role of 320 slice CT angiography in predicting vascular trauma

Objective: To determine the accuracy of multidetector CT angiography [MDCT angiography] as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up

Study Design: Descriptive analytical study

Place and Duration of Study: Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013 Methodology: Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT [Aquilion One[TM]] and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography [DSA]. Sensitivity and specificity was calculated

Results: The age of the patients ranged from 7 to 90 years with 94% [48] males and 6% [3] females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one [41%] patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen [29.5%] patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%

Conclusion: MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries

A case report of subependymal giant cell astrocytoma in 7 month old patient with tuberous sclerosis

Tuberous sclerosis is a neurocutaneous syndrome with a wide variety of clinical, pathologic, and radiologic manifestations. Intracranial phakomatosis has been reported to include subependymal nodules; cortical, and subependymal giant-cell astrocytomas. Subependymal giant-cell astrocytomas are rare, benign typically slow growing tumors of mixed neuroglial lineage, which can become aggressive and cause increased intracranial pressure, seizures, and focal neurologic signs. The standard treatment of these tumors is total neurosurgical resection [1,2,3]. We report a 07 month old male patient with tuberous sclerosis who underwent surgery for a large subependymal giant-cell astrocytoma [SEGA]. It is rare to find SEGA in this age period

Paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features of multiple myeloma

Black brown hyperpigmentation of the mucosae, sunexposed skin, palmar creases and frictional sites [Addisonian pigmentation] is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation.We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up

Pulmonary varices - rare cause of haemoptysis

Haemoptysis has a long list of causes, but pulmonary varices are amongst the rare causes. Pulmonary varices are rare abnormalities of pulmonary veins that may exist either as an isolated malformation or in association with pulmonary venous hypertension. This case report describes pulmonary varices as a cause of hemoptysis in an adolescent boy, which was diagnosed on multislice CT and confirmed on angiography

Acute Intermittent Porphyria with Transient Cortical Blindness.

Acute intermittent porphyria is a hereditary disorder characterized by deficient activity of the enzyme porphobilinogen deaminase. It manifests with occasional neurovisceral crises due to overproduction of porphyrin precursors. We report a 12 year old male child with acute intermittent porphyria, who presented with encephalopathy and transient blindness of cerebral origin.

Crossed fused renal ectopia with staghorn calculus and gross hydronephrosis

Crossed fused renal ectopia is a rare renal anomaly. Formation of staghorn and struvite calculi within it has never been reported in local literature. A 25-year-old man with macrohematuria and right flank pain was admitted to the hospital. An intravenous pyelography revealed right sided crossed fused ectopic kidney showing a staghorn and struvite calculi in upper-moiety along with gross hydronephrosis. Patient was conservatively managed after exclusion of other congenital anomalies

Transverse testicular ectopia

A case of transverse testicular ectopia of the left testis is hereby reported. A 5-year-old boy presented in surgical outpatient department with right inguinal hernia and impalpable testis in left scrotum and inguinal canal. Right herniotomy was performed. Left testis was found in right superficial inguinal pouch and brought to the left scrotum through transceptal window

Inverted Meckel's diverticulum causing intussusception in an adult

Adult intussusception is rare, making-up only about 1% of the causes of bowel obstruction intussusception, secondary to an inverted Meckel's diverticulum, is also a rare occurrence. Chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms may lead to an unnecessary delay in diagnosis. This case report describes a rare cause of adult intestinal intussusception due to inverted Meckel's diverticulum. Intussusception was diagnosed on emergency ultrasound of the patient, who was successfully managed with surgery

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

Pneumonia; frequency of under nutrition in children under 5 years of age

To find out an association between undernutrition and severity of pneumonia in children under five years of age. The study was carried out at paediatric department of Military Hospital Rawalpindi. From August 2003 to January 2004. Cross sectional analytical study. Children of either gender from 2 to 59 months of age with the clinical diagnosis of pneumonia made according to WHO guidelines were classified into various grades of nutritional status with referrence to the NCHS standards for weight for age. Five hundred children, including 280 [56%] boys and [220] 44% girls with the mean age 20.36 [ +/- 14.26] months were evaluated. One hundred and ninety five [39%] had pneumonia, 158 [31.6%] had severe pneumonia, whereas 147 [29.4%] had very severe pneumonia. Two hundred and eighty six [57.2%] children were normally nourished whereas 214 [42.8%] were undernourished; 133/214 [62.1%] had moderate and 81/214 [37.9%] had severe undernutrition. Fever [81%], cough [77%], nasal flaring [76%], tachypnoea and chest indrawing [61%] were the commonest presentations. The mean hospital stay was 6.9 [ +/- 2.65] days. Thirteen [2.6%] patients including 5 [38.5%] boys and 8 [61.5%] girls, who all were undernourished, expired. The relative risk of death in undernourished children was 1.065 times [95%CI= 1.029 to 1.102] that of normally nourished children [p<0.0001]. Younger age, severity of pneumonia and undernutrition are significant risk factors for morbidity, prolonged hospitalization and mortality in young children with pneumonia

Cystic hygroma-an unusual cause of induced abortion

A male infant was diagnosed prenatally at 20 weeks of gestation with posterior cervical cystic hygroma. The mother was a 31-year-old gravida, who had an otherwise normal systemic examination. A therapeutic abortion was arranged and fetus was aborted. Sonographic findings were confirmed on examination of aborted fetus

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

Tuberous sclerosis: Report of two cases diagnosed by computer assisted cranial tomography without cutaneous manifestations

We represent two patients suffering from tuberous sclerosis without cutaneous manifestations Both were diagnosed on cranial CT scan. Both had typical calcified ependymal lesions. Our first patient had bilateral renal angiomyolipomas as well. Second patient had typical calcified ependymal lesions near foraman of Monro and calcified left cerebella tubers

MultipleBbrain Abscesses in a child with congenital cyanotic heart disease

We report multiple and diffuse supratentorial and infratentorial brain abscesses in a ten months old girl with D- transposition of great arteries. The child was managed medically with intravenous antibiotics for 4 weeks. Her fever settled, however, weakness of right half of the body persisted despite remarkable improvement. Multiple abscesses [about 40 in number], in a child less than 2 years age, associated neutrophilia with toxic granulations and successful therapy with antibiotics alone makes this an unusual case