Occasionally,

a cluster

eter)

calcifications

biopsy

of oven

fine

of very

is found

(less

by means

30 of these

than

0.3 mm

of magnification.

“clusters

of dust

particles,”

in diam-

References

After

1.

I have

Sicktes lesions:

yet

468. Homer MJ. cally benign

to find a malignancy. Dr Sicbdes

gestive lions

routinely

uses

of malignancy. that

dust.”

he

I wonder

followed

up

If so, perhaps

sidered

magnification

suggestive

if many

fit into

these

tiny

the

2.

in cases that are sugof the tiny calcifica-

category

I call

calcifications

“particles

need

not

be

of

Imaging features and management and probably benign breast lesions.

Am 1987; 25:939-951. Sickles EA, Ominsky SH,

3.

con-

Medical

of malignancy.

follow-up of probably benign cases. Radiology 1991; 179:463-

EA. Periodic mammographic results in 3,184 consecutive

practice: ogy 1990;

Sollitto

RA, Calvin

audit of a rapid-throughput methodology and results

of characteristiRadiol Clin North

HB, Monticciolo

DL.

mammography screening of 27,114 examinations. Radiol-

175:323-327.

References 1.

Sicktes

EA.

lesions: 468. 2.

3.

Hetvie low-up

results

Periodic mammographic in 3,184 consecutive

follow-up

of probably

cases. Radiology

MA, Pennes DR. Rebner M, Adler DD. Mammographic of low-suspicion lesions: compliance rate and diagnostic Radiology 1991; 175:155-158.

yield. WolfeJN, Buck KA, Salane M, Parekh breast: overview of 21,057 consecutive

Edward

benign

A. Sickles,

Department

1991; 179:463fot-

NJ. Xeroradiography of the cases. Radiology 1987; 165:

305-311.

U Aneurysm of the Aorta

Formation

responds:

to be seen

after

Repair

of Coarctation

Washington

University

mammograms

Dr Saylem’s if they are too

because

I do not ob-

tam additional

spot-compression magnification views of calcifications unless some calcific particles already have been identifled on conventional (nonmagnification) images. I do occasionally

encounter

in diameter)

calcifications,

clusters

of very

as does

magnification

are too small

to demonstrate

as pinpoints

views,

discrete

of white.

(less

tiny

Dr Sayler.

than

these

calcific

shapes,

usually

Therefore,

0.3 mm

However,

I do not

even

on

a biopsy

in this

situation.

Among

pe-

the

Pennsylvania

last

Avenue,

Northwest,

Washington,

DC

I read with

interest

the article

by Pinzon

et al (1) in the July

1991 issue of Radiology. They reported aneurysm formation in 30% of their patients after surgical repair of coarctation of the aorta.

Among

lated

to the

the

not

A widely synthetic

mechanisms

synthetic

(eg, scar,

accepted patch

they

patch

graft

infection,

theory

repair

discussed,

used

and

about

some

in the

repair,

aneurysm

is compliance

many

clusters

My report

of calcifications

that

of an 11.2% frequency

intermediate

among

those

others

choose

of probably

found

in the

Currently,

this

theory

certainly

is strongly

supported

cases

is

is composed

which

almost

entirely

of asymptomatic

Sayler) term

them

as “bow-level

or with

any other

“suspicious.”

These

suspicious”

wording lesions

lesions

that includes are much

better

native

of aneurysm formation is extremely no such complication was encountered

of 62 consecutive and

10 for

balloon

postsurgical

angioplasty aomtic

procedures

coamctations)

(3).

(as does

Dr

the pejorative called

References

“proba-

bly benign,” thereby giving proper emphasis to the overwhelming likelihood of a benign origin, and reducing the chance that either the patient or her surgeon will opt for

Pinzon the

2.

3.

women, less than 2% of cases eventually are managed by means of periodic mammographic surveillance (3). Finally, I want to reiterate an important recommendation made in my article: For those lesions that we choose to follow up as an alternative to biopsy, we should scrupulously avoid describing

(52 for

1.

literature,

higher than those cited by Dr Sayler, but considerably lower than the 20% frequency published by Homer (2). These differences may well relate to the patient population examined in a given mammography practice. For example, in my screening practice,

in one series

from

angioplasty balloons

to call normal.

benign

American

after

tion of mechanical forces in the aortic wall, postulated by Olsson et al (2). These investigators implicated the effect of diffement tensile strengths across the aomtic wall in conjunction with the use of a noncompliant foreign material.

are used, the prevalence rare; as a matter of fact,

in my study

oth-

or maldistribu-

cases and senvations.

that I included

me-

formation

mismatch,

the recent experiences with percutaneous balloon of coarctation of the aorta. When appropriate-sized

that directly address this issue. I do not share Dr Sayler’s belief

were while

thrombosis).

10 such cases I have encountered, three were ductal carcinoma in situ. Readers should note that my cancer yield of three of 10 Dr Saylem’s yield of zero of 30 cases are anecdotal obTo my knowledge, there are no published studies

20037

Editor:

appearing

recommend

George

Center

ems were

particles

riodic mammographic surveillance for these lesions because I cannot identify discrete round or oval particles (see intempretive criteria for probably benign calcifications, described on page 464 of my article [1] and illustrated in fig 1). Rather, I recperforming

2150

MD

of Medicine,

Medical

on regular

spot-compression

0. Cheng,

Department

The data in my article cannot be used to answer question of whether calcifications are significant

ommend

of California

From:

Dr Sickles

only

Box 0628, University

School of Medicine San Francisco, CA 94143-0628

Tsung

small

MD

of Radiology,

JL, Burrows

aorta

PE, Benson

in children:

LN, et at.

postoperative

Repair

morphology.

of coarctation Radiology

of

1991;

180:199-203. Otsson P, Sodertund 5, Dubiel WT, Ovenfors CO. Patch grafts or tubular grafts in the repair of coarctation of the aorta: a follow-up study. Scand J Thonac Cardiovasc Sung 1976; 10:139-143. Rao

PS.

Cardiovasc

Pseudoaneunysm

Diagn

following

balloon

angioplasty?

Cathet

1991; 23:150-151.

Notice

to the

Readers

“Anatomy Thin-Section

of the Major Fissure: Evaluation with CT.” Radiology 1991; 180:839-844

We were unable to maintain the quality in this article at the level of the original apologize for the occurrence.

Standard

and

of the printed figures submitted images. We

biopsy.

Volume

181

#{149} Number

3

Radiology

#{149} 905

Aneurysm formation after repair of coarctation of the aorta.

Occasionally, a cluster eter) calcifications biopsy of oven fine of very is found (less by means 30 of these than 0.3 mm of magnificatio...
217KB Sizes 0 Downloads 0 Views