and right hydroureteronephrosis. Computed tomography imaging revealed a retroperitoneal soft tissue mass encasing the right common iliac artery which is a first reported case in its anatomical distribution. Patient was referred to interventional radiology service where a percutaneous nephrostomy tube was placed followed by double J stenting. Subsequently, treatment with steroids was started. Follow up imaging a few months later revealed progressive resolution of the inflammatory process.

Objectives: The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions., Key Findings: Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available., Conclusion: Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma., Implications for Practice: It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer., Competing Interests: Conflict of interest statement All authors have nothing to disclose and have no conflict of interest., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background and Study Aims: Bowel wall thickening (BWT) on computed tomography (CT) has been frequently reported by radiologists. There are no clear guidelines regarding the level of thickening that is correlated with definite pathology. Radiologists usually rely on their overall subjective impression, and studies on inter-observer agreement (IOA) are lacking. This study evaluated IOA concerning BWT found on abdominal CT and identified the corresponding findings on endoscopy., Patients and Methods: Reports of abdominal CTs performed between January 2000 and December 2015 containing the term 'thickening' were retrieved from the radiology department database. Corresponding patients who later underwent endoscopy were included. IOA concerning BWT was evaluated using a randomly mixed sample of 80 patients with normal findings or pathological BWT on endoscopy. A search for predictive factors for the subsequent finding of malignancy on endoscopy was performed using multivariate analysis., Results: During the study period, 6142 CT scans described thickening, equivalent to a BWT prevalence of 13.7%. Ninety-one patients (mean age, 58 years) were included in the analysis. Thickening was found most commonly in the stomach (38.5%), followed by the rectum (22%) and small intestine (14%). Twenty-seven patients (29.7%) exhibited diffuse BWT, whereas 64 patients showed localised BWT (70.3%). Biopsy was performed for 64 of 91 patients with endoscopies. Among these patients, 8.8% exhibited normal findings, whereas inflammation and malignancy were discovered in 25 and 51.6% of patients, respectively, with a positive predictive value for malignancy of 0.36. The IOA concerning CT for predicting significantly pathological BWT was moderate (mean κ = 0.6). A strong association was evident between the presence of lymph nodes on CT and the presence of neoplastic lesions., Conclusion: Our study strongly recommends endoscopic follow-up of patients exhibiting BWT irrespective of the thickening location, especially if it is associated with lymphadenopathy. IOA between radiologists was moderate., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: The aim of this paper is to evaluate contrast media (CM) bolus geometry and opacification patterns in the coronary arteries with particular focus on patient, scanner and safety considerations during coronary computed tomography angiography (CCTA)., Key Findings: The rapid evolution of computed tomography (CT) technology has seen this imaging modality challenge conventional coronary angiography in the evaluation of coronary artery disease. Increases in spatial and temporal resolutions have enabled CCTA to become the modality of choice when evaluating the coronary vascular tree as an alternative in the diagnostic algorithm for acute chest pain. However, these new technologic improvements in scanner technology have imposed new challenges for the optimisation of CM delivery and image acquisition strategies., Conclusion: Understanding basic CM-imaging principles is essential for designing optimal injection protocols according to each specific clinical scenario, independently of scanner technology., Implications for Practice: With rapid advances in CT scanner technology including faster scan acquisitions, the risk of poor opacification of coronary vasculature increases significantly. Therefore, awareness of CM delivery protocols is paramount to consistently provide optimal image quality at a low radiation dose., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Aim: To investigate the frequency of different etiologies of acute scrotal pain in males presenting to the emergency department at American University of Beirut Medical Center in Beirut, Lebanon., Materials and Methods: In all, 94 patients between the ages 18 and 40 years presenting to the emergency room at American University of Beirut Medical Center with acute scrotum were recruited. The scrotum was inspected with palpation, and Doppler Ultrasound of the testicle was performed by a radiology resident to confirm the diagnosis. The study results were then collected after the official reports were signed by a board-certified radiology attending with expertise in ultrasound., Results: Of the 94 patients presenting with acute scrotal pain, 23.4% (95% confidence interval (0.70-0.87)) had no ultrasound findings and were considered normal. On the other hand, 54.3% (95% confidence interval (0.45-0.66)) were diagnosed with varicocele, 9.6% (95% confidence interval (0.04-0.16)) were diagnosed with epididymo-orchitis, and 9.6% (95% confidence interval (0.04-0.16)) had a history of trauma to the testicle. Patients presenting with acute scrotum had a pain duration of 13.2 ± 4.5 h, with 10.6% (95% confidence interval (0.04-0.17)) having associated urinary symptoms, 18.1% (95% confidence interval (0.09-0.25)) have had sexual activity within 48 h of presentation, and 10.6% (95% confidence interval (0.04-0.17)) were pre-diagnosed with varicocele., Conclusion: Varicocele is the most common cause of acute scrotal pain in patients presenting to American University of Beirut Medical Center in Beirut. This should direct varicocele to the top of our differential when a patient with acute scrotum presents to the emergency department. Nevertheless, ruling out torsion remains the first step in the workup.

Introduction: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB)., Materials and Methods: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher's exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05., Results: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05)., Conclusion: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure.

Introduction: To investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers., Methods: Hospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens' kappa analyses were performed., Results: The CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86)., Conclusion: CTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Purpose: This hybrid retrospective and prospective study performed on 200 consecutive patients undergoing renal CTA, investigates the opacification of renal vasculature, radiation dose, and reader confidence., Materials and Methods: 100 patients were assigned retrospectively to protocol A and the other 100 were allocated prospectively to protocol B. Both protocols implemented a contrast material and saline flow rate of 4.5 mL/sec. Protocol A utilized a 100 mL of low-osmolar nonionic IV contrast material (Ioversol 350 mg I/mL) while protocol B employed a patient-tailored contrast media formula using iso-osmolar non-ionic (Iodixanol 320 mg I/mL)., Results: Arterial opacification in the abdominal aorta and in the bilateral main proximal renal arteries demonstrated no statistical significance (p>0.05). Only the main distal renal artery of the left kidney in protocol B was statistically significant (p<0.046). In the venous circulation, the IVC demonstrated a significant reduction in opacification in protocol B (59.39 HU ± 19.39) compared to A (87.74 HU ± 34.06) (p<0.001). Mean CNR for protocol A (22.68 HU ± 13.72) was significantly higher than that of protocol B (14.75 HU ± 5.76 p<0.0001). Effective dose was significantly reduced in protocol B (2.46 ± 0.74 mSv) compared to A (3.07 ± 0.68 mSv) (p<0.001). Mean contrast media volume was reduced in protocol B (44.56 ± 14.32 mL) with lower iodine concentration. ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (p<0.0001), with inter-reader agreement increasing from moderate to excellent in renal arterial visualization., Conclusion: Employing a patient-tailored contrast media injection protocol shows a significant refinement in the visualization of renal vasculature and reader confidence during renal CTA., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Coronary anomalies occur in about 1% of the general population and in severe cases can lead to sudden cardiac death. Coronary computed tomography angiography and magnetic resonance imaging have been deemed appropriate for the evaluation of coronary anomalies by accurately allowing the noninvasive depiction of coronary artery anomalies of origin, course, and termination. The aim of this article is to describe and illustrate a comprehensive array for the classification of coronary artery anomalies.