Detection of temporal bone cholesteatoma by multidetector computed tomography

Objective: To determine the CT patterns of temporal bone cholesteatoma in patients presenting with chronic discharge from ear

Methodology: This was a cross-sectional study conducted at Department of Radiology, Rehman Medical Institute Peshawar from January 2013 to June 2014. 78 patients with chronic discharging ear, who were referred from E.N.T outpatient department, were included in the study. All scans were performed on 128 slice Multidetector Computed tomography [MDCT] scanner.O.Smm reconstructed images in bone window and 3mm images in soft tissue window were viewed on 5.1 vitrea workstation in axial, coronal and sagittal planes. The CT studies were correlated with clinical examination findings, surgical and histopathology. Basic radiologic patterns of cholesteatoma described on CT scan were assessed. The data was processed using Microsoft excel 2007

Results: Cholesteatoma was present in 48 [61%] cases. The disease was bilateral in 7 cases [14 %], 39 [81 %] were unilateral. 25 [52%] were left sided and 14 [29%] right-sided. 24 [30 %] patients were characterized as having otomas-toiditis whereas 7[8%] patients were radiologically difficult to characterize if they were cholesteatoma or not

Conclusion: Cholesteatomas can cause bone erosions and should be detected early. The important role of MDCT lies in the early detection of cholesteatoma, and more conservative surgical procedures can be used to eradicate the disease

Uterine fibroids going into the heart: intra-vascular and intra-cardiac leiomyomatosis: a very unusual presentation

This case report is of a 50 years old female who presented with vague history of long term abdominal pain, shortness of breath and echocardiographic suspicion of right atrial mass. She was investigated using 128-slice Multidetector Computed tomography [MDCT] scanner in the Department of Radiology

Images of lower chest, entire abdomen and pelvis were taken in venous phase. On CT images of our patient, uterus was significantly enlarged and replaced by multiple contour deforming fibroids, which were involving the right ad-nexa, invading the right ovarian vessels, and extending into the right ovarian vein, inferior vena cava [IVC] and right atrium of heart

The findings were confirmed on surgery. Surgery also confirmed extension into right ventricle and pulmonary arteries i.e. pulmonary leiomyomatosis emboli. The histologi-cal findings were consistent with intravascular leiomyoma. MDCT images play instrumental role for preoperative morphologic assessment of IVL as it can easily identify the precise location, extent and provide a roadmap for the surgeons

HRCT lung findings in post chemotherapy patients - emerging challenge for radiologists

Objective: to characterize, diagnose and to differentiate various HRCT manifestations of lung abnormalities in post chemotherapy patients

Methodology: this was a retrospective study of 50 patients conducted at Ra-diology department of Rehman Medical Institute, Peshawar. Duration of study was 6months i.e from April 2013 to September 2013. Patients were investigated using 128-slice Multidetector Computed tomography [MDCT] scanner in the Radiology department of Rehman Medical Institute Peshawar. 0.5mm reconstructed images in lung window and 3mm images in mediastinal window were viewed on workstation in axial, coronal and sagittal planes. The data was processed using Microsoft excel 2007

Results: a total of 50 patients were included. Age of the patients ranged from 6 to 70 years with a mean age of 35 years. In our study, we found five radiologic patterns on CT scan; [1]non-specific ground-glass attenuation 17[34%],[2] patchy distribution of ground-glass attenuation accompanied by interlobular septal thickening 7[14%], [3]multifocal areas of airspace consolidation 7[14%],[4]extensive bilateral ground-glass attenuation or airspace consolidations with traction bronchiectasis 4[8%], and [5] nodules of variable sizes randomly distributed in both lungs 15[30%]

Conclusion: the most common pattern was found to be patchy areas of ground-glass attenuation. Pulmonary diseases that are induced by chemotherapy represent particular challenges for radiologists due to non-specific and atypical imaging features

Uncommon sites of a common disease - hydatid cyst

Objective: To review uncommon sites of hydatid cysts and to assess radiological features of hydatid disease in head, neck, spine and heart

Methodology: A retrospective study of 50 cases of hydatid disease attended at Radiology department of Rehman Medical Institute, Peshawar between May 2012 and November 2013 was conducted to determine the incidence and imaging presentations of atypical localization of the disease. After taking permission from ethical committee, indoor and outdoor patients with hydatid cysts were selected for the study. All data was entered and analyzed using SPSS version 10.0.The data was assessed using Microsoft excel 2007

Results: A total number of 50 patients had Hydatid cysts. Two patients had multiorgan involvement i.e., one had liver and lung involvement while other had liver and brain involvement. The cysts were present in brain [n=3, 6%], spine [n=2, 3%], neck soft tissues [n=1, 1%], heart [n=2, 3%], ovary [n=3, 6%], kidney [n=1, 1%], spleen [n=3, 6%], peritoneal cavity [n=2, 4%] and pancreas [n=1, 1%]. Liver was involved in 20 [41%] cases while lung was involved in 14 [28%] cases

Conclusion: Hydatid disease can involve unusual sites like heart, brain, neck, spine and pancreas. It may occur anywhere, from the big toe to the crown of the head and should be kept in consideration when a cystic lesion is encountered anywhere in the body especially in endemic areas

Visualization of a giant coronary artery aneurysm by multi-detector computed tomography

The diagnostic criteria, Computed tomography [CT] appearances, and importance of multidetector CT in diagnosis of coronary artery aneurysms is reviewed in this case report. CT coronary angiography was performed using a 128-slice MDCT scanner in an adult male with chest pain and echocardiographic suspicion of a complex lesion in pericardial cavity. CT revealed giant aneurysm of first obtuse marginal [OM 1] branch of left circumflex coronary artery. It was partly thrombosed. There was mild pericardial effusion raising strong suspicion of aneurysmal leak. Results were confirmed on conventional coronary angiography performed later. MDCT can visualize coronary artery aneurysms very precisely and it provides an excellent view of the anatomy of the coronary artery as well as the surrounding tissues. This exact knowledge of the anatomy is crucial for planning a surgical or interventional approach. With the increasing use of multidetector CT [MDCT] to image the coronary arteries, aneurysms will be identified more frequently

Validity of color doppler sonography in evaluation of malignant portal vein thrombosis in hepatocellular carcinoma

The objective of this study was to assess the validity of color doppler sonography in the evaluation of malignant portal vein thrombosis in hepatocellular carcinoma [findings on biphasic spiral computed tomography were used as the gold standard]. This study was conducted in the Department of Diagnostic and Interventional Radiology at Shifa International Hospital, Islamabad from March 2009 to November 2009. A total of 100 patients those who were already diagnosed cases of HCC or those having high suspicion of HCC based on clinical criteria [e.g., chronic hepatitis B or C, liver cirrhosis, increased alpha fetoprotein level [>400ng/dl]] and /or Imaging findings [e.g., sonography, MRI, CT] were included in this study. Color doppler sonography had 80.7% sensitivity and 100% specificity in the detection of arterial flow in the portal vein thrombus [i.e., malignant thrombus] in comparison with biphasic CT [taken as gold standard]. Color doppler sonography is an effective, noninvasive method for evaluating the presence of malignant portal vein thrombosis associated with HCC

Lateral medullary syndrome: clinicao-radiological correlation

Lateral Medullary syndrome is not a very common disorder and remains undiagnosed at times. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The usual symptoms of this syndrome include vertigo, dizziness, nystagmus, ataxia, nausea and vomiting, dysphagia, hoarseness, hiccups, impaired sensation over half the face, impairment of pain and thermal sensation over the contralateral hemibody and limbs and the ipsilateral face, and Horner's syndrome. Four cases of lateral medullary syndrome are reported who were diagnosed on clinical basis and later on confirmed by MRI. Our objective is to correlate clinical and radiologic findings in patients with lateral medullary syndrome