Breast density is now established as an independent risk factor for developing breast cancer irrespective of other known risk factors. Women with breast density in the upper quartile have an associated four to five times greater risk of developing breast cancer relative to women with breast density in the lower quartile. Many states have enacted or proposed legislation requiring mammographers to report to patients directly if they have dense breast tissue and recommend discussing the possibility of a supplemental screening examination with their physicians. However, there is currently no consensus as to whether a supplemental screening examination should be pursued or which modality to use. Possible supplemental screening modalities include ultrasound, MRI, digital breast tomosynthesis, and molecular breast imaging. The U.S. Food and Drug Administration recently approved an automated breast ultrasound system for screening whole-breast ultrasound in patients with dense breasts. However, many questions are still unanswered including the impact on morbidity and mortality, cost-effectiveness, and insurance coverage.

Endometriosis is a highly prevalent disease that affects up to 10 % of menstruating women. Patients commonly present with pelvic pain or infertility, although the range of clinical symptoms varies widely. Affected women may be asymptomatic or experience mild, moderate, or severe pain that fluctuates with hormonal cycles. Patients who suffer extreme pain may seek immediate care and present to the emergency department with clinical signs of an acute abdomen. In the case of patients without a prior history of endometriosis, the differential diagnosis is broad and making the correct clinical and radiologic diagnosis in the emergency setting can be challenging. In some cases, the diagnosis is only made after surgical or histopathological analysis. Prompt and accurate clinical and radiological evaluation is necessary because complications of endometriosis, such as bowel obstruction and appendicitis, may require immediate surgical intervention. This pictorial essay analyzes nongynecological manifestations of endometriosis that may have a clinical presentation of an acute abdominal emergency. Atypical clinical presentations and unusual sites and complications of endometriosis are discussed, as well as the differential diagnostic considerations. The radiologic features of endometriosis are shown on multiple modalities, including computed tomography, magnetic resonance imaging, and ultrasound.

A 34-year-old female with sickle cell anemia (hemoglobin SS disease) and severe iron overload presented to our institution with the subacute presentation of recurrent pain crisis, fever of unknown origin, pancytopenia, and weight loss. A CT scan demonstrated both lung and liver nodules concerning for granulomatous disease. Subsequent biopsies of the liver and bone marrow confirmed the presence of noncaseating granulomas and blood cultures isolated Mycobacterium avium complex MAC. Disseminated MAC is considered an opportunistic infection typically diagnosed in the immunocompromised and rarely in immunocompetent patients. An appreciable number of mycobacterial infection cases have been reported in sickle cell disease patients without immune dysfunction. It has been reported that iron overload is known to increase the risk for mycobacterial infection in vitro and in vivo studies. While iron overload is primarily known to cause end organ dysfunction, the clinical relationship with sickle cell disease and disseminated MAC infection has not been reported. Clinical iron overload is a common condition diagnosed in the sub-Saharan African population. High dietary iron, genetic defects in iron trafficking, as well as hemoglobinopathy are believed to be the etiologies for iron overload in this region. Patients with iron overload in this region were 17-fold more likely to die from Mycobacterium tuberculosis. Both experimental and clinical evidence suggest a possible link to iron overload and mycobacterial infections; however larger observational studies are necessary to determine true causality.