Synchronous haematogenous colonic metastasis from a primary renal cell carcinoma: an unusual cause of colonic haemorrhage: [case report]

Background: renal cell carcinoma [RCC] represent 2-3% of all malignant tumors in adults. Clear cell carcinoma is the most frequent histological type, and 25-30% of renal carcinoma have metastasis at the time of diagnosis. RCC very rarely metastasize to the colon. The objective of the present study is to report synchronous haematogenous solitary colonic metastasis that presented as severe recurrent lower gastrointestinal haemorrhage which required right hemicoloectomy and right nephrectomy plus chemotherapy

Clinical Case: we report the case of a 46-year old male patient who presented with multiple episodes of severe haemotochezia and anemia. He had a right flank mass. CT scan of the abdomen showed a large right kidney mass together with a lesion in the ascending colon, not connected to the renal mass. It also showed hepatic metastasis, lung metastasis and ascites. Colonoscopy revealed an ascending colonic mass. The patient was managed by right nephrectomy and right hemicolectomy. The pathology report of the colonic mass showed clear cell carcinoma with involvement of the colon from serosa to mucosa. It indicated the presence of haematogenous spread of the RCC as the mechanism of metastasis. The colonic haemorrhage did not recur. the patient survived close to a year after surgery

Conclusion: RCC metastasis to the colon is very rare and can be synchronous with the primary renal tumor and can be metachronous after nephrectomy. Also, it can be the result of direct invasion, haematogenous spread or after local recurrence following nephrectomy. Metastatic RCC requires surgery, immunotherapy, tyrosine kinase inhibitors, and mammalian target rapamycin inhibitors. Surgery is the first step for disease control and control bleeding from colonic metastasis. Metastectomy is indicated in localized disease and when surgically accessible

role of magnetic resonance enterography [MRE] in detecting features of inflammatory bowel disease [IBD]

Magnetic resonance enterography MRE is a clinically useful technique for the evaluation of intraluminal and extraluminal small bowel disease, particularly in younger patients with Crohn disease [CD]. MRE offers the advantages of multiplanar capability and lack of ionizing radiation. It allows evaluation of bowel wall contrast enhancement, wall thickening, and edema, findings useful for the assessment of CD activity. MRE can also depict other pathologic findings such as lymphadenopathy, fistula and sinus formation, abscesses, and abnormal fold patterns

Objective: to enhance the use of MRE in the diagnosis of IBD in the Middle East area especially in Jordan

Prostatic abscess MRI findings: case report

Prostatic abscesses are a rare complication of acute prostatitis, and an uncommon clinical entity in the antibiotic era. Despite their rarity, untreated abscesses still remain potentially life-threatening, and require formal drainage to permit resolution. Here in, we report the MRI findings in 73 - years old man who presented with severe dysurea of two weeks duration . He was found to have multiple prostatic abscesses which was surgically drained

Hip magnetic resonance imaging: descriptive epidemiology and outcome in Jordan University Hospital

To evaluate the experience in Jordan University Hospital regarding hip magnetic resonance imaging and to compare our findings with those published in medical literature. one hundred eighty two hip magnetic resonance images performed over the period of 7 years were reviewed, 88 patients [48.3%] had normal hip magnetic resonance image and were excluded from the study while the remaining 94 images [51.6%] with variable abnormalities were included in our study. Variable hip pathologies were seen, the most common was bone marrow edema syndrome found in 22 patients representing [23.4%] of the pathologies detected, followed by transient osteoporosis in 16 [17%] patients and avascular necrosis of the hip joint in 13 [13.8%] patients. Slipped femoral capital epiphysis and Paget_s disease were the least common seen in [1.1%] for each. In Jordan University Hospital referred patients for hip MRI scanning showed diverse findings with the most common abnormality detected being bone marrow edema syndrome of the femoral head followed by transient osteoporosis and avascular necrosis. The great benefit from magnetic resonance imaging was in diagnosing transient osteoporosis, staging avascular necrosis of the hip joint and characterization of deep pelvic soft tissue masses. The prevalence of hip pathology among Jordan University hospital patients as revealed by magnetic resonance imaging was in concordance with what was published in the literature

Ultrasound measurement of liver span in Jordanian adults: a preliminary experience

One of the most frequent ultrasound requests by clinicians is evaluation of hepatic size. Clinical evaluation by percussion and palpation can be inaccurate, unreliable with significant inter-observer variation. Ultrasound remains a very important imaging modality when the liver is concerned because it is simple, practical and easy-to-use. Yet, ultrasound measurement of liver span didn't receive much attention, particularly in this region. The aims of this study were to establish a normal figure of liver span for adults in Jordan, to investigate relationships between liver span and several anthropometric factors including age, gender, weight, height, body mass index and body surface area and to standardize ultrasound measurement of liver span. A prospective study was carried out at Jordan University Hospital between March 2007 and April 2008, on non-selected population sample of 242 male and 275 female adults with age range of 18-76 years. Statistical analyses including correlation, regression and 95% confidence intervals were performed on the data to test the statistical significance of the various relationships between liver span as represented by midclavicular line longitudinal diameter on one side, and several anthropometric factors including age, gender, weight, height, body mass index and body surface area. Our results showed that all anthropometric variables contributed highly and significantly to the variation in female liver span. The same factors however, with the exception of body mass index, significantly contributed to the variation in male liver span, however to a much lesser extent than females. The best predictor of liver span was height in case of males, body surface area in case of females. And both height and body surface area when both genders are considered. The 95% liver span confidence intervals were 12.3-12.8, 11.9-12.3 and 12.2-12.5 for males, females, and both genders combined, respectively. Height and body surface area were the best determinants of liver span in males and females, respectively

Uncommon incidental pseudoaneurysm. Diagnostic and management challenges

To analyze patients with uncommon incidental pseudoaneurysms, secondary to non-catheterization causes, and to discuss the peculiar clinical spectrum, and focus on some aspects of difference from post-catheterization pseudoaneurysms. Eleven patients, 8 males and 3 females, were studied retrospectively in Jordan University Hospital, Amman, Jordan, between 2002-2008. Radiological studies performed included duplex sonography [DS], computed tomography [CT], conventional angiography, magnetic resonance imaging [MRI], and magnetic resonance angiography [MRA]. Pseudoaneurysms were most commonly encountered in young males [63.6%], especially in the lower limb vessels [36%]. Clinical findings were suggestive of pseudoaneurysms in 27% of our cases. Four out of the 8 DS scans showed the neck of pseudoaneurysms, and the "to and fro" waveform, the strongest indicators for pseudoaneurysms. Both CT with intravenous contrast and angiography failed to establish the diagnosis in one out of 5 cases. The MRI with MRA showed the pseudoaneurysms in 2 patients that underwent the scan. Incidental pseudoaneurysms are considered following iatrogenic procedures, penetrating, or blunt traumas with variable delay time. Young healthy males are at increased risks, as opposed to elderly females with calcified vessels in post-catheterization cases. Duplex sonography is less sensitive in incidental than post-catheterization pseudoaneurysms. The CT scan with intravenous contrast has high accuracy in establishing the diagnosis in small, or medium sized pseudoaneurysms. The MRI and MRA are accurate valuable studies and comparable to conventional angiography

Influence of patient's age on prostate volume, and serum PSA levels

Prostate specific antigen could be elevated in prostatic and non prostatic diseases, therefore it is not specific for prostate pathology .We evaluated in this retrospective study other factors such as patient's age to determine its effect on the prostate specific antigen level and prostate volume in normal, benign, and malignant conditions. One hundred twenty one patients who underwent transrectal ultrasound biopsy were included in this study. The prostate volume, total prostate specific antigen, free prostate specific antigen, and percent free prostate specific antigen in normal, benign, and malignant conditions were evaluated Descriptive analysis, Two tailed student's t- test, Anova test and Pearson's correlation coefficient were used for statistical analysis. Biopsy results yielded 35 patients with prostate cancer [29%], 77 patients with benign prostatic hyperplasia [64%], and no abnormal histological finding in nine patients [7%].There was positive correlation between patient's age and prostate volume [r = 0.22, p < 0.05] Positive correlation was also found between patient's age and prostate specific antigen levels, total prostate specific antigen, and free prostate specific antigen [r = 0. 10 and r = 0. 1 8 respectively, p value was > 0.05]. Across categories no significant difference was found neither in the mean patient's age, nor in the prostate specific antigen levels [p > 0.05]. Although patient's age affects both total and free prostate specific antigen levels, but it could not be used as prostate cancer predictor