Diagnostic accuracy of x-ray chest in interstitial lung disease as confirmed by high resolution computed tomography [HRCT] chest

Objective: To determine the diagnostic accuracy of x-ray chest in interstitial lung disease as confirmed by high resolution computed tomography [HRCT] chest

Study Design: A cross-sectional validational study

Place and Duration of Study: Department of Diagnostic Radiology, Combined Military Hospital Rawalpindi, from Oct 2013 to Apr 2014

Material and Method: A total of 137 patients with clinical suspicion of interstitial lung disease [ILD] aged 20-50 years of both genders were included in the study. Patients with h/o previous histopathological diagnosis, already taking treatment and pregnant females were excluded. All the patients had chest x-ray and then HRCT. The x-ray and HRCT findings were recorded as presence or absence of the ILD

Results: Mean age was 40.21 +/- 4.29 years. Out of 137 patients, 79 [57.66%] were males and 58 [42.34%] were females with male to female ratio of 1.36:1. Chest x-ray detected ILD in 80 [58.39%] patients, out of which, 72 [true positive] had ILD and 8 [false positive] had no ILD on HRCT. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of chest x-ray in diagnosing ILD was 80.0%, 82.98%, 90.0%, 68.42% and 81.02% respectively

Conclusion: This study concluded that chest x-ray is simple, non-invasive, economical and readily available alternative to HRCT with an acceptable diagnostic accuracy of 81% in the diagnosis of ILD

H-type tracheoesophageal fistula in a child with dysmorphism: vater or not?

Tracheo-Esophageal fistula [TEF] with or without esophageal atresia occurs in approximately 1 in 3500 births. In around half of the cases there are associated anomalies while esophageal atresia/TEF occurs in isolation in the remainder. Congenital H-type tracheoesophageal fistula [TEF] in adults is a rare presentation and can test the diagnostic acumen of a surgeon, endoscopist, and the radiologist. These undetected fistulas may present as chronic lung disease of unknown origin because repeated aspirations can lead to recurrent lung infections and bronchiectasis. Congenital TEFs should be considered in the diagnosis of infants and young adults with recurrent respiratory distress and/or infections. Here, we present the successful management of this rare case in an adult patient. Congenital H-type TEF in children is a rare presentation and search revealed no such case reported in local literature. Here, we present the diagnosis and successful management of a child with congenital H-type TEF with vertebral and limb defects

Branchio-oto-renal syndrome

The association of branchial arch anomalies [branchial cysts, branchial fistulas], hearing loss and renal anomalies constitutes the branchio-oto-renal [BOR] syndrome also known as Melnick Fraser syndrome. We present a case of this rare disorder in a girl child who presented with profound deafness, preauricular pits, branchial sinuses and renal hypoplasia

[Familial spastic paraplegia] [strumpell-lorrain syndrome]

Familial spastic paraplegia [FSP] is not a single disease entity; it is a group of clinically and genetically diverse disorders that share a primary feature of progressive and generally severe lower extremity weakness and spasticity. We present a family with uncomplicated FSP from a remote village of Gilgit, Pakistan. Clinical presentation of 6 years of gait disturbance and frequent falls in elder son, led us to the diagnosis of definite FSP in our index patient and one of the siblings and findings consistent with probable FSP in their mother

Maternal perception of fever in children by tactile technique. how valid it is?

To determine the validity of tactile technique as a tool for fever assessment in children by mothers. Study Design: A cohort study. The study was conducted at the department of Paediatrics, Combined Military Hospital, Bahawalpur, Pakistan, from September 2007 to September 2009. Convenient sampling technique was employed. Three hundred and ninety three children between the ages of 6 months and 5 years, brought to hospital by mothers with history of prolonged fever [7 days or more] perceived by tactile technique. Children were not supposed to be necessarily febrile at the time of enrollment. A six hourly temperature recording was done. Moreover, whenever mothers felt that their child is febrile by using tactile method of their choice, axillary thermometry was done irrespective of the number of recordings. Standard mercury thermometry by axillary technique [without adding a degree to measured value] was chosen. Reading of more than 99.50 Fahrenheit [37.50 centigrade] was labeled as fever. Cases that remained fever free for five days were labeled afebrile and discharged. Mothers were advised to watch for fever for one week at home and to report back immediately if they felt that their child has fever, confirmed by a single tactile measurement. Those who reported back were readmitted and subjected to the same method of monitoring and recording as was applied on first admission. Data was analyzed using SPSS version 17. Descriptive statistics were applied to calculate the frequencies, means and standard deviations. Among the 392 children 58.4% were males and 41.4% were females. The mean age was 24.4 +/- 14.39 months. Majority had a history of fever of 5 to 24 days [70.2%]. In only 184 [46.93%] patients fever was confirmed. In 208 [53.08%] patients no fever was recorded and were discharged. Twenty one patients reported back with fever. However, fever was confirmed in only 11 patients. In summary, a total of 195 [49.74%] patients actually had fever while a large population of 197 [50.25%] did not had fever. Fever was over estimated by the mothers when detected by tactile technique. Axillary thermometry as a tool for fever assessment at home and clinics should be encouraged. This will significantly reduce the need for undue investigations and unnecessary medications

Grebe syndrome: a rare association with congenital heart disease

Grebe syndrome is a very rare form of short-limbed dwarfism. It is a genetic condition, passed by autosomal recessive inheritance. It is characterized by marked acromesomelic shortening of all the four limbs. There are no other associated anomalies. The affected baby has normal intelligence and normal life span. We present here a case of Grebe syndrome along with congenital heart disease

Brodie's abscess-an uncommon cause of leg pain

A rare case of Brodie's abscess of distal left tibia is presented in a child which was initially missed on clinical grounds alone. Differentiation from different bone neoplasms was done on radiological grounds. The patient was managed surgically with high dose intravenous antibiotics. Brodie's abscess is very rarely encountered in our reporting of X-rays

Peripheral puddling of contrast-classical enhancement pattern of giant cavernous hepatic hemangioma revealed on computed tomography in an adult male

A forty two years old male was admitted with three months history of vague right upper quadrant abdominal pain, together with nausea and early satiety. On abdominal examination, there was a palpable mass in the right upper quadrant. The sonographic examination of the liver revealed a large echogenic mass. Computed tomographic scan [CT scan] of the abdomen revealed a very large solitary isodense mass in the right and left lobes of the liver. The mass was superficially placed in the liver abutting the antero-lateral wall of the abdomen. The mass measured 10x8 x 8 cm. It revealed a curvilinear hyperdense area in the centre with hypodense portion as well. Arterial phase of contrast enhanced CT scan demonstrated the location and margins of the mass clearly. It was occupying left supero-medial and inferomedial quadrants of the left lobe of the liver [segments 4a and 4b] as well as right superoanterior and infero-anterior quadrants [segments 8 and 5 respectively]. The mass was compressing the porta hepatis, gall bladder, inferior vena cava and the head of the pancreas. Peripheral enhancement of the mass was seen caused by the puddling of contrast in dilated, ectatic vascular spaces within the tumor that was iso-attenuating with the aorta. Based on above mentioned findings a diagnosis of giant cavernous hepatic hemangioma was made

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly

Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier