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Uterine leiomyomas are the most common gynecological and pelvic neoplasm, reported in up to 80 percent of women by age 50. While the majority are asymptomatic, uterine leiomyomas, depending on size, number, and location can result in bulk symptoms, abnormal uterine bleeding (AUB), infertility or recurrent pregnancy loss. Ultrasonography (USG) remains first-line for the diagnosis of leiomyomas and is the most appropriate imaging modality for the initial assessment of abnormal uterine bleeding. In an effort to standardize nomenclature and identify causes of AUB, the International Federation of Gynecology and Obstetrics (FIGO) developed a classification system based on the acronym PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified). For the L category of leiomyoma, when present, a secondary and tertiary subclassification system is described distinguishing submucosal masses from others and categorizing the relationship of the mass to the endometrium and serosa. With advancements in newer minimally to non-invasive techniques developed for the management of leiomyomas, uniform characterization, mapping, and classification of leiomyomas is necessary to decide the optimal therapeutic approach. While this classification system has recently been reviewed on MR, to our knowledge, it has not been reviewed on ultrasound in the radiology literature. We hereby present a pictorial review of USG images of all the FIGO categories of leiomyomas to provide a standard guide for radiology reporting.

Novel chemotherapeutic agents are developed to treat recurrent/relapsed lymphoid malignancies. Umbralisib, a novel phosphatidylinositol 3-kinase inhibitor with a selective isoform binding, has shown an improved efficacy and safety profile in clinical trials. Immune-mediated colitis, a frequently observed dose-limiting adverse event of phosphatidylinositol 3-kinase inhibitors, has been mostly observed at supratherapeutic doses in the trials, with grade 1 or 2 diarrhea being the most common adverse event at the therapeutic dose (800 mg PO QD). We present a grade-3 colitis that can be attributed to umbralisib-mediated immune toxicity in a patient with chronic lymphocytic leukemia at the therapeutic dose.

Objective To analyze the temporal trends and state-wide geospatial variations in Vascular and Interventional Radiology (VIR) workforce in the United States. Methods The State Physician Workforce Data from the AAMC website was accessed for years 2015, 2017, and 2019. The variables collected for each state included total number of active physicians, total number of physicians per specialty and total number of female physicians in VIR. Comparative data was obtained for vascular surgery (VS), diagnostic radiology (DR), and radiation oncology (RO). The annual growth rate for total physicians and sub-analysis of female physicians in each state was computed for each specialty. Results From 2015 to 2019, the total number of active physicians in the United States grew by 1.8% per year. Growth of active physicians in VIR grew by 8.3%, DR 0.06%, VS 4.4%, and RO 1.9% per year. Colorado and Minnesota had the highest growth rate for VIR physicians (15%). VIR physicians per 100,000 people increased from 0.84 (2015) to 1.10 (2019) in the US. In comparison, VS physicians increased from 0.99 (2015) to 1.14 (2019), DR physicians decreased from 8.61 (2015) to 8.43 (2019), and RO physicians grew from 1.48 (2015) to 1.56 (2019). Women represented 6.8% of the VIR workforce in the US in 2019 and increased by a rate of 16% annually in the US from 2015 to 2019. In comparison, the number of women in VS has grown by 21%, DR by 2%, and RO by 2.4% during the same period. The state of Maryland has the highest proportion of women in VIR at 18%. Conclusion The number of VIR physicians is increasing at a higher rate than the national overall physician growth, and while female VIR physicians makeup a small fraction of the VIR workforce, their numbers have increased at a faster rate than overall VIR physicians.

Subclavian steal is a term used to describe hemodynamics of blood flow in the branches of subclavian artery in patients with an occlusive or stenotic lesion in the proximal subclavian artery. This leads to a retrograde or reversed flow in the ipsilateral vertebral artery supplied by the contralateral vascular bed due to minimal anterograde pressure in the ipsilateral branch. The occlusive lesion is most commonly due to significant atherosclerotic disease. Most patients remain asymptomatic despite having an occlusive lesion. Subclavian steal syndrome (SSS) is the term used when patients develop symptoms related to poor blood supply in the regions supplied by the vertebral artery (posterior circulation symptoms like transient ischemic attacks, vertigo, and dizziness) and/or the brachial artery (arm claudication). Diagnosis is usually made using Doppler ultrasonography (USG), but other cross-sectional imaging modalities have shown increased prevalence than once thought. Most patients are managed conservatively; however symptomatic patients may need additional endovascular or surgical intervention. Herein, we present a patient of SSS who received subclavian artery stenting followed by complete resolution of symptoms and also review the clinical and management aspects of SSS in detail.

Hyperhomocysteinemia has been associated with an increased risk of systemic atherosclerosis, cardiovascular disease, and stroke. It can result from an impaired homocysteine metabolism resulting from a dietary deficiency of folic acid, vitamin B6, and vitamin B12 or as a result of genetic predispositions due to impaired gene function involved in the methionine and homocysteine metabolism. Nitrous oxide use can also lead to hyperhomocysteinemia by irreversibly oxidizing the cobalt atom of vitamin B12, which results in an inhibition of the enzyme methionine synthase. Here, we report a rare case of a young patient who presented with acute ischemic stroke after years of recreational nitrous oxide use.