T.B and pyogenic neck infection: different patterns in CT examination

The aim of this work was to illustrate the different CT patterns of neck infections. This study included 28 patients with suspected neck infection were referred to the Radiodiagnosis Department. They were subjected to history taking, clinical examination and multislices computed tomography [CT] evaluation with contrast. 28 patients were included in this study, 19 males and 9 females, their age ranged from 2-73 years. The different affected neck spaces were as follows: 12 peritonsillar, 7 submandibular, 7 parapharyngeal, 4 retropharyngeal, 2 sublingual, 4anterior cervical, 1 posterior cervical, and 1 parotid space. Lymph nodal abnormalities were identified in 9 patients. Nine patients with chest involvement as mediastinal extension in 6 patients, lung parenchymal lesions 2, one with mediastinal lymph nodes. CT is sufficient in detection of the extension of various neck infections. CT chest in the same sitting with CT neck may add information about the extension of the disease or can give a due to the diagnosis

Evaluation of the role of ultrasonography versus immunologic tests in diagnosis of chronic hepatosplenic sechistosomiasis

This study aims to evaluate the sensitivity of different EL1SA techniques versus ultrasonography as a 'stablished tool in diagnosis of chronic hepatosplenic schisosomiasis and assessment of different degrees of morbidity. Based on clinical, sonographic md laboratory testing 100 patients enrolled in this study were devided into 4 main groups: Group I with simple intestinal schistosomiasis, group II with periportal fibrosis with or without organomegaly, group III with hepatosplenomegaly and portal hypertension and group IV with advanced morbidity and end stage liver disease. All patients were subjected to ultrasonographic evaluation and serological assessment using Two techniques of ELISA conventional versus Dot ELISA with two types of antigens crude adult worm and soluble egg antigens assessing both IgG and IgM antibodies. The positivity of different ELISA techniques decreases with the advance of morbidity being 95% in group [compared to 15% in group 4 for conventional ELISA and 75% in group I compared to 10% in group 4 for the Dot ELISA. Ultrasonographic evaluation proved to have the main role with the advance of the degree of morbidity and there is no relation between different stages of the disease and the degree of antibody positivity. Antibody burden was higher in the earlier stages of the disease compared to stages of advanced morbidity. IgM antibodies are more prevalent in the earlier stages of the disease while IgG antibodies are more consistent in different stages of the disease being also higher in the [earliest stages of the disease. Based on the conditions of antigen preparations used conventional ELISA was more Sensitive compared to dot ELISA [88% versus 80%] for the conventional using adult worm and soluble egg antigen in group 1 and [68% versus 60%] for the dot ELISA using the Be types of antigens. Conventional ELISA is more sensitive than Fdot ELISA with the adult worm antigen more sensitive than isoluble egg antigens. With advance of morbidity of the disease the sensitivity of both tests as well as the antibody burden decreases that may be attributed to decrease of the intensity of infection as well as low immune status of the individual and this spotlight on the role of ultrasonography with the advance of morbidity. Targeting treatment and control programmes for earlier stages of the disease is essential to reduce heavy antigenic burden that might be responsible for intense immune reaction and progression of the disease state to advanced irreversible morbidity.

Cardiac abnormalities in patients with chronic renal failure on haemodialysis: role of parathormone

The study was conducted at Kasr Al-Aini University Hospital between December 2001-December 2003 on 42 patients [19 males and 23 females] with a mean age of 43 +/- 10 years. All patients have established end stage renal disease and on regular haemodialysis at the dialysis unit at Kasr El Aini Teaching Hospital. Patients were divided into three groups according to their serum parathormone [PTH]: Group A includes 11 patients with normal serum PTH ranging between [12-71Pg/dl], group B includes 15 patients with target PTH range [3-4 folds the upper limit of normal 210-280 Pg/dI]. Group C includes 16 patients with high serum PTH [higher than target range >280Pg/dl]. All patients have a target urea reduction ratio [URR] >65% i.e. >1.3 Kt/v indicating efficient dialysis. The mean age of patients in the different groups showed no significant difference. Assessment of the traditional risk factors for atherosclerosis regarding arterial blood pressure, serum lipid profiles showed that the mean arterial blood pressure was significantly higher [p<0.05] in group C when compared to group B and highly significant when compared to group A [p<0.01]. Serum LDL cholesterol was significantly higher in group C patients compared to group A [p<0.01] with no significant difference in relation to group B. Serum HDL was significantly lower in group C compared to group A and B [p<0.01]. Also group B showed highly significant decrease in serum HDL compared to group A [p<0.01]. Serum triglycerides was significantly higher in-group C compared to group B, A with a p value [0.05, 0.01] respectively. The principal serum correlates with parathormone that are calcium and phosphorus were compared between the three groups. Serum calcium was found to be highly significantly lower in group C compared to group B and A and also in group B compared to group A with a p value <0.01]. Also serum phosphorus was highly significant higher in-group C compared to group B and A and also in-group B compared to group A with a p value [<0.01]. Resting ECG ischaemic changes was observed in 6/16 patients in group C compared to 2/15 patients in group B, while no resting ECG changes was observed in group A. Assessment of the systolic functions of the heart by echocardiography showed that the ejection fraction [EF] was significantly higher in group B compared to group A, while in group C the EF was significantly lower compared to group A and B [p<0.01]. As for diastolic functions [E/A] ratio, the only significant difference was found between group C and A [p<0.05]. Structural alteration was studied by assessment of the interventricular system thickness [IVS] and left ventricular mass. Patients with group C showed a highly significant difference compared to group A and B [p<0.01] being higher in group C. Left ventricular mass was also significantly higher in group C compared to group A and B [p<0.01] with no significant difference between group A and B. As regards valvular and soft tissue calcifications patients with group C showed significantly higher calcific valvular lesions compared to group A and B [p<0.01]. Correlation between PTH, calcium and phosphorus and different variables showed that PTH and serum phosphorus was significantly positively correlated with mean arterial blood pressure, triglycerides Total cholesterol, left ventricular mass and interventricular septum thickness while calcium showed significant negative correlation with the same variables [p<0.01]. As for cardiac ejection fraction, serum PTH and phosphorus showed significant negative correlation while serum calcium showed significant positive correlation with the same variables [p<0.01]. In conclusion alteration of serum PTH level with calcium, phosphorus homeostasis in patients with renal failure may play an important role in potentiation of the classic risk factors for cardiovascular morbidity in addition to its direct effect on structural and functional alteration of the myocardium in these patients making control of such metabolic derangement an essential target for the prevention of cardiovascular morbidity in these patients

Diagnostic value of cardiac troponin I in patients with pulmonary embolism

The main aim of this study is to test the value of estimation of serum troponin I as a marker of right ventricular ischaemia and /or dysfunction in diagnosis of patients with pulmonary embolism aiming for more accurate risk stratification of these patients to detect those who are in need for more aggressive therapy. 22 patients 14 females and 8 males with confirmed pulmonary embolism based mainly on ventilation perfusion lung scan in 14/22 cases, spiral CT angiography in 1 case and combined echocardiographic evidence of right ventricular strain in addition to clinical presentation of acute dyspnoea in absence of major chronic obstructive pulmonary disease in seven cases. Patients were divided into two main groups according to both their haemodynamic state and /or the presence of abnormal echocardiographic parameters. Group A includes 8 patients with normal haemodynamic status and echocardiographic parameters; group B includes 14 patients with abnormal echocardiographic parameters of the right ventricle. They were further subdivided according to their haemodynamic status into 6/14 patients [43%] with abnormal haemodynamic status and 8/14 patients [57%] with normal haemodynamics. Serum troponin I was considered elevated above 0. IMcg/L, it was found restrictly elevated in 11/14 of patients [79%] and borderline in 3 patients [21%] in group B compared to 0/8 in group A, the difference was statistically significant [p=0.004]. Serum Troponin I was found to be statistically significant higher in patients with abnormal haemodynamics compared to patients with normal haemodynamics in group B [p=0.04] Troponin I was found to be significantly positively correlated with right ventricular size [r 0.529, p<0.01], pulmonary artery pressure [r 0.659, p<0.001]. Serum troponin I may be a helpful diagnostic tool in patients with pulmonary embolism and may improve the risk stratification of these patients as its elevation is significantly correlated with other adverse prognostic factors in these patients such as haemodynamic status, right ventricular size and pulmonary artery pressure and its elevation even in absence of haemodynamic alteration may point to aggressive intervention in these patients

Adrenal metastasis: US, CT and MR imaging

The purpose of this study is to illustrate the role of US, CT and MRI in the characterization of adrenal metastases in patients with known primary cancer. Thirty metastatic adrenal masses and 10 adenomas were prospectively identified in 35 oncologic patients on non contrast and contrast enhanced CT scans of the chest and abdomen. All patients were studies with US, CT as well as chemical shift MRI [1.5 T]. Using CT, regions of interest were obtained at non enhanced, dynamic [60 seconds post contrast enhancement], and delayed [10 minutes post contrast enhanced] 3-8 mm thickness CT scans of the adrenal glands. These measurements were used to calculate a relative percentage contrast wash out as follows: 1-HU on delayed images/ HU on dynamic images x 100%. A relative percentage wash out threshold of 50% was applied with calculation of sensitivity and specificity of the protocol. Also the attenuation characteristics, size, shape and relation to nearby structures were determined on CT images. On MRI, the adrenal mass / splenic ratio [ASR] was calculated applying the chemical shift MRI protocol using 2.3 msec [out of phase images] and 4.6 msec [in phase images] echotime. The percentage of signal remaining in the out of phase images relative to the in phase images was determined. Diagnoses were confirmed by fine needle aspiration cytology, imaging findings and follow up findings. The study group included 35 patients with adrenal masses; 25 had 30 adrenal metastases and 10 patients had 10 adrenal adenomas. The malignant metastatic group included 20 men and 5 women. The mean age of 65 years. The non malignant group included 10 patients with adrenal adenomas, 8 women and 2 men, with mean age of 52 years. The primary malignant lesions were bronchogenic carcinoma in 14 patients, hepato-cellular carcinoma, renal cell carcinoma, infiltrating breast duct carcinoma, in 2 patients for each, colorectal, urinary bladder, uterine and prostatic carcinoma in one patient for each as well as one patient with pleural mesothelioma. US was performed as part of the routine diagnostic work up of patients. It could detect 23/30 [77%] adrenal metastases and 5/10 [50%] adrenal adenomas. Analysis of the CT images showed mean size of metastatic lesions of 4 cm [rang 3.3-12 cm], irregular shape in 25/30 [83%] lesion and heterogeneous attenuation in 26/30 [87%] lesion. The mean size of adrenal adenomas was 2.2 cm [range 1-3.2 cm], all were regular in shape and 90% shows homogeneous attenuation pattern. The mean CT attenuation values of the 30 metastatic lesions was 32 +/- 7.2HU. Only one lesion showed attenuation <18 HU. Adrenal adenomas shows mean attenuation values of 6 +/- 9.2 HU [range -20 to 19HU]. Only one adenoma showed attenuation >18 HU. The sensitivity: specificity ratio for the diagnosis of adrenal metastasis applying the CT attenuation characteristics was 97%: 90% at a threshold value of 18HU. Twenty nine of 30 [97%] metastatic lesions were correctly diagnosed as malignant with relative wash out threshold of 50% on delayed scans. All showed <50% contrast wash out. 90% adenomas shows contrast wash out of >50% at delayed post contrast scans. Therefore, the sensitivity and specificity of the protocol were 97% and 90% respectively. The analysis of the MR images revealed that signal intensity was not useful to reliable characterization of the adrenal metastatic lesions. Applying chemical shift imaging, 29/30 [97%] adrenal masses showed no significant signal loss in out of phase images. On the other hand, all adenomas [100%] showed marked signal loss in the out of phase images. The sensitivity and specificity of the protocol was 97% and 100% in differentiation of benign from metastatic adrenal masses. CSI was proved to be the most sensitive technique for differentiating adrenal adenoma from metastases. When CT examinations are equivocal, CSI would be the next imaging study of choice for characterization of adrenal masses

Evaluation of plasma elastase, D-dimer and fibrin degradation products in comparison to doppler ultrasonography in the diagnosis of patients with deep vein thrombosis

The present work aimed at evaluating the usefulness of plasma elastase, D-dimer and fibrin [ogen] degradation products [FDPs] in comparison with doppler ultrasonography for the diagnosis of deep vein thrombosis [DVT] among 20 adult patients who were admitted to the emergency unit of Alexandria main University hospital with symptoms and signs suggestive of DVT. 10 healthy age and sex matched controls were also enrolled in this study. Plasma elastase, D-dimer were estimated by ELISA technique while FDPs by semiquantitative latex agglutination. They were done at presentation and 10 days after heparin therapy while they performed once in control group. It was found that the mean values of plasma D-dimer elastase and FDPs were significantly higher than those in control group both before [P[1]< 0.0001] and after therapy [P[2]< 0.0001] respectively. Post heparin therapy, the mean values of same parameters were significantly decreased when compared with pretreatment mean values using paired t-test [p= 0.000] for D dimer, elastase and FDPs respectively. As regards the extent of thrombus diagnosed by doppler ultrasonography, there was a significant increase in the mean values of D-dimer in proximal and all DVT than those in distal DVT while there was no significant difference between plasma elastase and FDPs and the extent of thrombus. A significant positive correlation was found between plasma D-dimer and elastase both before [r=0.845, p=/< 0.0001] and after heparin therapy [r= 0.764, p= 0.000]. No significant correlation was found between FDPs and the previous two parameters neither before nor after treatment. Doppler ultrasonography is a definitive test for diagnosis and localization of thrombus in DVT. Plasma D-dimer, elastase and FDPs can be used for initial evaluation of DVT suggestive patients in the emergency unit and further studies are needed to clarify their role in predicting the recurrence of DVT

Role of computed tomography in diagnosis of cerebral infarction

CT study was done to 78 patients presenting with clinical findings suggestive of brain infarction. The CT appearance of brain infarction was found to be dependent on many parameters, mainly the age and stage of the infarction whether initial, developmental or sequellar stage, the location of infarction whether superficial or deep and the size of infarction area whether small or massive. Hypodensity was the most characteristic and most stable CT abnormality of brain infarct. Diminution or disappearance of hypodensity, the fogging effect, occurred during the second and third weeks after the ictus. This phenomenon lasts for few days and may present a great diagnostic difficulty. Contrast enhancement is of utmost importance in detecting cerebral infarction during this period