Isolated tuberculosis thyroiditis as solitary thyroid nodule

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan

Cleaning methods for ultrasound probes

To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Experimental study. Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A [n = 25], group B [n = 25] and group C [n = 25] respectively. Number of Colony Forming Unit [CFU] of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning [p < 0.001], however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods [p < 0.001]. The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes

[99m]Tc-nannocolloid localization of lymphorenal fistula causing chylurla

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb and visualization of tracer in the left kidney consistent with lymphorenal fistula. Subsequent cystography revealed appearance of chylous urine from left ureter. Patient refused surgery

Bone scan: a sensitive modality for diagnosing and predicting outcome for reflex sympathetic dystrophy

Reflex sympathetic dystrophy is a consequence of overactive sympathetic nervous system that results in burning pain, stiffness, swelling and discoloration of the affected limb. This case report describes the condition in a man that was diagnosed with the help of radionuclide bone scan

Extra pulmonary uptake of Tc 99m MAA perfusion lung scan as a result of right to left intra cardiac shunt

Extra pulmonary accumulation of Tc-99m-macroaggregate of albumin [MAA] is rarely seen on perfusion lung scan, and has been reported in less than 4% of a study population of nearly 380 patients1. It occurs when the agent bypasses the lungs due to a right to left [R-L] cardiac or pulmonary shunt, when it is shunted to the portal vein before reaching the right atrium and ventricle of the heart, and when the agent is degraded to a submicron particle size.2 When a pharmaceutical problem is excluded, extra-pulmonary uptake implies unusual hemodynamics with a shunt. A case is reported in which a clinically unsuspected shunt was diagnosed from the lung perfusion scintigraphy

uniform system for mammographic reporting BI-RADS

Breast image reporting and data system [BI-RADS] is a new system of categorizing and reporting mammographs and mammographic findings recommended by American College of Radiology. The importance of BI-RADS and final assessment categories are discussed. The purpose is to introduce the above-mentioned mammgraphic reporting system so that it becomes a standard terminology among the medical personnel, involved in the diagnosis and management of breast diseases

Pneumoperitoneum following mechanical ventilation in child

A case of spontaneous pneumoperitoneum in a 5 months old child is being described. This child developed massive pneumoperitoneum while being mechanically ventilated. This possibility should always be kept in mind specially if child develops pneumoperitoneum in the presence of very high airway pressures. A 5 month old baby girl with a history of loose motions and fever for 1 week was presented in the emergency room of our hospital. Her past medical history was unremarkable. On examination she was restless, her heart rate was 140/min, respiratory rate was 65/min, and oxygen saturation 59%. Her blood pressure was 100/60. She had a cardiopulmonary arrest in the emergency room. She was resuscitated and shifted to ICU and put on mechanical ventilation. Further examination and investigations revealed that she was suffering from rickets, pneumonia and hypocalcemia. One the 1st day of admission, she was put on pressure control ventilation. Her pressure control was set at 8 cms H20, respiratory rate was 20/min, FiO2 was kept at 0.5. Her arterial blood gases were showing a pH of 7.43, PaCO2 of 32 mmHg, PaO2 of 80 mmHg, HCO3 was 21 meq/l and SaO2 was 98%. Her chest x-ray revealed evidence of surgical emphysema in the neck and hyperinflation in both lungs. On 3rd day in the ICU deterioration in lung function was noted. Her chest x-ray revealed pneumomediastinum and irregular densities in the lung field suggesting onset of respiratory distress syndrome