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Eighty malpractice claims were taken against the U.S. government alleging negligence and delay in the diagnosis of breast cancer in federal medical facilities during the period from 1980 to 1989. Medical records and claim documents were reviewed together with the opinions of expert witnesses, journal articles, and opinions of the Department of Legal Medicine of the Armed Forces Institute of Pathology. The radiology and pathology reports were reviewed. Of the 80 claims, 68 were closed; compensation amounts ranged from $6,000 to $1 million. There was no correlation between the length of delay in diagnosis and the amount of compensation paid. The reasons for delayed diagnosis are considered in detail, and recommendations are made in an attempt to minimize the number of such claims in the future.

Because of significant difficulties encountered in the manipulation of data from 99Tcm-DTPA and 99Tcm-mercaptoacetyltriglycine (MAG3) renogram studies, it was decided to try to improve the percentage dose of radioisotope injected and thus the number of counts obtained by using a minimum dose volume of 1 ml for all injections. This resulted in an improvement in the percentage dose injected. However, difficulties were still encountered in the younger children. 18.7% of children aged less than 3 months, received less than 50% of the injected dose, showing little or no improvement using the newer method. The difficulty of injecting small babies seems the most obvious reason. During the interpretation of the findings in paediatric radioisotope studies, it is important to remember that not all children may have received an adequate percentage dose to constitute a reliably diagnostic study.

We describe a case of dirofilariasis of the breast in a woman presenting with a breast lump. The mammogram and ultrasound appearances are described with histopathological correlation. The suspicion of a parasitic infection was raised by the presence of rod-like structures within a hypoechoic nodule on sonography, appearances that have not been previously described. The case illustrates an unusual diagnostic problem since it presented in a non-endemic area.

A case is outlined of a patient presenting with a painful shoulder. Metastatic malignant melanoma was diagnosed. The sites of origin of melanotic lesions as well as metastatic sites are described. Both gross and radiological appearances of such lesion are not uniform, varying from osteolytic to osteoblastic forms. Treatment is for the most part ineffective. The outcome is rapid and invariably fatal.