Does gauge of needle effects causation of pneumothorax following ultrasound guided thoracentesis?

Objective: to determine the frequency of pneumothorax following ultrasound guided thoracentesis in our department and its association with gauge of needle in causation of pneumothorax

Methadology: this is descriptive cross sectional study conducted at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital [SIH], Islamabad from January 2010 to April, 2012. A total of 359 ultrasound guided thoracentesis were performed followed by a chest radiograph between January 2010 and April, 2012 fulfilling the inclusion criteria. All procedures were performed by radiology consultants and residents. Generally 18 and 16 G cannulas were used. A few were done with 16 and 18 G spinal needle and 21G syringe needle. Relevant data was collected from hospital data base system on the performa and was analyzed for demographic variables, frequency of pneumothorax, and its association with operator's experience [residents or consultants] and gauge of needle by applying chi square test. P value of < 0.05 was considered significant

Results: 309 patients had thoracocentesis while performed by residents and 50 by consultants. Pneumothorax occurred in 22 of these 359 cases with an overall frequency of 6%. In 219 patients 18 G cannula was used and 8 of these developed pneumothorax [3.6%]. In 94 patients 16 G cannula was used. Pneumothorax occurred in 11 [11.6%]. Statistical analysis confirmed that the frequency of pneumothorax was significantly increased following use of 16G as compared to 18G [p=0.02]

Conclusion: the frequency of pneumothorax following ultrasound guided thoracentesis increases significantly with use of 16G as compared to 18G [p=0.02]

Multidetector ct patterns of peritoneal involvement in patients with abdominopelvic malignancies

To determine the patterns of peritoneal involvement in patients with abdominopelvic malignancies. Retrospective observational study. Shifa International Hospital, Islamabad, Pakistan, from May 2004 to May 2012. Two hundred and three patients with histopathologically proven abdominopelvic malignancies with peritoneal involvement who underwent contrast-enhanced CT abdomen and pelvis were identified through electronic data base system and were included in this study after ethical committee approval. Peritoneal disease pattern, predominant sites of involvement and associated findings of ascites, lymph nodes and metastasis were assessed. Patients with tuberculosis and lymphoproliferative disorders were excluded. The malignancies showing peritoneal involvement, in decreasing order of frequency, were ovarian cancer [n=118], colorectal cancer [n=45], pancreatic cancer [n=11], gastric cancer [n=7], endometrial cancer [n=6], gallbladder/ cholangio-carcinoma and hepatocellular cancer [n=5 each], cervical cancer [n=3], renal cell carcinoma [n=2] and transitional cell urinary bladder cancer [n=1]. The most common pattern of peritoneal involvement was mixed in 79 patients [39%], omental caking in 74 patients [37%] and nodular deposits in 50 patients [24%]. The most common sites of peritoneal involvement were pelvic peritoneum followed by greater omentum. Peritoneal involvement is the commonest with ovarian and colorectal carcinoma. Mixed pattern of peritoneal disease was most frequently seen in these patients followed by omental caking and nodular peritoneal deposits

MRI in the pre operative evaluation of perianal fistula

Objective: To assess the diagnostic accuracy of Magnetic Resonance Imaging [MRI] in the pre operative evaluation of perianal fistulae

Methodology: Between Decemebr 2010 and January 2013, thirty patients with clinical suspicion of perianal fistulae had MRI scans done for evaluation of extent of disease. Out of these 11 patients underwent surgery in our hospital and were included in the study. All patients had body-coil MR Imaging examinations including the following sequences for anatomic and pathologic information: T2 sagittal, T1, T2 and STIR axial oblique, T2 and STIR coronal oblique and post contrast T1 FAT SAT sagittal, axial oblique and coronal oblique planes. Scans were interpreted by a senior radiologist with more than 5 year experience in body MR imaging. Surgical findings were accepted =as the gold standard and were recorded independently by the surgeon. MRI findings were compared with surgical findings using Park's classification

Results: The MRI findings were in accordance with surgical findings in 10 out of 11 patients regarding type and extent of fistula in ano. In one patient peroperatively diagnosed and treated fistula did not show on MRI. Statistical parameters showed that MRI has a sensitivity of 90%, specificity of 100% and diagnostic accuracy of 90% in determining type and extent of perianal fistula

Conclusion: MRI is an accurate and non invasive imaging modality for determining type and extent of peri-anal fistula and helps in pre operative management and surgical planning by giving correct assessment of extent of disease

review of patterns of CT scan appearances of abdominal Tuberculosis

To assess role of CT in diagnostic workup of abdominal tuberculosis. In this descriptive study, through electronic database, out of 7000 CT abdomens performed between January, 2002 to August, 2013, 30 patients with suggestion of Abdominal TB based upon CT and clinical findings were identified. Out of these 30 cases, twenty one patients were confirmed to have abdominal TB based upon histopathological data and response to anti tuberculous treatment and were included in the study and the remaining 9 patients were excluded from the study. Out of 21 confirmed abdominal TB cases, majority [n=13] were females. Peritoneal involvement was the most common feature seen in all 21 [100%] patients. Smudgy pattern, with or without smooth marginal enhancement, was the most commonly seen pattern of peritoneal involvement. Wet peritonitis [peritonitis with ascites] was seen in 14 [66%] out of 21 patients while dry peritonitis was seen in 7 [34%] patients. Lymphadenopathy was the second most common feature seen in 13 [62%] out of 21 patients. Bowel involvement was demonstrated in 11[52%] patients. Ileocecal region was the commonest site of bowel involvement seen in 7 of these 11 patients. Liver lesions were observed in 2 patients and splenic and pancreatic lesions were identified in 1 patient each. Smudgy pattern of peritoneal involvement, enlarged necrotic abdominal lymph nodes, high density ascites and ileocecal involvement are the most common abnormalities seen in patients of abdominal tuberculosis in our local population.

Uterine artery embolization for the treatment of uterine fibroids: Initial experience

To evaluate the initial results of uterine artery embolization for the treatment of symptomatic uterine fibroids in our local population. Medical records and radiological images of all patients undergoing uterine artery embolization [UAE] in Aga Khan University Hospital [AKUH] between January 2003 and December 2009 were retrospectively analyzed. Fourteen patients [Age range: 19-50 years] with sonographic diagnosis of uterine fibroids associated with menorrhagia and/or pelvic pain underwent uterine artery embolization with use of polyvinyl alcohol [PVA] particles. Single femoral access technique was used in all patients. Clinical improvement was assessed by detailed questionnaire for symptomatic improvement and follow up ultrasounds. All 14 patients underwent technically successful embolization. Five patients were lost to follow up and were not included in the final analysis. Out of remaining 9 patients, eight patients had initially presented with menorrhagia with pelvic pain while one patient had presented with menorrhagia alone. On follow up after one year menorrhagia was significantly reduced in 7 out of 9 patients [77%]. Pelvic pain was improved in 7 out of 8 patients [89%]. Majority of patients experienced post procedure pain of various intensities which was treated conservatively. One patient developed scanty periods, a known complication of this procedure. No other procedure related significant complications were seen. Uterine fibroid embolization represents a promising method of treating fibroid-related menorrhagia and pelvic pain. Further studies with larger patient population will be required for definitive results