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Case: A 76-year-old female with a history of multiple falls on the patella presented with worsening knee pain, swelling, and reduced range of motion. Radiographs revealed tricompartmental osteoarthritis and subtle erosion of the posterior cortex of the patella that was missed by the referring orthopedist and radiologist. Her persistent pain prompted an MRI, revealing a mass later confirmed to be primary diffuse large B-cell lymphoma of the patella after biopsy and appropriate metastatic workup., Conclusion: Primary B-cell patellar lymphoma is a rarely described cause of knee pain requiring broad differential diagnosis and multidisciplinary workup in order to avoid erroneous treatment and ensure prompt oncologic treatment., Competing Interests: None., (© 2023 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Introduction: Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP., Cases: Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids., Conclusions: Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.

Purpose Technetium Tc-99m sulfur colloid (99mTc-SC) breast lymphoscintigraphy is commonly performed to identify the sentinel lymph node (SLN) in patients diagnosed with breast carcinoma undergoing lumpectomy. The purpose of this report is to describe how the use of 2% topical lidocaine jelly immediately after the completion of needle localization and prior to scintigraphy may substantially reduce pain associated with the injection of 99mTc-SC. Materials and methods This was a quality improvement project. Patients were asked to score the severity of pain associated with the periareolar 99mTc-SC injections for sentinel node lymphoscintigraphy. In order to decrease the discomfort, topical lidocaine was applied to the periareolar skin after the completion of the needle localization, but prior to transferring the patient from the mammography room to the nuclear medicine department for the 99mTc-SC injections. At the time of 99mTc-SC injection, patients were asked to score the pain of injection from 0 (none) to 10 (worst). Results The average pain score of the women who did not receive topical lidocaine jelly was 8 (range: 5-9). In the 10 women who received topical lidocaine jelly after needle localization, the average pain score was 2.5 (range: 1-5). Interestingly, the pain score for women who discussed the possible use of lidocaine jelly with the radiologists but still did not receive topical lidocaine jelly was also low at 6.5. For patients who received the lidocaine jelly only five minutes prior to injection, the average pain score was 6. Conclusion The application of lidocaine jelly after the conclusion of needle localization, with a 15-40-minute delay prior to periareolar injections with 99mTc-SC for sentinel node lymphoscintigraphy, appears to substantially reduce the pain associated with the injection of 99mTc-SC., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Virk et al.)

The skin and subcutaneous tissues are inevitably imaged as part of most body MRI studies. Incidental or even symptomatic skin lesions may, therefore, be detected and present a diagnostic challenge for the radiologist. We aim to provide a comprehensive review, with illustrative examples, of the skin abnormalities encountered on body MRI studies in our busy academic radiology department.

Xanthogranulomatous pancreatitis (XGP) is an extremely rare cause of a cystic pancreatic mass. The pathophysiology of this process is not entirely clear but likely results from a combination of duct obstruction, infection, and repeated hemorrhage. It is difficult to differentiate this inflammatory lesion from a cystic neoplasm and, therefore, in the majority of cases XGP is misdiagnosed as a neoplasm on preoperative imaging. In this report, we describe a case of XGP, the imaging characteristics of XGP, and a differential diagnosis for a cystic pancreatic lesion., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aim: To elucidate causes for false negative magnetic resonance imaging (MRI) exams by identifying imaging characteristics that predict viable hepatocellular carcinoma (HCC) in lesions previously treated with locoregional therapy when obvious findings of recurrence are absent., Methods: This retrospective institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study included patients who underwent liver transplantation at our center between 1/1/2000 and 12/31/2012 after being treated for HCC with locoregional therapy. All selected patients had a contrast-enhanced MRI after locoregional therapy within 90 d of transplant that was prospectively interpreted as without evidence of residual or recurrent tumor. Retrospectively, 2 radiologists, blinded to clinical and pathological data, independently reviewed the pre-transplant MRIs for 7 imaging features. Liver explant histopathology provided the reference standard, with clinically significant tumor defined as viable tumor ≥ 1.0 cm in maximum dimension. Fisher's exact test was first performed to identify significant imaging features., Results: Inclusion criteria selected for 42 patients with 65 treated lesions. Fourteen of 42 patients (33%) and 16 of 65 treated lesions (25%) had clinically significant viable tumor on explant histology. None of the 7 imaging findings examined could reliably and reproducibly determine which treated lesion had viable tumor when the exam had been prospectively read as without evidence of viable HCC., Conclusion: After locoregional therapy some treated lesions that do not demonstrate any MRI evidence of HCC will contain viable tumor. As such even patients with a negative MRI following treatment should receive regular short-term imaging surveillance because some have occult viable tumor. The possibility of occult tumor should be a consideration when contemplating any action which might delay liver transplant.

Purpose: To evaluate the utility of dynamic, contrast-enhanced magnetic resonance imaging (MRI) in combination with single-shot T2-weighted (ssT2) sequences in the differentiation of lipid-poor adrenal adenomas from non-adenomas., Materials and Methods: This retrospective study was approved by the institutional review board and is HIPAA compliant. Between January 2007 and December 2010, 46 patients with MRI demonstrating a lipid-poor adrenal lesion who underwent either surgical resection or a minimum of 24 months of imaging follow-up were identified retrospectively. All images were retrospectively reviewed in blinded fashion by two radiologists. Each adrenal lesion was categorized by dynamic enhancement features and qualitative signal on ssT2 images and was categorized as an adenoma if it demonstrated homogenous enhancement in the arterial phase, washout with capsule enhancement in the delayed phase, and T2 signal isointense to normal adrenal tissue. Any lesion that did not fulfill all the criteria was classified as a non-adenoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for characterization of adenoma were calculated for each reader with 95% confidence intervals. A κ test assessed level of agreement between readers., Results: Application of our criteria lead to an MRI diagnosis of lipid-poor adrenal adenoma with a sensitivity of 84.2-89.5% (16/19-17/19), specificity of 96.3% (26/27), positive predictive value of 94.1-94.4% (16/17-17/18), negative predictive value of 89.7-92.9% (26/29-26/28), and accuracy of 91.3-93.5% (42/46-43/46). Agreement between the two readers showed substantial κ agreement for the differentiation of adenoma from non-adenoma., Conclusions: Dynamic, contrast-enhanced T1-weighted three-dimensional gradient echo sequences in combination with ssT2 images can accurately differentiate lipid-poor adrenal adenomas from non-adenomas., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)