Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

The objective of this study is to determine the outcome of pulmonary embolism [PE] and the clinico-radiological predictors of mortality in a university hospital setting. A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients [49.9 +/- 18.7 years] with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge. Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery [35.2%], obesity [34.3%] and immobility [30.5%]. The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients [25%] had evidence of right ventricular strain and 14 [13.3%] were hypotensive. Multivariate analysis revealed that heart failure [Beta = -0.53, P< 0.001], palpitation [Beta = -0.24, P= 0.014] and high respiratory rate [Beta = 0.211, P < 0.036] were significant predictors of mortality. There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors. The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death

Hyperphosphatasemia in an adult. Clinical, conventional roentgenographic, and CT findings

A 47-year-old Saudi deaf lady with short stature presented being unable to walk. She had long standing diffuse skeletal deformities, and progressive head enlargement. She had markedly elevated serum alkaline phosphatase. The radiographic changes were those of hyperphosphatasemia, and the CT scanning of the skull, which was not studied before, further elicited the extensive calvarial and basilar changes. The various entities of hyperphosphatasemia with and without bony changes are reviewed

Saroidosis-associated pulmonary hypertension: clinical features and outcomes in Arab patients

Pulmonary hypertension [PH] occurs in many patients with interstitial lung disease, including sarcoidosi. We explored the frequency, clinical characteristics and outcomes of PH in Arab patients diagnosed with pulmonary sarcoidosis. A retrospective study in three tertiary hospitals was performed on 96 patients who underwent Doppler echocardiography. Demographic and clinical characteristics, physiological studies and computed tomography [CT] results were collected and compared between patients with and without PH. Twenty [20.8%] patients were found to have PH. Patients with PH were more likely to be sumptomatic [cough, P= 0.008; dyspnea, P=0.04], to have an advanced radiographic stage [P=0.001], and to be receiving systemic therapy [P=0.0011], compared to those without PH. Physiological data including pulmonary function test parameters, arterial blood gas levels and oxygen saturation at rest and after exercise were all significantly lower in patients with PH compared to those without PH. Compariosn of CT patterns between patients with and without PH showed significant differences in the frequencies of ground-glass opacity [61.5 vs. 28.8%, P=0.032] and fibrosis [76.9 vs., 44.2%, P=0.035]. In total, four patients died during the study period, including three with evidence of PH. The frequency of PH in the present study was 20.8%. Clinical, physiologic and radiographic characteristics appeared to differentiate patients with PH from those without PH. The presence of PH contributed to poor outcomes in patients with pulmonary sarcoidosis

Bilateral intraductal papillomas arising in ectopic axillary breast tissue synchronously with right breast intraductal carcinoma

This study describes a case of 45-year-old woman with a mass developed in the right breast. Physical examination revealed a 3 cm painless mass in the right breast as well as diffuse bulge in both axillary regions, though no significant lymphadenopathy was evident. Mammogram and ultrasound examination were carried out and showed malignant mass in the right breast and ectopic breast tissue in both axillae with multiple intraductal papillomas. Both mammographic and sonographic appearances of these lesions are described and discussed. The purpose of this study is to highlight the importance of occurrence of bilateral ectopic axillary breast with intraductal papilloma synchronously with right breast malignant mass and emphasize the importance of thorough mammographic and sonographic examination of the axilla in detecting such pathology

Magnetic resonance imaging evaluation of temporomandibular joint derangement in symptomatic and asymptomatic patients

To highlight the importance of MRI in evaluation of the tempromandibular joint [TMJ]. The MRI examination was performed at King Khalid University Hospital, Riyadh, Saudi Arabia with the approval from the local ethics committee, on 34 patients [68 joints] between January 2006 and November 2007, in which 10 were considered asymptomatic subjects [control]. The remaining had symptoms and signs of TMJ pain or dysfunction, including limitation of movement and clicking. All our subjects were examined in both closed and open mouth position. Images were obtained by 1.5-T MRI system, in oblique sagittal plane utilizing 3 pulse sequences including T1 and T2 spin-echo, and spoiled gradient recall sequences. The evaluation of the meniscal disc configuration and position was carried out by 2 radiologists. Sixteen out of 20 joints of asymptomatic subjects were normal. In the other 2 asymptomatic subjects, the MRI showed anterior disc displacement with reduction in 3 joints, and degenerative changes in 2 joints. Out of the 48 symptomatic joints, 26 [45%] joints were considered normal, while the other 22 joints showed anterior dislocation without reduction. Degenerative joint disease was also seen in 18 joints. The MRI with the use of surface coils markedly improves the delineation of internal derangement of the TMJ, therefore, it enhanced the capability of detecting certain abnormalities, which proved to have a statistical significance in symptomatic patients