Unusual presentation of fibrosarcoma in a child

Malignant soft tissue tumours are rare in infants. Specific radiologic features help differentiate benign from malignant musculoskeletal entities. We report a case of malignant soft tissue tumour with initial radiologic evaluation suggesting a benign entity, thus delaying diagnosis. The case was treated as a case of cystic hygroma, suggested by ultrasound and MRI with good initial response to bleomycin injection. Later, symptoms recurred with poor response to repeat therapy which led to review the diagnosis. Angiography, arterial embolisation, surgical excision, and finally histopathology showed that a cystic infantile fibrosarcoma was initially misinterpreted as cystic hygroma. A comprehensive literature review and discussion on infantile fibrosarcoma; and its mimics are provided

Pattern of peripheral vascular disease in troops and troop families in armed forces

Objective: To delineate pattern of peripheral vascular disease [PAD] [upper or lower limb vessels] among troops and their families in the Armed Forces. Study Design: Cross sectional descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology [AFIC] and National Institute of Heart Diseases [NIHD] Rawalpindi and Combined Military Hospital [CMH] Rawalpindi over a 3 year period, from Aug 2012 to Aug 2015

Material and Methods: All serving and retired army personnel and their families were included in the study. Method of sampling was non probability convenience sampling. The total number of patients was 156. All referrals were from CMH vascular surgery department. All arteriograms were performed on Siemens angiography equipment without facility of DSA [digital subtraction angiography]. The lesions were placed in one of the following categories: normal category in whom either the vessels were normal or minimally diseased without any flow limitation, short and long segment stenoses, and short and long segment occlusions and diffusely diseased vessels. The arteriogram of infra inguinal region was divided into femoropopliteal segment and infra popliteal segment. SPSS version 14 was used to calculate the frequency and percentage of various disease patterns

Results: The pattern of peripheral vascular disease was divided in the lower limb in infra inguinal region into femoropopliteal disease and infra popliteal disease. The predominant pattern of disease in the femoro popliteal segment was long segment occlusion and the disease pattern in the infra popliteal segment was diffuse disease of the involved vessels. The predominant pattern of disease in upper limb was long segment blockage

Conclusion: Peripheral vascular disease among soldiers and families show advanced disease pattern at presentation

Congenital heart disease screening: which referral factors are most important?

To identify the referral factors for fetal echocardiography which are associated with congenital cardiac defects in the fetus. Cross-sectional descriptive study. Radiology Department, CMH, Rawalpindi, from January 2007 to November 2010. All patients referred for fetal echocardiography with one or more risk factors for the development of congenital heart disease, and those patients with incidental discovery of congenital heart disease on antenatal ultrasound were evaluated. Patients with no risk factors who were found to have normal fetal echocardiography were excluded from the study. Univariate logistic regression analysis was carried out for each variable. The variables with statistical significance of less than 0.05 were subjected to multivariate logistic regression. Fetal echocardiographic diagnosis was taken as the dependent variable and all other variables were the independent variables. Two hundred and sixty four patients were evaluated by fetal echocardiography for congenital heart disease. The statistically significant factor was detection of congenital heart disease on routine ultrasound examination. A routine obstetric scan should include evaluation of the heart with four-chamber and base-of-heart views to exclude cardiac anomalies. A cardiac anomaly picked up on routine ultrasound scan is the most important indication for referral for fetal echocardiography. Fetal arrhythmias and echogenic focus in the left ventricle do not have a significant association with structural cardiac malformation

Detection of congenital heart disease by fetal echocardiography

The objective of the study was to determine the sensitivity, specificity, accuracy and predictive value of fetal echocardiography in our set up using postnatal echocardiography as gold standard. Validation study. This is an ongoing study in the Radiology department of CMH Rawalpindi and Armed Forces Institute of Cardiology [AFIC] Rawalpindi and the data collected from January 2007 to Jan 2012 is presented. Two hundred eighty seven patients reported for fetal echocardiography. Two hundred twenty nine patients were subsequently included in the study. These included patients of all ages who reported to the Radiology department of CMH Rawalpindi for fetal echocardiography. Fetal echo was done on Toshiba Aplio with 3.5 MHz probe having Doppler facility. Post natal evaluation was done by a pediatric cardiologist. There were 207 [90.4%] true negative cases, 15 [6.6%] true positive, 2 [0.9%] false positive and 6 [2.2%] false negative cases. The sensitivity, specificity, positive and negative predictive values were 75%, 99%, 88%, 97% respectively. Fetal echocardiography has high specificity, negative predictive values and accuracy and cases diagnosed as normal can reassure the parents about the normal cardiac status of the fetus

Successful treatment of hydatid cyst of lesser sac with pair therapy

Hydatid disease has varied presentations and may involve any part of the body with hydatid disease of the liver being the most common site. Hydatid disease of lesser sac is a rare entity. Different treatment options of hydatid liver disease are available which include surgical, medical and radiological management. Surgical management has its limitations in terms of cost, morbidity, mortality, rate of recurrence and patient fitness to undergo surgery. Medical management alone carries a low chance of cure. Radiological management with PAIR therapy [percutaneous aspiration, injection and re-aspiration] of hydatid liver disease has been well described in literature. However, hydatid disease of lesser sac in itself is a rare entity and its treatment with PAIR procedure has not been described before. We describe a case of hydatid disease of lesser sac treated with the PAIR procedure.

Risk factors for transitional cell carcinoma of urinary bladder: a hospital based study

The objective of the study was to determine the role of various known risk factors for the development of Transitional cell carcinoma [TCC] of urinary bladder in our set up. Case control study. Department of Radiology CMH Rawalpindi, from March 2007 to December 2007. 70 patients with TCC urinary bladder were included in the study. 70 controls were included. The patients were enquired about the risk factors as mentioned in Table 1. The data was analysed on SPSS version 12. Odds ratio for each factor was carried out. p value of < 0.05 was considered statistically significant. Smoking was the most important factor in the development of TCC of urinary bladder with odds ratio of 3:1. Driving was the next common factor. Low socioeconomic conditions appear to be an important factor in our set up. The role of chemicals in industrial work could not be established. Differences from the West exist regarding the etiological factors for the development of TCC of urinary bladder. Males outnumber the females by a significant ratio. Smoking is an important factor in the development of TCC of urinary bladder. Most bladder cancers arise in low socioeconomic group in our set up

Frequency of placenta accreta on doppler studies in patients with previous caesarian section

To determine frequency of placenta accreta in patients with previous Caesarian section on Doppler ultrasound examination. A descriptive study. The study was conducted in Radiology Department CMH / MH Rawalpindi which is a tertiary care hospital from April 2006 to February 2007. All patients who were pregnant and had previous LSCS were included in our study. The patients were included on the basis of Non-probability convenience sampling. Patients who had all previous normal deliveries were not included in our study. The method adopted on Doppler ultrasound studies placenta accreta in patients with previous caesarian section was confirmed in the first trimester if sac was low lying and attached to anterior wall of uterus with little or no myometrium between sac and bladder. In the second and third trimester visualization of multiple irregular vascular spaces/ sinuses within placenta and visualized vascular bundles leaving the placenta and reaching lower part of bladder was diagnostic of accreta. We found the frequency of placenta accreta in patients with previous caesarian deliveries to be 3% [3/100] in CMH / MH Rawalpindi which is almost consistent with other studied performed in Pakistan and abroad. Out of 100 selected patients 3 were given suspicion of accreta on Doppler studies and confirmed to have accreta by our obstetrician and hysterectomy was done. Placenta accreta is a life threatening condition with increase risk to mother morbidity and mortality. Doppler ultrasound is a reliable radiological technique to diagnose placenta accreta

Multiple breast masses in a case of multiple myeloma

Myeloma of the breast is a rare entity with only a few reported cases in the literature. It is usually secondary to adjacent bone disease with only a few instances of primary involvement of the breast. We present a rare case of plasmacytoma of left humerus that presented with multiple breast masses and skin nodules. Histopathology of the breast and skin nodules showed plasma cells consistent with the diagnosis of multiple myeloma

Diagnostic yield of image guided core biopsy and fine needle aspiration cytology in the evaluation of various masses

The purpose of this study is to evaluate diagnostic yield of ultrasound/ computer tomography [CT] - guided core biopsies and fine needle aspiration cytology [FNAC] of various masses. An observational study. This study was carried out in radiology department of Combined Military Hospital Rawalpindi from Aug 2006 to May 2007. A total of 91 patients with wide range of masses involving different organs of body underwent image guided core biopsies and FNAC. Sixty seven patients were males and 24 were females. Age of patient ranged from were performed under ultrasound guidance. Out of the 91 cases, 48 were core biopsies and 43 FNAC. Biopsies were performed with 18G Monopty gun and FNAC were done with 20-22G lumbar puncture [LP] needle in all cases except FNAC of thyroid gland, cervical lymph nodes and calf muscle [in which FNAC was done with 5cc disposable syringe]. Out of 48 core biopsies, 40 [83.3%] had adequate diagnostic yield and histopathologist was able to give a definite diagnosis. However in 8 [16.7%] biopsies, diagnostic yield was inadequate and it was labeled non-diagnostic by histopathologist. Similarly out of 43 FNAC, 33 [76.7%] had adequate diagnostic yield and 10 FNAC [23.3%] were declared non-diagnostic. Over all success rate was found to be 80.22%. Image guided core biopsies and FNAC, both are very helpful in histophatological diagnosis of various masses and success rate is quite high when appropriate technique is employed

Vein of galen aneurysm: antenatal diagnosis: a case report

Aneurysm of vein of Galen is a rare congenital malformation with reported incidence of less than 1% of cerebral vascular malformations. Most cases present in neonatal life with congestive cardiac failure. We report a case of aneurysm of vein of Galen diagnosed in intrauterine life at 36 weeks of gestation. The importance of third trimester Doppler ultrasound is highlighted

Vein of galen aneurysm: antenatal diagnosis: a case report

Aneurysm of vein of Galen is a rare congenital malformation with reported incidence of less than 1% of cerebral vascular malformations. Most cases present in neonatal life with congestive cardiac failure. We report a case of aneurysm of vein of Galen diagnosed in intrauterine life at 36 weeks of gestation. The importance of third trimester Doppler ultrasound is highlighted

Achalasia cardia and alacrima in an infant

Achalasia cardia is a very rare entity in children and may go undiagnosed for many months if not suspected. We report a case of a 4 months old child who presented with regurgitation of milk and solids and failure to thrive. She was initially treated as gastro-oesophageal reflux. There was a family history of achalasia cardia in the kins with resultant death in one and grossly delayed milestones in the other. Along with achalasia cardia, our patient had alacrima, which brought attention to the associations of achalasia with 'double A', 'triple A' and the '4 A' syndromes