Faculty Bibliography

At ultrasonography (US), purely or predominantly echogenic breast masses are rare. These lesions were once assumed to be benign, but recent data suggest that approximately 0.5% of malignant breast lesions appear echogenic. However, correlation with the mammographic appearance, lesion location, and clinical history allows the need for biopsy to be determined. An echogenic mass that is radiolucent at mammography is benign. An echogenic mass that is not radiolucent at mammography may represent a hematoma, complex seroma, silicone granuloma, abscess, galactocele, or fat necrosis when the appropriate clinical history is present. In these cases, biopsy can usually be avoided. If there is a clinical history of cancer or radiation therapy, biopsy is often indicated to assess for metastasis or angiosarcoma. An echogenic mass in an ectatic duct warrants biopsy to exclude carcinoma. An echogenic skin lesion is most likely benign and can occasionally have peripheral vascularity due to surrounding inflammation. However, a skin lesion with internal vascularity is concerning for metastasis or lymphoma. If there is no suspicious clinical history, suspicious sonographic features or mammographic findings would lead to a recommendation for biopsy. Lesions with nonspecific imaging or clinical features (eg, angiolipoma or pseudoangiomatous stromal hyperplasia) may require biopsy to exclude malignancy.

AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.