Evaluation of normal appendix in adult Jordanians using non-enhanced dual source 64-slice MDCT

Objective: To evaluate the frequency of visualization and size measurements of normal appendix in Jordanian adultsusing non-enhanced dual source 64-slice multidetector computed tomography [MDCT]

Materials and Methods: A retrospective review of 240 consecutive adult patients [150 men and 90 women, age range 18-86 years, mean age = 49.8] who underwent a non-enhanced abdominal CT for possible renal stone disease was conducted. A senior radiologist interpreted the images in the axial, coronal, and sagittal planes. The visualization, location, contents, maximum outer diameter and two wall thickness of visualized appendices were recorded

Results: The appendix was visualized in 95% of patients. Intraluminal contents were identified in 70.6% of patients. The greatest outer diameter of the appendix ranged between 4 and 11.4 mm [mean= 6.2 mm], and the two wall thickness ranged between 1.8 and 7 mm [mean = 5.4 mm]. The prevalence of appendicitis in this study was 7.8%

Conclusions: Non enhanced MDCT is extremely useful in identification of normal appendix. The conspicuity and detection rate of normal appendix were significantly improved when additional multiplanar reformation images, particularly coronal images, were used. The wide variation in the outer diameter of normal appendix on CT may lead to significant overlap between normal and abnormal appendix, therefore, to reduce the false positive and false negative diagnoses of acute appendicitis other secondary signs should be recruited

Prevalence of urolithiasis in patients presenting with acute flank pain at jordan university hospital as demonstrated by unenhanced Helical CT scan

To identify the frequency and seasonal variations of renal stone disease in patients presenting clinically to Jordan university hospital with acute flank pain. Six hundred twenty five consecutive patients who had acute renal colic and underwent unenhanced urinary tract CT were retrospectively reviewed. The presence or absence of urolithiasis, site, and number of urinary stones in each sex and in each season were determined. Renal stone disease was depicted in 40% of patients. The incidence of male to female ratio was 2.3:1. The prevalence ratio of urinary stones in male and female patients in summer and winter seasons were 1.7:1, and 1.5:1, respectively. The most common site of urinary stones was the pelvicalyceal system with a prevalence rate of 74%. Renal stone disease is more common in male than in female patients; its frequency could be affected by dietary habits, socio-economic, and environmental conditions

Hip magnetic resonance imaging: descriptive epidemiology and outcome in Jordan University Hospital

To evaluate the experience in Jordan University Hospital regarding hip magnetic resonance imaging and to compare our findings with those published in medical literature. one hundred eighty two hip magnetic resonance images performed over the period of 7 years were reviewed, 88 patients [48.3%] had normal hip magnetic resonance image and were excluded from the study while the remaining 94 images [51.6%] with variable abnormalities were included in our study. Variable hip pathologies were seen, the most common was bone marrow edema syndrome found in 22 patients representing [23.4%] of the pathologies detected, followed by transient osteoporosis in 16 [17%] patients and avascular necrosis of the hip joint in 13 [13.8%] patients. Slipped femoral capital epiphysis and Paget_s disease were the least common seen in [1.1%] for each. In Jordan University Hospital referred patients for hip MRI scanning showed diverse findings with the most common abnormality detected being bone marrow edema syndrome of the femoral head followed by transient osteoporosis and avascular necrosis. The great benefit from magnetic resonance imaging was in diagnosing transient osteoporosis, staging avascular necrosis of the hip joint and characterization of deep pelvic soft tissue masses. The prevalence of hip pathology among Jordan University hospital patients as revealed by magnetic resonance imaging was in concordance with what was published in the literature

Pituitary magnetic resonance imaging experience in Jordan

To assess the pituitary findings as demonstrated on MRI and to compare the results with the data published in the literature. One thousand, one hundred and thirty-eight pituitary MRI's with and without intravenous contrast media [gadolinium] were performed over 6 years from 2001 to 2007 in the Department of Diagnostic Radiology, Jordan University Hospital, Amman, Jordan. The patients were referred from various departments and were evaluated for pituitary, other sellar, and juxtasellar abnormalities. The results were compared with those in the published literature. Four hundred and eight-three normal scans were excluded from the study. The remaining 655 were abnormal, pituitary adenoma was detected in 327 [49.9%], microadenoma was present in 213 [32.5%], and macroadenoma in 114 [17.4%]. Partial empty sella was seen in 157 [24%], diffuse pituitary gland enlargement in 98 [14.9%], ectopic pituitary posterior lobe in 13 [2%], and other findings in 31 [4.7%]. The incidence of pituitary adenoma was equal in both genders; however, microadenoma was more common, affected a younger age group, and was predominately seen in females. The other parameters showed agreement with the published literature

Ultrasound measurement of liver span in Jordanian adults: a preliminary experience

One of the most frequent ultrasound requests by clinicians is evaluation of hepatic size. Clinical evaluation by percussion and palpation can be inaccurate, unreliable with significant inter-observer variation. Ultrasound remains a very important imaging modality when the liver is concerned because it is simple, practical and easy-to-use. Yet, ultrasound measurement of liver span didn't receive much attention, particularly in this region. The aims of this study were to establish a normal figure of liver span for adults in Jordan, to investigate relationships between liver span and several anthropometric factors including age, gender, weight, height, body mass index and body surface area and to standardize ultrasound measurement of liver span. A prospective study was carried out at Jordan University Hospital between March 2007 and April 2008, on non-selected population sample of 242 male and 275 female adults with age range of 18-76 years. Statistical analyses including correlation, regression and 95% confidence intervals were performed on the data to test the statistical significance of the various relationships between liver span as represented by midclavicular line longitudinal diameter on one side, and several anthropometric factors including age, gender, weight, height, body mass index and body surface area. Our results showed that all anthropometric variables contributed highly and significantly to the variation in female liver span. The same factors however, with the exception of body mass index, significantly contributed to the variation in male liver span, however to a much lesser extent than females. The best predictor of liver span was height in case of males, body surface area in case of females. And both height and body surface area when both genders are considered. The 95% liver span confidence intervals were 12.3-12.8, 11.9-12.3 and 12.2-12.5 for males, females, and both genders combined, respectively. Height and body surface area were the best determinants of liver span in males and females, respectively

Influence of patient's age on prostate volume, and serum PSA levels

Prostate specific antigen could be elevated in prostatic and non prostatic diseases, therefore it is not specific for prostate pathology .We evaluated in this retrospective study other factors such as patient's age to determine its effect on the prostate specific antigen level and prostate volume in normal, benign, and malignant conditions. One hundred twenty one patients who underwent transrectal ultrasound biopsy were included in this study. The prostate volume, total prostate specific antigen, free prostate specific antigen, and percent free prostate specific antigen in normal, benign, and malignant conditions were evaluated Descriptive analysis, Two tailed student's t- test, Anova test and Pearson's correlation coefficient were used for statistical analysis. Biopsy results yielded 35 patients with prostate cancer [29%], 77 patients with benign prostatic hyperplasia [64%], and no abnormal histological finding in nine patients [7%].There was positive correlation between patient's age and prostate volume [r = 0.22, p < 0.05] Positive correlation was also found between patient's age and prostate specific antigen levels, total prostate specific antigen, and free prostate specific antigen [r = 0. 10 and r = 0. 1 8 respectively, p value was > 0.05]. Across categories no significant difference was found neither in the mean patient's age, nor in the prostate specific antigen levels [p > 0.05]. Although patient's age affects both total and free prostate specific antigen levels, but it could not be used as prostate cancer predictor

Macrodystrophia lipomatosa with syndactyly

Macrodystrophia lipomatosa [MDL] is a rare form of congenital localized gigantism characterized by hypertrophy of all mesenchymal tissues of the affected digits, with particular overgrowth of fat. Syndactyly is a rare association. We report a case of MDL associated with syndactyly affecting the hand. We describe the characteristic radiographic and MRI findings that distinguish the abnormality from other causes of localized gigantism

Intracranial meningioma

Meningiomas are the most common benign intracranial tumor, accounting for 15-30% of all primary intracranial tumors. They are usually diagnosed between 40-60 years and they are more common in females, but the aggressive type is more common in men and children. Pathologically, Meningiomas are divided into three grades: 1-Benign [90%] 2-Atypical [5-7%] 3-Anaplastic [3-5%]. The gross appearance of Meningioma is usually globular mass with regular surfaces and attached to the dura, but there is a certain type called meningioma en plaque, has a flattened appearance that conforms to the curves of the brain and the inside of the skull. Studying the immunohistochemistry and the biological activity of this tumor showed the presence of Epithelial Membrane Antigen [EMA] in 80% of cases, in addition to the presence of progesterone receptors in 57- 67% of cases which is associated with a good histological grade, lower frequency of recurrence, and overall favourable prognosis. Many causes are thought to be associated with meningioma like trauma, viral infection, radiation and genetic factors. The signs and symptoms are variable, and some of them are specific to the location of the tumor. The diagnosis of meningioma is done by CT scan and MRI, in addition to nuclear imaging and MRSpectroscopy. In many cases, angiography is also done either conventional or via MRAngiography. The treatment methods depend on the size and site of tumor, patient's age and clinical presentation starting by clinical observation and ending by surgical management. This article will discuss all of the above in detail with review of the medical literature

Brown tumor of the femur associated with double parathyroid adenomas

Severe parathyroid bone disease is a rare clinical presentation of primary hyperparathyroidism. Double parathyroid adenomas are even more rare cause of primary hyperparathyroidism. The authors present a case of double parathyroid adenomas in a 48-year-old man, who presented with painful left lower limb swelling, which was slowly growing in size in the last 20 years. Magnetic resonance imaging revealed a cystic bony lesion and coincidentally, a urinary bladder calculus. Biopsy of the mass revealed giant cell lesion. Laboratory investigations showed hypercalcemia and hypophosphatemia with elevated parathyroid hormone level. A computerized tomography scan of the neck delineated an adenoma of the left superior parathyroid gland, which was surgically removed. The left inferior parathyroid was also enlarged and was removed. Histological diagnosis confirmed double parathyroid adenomas. The rarity and the interesting clinical presentation of such association are discussed

Multiple enchondromatosis [Ollier's disease] with two primary brain tumors

A rare case of multiple enchondromatosis associated with 2 primary brain tumors is reported. A 21-year-old female who has diagnosed as Ollier's disease at the age of 9-years was admitted to the hospital with complaint of diplopia and progressive right upper and lower limb weakness. Magnetic resonance imaging of the brain depicted 2 intra-axial mass lesions. Stereotactic biopsy showed low grade fibrillary astrocytoma in both lesions. This report emphasizes that patients with Ollier's disease are at a higher risk for primary brain tumors than has been previously recognized