ObjectiveSubstantial physiological changes occur during pregnancy and lactation, making breast evaluation challenging in these patients. This article reviews the imaging challenges of the breast during pregnancy and lactation. The normal imaging appearance, imaging protocols and the imaging features of each commonly encountered benign and malignant entity with pathological correlation and supporting examples is described. An awareness of the imaging features of the breast during these physiological states and of various benign and malignant diseases that occur permits optimal management.ConclusionsEvaluation of the pregnant and lactating patients who present with a breast problem is challenging. Although ultrasound may characterise the finding in many cases, mammography and even MRI may have a role in the management of these patients.Teaching points• To review physiological changes of the breast during pregnancy and lactation• To review imaging protocols of the breast during pregnancy and lactation• Discuss imaging findings with pathological correlation of benign and malignant diseases in pregnancy and lactation• Discuss pathological correlation of imaging findings in pregnancy and lactation

The objective of the study was to highlight the diagnostic challenge of this elusive rare disease. A retrospective study of non-tuberculous spinal epidural abscesses (SEA) was carried out in Southern General Hospital, Glasgow, University Hospital of Wales, Cardiff, and Morriston Hospital, Swansea, from 1990 to 2000. Thirty-nine patients, consisting of 20 females and 19 males, with an age range from 20 to 85 years (mean: 61.1) were identified. Thirty-eight had localized back/neck pain. Eighteen were apyrexial. Twenty-nine demonstrated neurological deficit. All patients had raised inflammatory markers and gadolinium-enhanced magnetic resonance imaging (MRI) was diagnostic in 34. The most commonly identified organism was Staphylococcus aureus. All underwent surgical decompression, of which 13 required stabilization. Three died, seven lacked sphincter control and nine had motor deficit at the end of 1 year. It was concluded that fever is not mandatory for the diagnosis of SEA. Patients with localized back/neck pain and raised inflammatory markers need urgent MRI.

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A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented. Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years. Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection. The diagnosis was made with enhanced computed tomography (CT) in all the cases. Positive bacteriology was found in only nine cases. The treatment consisted of 6 weeks of intensive intravenous antibiotics and emergency surgical drainage of the abscess. Five out of the total cases died (13.5%). These patients were all in an extremely poor condition at the time of presentation. All the survivors made a good recovery. With timely CT diagnosis, surgical drainage and antibiotics, good results can be achieved even in a developing country.

Giant pituitary adenomas causing hydrocephalus are rare (Scarone P, Losa M, Mortini P, Giovanelli M. J Neurooncol 2006;76:51-4; Zikel OM, Atkinson JL, Hurley DL. Mayo Clinical Proc 1999;74:475-7). Guidelines for management of this rare condition are missing. Here we present a five-case series collected over 22 years. We suggest that where the two conditions coexist, the safest option is to insert an external ventricular drain prior to any definitive surgical intervention.