Colorectal carcinoma preoperative evaluation by spiral computed tomography

To assess the capability of spiral computed tomography [CT] scan in preoperative evaluation of colorectal carcinoma [CRC]. A cross sectional study on 52 patients with recent histopathologic diagnosis of CRC was conducted over a period of one year at the Aga Khan University Hospital, Karachi. All these patients underwent spiral CT with oral and intravenous contrast administration. Surgery was subsequently done in all cases and surgical specimens were sent for detailed pathologic analysis. The radiologic findings on the CT scans were compared with the pathological findings. The results proved that spiral CT had 60% sensitivity and 83% specificity for assessment of local spread of disease, 66% sensitivity and 76% specificity for the evaluation of lymph nodal metastases and 89% sensitivity and 94% specificity for hepatic metastases. In all the cases, the visualized tumour growth with wide zone of resection and regional nodal chains were surgically removed. It was however, the distant metastases which made a difference to the type of curative or palliative surgery planned and in this study spiral CT had 92% accuracy for detection of hepatic metastases. With technological advances and improvement in imaging protocols the results for local tumor spread are expected to improve, however based on the accuracy in detecting hepatic metastases in clinically unsuspected patients, this study proves that spiral CT has a significant role in preoperative evaluation and subsequent management of CRC

Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis

To determine the accuracy of FACT [focused appendiceal computed tomography] in evaluation of acute appendicitis. The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix [>6 mm diameter] and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up. There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%. Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis

case of non - resolving cough and Weight loss

Sarcoidosis is a chronic granulomatous multi-system disease with a clinical picture often mimicking tuberculosis. We present a case of a patient who presented with a clinical picture akin to both of these granulomatous disorders and was started on anti-tuberculous regimen despite the lack of any solid evidence pointing towards tuberculosis. As a result her clinical condition continued to deteriorate for months until finally a bronchoscopic biopsy established her disease process as sarcoidosis. She was then started on systemic corticosteroid therapy for sarcoidosis and during the ensuing period has shown marked improvement in her clinical picture with near normalization of the biochemical and radiographic parameters of her pathology. This case illustrates the need for vigilant interpretation of the clinical scenario in patients such as these where a misdiagnosis may lead to significant patient distress as well as weighing down on the economic and health resources

Cerebral deep venous thrombosis: case report and literature review

The case of a 28 years old woman presenting with headache, drowsiness and vomiting of a short duration, is presented. She was diagnosed as deep cerebral venous thrombosis on the basis of MRI findings. Treatment with heparin gave completed recovery

Mesenteric panniculitis

A 68 years old female was referred from the clinic for ultrasound pelvis on 03-02-2003. She had pain in the hypogastrium for the last 2 months. On clinical examination no significant abnormality was detected. Her laboratory investigations were within normal limits. Ultrasound pelvis was normal but incidentally, a hyperechoeic mass was noted anterior to abdominal aorta and inferior to the pancreas. The size of the mass was 7.4 x 6 cm and vessels were traversing through the mass. CT scan was advised for further evaluation. CT scan was performed after 2 weeks which showed soft tissue stranding in the mesenteric fat, anterior to aorta, at the same level described in the ultrasound report. Superior mesenteric vessels were traversing the mass. No abdominal or pelvic lymphadenopathy was noted. These features were consistent with mesenteric panniculitis [Figure 2]. The case was managed conservatively and follow-up was planned. The patient had a follow-up ultrasound examination performed 6 months later which showed resolution of the earlier findings. The patient was asymptomatic at the time of follow-up

Unenhanced helical CT scan for ureterolithiasis

The study was carried out from November 2002 to January 2004 and included patients who presented with flank pain at the Aga Khan University Hospital. One hundred and twenty patients were excluded from the study that were less than 15 years of age, pregnant or had history of trauma and infection. A total of 80 out of these 200 patients were included in this study that had a CT diagnosis of ureteric calculus after a UEHCT. In all those 80 patients with diagnosis of ureteric calculus on CT scan was confirmed later on either IVU, stone passage in the urine, ESWL [extracorporeal shock wave lithotripsy] or on the ureteroscopic removal of calculus. The images were interpreted for site, size and location of ureteric calculus, hydronephrosis, hydroureter, perinephric stranding, periureteral stranding, nephromegaly and incidental findings. The age range was 15-69 years, with a mean age of 37.5 years. Out of 80 patients, 32 [40%] patients presented with right sided flank pain and 48 [60%] of the patients had left sided flank pain. In 12 [15%] patients, calculi were present in the proximal ureter, in 24 [30%] in the mid ureter and in 44 [55%] in distal ureter. Most of the stones were between 3-5 mm size range [47%]; 20% stones were less than 3 mm in size and 32.5% of stones were more than 5 mm in size. Most common secondary sign was perinephric stranding seen in 48 patients [60%]. The second most common secondary sign was periureteral stranding seen in 44 [55%] patients. In 30 of the patients [37.5%] hydronephrosis was observed. In 18 [22.5%] hydroureter was present. Nephromegaly was observed in 2.3% of the patients. In 2 of 120 patients in which CT was negative, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. In 2 of 120 patients in which CT was negative for ureteric calculus, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. The sensitivity, specificity, positive and negative predictive values of unenhanced helical CT scan for detection of ureteric calculi was 97.5%, 98.3%, 97.5% and 98.3% respectively