Machine learning in action: Revolutionizing intracranial hematoma detection and patient transport decision-making.

Objectives: Traumatic intracranial hematomas represent a critical clinical situation where early detection and management are of utmost importance. Machine learning has been recently used in the detection of neuroradiological findings. Hence, it can be used in the detection of intracranial hematomas and furtherly initiate a management cascade of patient transfer, diagnostics, admission, and emergency intervention. We aim, here, to develop a diagnostic tool based on artificial intelligence to detect hematomas instantaneously, and automatically start a cascade of actions that support the management protocol depending on the early diagnosis. Materials and Methods: A plot was designed as a staged model: The first stage of initiating and training the machine with the provisional evaluation of its accuracy and the second stage of supervised use in a tertiary care hospital and a third stage of its generalization in primary and secondary care hospitals. Two datasets were used: CQ500, a public dataset, and our dataset collected retrospectively from our tertiary hospital. Results: A mean dice score of 0.83 was achieved on the validation set of CQ500. Moreover, the detection of intracranial hemorrhage was successful in 94% of cases for the CQ500 test set and 93% for our local institute cases. Poor detection was present in only 6-7% of the total test set. Moderate false-positive results were encountered in 18% and major false positives reached 5% for the total test set. Conclusion: The proposed approach for the early detection of acute intracranial hematomas provides a reliable outset for generating an automatically initiated management cascade in high-flow hospitals.

Transhepatic ultrasound guided embolization as a successful novel technique in treatment of pediatric complex intrahepatic arterioportal fistula: a case report and review of the literature.

INTRODUCTION: Intrahepatic vascular shunts "IHVS" are abnormal communications between intra-hepatic vasculature involving the arterial, portal, or hepatic venous system. Arterio-portal fistula "APF" is an intrahepatic communication between the hepatic arterial system and the portal venous system without any communication with the systemic venous circulation. APF is considered a rare cause of portal hypertension and gastrointestinal bleeding in infancy. CASE PRESENTATION: A 3-month-old Mediterranean female with known cardiac congenital anomalies presented to us with abdominal distension and diarrhea. Ultrasonography revealed massive ascites and computerized tomography (CT) abdomen with intravenous (IV) contrast revealed a left hepatic lesion. On further evaluation, an intrahepatic arterio-portal vascular malformation was detected. Attempted trans arterial embolization failed and radiology team successfully carried out direct trans hepatic ultrasound guided coiling of the aneurysmal venous sac followed by successful resection of segment 4 of the liver with the vascular malformation avoiding life threatening intra operative bleeding. CONCLUSION: Any child with recurrent gastrointestinal bleeding, failure to thrive, vomiting, diarrhea, steatorrhea, splenomegaly, or ascites should be investigated for intrahepatic arterio-portal fistula "IAPF". Our novel technique of direct trans hepatic ultrasound guided coiling is an alternative method if trans arterial embolization "TAE" failed.

Bilateral subdural hygromas after endovascular coiling for ruptured aneurysmal subarachnoid hemorrhage: an unusual and rare complication.

Subarachnoid hemorrhage (SAH) with subdural hygroma (SH) was rarely reported after endovascular coiling. A 60-year-old male presented with impaired consciousness and convulsions due to SAH from a ruptured aneurysm. It was managed by endovascular coiling 20 h after the onset of symptoms. Serial brain imaging for 2 weeks revealed progressive bilateral SHs, more on contralateral side of leaking aneurysm. Management of SH was discussed in a multidisciplinary setting to be conservative as there was neither significant mass effect nor hydrocephalus. The patient recovered neurologically except for mild dysarthria. The SH persisted for 2 months and then cleared gradually. We concluded that SH may arise and become symptomatic as an unusual sequela of post-coiling of a ruptured intracranial aneurysm, in which the SH can complicate the clinical course of SAH. However, the symptomatic SH may resolve spontaneously and completely without any intervention, but needs meticulous neurological assessment and follow-up.

Report of a case of Cobb syndrome: multimodality imaging.

Cobb syndrome is a rare vascular disorder characterized by vascular skin lesions distributed in a dermatomal pattern, with corresponding muscular, osseous, paraspinal, and/or spinal vascular lesions occurring at the same body somite (metamere). We present a case of a 25-year-old man who presented with a history of right upper limb paresthesia followed by bilateral progressive upper and lower limb weakness and heaviness. Physical examination showed large cutaneous port wine stains on the right side of the chest, the nape, and along the whole right upper limb in a dermatomal distribution, with no corresponding limb hypertrophy or asymmetry. MRI and CT scan of the cervical spine showed aggressive vertebral hemangiomas involving the right side of C1 down to C4 vertebrae associated with extraosseous epidural lesion causing cervical cord compression, in addition to right paraspinal muscular low flow vascular malformations. Digital subtraction angiography of the neck vessels showed corresponding vascular blush and delayed contrast pooling in the affected regions. Cobb syndrome was diagnosed based on the dermatomal distribution of the cutaneous vascular lesions and the corresponding vertebral, epidural, and paraspinal vascular lesions occurring at the same metamere. The patient underwent a decompressive laminectomy at C2-C6 levels with removal of the epidural lesion, after which his symptoms had improved.

CT tractography in anterior abdominal stab wounds: a proposed algorithm.

PURPOSE: This study evaluates the accuracy of IV contrast-enhanced computed tomography (CT) tractography in the detection of peritoneal violation in anterior abdominal stab wounds (AASW) and its impact on the management algorithm. METHODS: This prospective study included 61 patients who presented to Kasr Alainy Hospital with AASW. According to the IV contrast-enhanced CT tractography, they were classified into penetrating, equivocal and non-penetrating injuries. The former two were subjected to diagnostic laparoscopy (DL), while the non-penetrating group was subjected to serial abdominal examination (SAE). The accuracy of CT tractography to detect peritoneal violation was assessed by correlating its findings with management outcome. RESULTS: CT tractography stratified the injuries into non penetrating (54.1%), equivocal (14.8%) and penetrating (31.1%). All non-penetrating stabs were managed successfully by SAE. DL proved negative for peritoneal violation in all equivocal injuries and positive in all injuries designated as penetrating. Consequently, sensitivity, specificity, positive and negative predictive values and accuracy of CT tractography in detecting peritoneal violation was 100%. No missed injuries were encountered in this study. CONCLUSION: IV contrast-enhanced CT tractography is an effective tool in the evaluation of patients with AASW. Patients with negative tractography can be safely managed by SAE. Positive tractography accurately indicates peritoneal violation which warrants further management. Patients with equivocal findings were all negative for peritoneal violation by laparoscopy, therefore, they might be reallocated for frequent SAE to reduce the rate of non-therapeutic interventions.

Endoscopic intervention in a case proven latterly to be a COVID-19.

BACKGROUND: COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the newly developed worldwide outbreak of coronavirus disease with a high rate of mortality especially among elderly and multiple co-morbid personnel. Asymptomatic COVID-19-infected patients are a well-known source of transmission of infection. The risk of exposure to respiratory secretions and/or feces is hardly avoidable during the endoscopic procedure; also, the aerosol and droplets take up to an hour disperse, so they remain a risk to staff and other patients after they leave the room; therefore, strict infectious precautions should be taken by all health care workers to limit the virus spread. MAIN BODY: We present an endoscopic trial of duodenal stent insertion in non-operable gastric carcinoma that is proven 2 days later to be a COVID-19-positive case. Fortunately, no one of the health care workers that came in contact with the case becomes infected owing to the proper infection control measures. CONCLUSION: We recommended that the endoscopy examination and procedures should be strictly limited to urgent cases to minimize the risk of virus infection among health care workers.