To determine if ultrasound and/or mammography is helpful in detecting breast cancers in patients presenting with focal breast pain. Patients who presented between February 2008 and April 2011 with focal breast pain without a lump were included in the study. The mammographic and US findings were retrospectively reviewed. BIRADS 0, 4, and 5 were considered positive on mammogram while BIRADS 4 and 5 were considered positive on US. The efficacy of mammogram-alone, ultrasound-alone, and in combination to detect breast cancer was evaluated. The performance of mammography for detecting any mass lesions that were present on subsequent US was also evaluated. A total of 257 patients were evaluated with US and 206 (80.1%) of these also had mammograms prior to the US. Cancer incidence was 1.2% (n = 3). The sensitivity, specificity, PPV, and NPV of mammogram-alone and US-alone for detection of breast cancer in these patients were 100%, 87.6%, 10.7%, 100% and 100%, 92.5%, 13.6%, and 100%, respectively, while for combined mammogram and US was 100%, 83.7%, 8.3%, and 100%. The sensitivity, specificity, PPV, and NPV of mammogram for identifying an underlying suspicious mass lesion that was subsequently detected by US was 58%, 91%, 39%, and 95%. The NPV of a BIRADS 1 mammogram for any underlying mass lesion was 75%. Addition of an ultrasound to a mammogram did not detect additional cancers; likely due to low cancer incidence in these patients. However, US detected underlying mass lesions in 25% cases with a BIRADS 1 mammogram result.

Mechanical small-bowel obstruction is the most frequently encountered surgical disorder of the small intestine. It accounts for 20% of hospital admissions. Although a wide range of etiologies for this condition exist, intra-abdominal adhesions related to prior abdominal surgery is the cause in up to 75% to 80% of cases. More than 300,000 patients are estimated to undergo surgery annually to treat adhesion-induced smallbowel obstruction in the United States. 1 Several modalities used to evaluate small-and large-bowel obstruction will be discussed.The diagnosis of intestinal obstruction usually can be made by plain abdominal radiography. However, with crosssectional imaging, which is emphasized in this CME activity, the radiologist often will be able to obtain additional important preoperative information such as the actual site and cause of the bowel obstruction and vascular viability of the obstructed bowel. The radiologist can then communicate this information to the surgeon for timely treatment. Plain RadiographyPlain abdominal radiographs are usually the first imaging modality ordered for diagnosis of suspected small-bowel obstruction. Plain radiography is less sensitive than other imaging modalities in the setting of low-grade or partial bowel obstruction. Despite these limitations, abdominal radiographs remain an important study in patients with suspected small-bowel obstruction because of their widespread availability and low cost.Findings of small-bowel obstruction on plain radiographs include small-bowel dilatation and air fluid levels within the small-bowel loops. 2,3 The dilated small-bowel loops can exceed the caliber of the largest loop of colon visualized by more than 50%. An increase in the number of distended small-bowel loops when compared with recent prior studies also is suggestive of obstruction. This finding is useful in differentiating cases of small-bowel obstruction from cases of chronic ileus or chronically dilated bowel from prior abdominal surgeries. Air fluid levels are a well-known finding associated with small-bowel obstruction. A single air fluid level is not diagnostic of obstruction and can be normal; however, more than 2 air fluid levels greater than 2.5 cm in diameter and more than 1 air fluid level within the same loop of dilated small bowel are associated with high-grade obstruction. [2][3][4] The air fluid levels should be visualized in conjunction with dilated loops of bowel because After participating in this activity, the diagnostic radiologist should be better able to evaluate not only the types and many causes of small-and large-bowel obstruction but also their imaging features, with an emphasis on small-bowel obstruction.