Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel’s sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

problem encapsulated-role of CT

Sclerosing encapsulating peritonitis [SEP] is a rare but serious complication of abdominal surgery, recurrent peritonitis, and continuous ambulatory peritoneal dialysis with a high morbidity and mortality. The etiology of this condition is largely unknown. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating, small bowel obstruction. We report a case of a patient who presented with intestinal obstruction and who showed typical CT findings of SEP which was diagnosed pre-operatively on a CT scan and confirmed at surgery. The interest of this case lies in its rarity and difficult pre-operative diagnosis

Right abdominal mass: keep an open mind

Amebic colitis is common in tropics, usually presenting with variable and non-specific symptoms. Amebomas occur rarely, usually in cecum and ascending colon, when they can masquerade as colon carcinoma. This report describes the case of a 27-year-old male who presented with right abdominal mass. Radiological examination prompted us to the differential diagnosis of ameboma and he was treated with metronidazole and broad-spectrum antibiotics for two weeks. Amebic colitis should be considered as a possible diagnosis when dealing with right-sided abdominal mass

Outcome of Libyan national organ transplant programme in it's third anniversary

To establish a successful live-related kidney transplantation programme in Libya and to bring down healthcare costs in management of patients with end-stage renal disease. The transplant programme was launched on 17th August, 2004 and 135 patients have been transplanted since then till 17th August, 2007. The donors and recipients were screened thoroughly prior to transplant. Recent surgical techniques were employed during transplant procedure. Close monitoring of both donors and recipients was undertaken in post-transplant period. Our immunosuppressive protocol was cyclosporine based. Both donors and recipients were followed up in the transplant out-patient clinic. Among 135 accepted pairs, donors and recipients were genetically-related in 133 cases [98.5%] and emotionally related in two cases. Mean donor age was 37 +/- 9.5 [range 18-56 years]. Recipient age was significantly lower with 37 +/- 13.6 years [range 7-67 years]. In all recipients, 95[70.4%] were males and 40[29.6%] were females while in donors, 102[75.6%] were males and 33[24.4%] females. The most common donor-recipient relationship was brother-to-brother. The HLA-matching was either identical or one haplotype match. There was no early or late surgical mortality in donors. Delayed graft function was seen in 3[2.2%], acute rejection in 6[4.4%] and post-transplant infections were seen in 8 patients[5.9%]. Urinary tract infection was seen in 6 patients[4.4%] and pneumonia in 3 patients [2.2%]. Post-surgical complications included ureteric kink in 2[1.5%] and anastomotic urine leak in 4[3.0%]. Graft survival in 36 months was seen in 130 patients [96.3%] while patient survival in the same period was 126 patients [93.3%]. The National Organ Transplant Programme in Libya has been a very successful programme with its results better than most middle-eastern programmes and comparable to international levels

Takayasu arteritis diagnosed by 16-row multidetector CT angiography

Takayasu's arteritis is a well-known systemic disease that involves the aorta, major aortic branches, and pulmonary arteries. Conventional catheter angiography remains the 'gold standard' for disease diagnosis, in correlation with clinical data and laboratory findings. Multislice computed tomography angiography [MSCTA] has the advantage of non-invasively providing the angiographic data and combining morphological mural assessment with luminal evaluation. We present 2 such cases diagnosed by 16-slice MSCTA

Congenital Renal Anomalies - A brief spectrum

Congenital anomalies of the renal tract are fairly common and are usually asymptomatic. These are more often detected incidentally by various imaging modalities like ultrasound and computed tomography. Anomalies of the vascular supply of the kidneys have recently been diagnosed preoperatively due to the advent of fast imaging techniques like multislice computed tomography [MSCTA] and contrast-enhanced magnetic resonance angiography [MRA]. We present a fresh perspective on four commoner congenital renal anomalies detected by MSCTA

Imaging of peripheral arteries by 16-slice CT angiography: a valuable tool?

To evaluate the efficacy of multislice [16-slice] computed tomography [MSCT] in imaging the upper and lower limb arterial tree in trauma and peripheral vascular disease. 33 patients underwent CT angiography of the upper or the lower limb on multislice [16-slice] CT scanner. The findings were retrospectively compared with the surgical outcome in cases of trauma with suspected arterial injuries; or with colour Doppler for patients with peripheral vascular disease, CT angiography allowed a comprehensive diagnostic work-up in all trauma patients with suspected arterial injuries. In the 23 cases of peripheral vascular diseases, CT angiography adequately demonstrated the presence of any stenosis or occlusion, its degree and extent, the presence of collaterals and distal reformation if any and the presence of plaques. Our initial experience of CT angiography with multislice [16 slice] CT scanner has clearly demonstrated its efficacy as a promising, new, fast, accurate, safe and non-invasive imaging modality of choice in cases of trauma with suspected arterial injuries; and as a useful screening modality in cases of peripheral vascular diseases for diagnosis and for grading

Crossing renal vessel causing ureteropelvic junction obstruction-report of two cases

Ureteropelvic junction [UPJ] obstruction is caused by the presence of an aperistaltic dysplastic segment at the UPJ. Besides this intrinsic aetiology, extrinsic factors, mainly crossing vessels, may be the causative factor. The controversy regarding the functional significance of vessels crossing at the UPJ is not a new one, though this debate has been resurrected in recent years because of improved detection due to advent of advanced imaging techniques like multidetector row computed tomography [MDCT] and fast magnetic resonance imaging. We present two similar cases where MDCT proved the crossing renal vessel [CRV] to be the cause for UPJ obstruction

Isolated massive splenic hydatidosis

Hydatid disease or echinococcosis is fairly common worldwide and is endemic along the Mediterranean. It is still a serious health problem in Libya, where it is endemic. It commonly involves the liver and lungs. We report an unusual presentation of this common disease. The interest of this case lies in its rarity and huge size at presentation

pattern of renal vessels in live related potential donors pool. A multislice computed tomography angiography review

To assess the renal vessel anatomy, compare the findings with the perioperative findings, to determine the sensitivity of multislice computed tomography [CT] angiography in the work-up of live potential donors and to discuss and compare the results of the present study with the reported results using single slice CT, magnetic resonance [MRI] and conventional angiography [CA]. Retrospective analysis of the angiographic data of 118 of prospective live related kidney donors was carried out from October 2004 to August 2005 at the National Organ Transplant Centre, Tripoli Central Hospital, Libya. All donors underwent renal angiography on multislice [16-slice] CT scan using 80 cc intravenous contrast with 1.25 mm slice thickness followed by maximum intensity projection [MIP] and volume rendering techniques [VRT] post-processing algorithms. The number of vessels, vessel bifurcation, vessel morphology and venous anatomy were analyzed and the findings were compared with the surgical findings. Multislice spiral CT angiography [MSCTA] showed clear delineation of the main renal arteries in all donors with detailed vessel morphology. The study revealed 100% sensitivity in detection of accessory renal vessels, with an overall incidence of 26.7%, which is the most common distribution in the parahilar region. The present study showed 100% sensitivity in the visualization and detection of main and accessory renal vessels. These results were comparable with conventional angiography which has so far been considered as the gold standard and were found superior in specificity and accuracy to the use of single slice CT [SSCT] and MR in the angiographic work-up of live renal donors. Due to improved detection of accessory vessels less than 2 mm in diameter, a higher incidence of aberrant vessels was seen on the right side as has been suggested so far

Trichobezoar

Trichobezoar is an uncommon condition often presenting, among other signs, with a history of trichotillomania and trichophagia. We report an unusual case of gastric trichobezoar with extension into jejunum in a patient with an unusual habit of ingesting hair plucked from other people's scalp

Crossing renal vessel causing ureteropelvic junction obstruction

Ureteropelvic junction UPJ obstruction is caused by the presence of an aperistaltic dysplastic segment at the UPJ. Besides this intrinsic etiology, extrinsic factors, mainly crossing vessels, maybe the causative factor. The controversy regarding the functional significance of vessels crossing at the UPJ is not a new one, though this debate has been resurrected in recent years because of improved detection due to the advent of advanced imaging techniques such as multidetector row computed tomography MDCT and fast magnetic resonance imaging. We present a similar case where MDCT proved the crossing renal vessel to be the cause for UPJ obstruction