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Aim: To identify the magnetic resonance (MR) morphological and enhancement characteristics of the normal and diseased nipple. Materials and methods: The MR appearances of the nipple in 35 patients with known primary breast cancer who went on to mastectomy was reviewed by two radiologists (blinded to the clinical, mammographic and histopathological information) and correlated with histology. The appearance of the contra-lateral nipple in 31 patients was reviewed and compared with that of the affected side. MR was performed at 1.0T using a receive-only double breast coil in 33 patients and a single breast coil in two patients. Three dimensional (3-D) T1-weighted gradient-echo images were made before and immediately after a fast hand injection of gadolinium-DTPA (0.1 mmol/kg). Results: Twenty-six breasts had histopathologically normal nipples and retroareolar tissue, four had evidence of tumour within the nipple and four had retroareolar tumour but with nipple sparing. Fifteen normal nipples were everted and 11 were inverted (flat). All showed superficial linear dermal enhancement above a non-enhancing zone in the nipple areolar complex. Linear or patchy enhancement deep to the non-enhancing zone was seen in four breasts and linear enhancement through the non-enhancing zone was seen in two. The nipple in all four breasts with tumour involvement showed increased thickening/bulkiness and enhancement of the nipple-areolar complex and retroareolar tissue. The four breasts with retroareolar tumour and nipple sparing showed increased thickening and enhancement of the retroareolar tissue only. There was one false positive result on breast MR for retroareolar tumour involvement. In this case the abnormally enhancing retroareolar tissue adjacent to the focal mass was shown to be an area of sclerosing adenosis on histology. The 31 contra-lateral nipples had the characteristic ‘normal’ appearance and when compared with its normal ipisilateral nipple showed marked symmetry. When compared with its abnormal ipsilateral nipple showed marked asymmetry. Conclusion: MR of the breast can show nipple involvement even when clinically unsuspected. This is important for treatment planning of breast cancer, in particular nipple preserving surgery.

In this paper we describe the application of three-dimensional (3D) imaging and computer-generated models in the management of orbital deformity. The technique was found to be particularly useful in posttraumatic deformity and fibrous dysplasia involving the orbit. Further application was found in cases of radiation hypoplasia, high facial cleft, and facial atrophy. Funding restrictions necessitate appropriate selection of cases when using new and expensive 3D imaging rather than traditional and less expensive methods. To remain within a realistic budget only those patients who will clearly benefit from the third dimension compared with traditional methods of assessment and management should be selected. These include patients requiring precise reduction or secondary reconstruction in which there is a matched normal anatomical component for comparison. This application is also only beneficial where the planned reconstruction is dimensionally stable.

Infection with Cryptococcus neoformans occurs with increased frequency in patients with the human immunodeficiency virus (HIV). Despite the lungs being the portal of entry for the fungus the commonest presentation is with meningitis: Cryptococcal broncho pulmonary infection occurs less commonly. The chest radiographs of fourteen HIV positive patients with cryptococcal pneumonia were reviewed. The commonest radiographic abnormalities were interstitial infiltrates, (nine patients) and focal or widespread alveolar consolidation (seven patients). Ground glass shadowing, not previously described in cryptococcal pneumonia, occurred in six radiographs, miliary nodules in one, lymphadenopathy in four, and small pleural effusions in three. Two patients had a normal chest radiograph. In contrast to previous reports, we found alveolar consolidation and ground glass shadowing to be common and nodules and cavitation to be rare. Cryptococcal pneumonia should be considered in the differential diagnosis of Pneumocystis carinii pneumonia, bacterial pneumonia and miliary tuberculosis in HIV positive patients.