Sonographic Journey for the detection of gastrointestinal masses from distal esophagus to rectum with histological correlation

Objective: To demonstrate the sonographic features of gut masses detected either incidentally or purposely through the gastrointestinal tract sonography with histological correlation to compare the detected abnormalities for their benign and malignant nature

Material and Methods: The study was conducted between September 2009 and February 2013. Ultrasound scanning was performed on 72 patients [20-75 years, mean age 46 years] presenting with clinical suspicion of underlying primary gastrointestinal pathology due to abdominal symptoms. The histological confirmation was done either through surgically resected specimen, trucut biopsy, flexible endoscopic biopsy or fine needle aspiration

Results: Out of 72 patients, upper GI tract masses included 2 distal esophageal and 7gastric cancers. Mid gut included 9 cases of primary small bowel lymphoma. Intussusception was found in 6 patients. Ileoceacal masses were found in 13 patients with one case of jejunal mass. 18 patients were diagnosed as acute appendicitis, 3 patients demonstrated appendicular mass. Large intestine revealed a single case of diverticulitis besides 15 cases of colorectal cancer. The masses were either lobulated or revealed a segmental wall thickening simulating appearance of kidney [Pseudokidney sign], or diffused wall thickening [Target sign]

Conclusion: In our experience, ultrasonography of the gastrointestinal tract is an extremely useful modality for evaluating gut masses from distal esophagus up to rectum. Sonographic appearance ofgut related masses helps to evaluate the clinical differential diagnosis. However, additional work-up may be needed in the form of contrast study, cross-sectional imaging or endoscopy for specifying the diagnosis with histological confirmation

Osteopoikilosis; a rare incidental spotted bone disease on CT

Osteopoikilosis is a benign, asymptomatic, sclerosing bone dysplasia with an autosomal dominant trait. The disease is characterized by diffuse symmetrical small round and ovoid radiopacities in the juxta-particular region of cancellous bone. We reported a rare case of a middle aged female presented with abdominal distension, whose radiological work up revealed an incidental osteopoikilosis

Role of MRI in functional prognosis of metastatic cord compromise

Objective: primary objective of our study was to establish the strength of association of MRI findings at presentation with clinical outcome of patient i.e. Motor deficit and Sphincter control. Secondary objectives included Incidence of tumors affecting spinal cord and Correlation of motor weakness and sphincter control with patient presentation

Methods: this retrospective study was conducted in Department of Radiology,Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, between Jan 2013 and June 2013. The study included series of 64 patients, including 38 men and 26 women, ranging between 35 and 70 years [mean, 48.5+/-13 years], presenting with symptoms and signals of spinal stenosis

Results: results for tumors involving less than 25%, N: 24 [37%] were included in this group. All showed stable appearance or improvement on follow up. Data was not significant [when expecting stability/improvement in 75-100% of patients].When further divided into 2 groups. Improvement was seen in [6] p> 0 and stability in [18] p< 0.05 significant. Results for tumors involving less than 25-50%, N: 26 [40.6%]. 45% showed improvement, when expecting stability/ improvement in 50-75% of patients. Data was statistically insignificant data with p > 0.05.Moreover, the results for tumors involving less than 50-75%, N: 4 [6.2%]. 50% showed improvement/stability post treatment. 50% showed progression. In patients tumors involving less than 75-100%, N: 10 [15%]. 20% showed improvement. Statistically significant data with p< 0.05.Cord signal was compromised in 28 [34.3%]. 22 had muscular weakness. Improvement was seen in 45%. 12 had sphincter dysfunction. 50% showed improvement in clinical symptoms

Conclusion: MRI has a potential to predict the functional outcome in patients with metastatic cord compromise

High resolution ultrasound guided needle aspirate of parathyroid lesion; a preliminary but accurate approach to preoperative identification and localization of parathyroid adenoma

Objective: to determine the sensitivity and specificity of high resolution ultrasound guided FNAC as a preliminary but accurate investigation for identification and localization of parathyroid adenoma for minimally invasive surgical road mapping to position the incision directly over the diseased gland

Material and Methods: this cross sectional study was conducted in Department of Radiology, Omer hospital, Lahore, between September 2012 and September 2013. The study included series of 13 patients, including 5 men and 8 women, ranging between 35 and 70 years [mean 48.5 +/- 13 years]. Neck ultrasound for parathyroid glands was performed in the patients presented with non-specific symptoms of hypercalcaemia. Serological analysis included serum calcium, serum PTH, alkaline phosphatase and creatinine. Exact size, location and number of parathyroid adenomas were assessed followed by US-guided FNA

Results: in 12 out of 13 patients, the position and size of the normal parathyroid gland as well as parathyroid lesions were adequately demonstrated on ultrasound. One patient had ectopic parathyroid adenoma which was confirmed on scintigraphy and excisional biopsy. Two patients had normal appearing parathyroid gland which turned out to be adenomatous on histology. One patient had indeterminate histology of an otherwise hypoechoic parathyroid region reported as adenoma on ultrasound. Remaining 9 patients had large parathyroid adenomas initially picked on ultrasound and later on confirmed on histology through US guided FNA. None of the patients had concomitant thyroid disease or involvement of more than one parathyroid gland. All patients had serum calcium of more than 11 mg/dl and elevated serum PTH. On histopathology of FNA, predominant cell type was chief cells arranged in sheets and occasionally small follicles with variably thick connective tissue capsule. Cells with a clearer cystoplasm and occasionally oncocytic cells were also seen

Conclusion: high resolution ultrasound is a preliminary but sensitive investigation in detecting parathyroid adenomas. When combined with US guided FNA, it becomes a highly specific and accurate modality for preoperative identification and localization of parathyroid adenoma. We highly recommend ultrasound for surgical road mapping of adenomas

Cystic adenomatoid malformation in a young male adult with recurrent respiratory tract infections

We present a case of 26-year-old male with congenital cystic adenomatoid malformation. His medical history started after birth as recurrent respiratory tract infections and breathlessness during his infancy which persisted even after continued medical treatment. Cystic bronchiectasis of right lower lobe was suspected. On cross-sectional imaging at our hospital, congenital cystic adenomatoid malformation of right lower lobe was diagnosed. The clinical features, radiological characteristics, differential diagnosis and prognosis of the disease are discussed

Empyema necessities in a 17 years male with long standing pneumonia

Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleural, usually in the chest wall, to form a subcutaneous abscess. We present a case of 17 year old adult male presented to us for cross-sectional imaging and was diagnosed to be a case of Empyema necessitans besides bilateral empyema associated with right hydro/ hemopneumothorax and multiple thick walled cavitations of variable sizes with multiple air fluid levels in non-segmental distribution involving all lobes bilaterally placed peripherally