A comparative study on the use of ultra-low dose computed tomography scans with conventional computed tomography scans for the evaluation of proximal tibia intra-articular fractures.

Purpose: A rise in the need of preoperative CT assessment of proximal tibial intra-articular fractures has given rise to an increased load of radiation exposure. This comparative study aims at assessing the efficacy of low dose CT scan by collating images of tibial plateau fractures produced by low dose CT scan with that of conventional dose CT scan. Furthermore, the study aims at computing the comprehensive reduction in the effective dosage of radiation when low dose CT scan is employed for assessing these fractures. Methods: The study comprise of 23 cases of proximal tibial intra-articular fractures (confirmed by initial radiographs). Low-dose CT scan of the injured limb was preceded by conventional dose CT scan for generating images that were assessed and reported independently by five (single blinded) radiologists (using Schatzker's CT based classification). Quantification of fracture was done to compare them statistically. Results: A sensitivity of 93.94 % and positive predictive value of 93.92 % was observed on comparing images from low dose and conventional dose CT scan. An effective reduction of 89.81 % in overall dosage of radiation exposure was observed. Conclusion: Near equal quality images were generated by low dose CT scan as compared to conventional dose CT scan, thereby demonstrating its non-inferiority with an effective reduction of 89.81 % in overall dosage of radiation exposure.

An unusual presentation of filariasis in a nonendemic country.

INTRODUCTION: Filariasis is an endemic disease with worldwide distribution in tropical and subtropical regions. It is uncommon in Qatar. The conventional diagnostic procedure is the demonstration of microfilaria in blood smears. Even with its high incidence, it is unusual to detect microfilaria in fine needle aspiration cytology (FNAC) smears. Although the 'filarial dance sign' is rarely documented, it remains a classical ultrasonographic sign in lymphatic filariasis. CASE PRESENTATION: We present a case of a 38-year-old male patient with fever, chills, shortness of breath and a tender warm swelling on his right thigh. Ultrasound of the thigh lesion showed the classical filarial dance sign. Subsequently FNAC from the lesion documented microfilaria in spite of absent peripheral blood eosinophilia and microfilaria. The patient underwent an incision and drainage of the thigh lesion and was treated with ivermectin and diethylcarbamazine. He was subsequently admitted to the medical ward and discharged home after two weeks in a stable condition. CONCLUSION: This case report illustrates the importance of diagnostic tools like ultrasound and FNAC along with a high index of clinical suspicion while evaluating patients presenting with unusual signs and symptoms. We would like to highlight the rarity of filarial presentation in a nonendemic country like Qatar. This case is unique since microfilaria was demonstrated in the pus aspirated from the thigh abscess and showed the filarial dance sign by ultrasound along with involvement of the pleura and pericardium.