Safety of percutaneous transhepatic biliary stenting in patients with obstructive jaundice

Objective: To determine the safety of percutaneous transhepatic biliary stenting [PTBS] in patients with obstructive jaundice

Study Design: A case series

Place and Duration Of Study: Department of Radiology, The Aga Khan University Hospital Karachi, Pakistan, from February 2012 to April 2013

Methodology: Patients with obstructive jaundice due to any cause referred for percutaneous transhepatic biliary stenting were included in the study. Patients were excluded if they had undergone previous ERCP, had guided transhepatic biliary stenting, previous percutaneous transhepatic biliary stenting and were lost to follow-up. Follow-up was taken at a 2, 4 and 6 week interval and clinical outcome was assessed as the difference between the bilirubin levels at base line and 6 weeks after PTBS, which was measured using Freidman's test

Results: A total of 102 patients were included; 59 [58%] were males and 43 [42%] were females. The age ranged from 21 to 89 years. A total of 30 patients experienced complications making an overall complication rate of 29.4%; 20 experienced minor and 10 experienced major complications. Pain was the most frequent minor complication [n=15 patients, 14.7%] followed by biliary leakage, fever and cholangitis. Major complications included death in 10 [10%] patients followed by biliary peritonitis and septicemia

Conclusion: PTBS achieved satisfactory palliation with a low complication rate in patients with obstructive jaundice

Carotid intima media thickness percentiles for Pakistani population

Carotid artery intima media thickness estimation is a well-established way of cardio vascular disease evaluation. The purpose of this cross-sectional study was to develop normal carotid intima media thickness percentile values for a Pakistani cohort. Data was collected at the Departments of Radiology and Family Medicine, The Aga Khan University Hospital, Karachi, from April 2014 to August 2015. High frequency ultrasound of carotid was done in 257 patients [97 male [38%], 160 female [62%]] without any known carotid artery disease. Reference ranges [90% range between 5th and 95th centiles] were constructed for each common carotid and internal carotid artery measurement and displayed in graph form. The mean difference was found in left common carotid artery [0.55 +/- 0.13] and left internal carotid artery thickness [0.50 +/- 0.10] significant at p=0.031 and p=0.014, respectively. The IMT percentile graphs developed in this study for internal and common carotid arteries are exclusive for this population and can be used to assess vascular health from ultrasound measurements

Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis

To determine the accuracy of FACT [focused appendiceal computed tomography] in evaluation of acute appendicitis. The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix [>6 mm diameter] and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up. There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%. Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis

Non contrast helical CT scan for acute flank pain: non calculus urinary and extra urinary causes

To determine the value of non contrast helical CT in the diagnosis of non calculus renal and extraurinary causes of acute flank pain. A prospective descriptive study. Radiology Department, Aga Khan University Hospital Karachi from January 2005 to June 2005. 130 consecutive patients with acute flank pain underwent Noncontrast enhanced helical CT scan [NHCT]. 100[73%] were male and 30[23%] were female. Scans were observed for noncalculus renal and extraurinary causes of acute flank pain. Out of 130 patients, 30 patients were excluded. In 23[23%] patients non calculus causes of pain were diagnosed. In 5 [5%] patients incidental findings were recorded which were most likely not cause of pain. Three patients had non calculus renal abnormalities which included renal cell carcinoma, horseshoe kidney adult polycystic kidney disease. The accurate and timely diagnosis of an obstructing ureteral calculus, a non calculus urinary abnormality or an extra urinary tract pathology, establishes non contrast helical CT as the diagnostic study of choice for the evaluation of patients with flank pain

Role of computed tomography in acute pancreatitis and its complications among age groups

To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups. The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients [33 male and 7 female] with age range from 16-71 years were divided in three groups. Group I was less than 40 years [12 patients], Group II was between 40-60 years [17 patients], and Group III was more than 60 years [11 patients]. CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index [CTSI] was calculated according to Balthazar's method. In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI. The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications

Role of computed tomography in acute pancreatitis and its complications among age groups

To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups. The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients [33 male and 7 female] with age range from 16-71 years were divided in three groups. Group I was less than 40 years [12 patients], Group II was between 40-60 years [17 patients], and Group III was more than 60 years [11 patients]. CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index [CTSI] was calculated according to Balthazar's method. In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI. The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications

Multiple parameters in the diagnosis of Ectopic pregnancy

To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy. A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml. Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitivity. The use of multiple parameters in the diagnosis of ectopic pregnancy resulted in 100% sensitivity and specificity

Cerebral deep venous thrombosis: case report and literature review

The case of a 28 years old woman presenting with headache, drowsiness and vomiting of a short duration, is presented. She was diagnosed as deep cerebral venous thrombosis on the basis of MRI findings. Treatment with heparin gave completed recovery

Ultrasound in the diagnosis and management of intrauterine growth retardation

To evaluate the value of ultrasound in the diagnosis and management strategies of intrauterine growth retardation. Design: A descriptive study. Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi, from April 1998 to August 1999. Patients and The study population comprised of 206 subjects evaluated for suspected intrauterine growth retardation. Grey scale as well as Doppler ultrasound findings were evaluated and compared against post-natal outcome. One hundred and eight out of 206 subjects showed positive imaging results with 40 false positive and 20 false negative subjects. The sensitivity, specificity, positive predictive and negative predictive values were 77.8%, 66.1%, 55.6%, and 45.1% respectively. Forty subjects showed false positive results on imaging [low biophysical profile score and Grey scale biometry discrepancy] while 20 of the subjects showed false negative results [normal on US imaging] when compared with postnatal neonatal body weight criteria. Twenty-two subjects had oligohydramnios with amniotic fluid index below 5 percentile for their respective gestational ages [20%] out of 108. Obstetric and Doppler ultrasound is an accurate method for diagnosis and management of fetal growth retardation

Mesenteric panniculitis

A 68 years old female was referred from the clinic for ultrasound pelvis on 03-02-2003. She had pain in the hypogastrium for the last 2 months. On clinical examination no significant abnormality was detected. Her laboratory investigations were within normal limits. Ultrasound pelvis was normal but incidentally, a hyperechoeic mass was noted anterior to abdominal aorta and inferior to the pancreas. The size of the mass was 7.4 x 6 cm and vessels were traversing through the mass. CT scan was advised for further evaluation. CT scan was performed after 2 weeks which showed soft tissue stranding in the mesenteric fat, anterior to aorta, at the same level described in the ultrasound report. Superior mesenteric vessels were traversing the mass. No abdominal or pelvic lymphadenopathy was noted. These features were consistent with mesenteric panniculitis [Figure 2]. The case was managed conservatively and follow-up was planned. The patient had a follow-up ultrasound examination performed 6 months later which showed resolution of the earlier findings. The patient was asymptomatic at the time of follow-up

Ultrasound differentiation of bening versus malignant solid breast masses

To determine the reliability of ultrasonographic features in differentiating benign from malignant solid breast masses. Design: Descriptive, analytical study. Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi from July 2000 to June 2002. Subjects and One hundred solid breast masses in females with a tissue diagnosis available were reviewed. Two radiologists reviewed the sonographic features of masses without knowledge of clinical history or histologic examination results. Ultrasound features were corrected later with histologic features to determine the reliability of the former in benign or malignant nature of nodules. Ultrasound features that most reliably characterize masses as benign were a round or oval shape, circumscribed margins and a width to antero-posterior [AP] dimension ratio greater than 1.4. Features that characterized masses as malignant included irregular shape, spiculated margins and width to antero-posterior [AP] dimension ratio of 1.4 or less. If these three most reliable criteria had been strictly applied by the primary reporting radiologist, the overall cancer biopsy yield would have increased. The data confirms that certain ultrasound features can help differentiate benign from malignant masses. However, practice and interpreter variability should be further explored before these criteria are applied to defer biopsy of solid masses

Accuracy of magnetic resonance imaging in the knee

To determine the accuracy of magnetic resonance imaging [MRI] in the assessment of various knee disorders in comparison with arthroscopic findings and pathologic diagnosis. Design: A retrospective and comparative study. Place and Duration of Study: Radiology Department, Aga Khan University Hospital, Karachi, from 01-12-1996 to 30-06-2000. Patients and Fifty-six subjects [36 males and 20 females], included in this study, had abnormal findings on MRI, which were correlated with arthroscopic findings in 50 cases and pathological diagnosis in 6 cases. Plain X-rays were available in all cases. The sensitivity, specificity and accuracy for MRI of the menisci and cruciate ligaments were as follows: medial meniscus pathologies 87% sensitivity, 94% specificity and 92% accuracy; lateral meniscus pathologies 92% sensitivity, 89% specificity and 90% accuracy; anterior cruciate ligament injuries 95% sensitivity, 96% specificity and 96% accuracy and posterior cruciate ligament injuries 100% sensitivity, 98% specificity and 98% accuracy. Pathological diagnosis was available in 6 cases. MR imaging suggested the diagnosis of tuberculosis and metastases as well as mapped out the extent of osteogenic sarcoma, fibromatoses and rhabdomyosarcoma. This study confirms that MR imaging of the knee is highly sensitive, specific, and accurate

Gossypiboma - A case report

Gossypiboma [retained surgical sponge] is a rare occurrence and can occur after any surgical procedure, which requires the use of internal swabs. We present a case of 40 years old female who underwent laparotomy for hysterectomy. This case is presented to highlight the fact that this condition should always be included in the differential diagnosis of patients who have had previous surgery and vague symptoms