Accuracy of high resolution ultrasound examination for prediction of malignancy thyroid nodules: FNAC or HP as reference standards

Background: Thyroid nodules comprise a diagnostic challenge mainly because of the need to exclude thyroid malignancy. Approximately, 4% is an estimated prevalence of thyroid nodule on palpation with 15% lifetime risk of developing a thyroid nodule

Objective: To provide importance of sonographic and doppler criteria for differentiation between benign and malignant solid thyroid nodules and their correlation with Fine-needle aspiration cytology [FNAC] or histopathology [HP]

Methods: A prospective study of 103 patients [January 2012 to June 2013] selected from radiology department of Dr.Ziauddin Hospital Karachi who came for ultrasound [US] of thyroid with clinical diagnosis of thyroid nodule followed by FNAC. Presence of malignant features were taken as positive finding for malignancy. The results of US were compared with FNAC/HP and diagnostic accuracy was calculated

Results: Out of 103 cases, 80 were labeled as true positive because US and FNAC results were positive for malignancy while the 2 were false positive as US shows malignant features but FNAC results were negative. 8 patients were labeled as true negative because US and FNAC were negative for malignancy and 13 patients were false negative because US results were negative for malignancy but FNA results were positive. The overall sensitivity and specificity of US was 86.0% and 80.0% respectively. Similarly the positive predictive value [PPV] was 97.5%, negative predictive [NPV] was 38.0% and diagnostic accuracy was 85.43% when compared with FNAC/HP results

Conclusion: Although US is an important tool for prediction of thyroid nodule malignancy, it cannot substitute FNAC/HP for accurate detection for malignancy. However, it can reliably anticipate the suspicion lesions which need intervention on priority basis

Diagnosis of pfeiffer syndrome with umbilical hernia

Pfeiffer syndrome [PS] is a form of acrocephalosyndactyly, a group of rare genetic syndromes, and is characterized by variable degrees of bicoronal craniosynostosis, variable hand and foot malformations and various other associated manifestations. Type I Pfeiffer syndrome is compatible with life. It is characterized by normal intelligence and a classic phenotype of craniosynostosis, broad thumbs, and syndactyly. Types II and III are sporadic in occurrence, with more severe involvement of the central nervous system [CNS] than in type I. Type II is associated with the classic cloverleaf-shaped skull. Neurologic compromise is common in both types II and III

Sonographic measurement of normal renal size and correlation with somatic variables in subset of Karachi pediatric population

Background: Multiple renal pathogenesis manifested as unilateral or bilateral size changes, therefore there should be normative reference data for proper comparison. Our goal is to determine normal standard value ranges for renal dimensions in pediatric population in Karachi. Sonographically renal length in 150 children were measured and correlate with age, gender, body height, weight and BMI

Objective: Sonographic Measurement of Normal Renal Size and Correlation with Somatic Variables in Subset of Karachi Pediatric Population

Methods: A six month cross sectional hospital based assessment of kidney size [length, width] was evaluated with the help of sonography. XarioTM 200 Toshiba with convex 3.5 frequency transducer will be used. The mean renal dimensions with standard deviation [SD] were estimated for every group of age. The renal length and width were determined and corresponded with different somatic variables. Descriptive statistics with Regression analysis was done

Results: The normal length and the width of kidneys and its ranges were obtained. Right kidney length moderately and significantly correlated with height and weight [r=0.651, r=0.654] and age [r=0.538] respectively. However, moderately insignificant with BMI [0.129]. Lefts kidney moderately and significantly correlated with height and weight [r=0.665 r=0.705], negative insignificant with age [0.564] and moderately weak insignificant relationship with BMI [0.174]

Conclusion: The research presents the normal range parameters of renal size and measurements by sonography in healthy pediatric population in Karachi. Guideline measurements of kidneys represent a statistically important and comprehensive interaction with specifications of growth which allows us to easily calculate the renal size by derived regression analysis

Unilateral mandibular condylar hyperplasia- a rare entity

True unilateral condylar hyperplasia [CH] of mandible including its variants is an uncommon maxillofacial deformity. It represents unilateral abnormal growth of the mandible including its body and ramus. Discrepancy in the growth of the mandible causing vertical facial asymmetry, creating aesthetic problem resulting in malocclusion as well as psychological issues requiring bi-maxillary surgical correction. In this report we discuss the use of imaging in the diagnosis of these pathologies and investigate its variants

Magnetic resonance imaging of the breast: a problem solving tool

Approximately one in every nine Pakistani women is likely to suffer from breast cancer. This is one of the highest incidence rates in Asia. Mammography and ultrasound are the basic imaging techniques for the detection and localization of breast tumors. Breast magnetic resonance imaging [MRI] has become increasingly important in the detection and delineation of breast cancer in daily practice. The utility of diagnostic value of MRI is mainly on specific situations such as detecting multifocal, multicentric or contralateral disease unrecognized on conventional imaging, assessing for the response to neoadjuvant chemotherapy, detection of cancer in dense breast tissue, recognition of an occult primary breast cancer. The standard breast MRI protocol includes T2 sequences [anatomy and signal analysis], T1 gradient-echo sequences which can detect markers placed after biopsy, and injected dynamic 3D sequences for performing volume and multiplanar reconstructions, which are particularly useful for locating lesions. Good patient positioning is essential. These aspects limit movement artefacts which alter subtraction sequences; it must be compared with the native sequences. New functional imaging sequences are now appearing in an attempt to increase the specificity of MRI, which is one of its main limitations. Of these, magnetic resonance spectroscopy appears to be the most promising

young girl with brachymesophalangia V

Brachymesophalangia is the most common hereditary anomaly of the middle phalanges. Brachymesophalangia-V [BMP-V] is the terminology used for a short and broad middle phalanx of the fifth digit which can present both alone and in a large number of complex brachydactylies with congenital disorders. Its frequency varied in different populations between 3.4% and 21%. To our knowledge no case of BMP-V has been reported from our country. We incidentally found a case of BMP-V who presented to us with the history of trauma which is presented in this case report. Literature search showed that this condition is caused by heterozygous mutations in the Indian hedgehog [IHH] gene

Normative data of hepato-splenic sizes in pakistani pediatric population using ultrasonography

Background: Hepatosplenic sizes of children vary with age .There are many diseases which affect the sizes of the liver and spleen ranging from acute liver disease to other hepatosplenic disorders . Ultrasound is a quick and reliable method .Unfortunately there is lack of sufficient data in our population therefore my study would be beneficial in determining various disease processes

Objective: To establish normative data of Hepato-Splenic sizes in Pakistani pediatric population using ultrasonography

Methods: The study was conducted at the Ziauddin University Hospital, a tertiary care teaching facility in Karachi. The cross sectional prospective hospital based study was conducted with 150 patients aged 1 month to 14 years. Ultrasonographic evaluation for the assessment of liver, spleen and portal vein size was performed. These were correlated with the age, sex, height/length and weight of the children

Results: Normal liver and spleen length and its ranges with portal vein diameter were obtained. The liver, spleen length and portal vein significantly correlated highly with the height/length [r=0.7,0.7,0.6]respectively and weight of the subjects [r=0.7,0.7,0.4 respectively]

Conclusion: The study provides the normal values of liver and spleen size by ultrasonography in healthy Pakistani pediatric population

Ectopic supernumerary kidney: a rare anatomic variant

Urogenital anomalies are common, correspond to 33% of all congenital anomalies and supernumerary kidney is one of the rarest entity; less than hundred cases have been reported in the past. The Supernumerary kidney is considered a third kidney in addition to the two already present independent kidneys and considered an infrequent developmental anomaly of the urinary tract. The accessory kidney most commonly located on left side caudal to the normal kidney. Because of uncommon occurrence and prevalence, it frequently causes diagnostic challenges in clinical practice. The supernumerary kidney must be differentiated from the more common congenital anomaly, duplex kidney, having two pelvicalcyceal systems that are connected with single or double ureters. The supernumerary kidney, in distinction, is thought to be an accessory organ with a separate arterio-venous supply, collecting system and a different capsule. The case of a 33 years old male patient is depicted who presented a history of hypertension and was diagnosed as having left sided unilateral supernumerary kidney located cranial to normal renal parenchyma