Hepatic vasculitis mimicking liver abscesses in a patient with systemic lupus erythematosus

Clinical and radiological liver diseases are uncommon in patients with systemic lupus erythematosus [SLE]. We report a 29-year-old female with SLE who presented with right upper quadrant abdominal pain, thrombocytopenia, elevated liver enzymes and multiple hypodense lesions in the liver on a computed tomography [CT] study that mimicked multiple liver abscesses. A liver biopsy showed mild chronic inflammation. Culture results were negative. With steroid therapy the patient improved clinically, the platelet count returned to the normal range and the multiple liver lesions disappeared radiologicaly. This patient represents a rare case of SLE that had hepatic vasculitis mimicking multiple liver abscesses

CT and barium features of gastrointestinal and peritoneal tuberculosis

The radiological features in barium gastrointestinal studies and computed tomographic [CT] examinations of 22 consecutive cases of proven peritoneal and/or intestinal tuberculosis were analyzed in order to highlight the radiological features which could provide ready identification of the disease. There were 15 cases of intestinal tuberculosis and 7 cases of peritoneal tuberculosis and 3 patients had both. The commonest location of intestinal tuberculosis was the ileocecal region [N=10] which occurred in association with colonic or ileal disease. Bowel wall thickening in CT was largely asymmetrical but minimal and symmetrical wall thickening occurred with peritonitis. Luminal narrowing with or without mucosal tethering were seen in both CT and Barium studies, Peritoneal TB had either high density ascites with smudge or nodular omental surface with a thickened omental lining. Also detected was fibrinous dry peritonitis with thickened mesenteric tissue. Lymphadenopathy in the peripancreatic, mesenteric or paracaval were common to both intestinal or peritoneal tuberculosis [21 out of 22]. Fifty% of the patients showed some lymph nodes with necrotic centers. The differential diagnosis included malignant peritonitis and intestinal or mesenteric carcinoid. The study shows that a combination of barium gastrointestinal study and computed tomography can provide distinct features which could strongly suggest the diagnosis of intestinal or peritoneal tuberculosis

Fetal biophysical profile monitoring and perinatal outcome

A prospective study of 109 high risk pregnancies on whom 279 fetal biophysical profile [FBP] examinations were performed showed positive and negative predictive values of 100% and 71.4% respectively in the last FBP examination prior to delivery. The study confirmed other reports in the literature of a high correlation between normal examination and satisfactory perinatal outcome. The absence of perinatal mortality within one week of a normal FBP examination, which was also in agreement with other reported studies, reaffirms the reassuring nature of a normal examination. The high positive predictive value in our study may be due to several factors, including the use of a protocol which ensured standardization of the patient's condition prior to examination as well as repeat evaluations after non-reassuring tests. FBP evaluation is considered a simple, reliable and useful examination for the management of high risk pregnancies. Its main value would appear to be a reduction in the number of high risk pregnancy patients who would otherwise have been admitted on the basis of the clinical findings

Radiographic profile of spondylosis and spondylolisthesis in Saudis

An analysis of 1554 consecutive cases of patients requiring radiographic evaluation of the lumbosacral spine to diagnose the cause of low back pain of varying shows that 171 patients [11%] had spondylolisthesis. The three major types consisted of: dysplastic [congenital], isthmic [spondylolytic], and degenerative. The most common was spondylolytic [61%], followed by the dysplastic [23%], and then degenerative [14%]. Spondylolsis, with or without spondylolisthesis, occurred in 136 patients [i.e., 9% of patients who underwent radiography for low back pain]. Patients of all ages were affected by both the dysplastic and spondylolytic type, with a peak incidence between 20 and 40 years of age. The degenerative variety is largely a disease of women over 40 years of age. No distinct predisposing factors, such as exercise, occupation, or family history, were elected. However, in the degenerative variety, a sedentary lifestyle involving prolonged sitting could be a causative factor. The discovery of spondylolisthesis does not necessarily incriminate the cause. More detailed evaluation with myelography and computed tomographic or magnetic resonance imaging is mandatory in cases in which there is unrelenting pain