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We present the case of an 82-year-old Caucasian lady with a 16-day history of colicky lower abdominal pain and reduced appetite. When presenting to hospital she was haemodynamically stable with no fever. Examination revealed a soft but tender abdomen with normal bowel sounds. No masses or hernias were present. Per-rectal examination revealed an empty rectum. Investigations showed raised inflammatory markers, white cell count 11.9 and C reactive protein 24, in addition to which she had dilated loops of small and large bowel on the abdominal radiograph. The patient underwent an emergency laparotomy where a mass in the descending colon was found to be intussuscepting into the proximal sigmoid colon for which a Hartmanns procedure was performed. Histopathology confirmed a Dukes B T3 N0 Mx adenocarcinoma.

We present a case of an appendicular mass mimicking symptoms of a bladder tumour in a 27-year-old female. The patient initially presented with a 5-month history of intermittent lower abdominal pain associated with dysuria, anorexia and weight loss. Cystoscopy revealed an erythematous urothelium with the appearance of a solid mass bulging into the bladder posteriorly. Urothelial biopsies were negative and computerised tomography showed a soft tissue mass extending from the right superior aspect of the bladder and abutting the distal ileum. At laparoscopy an appendiceal mass adherent to the bladder was found. The symptoms later resolved and she is well at follow-up.

Posterior dislocation of the sternoclavicular joint is an uncommon injury. Since 1824, when Sir Astley Cooper described the injury, little more than 100 cases have been described, and the majority of these have been in the last decade, identified by computed tomography. The significant morbidity and mortality associated with this injury is based upon serious damage to important anatomical structures found in the vicinity of the joint. We present a case report, describe the relevant clinical anatomy of this region, and review associated complications., (Copyright 2002 Wiley-Liss, Inc.)

Aim: To develop, test and validate an audit database, evolved from a prior, peer-reviewed, audit tool for symptomatic multi-modality breast imaging services., Materials and Methods: The database is to cover all aspects of non-invasive breast imaging and recognize subspeciality inputs. When more than one imaging investigation is used for diagnosis, an overall breast imaging audit grade is to be introduced. Data derived from clinical studies has been input into the new database., Results: Results for mammography alone are virtually identical to those of the previous program. A slight increase in accuracy is suggested by using more investigations if the first investigation is not conclusive. More comprehensive reports can be issued., Conclusion: The audit program can be used in the same context as the old audit. If mammography is the sole investigation, there is no change from the previous standards of a minimum mammography (ultrasound)/histopathology agreement of 70%, an equivocal rate of less than 15%, a false-positive rate of less than 7.5% and a false-negative rate of less than 6.5%. Although there is no statistical difference when more than one imaging investigation is used, there is some marginal improvement. It is suggested that initial audit standards for multi-imaging should be 75% for minimum agreement, a 10% maximum for an equivocal rate, a 5% maximum for false negative and an unchanged false positive rate of 7.5% maximum. These standards will be refined with experience. Due to the nature of the database, complex queries can be made including those about histopathological data. If widely used, the database will be a useful tool to audit the accuracy of symptomatic breast imaging services and types and frequencies of symptomatic breast disease, as seen in routine settings., (Copyright 2001 The Royal College of Radiologists.)

The first round screening films of 100 women who had cancers detected in the second round of the NHS Breast Screening Programme, were reviewed blindly, and then retrospectively, with knowledge of the site of the subsequent cancer. On initial blind viewing of the first screening mammograms, a lesion, later histologically proven to be the cancer, was correctly identified in 25 false-negative lesions. However, 51 false positive lesions which did not develop into cancer were also identified. Review with knowledge of the site of the lesions at second round screening identified an additional 19 false negative lesions. The mammographic features of the 25 false negative lesions initially identified on blind review were ill-defined masses (52%), architectural distortion (20%), asymmetrical densities (16%), enlarged lymph nodes (8%) and a well defined lesion (4%). Sixteen of these lesions were classified as minimal change, suspicious change in four, clearly malignant in three and benign in two. Forty-eight percent of the false negative lesions occurred in the established review areas of the breast. On retrospective review, 25% of incident round screen detected breast cancers were potentially detectable on the previous screening mammograms and the majority of these lesions were ill-defined masses that were more likely to occur in the 'review areas' of the breast. However, only 7% demonstrated mammographic features that were clearly recognized as suspicious of malignancy. We therefore recommend that radiologists involved in screen reading should pay particular attention to abnormalities occurring in the so-called review areas.