UCLA Radiological Sciences Proceedings

Most breast imaging practices have an organized system for reviewing the results of breast biopsies, assessing radiologic-histologic concordance, and making follow-up management recommendations. Yet, historically, the breast pathology report and radiologic addendum have been separated within the electronic medical record. Having the two entities fused into one integrated diagnostic report (IDR) has provided both a concise summary of the pertinent findings of imaging and histologic examinations related to the patient’s care and clear guidance for treatment and follow-up. Direct correlation between imaging and histologic findings has been shown to decrease discordance between these findings and increase diagnostic accuracy. The IDR is also a useful summary for conferences of tumor boards and multidisciplinary clinics. In addition, the software that is used for generating the IDR is capable of identifying patients who may benefit from clinical trials.

Arterial pseudoaneurysms are contained ruptures of the arterial wall that require prompt intervention. Iatrogenic pseudoaneurysms may result from various diagnostic and therapeutic procedures. Iatrogenic axillary pseudoaneurysms are quite rare, with few reported cases in the literature. We report a case of a 45-year-old woman who sustained an axillary pseudoaneurysm after an ultrasound-guided, vacuum-assisted biopsy of the axillary lymph node. An arteriovenous fistula developed concomitantly. Despite two image-guided treatments, thrombin injection and endovascular coil embolization, the pseudoaneurysm had persistent flow and was ultimately surgically resected at the time when the patient underwent mastectomy for breast cancer.

Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for ruptured thoracic aortic aneurysms. Poor access vessels are a relative contraindication to TEVAR. Intravascular lithotripsy (IVL) has recently been shown to be effective in treating calcified and stenotic vessels. Prior to the introduction of IVL, plaque modification techniques to increase vessel compliance and luminal diameter were limited to technically complex and risky surgical and interventional radiologic procedures. We present a case demonstrating the use of IVL in the emergency setting to treat severe atherosclerotic stenoses in the abdominal aorta and the iliac artery to facilitate TEVAR of a ruptured thoracic aortic aneurysm.

Endometriosis is one of the most common benign gynecological conditions with a prevalence of 6.6% to 16.2% among women of reproductive age in the United States. It is defined as the occurrence of hormone-responsive endometrial tissue outside of the uterine cavity. However, the pathophysiology of endometriosis is poorly understood. Intestinal endometriosis causing large bowel obstruction is rare despite being the second most common extragenital site of endometriotic implantation. In the adult population, intestinal endometriosis is a clinical challenge because it can be mistaken for other acute obstructive diseases, such as colorectal carcinoma. Computed tomography lacks specificity in the detection of bowel wall abnormalities that cause a large bowel obstruction, and endoscopy does not show an intraluminal mass. The gold standard diagnostic procedures are laparoscopy and biopsy, with laparoscopy used for surgical resection of the abnormal tissue if necessary.