Focal fatty infiltration of the liver mimicking metastatic disease

We report the mistaken diagnosis of metastatic liver disease by ultrasonography in a patient with congestive heart failure and focal fatty infiltration of the liver. Multiple echogenic space-occupying lesions in the liver can be caused by benign conditions as well as tumour deposits and in a debilitated patient the possibility of focal fatty infiltration should always be considered.     

Effectiveness of a breath-hold monitoring system in improving the reproducibility of different breath-hold positions in multiphasic CT imaging

This study tests whether the utilization of an electronic breath-hold monitoring device improves breath-hold reproducibility during computed tomographic (CT) scanning. Two cohorts of 40 patients underwent dual-phase abdominal CT scans, either with a breath-hold monitoring device or with the standard breath-holding technique. Two blinded readers measured the differences in diaphragmatic position between phases. There was no statistical difference in diaphragmatic position (P=.14) between the monitored (8.5±11.5 mm) and control (5.6±5.2 mm) cohorts. Ten percent of patients from the monitored cohort had greater than 20 mm of deviation, versus 0%–2.5% for the control cohort. Reproduction of breath-holding position remains challenging, even with a monitoring system.     

Severe exacerbation of multiple self‐healing squamous epithelioma (Ferguson–Smith disease) with radiotherapy,which was successfully treated with acitretin

We describe the challenging case of a patient presenting with extensive, eruptive mid‐facial squamous cell carcinomas (SCCs) and keratoacanthomas (KAs) consequent to radiotherapy. Our patient had a personal and family history of multiple KAs and SCCs. Multiple self‐healing squamous epithelioma, otherwise known as Ferguson–Smith disease, was diagnosed. This case presented a therapeutic challenge to preserve tissue and avoid severe facial disfigurement. We found oral acitretin to be the treatment of choice.