A discussion of recent developments in the speech of millions in and around London and the lower Thames

Aortic pathology can be more complex to understand on imaging than is initially appreciated. There are a number of imaging modalities that provide excellent assessment of aortic pathology and enable the accurate monitoring of disease. This review discusses the imaging of the most common disease processes that affect the aorta in adults, with the primary focus being on CT and MRI.

A development of the article ‘Estuary English – tomorrow's RP?’ (ET37, Jan 94) which considers the salient features of this ‘new’ accent in terms of institutional descriptions of Received Pronunciation

BackgroundSarcoidosis is a multi‐system granulomatous disease. The diagnostic procedures for histological confirmation are invasive and a less invasive approach to diagnostic pathway is warranted. The utility of diagnostic value of neck ultrasound was retrospectively evaluated. A histological diagnosis was made by ultrasound‐guided head and neck core biopsy to confirm clinically and radiologically suspected sarcoidosis.MethodsTwenty‐five patients were referred for sonographic evaluation of the head and neck after CT scan in an attempt to avoid the use of more invasive tests. These patients had mediastinal adenopathy, but not clinically apparent neck nodes. Where no cervical lymph node suitable for biopsy was seen, parotid glands were biopsied if deemed abnormal.ResultsA diagnosis of sarcoidosis was made in all cases where a core biopsy of cervical lymph nodes was attempted. The cervical lymph nodes in this cohort were not particularly enlarged, short‐axis dimensions being less than 10mm in majority, and they did not have any sonographic appearances to mark them as pathological. Nevertheless histological examination revealed non‐caseating granulomas in all cases. In further two cases, where no neck nodes were seen, a histological diagnosis of sarcoidosis was made from biopsy of diffusely abnormal parotid glands.ConclusionsGiven the clear advantages of cervical diagnosis in terms of invasiveness and economy compared to mediastinal alternatives, it is suggested that where the expertise for core biopsy of normal‐sized cervical lymph nodes is readily available, the technique may be considered as a first‐line investigation for the diagnosis of sarcoidosis.

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