Radiology Commons^™

Cerebral Fungal Infection With Mycotic Aneurysm Of Basilar Artery And Subarachnoid Haemorrhage, H. Ahsan, F. Ajmal, M. F. Saleem, A. B. Sonawala

Department of Radiology

A 28-year-old Pakistani man was admitted with unresolved severe headaches for the past four weeks. Magnetic resonance (MR) imaging and MR angiography showed an enhancing mass in the sphenoid sinus, bilateral cerebellar infarcts and aneurysmal dilatation of the basilar artery. The differential diagnosis included fungal infection versus neoplastic lesion. The scrappings taken through the endoscope from the sphenoid sinus were initially negative for fungal infection. However, the second biopsy, done after putting him on antifungal, itraconazole 200 mg twice daily, revealed the presence of a fungal infection (aspergillosis). MR imaging revealed extension of the fungal infection from the sphenoid sinus …

Autoimmune Pancreatitis: Disease Evolution, Staging, Response Assessment, And Ct Features That Predict Response To Corticosteroid Therapy, Dushyant V. Sahani, Nisha I. Sainani, Vikram Deshpande, Mehrine S. Shaikh, Dmitry L. Frinkelberg, Carlos Fernandez-Del Castillo

Department of Radiology

Purpose:To evaluate the evolution of morphologic features of autoimmune pancreatitis (AIP) at computed tomography (CT) and to identify imaging features that can predict AIP response to corticosteroid therapy (CST). Materials and

Methods:

This HIPAA-compliant retrospective study had institutional review board approval. From among a cohort of 63 Patients with AIP, 15 Patients (12 men, three women, mean age, 64.7 years, age range, 30-84 years) who underwent sequential CT examinations before treatment were included to assess the evolution of disease by reviewing pancreatic, peripancreatic, and ductal changes. Of these Patients, 13 received CST and underwent posttreatment CT, these CT studies …

Labrad : Vol 34, Issue 1 - January 2009, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• N-Telopeptide of Type I Collagen (NTx): A Biochemical Tool for Assessing Bone Turnover
• Automated Blood Grouping
• Leukocyte Alkaline Phosphatase (LAP Score)
• Pathology Quiz
• Synovial Fluid Analysis in Important Joint Diseases
• Intraductal Papillary Mucinous Tumor (IPMT) of the Pancreas: A Diagnostic Challenge
• Hepatitis Delta Virus (HDV)
• Answers to Pathology Quiz
• Thyroid Autoimmune Diseases and Thyroid Peroxidase (TPO) Antibody
• Therapeutic Monitoring of Tacrolimus
• Meeting Report: 32 Annual Conference of Pakistan Association of Pathologists
• AKU Clinical Laboratory Continuing Medical Education (CME) Seminar in Bahawalpur

An Audit Of Editorial Processing At Jcpsp: Issues And Compliance, Saba Sohail

Department of Radiology

No abstract provided.

Mesenteric Panniculitis With Pedal Edema In A 33-Year-Old Pakistani Man: A Case Report And Literature Review., Abdul M Zafar, Muhamad A Rauf, Tabish Chawla, Gule Khanda

Department of Radiology

Introduction:Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death. Case Presentation: A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The Patient underwent an exploratory laparotomy based …

Torsion Of Fallopian Tube, Fimbrial Cyst, Imrana Masroor, Nadir Khan

Department of Radiology

A case of fallopian tube fimbrial cyst torsion with haemorrhage is presented, occurring in a 37-year-old female who had tubal ligation 6 years back. She presented in emergency with acute abdomen. Initial assessment of ovarian cyst haemorrhage or torsion was made. Ultrasound showed cystic structures in left adnexa and complex cyst in right adnexa with suspicion of torsion. Laparoscopy was performed and bilateral fimbrial cysts in fallopian tubes were identified with torsion on right side, and a left ovarian haemorrhagic cyst, which was subsequently confirmed on histopathology. Although fallopian tube torsion of fimbrial cyst is rare, it should be considered …

Assessment Of Menisci And Ligamentous Injuries Of The Knee On Magnetic Resonance Imaging: Correlation With Arthroscopy, Gul-E Khanda, Waseem Akhtar, Humera Ahsan, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To evaluate the validity of MRI, in the assessment of the meniscal and cruciate ligamenteous injuries of the knee joint and comparison with arthroscopic findings.

METHODS: A one year prospective cross-sectional study from January 2006 to January 2007, was performed on 50 patients (32 males & 18 females) with knee injury presenting at the orthopedic unit of AKUH. The patients were referred to radiology department for MRI evaluation and arthroscopy.

RESULTS: The sensitivity, specificity and accuracy for MRI of the menisci and ligaments were as follows: medial meniscus resulted in 100% sensitivity, 69.27% specificity, 90% PPV, 100% NPV and …

Labrad : Vol 33, Issue 3 - September 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Vitamin D Deficiency: Are We Still Ignoring the Evidence?
• Collection and Transport of Urine for Culture
• Understanding and Interpreting Serum Protein Electrophoresis
• Cystic Fibrosis at a Glance
• What you need to know about Dengue Infection
• CT Colonoscopy: Introduction
• CT Enteroclysis: A New Technique to Evaluate Small Bowel
• CSF-DR: An Important Diagnostic Tool
• G6PD Quantification
• Quality Assurance
• Clinical Laboratory Continuing Medical Education (CME) Seminars
• Meeting Reports

99mtc-Nannocolloid Localization Of Lymphorenal Fistula Causing Chyluria, Maseeh Uz Zaman, Riffat Parveen Hussain, Khalil Ahmed Khan, Gufran Khan, M. Nadeem Ahmad

Department of Radiology

Chyluria is an abnormal condition in which chyle appears in the urine because of a fistulous communication between the lymphatics and the urinary tract. It is not life-threatening and spontaneous regression is reported in 50% of cases. Lymphangiography has been the main imaging modality for localization of the site of fistula, but it is invasive and requires expertise. Lymphoscintigraphy using Tc-99m labelled colloid is a safe, non-invasive, reproducible technique, which bears less radiation exposure. A 67-year-old male presented with 7-month history of chyluria following a spinal surgery. Bilateral lower limb lymphoscintigram revealed sluggish lymph flow in the left lower limb …

Perfusion Imaging In Ischaemic Stroke, Zafar Sajjad

Department of Radiology

Perfusion imaging allows the blood flow to the tissue to be imaged. It is currently widely applied to the management of acute ischaemic stroke. Using either Computerised Tomography or Magnetic Resonance Imaging techniques, perfusion maps can be created in a short enough time to allow their routine use in clinical practice. Perfusion Imaging enables the physician to directly estimate the tissue at risk which can be salvaged with reperfusion, enabling appropriate patient selection. Perfusion imaging however has its limitations which need to be kept in mind when these studies are interpreted. Although perfusion imaging is widely used, the evidence to …

The Unifying Dilemma Of The Pakistani Science Journals, Saba Sohail

Department of Radiology

No abstract provided.

Labrad : Vol 33, Issue 2 - May 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Tartrate Resistant Acid Phosphatase (TRAP): An Important Diagnostic Tool for Hairy Cell Leukaemia
• Heterotopic Pregnancy: A Case Report
• Biochemical Markers of Excessive Alcohol Use
• Osmotic Fragility
• Pattern of Drug Abuse in Patients Presenting at a Referral Lab
• Achondrogenesis
• Molecular Diagnosis of Human Papilloma Virus
• Diagnosis of Clostridium Difficile Associated Diarrhoea
• Pakistan Association of Pathologists – Meeting Report

Cleaning Methods For Ultrasound Probes, Waseem Akhtar Mirza, Syed Hadi Imam, Kharal Mohd Salim, Mubashir Aslam, Syed Arif Ali, I. Masroor, M. Nadeem Ahmad

Department of Radiology

Objective: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections.

Study Design: Experimental study.

Place and Duration of Study: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007.

Patients and Methods: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning …

Unusual Presentation Of Idiopathic Retroperitoneal Fibrosis: Case Report, N. Twahirwa, J. Rees

Imaging & Diagnostic Radiology, East Africa

Idiopathic retroperitoneal fibrosis (IRF) is an uncommon entity described as progressive proliferation of connective tissues leading to a fibrous plaque-like lesions that encases the aorta and inferior vena cava inferior to the level of the renal arteries. Mass forming retroperitoneal fibrosis is rare. We present a rare case of a unilateral focal retroperitoneal mass simulating a tumour encasing the middle third of the left ureter, with involvement of the ipsilateral scrotum.

Primary Cutaneous B Cell Lymphoma--Leg Type (New Eortc--Who Classification), With Nasal Sinuses Involvement, Asim Jamal Shaikh, Nehal Masood, Aamir Ahsan, Wasim Memon

Department of Radiation Oncology

Primary Cutaneous lymphomas of B cell origin are rare, there remains a controversy in truly classifying these lymphomas and an updated EORTC classification divides them on the basis of their distinct histopthological grounds rather than on the basis of their anatomic location as in WHO classification, while the new WHO- EORTC joint classification maintains some characteristics of both systems, We report an elderly gentleman who primarily had a typical Leg dominant Cutaneous lymphoma of B cell origin uniquely with involvement of nasal Sinusues, bearing the Immunohistochemical staining features of "Cutaneous lymphoma - Leg Type" befitting the new joint WHO-EORTC classification …

Effectiveness Of Assigning Bi-Rads Category-3 To Breast Lesion With Respect To Follow-Up, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up.STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi, from January 2002 to December 2004.

PATIENTS AND METHODS: Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased …

Film Retakes In Digital And Conventional Radiography, Waseem Akhtar Mirza, Mubashir Aslam, Arif Ali, Kashif Mirza, Nadeem Ahmad

Department of Radiology

Objective: To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method.
Study design: Comparative study.
Place and duration of study: Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006.
Patients and methods: X-rays of different body parts, conducted during the year 2004, with conventional radiography (n=170300), and in 2006 with digital radiography (n=174550), were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, …

Film Retakes In Digital And Conventional Radiography, Waseem Akhtar Mirza, Mubashir Ahmad, Syed Arif Ali, Kashif Mirza, Nadeem Ahmad

Department of Radiology

Objective: To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method.
Study design: Comparative study.
Place and duration of study: Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006.
Patients and methods: X-rays of different body parts, conducted during the year 2004, with conventional radiography (n=170300), and in 2006 with digital radiography (n=174550), were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, …

Isolated Tuberculous Thyroiditis As Solitary Thyroid Nodule, Maseeh Uz-Zaman, Riffat Hussain, Muhammad Kashif Mirza, Khalil Ahmed Khan, Ghufran Mohammad Khan, M. Nadeem Ahmad

Department of Radiology

Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan.

Magnetic Resonance Imaging (Mri) Findings In White Matter Disease Of Brain, Humera Ahsan, Muhammad Zafar Rafique, Fozia Ajmal, Mohsin Wahid, Muhammad Azeemuddin, Farah Iqbal

Department of Radiology

Demyelinating and dysmyelinating white matter diseases are important components of neurological problems. Recently, Magnetic Resonance Imaging (MRI) has played a key role in diagnoses of white matter diseases. Therefore, the purpose of the current study is to evaluate the usefulness of MRI in determining the type and frequency of white matter disease. We studied 35 patients who visited the Radiology Department of the Aga Khan University Hospital (AKUH) for MRI with suspected demyelinating/dysmyelinating disorder from January 2003 to December 2005. Multiple Sclerosis (MS) (17; 48%) and leukodystrophies (10; 29%) were the most common diseases. The MRI helped identify the sites …

Endovascular Stenting For Carotid Artery Stenosis: Results Of Local Experience At Aga Khan University Hospital, Karachi, Muhammad Azeem Uddin, Tanveer Ul Haq, Ishtiaque Ahmed Chishty, Zafar Sajjad, Basit Salam

Department of Radiology

Objective: To evaluate the results, complications and initial follow-up of patients after percutaneous stent placement for carotid artery disease.Methods: A retrospective study was carried out on patients treated with carotid artery stenting at the Radiology Department of Aga Khan University Hospital, Karachi, from September 2002 to December 2005. The patients were selected according to the institutional guidelines for Carotid Angioplasty and stenting. Preliminary angiogram was performed in all patients followed by stent deployment. Distal protection device was used in 12 patients. All patients underwent pre and post procedure independent neurological examinations. Follow-up consisted of serial duplex ultrasonography and clinical assessment.Results: …

Labrad : Vol 33, Issue 1 - January 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Diagnosis of Malaria
• Imaging Feature of Synovial Sarcoma in Pediatrics Patients
• Fine Needle Aspiration Biopsy: The best test to differentiate benign from malignant thyroid nodules
• HLA-B27 and Disease Association
• Bacterial Contamination of Blood Components
• Pathology Quiz
• Biochemical Investigations
• Leishmaniasis
• Answers to Quiz
• CD55 and CD59 for the Diagnosis of PNH
• Meeting Report

Comparison Of Doppler Studies In Obstetrics With Fetal Outcome, Sheila Waa

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: to compare umbilical artery and middle cerebral Doppler ultrasound values in normal and high risk pregnancies with fetal outcome. Method: 121 consecutive pregnancies (at or over 28 weeks gestation), stratified into low and high risk pregnancies based on clinician information were prospectively examined with doppler ultrasound of UA and MCA. Results: outcome was available for 100 of the 121 patients. 26% of pregnancies had poor outcome. Of these 73% (19) and 27% (7) were classified as high risk and low risk respectively. UA alone or in combination with MCA was shown to have 100% specificity for predicting fetal outcome. …

Evaluation Of Suspected Renal Colic Patients With Unenhanced Low-Dose Multidetector Computed Tomography (Mdct), Nebayosi Twahirwa

Master of Medicine in Imaging and Diagnostic Radiology

Acute renal colic is probably one of the most excruciatingly painful event a person can endure. [1]. Though this is typical of urinary tract calculi, it’s important to note that non-calculus and non-genitourinary conditions can present in a similar manner. Unenhanced helical CT (CT KUB), originally described by Smith et al [2] in 1995, is one single radiological test that has proven successful in the valuation of patients presenting with renal colic. This technique has been shown to be more accurate compared to abdominal radiography [3,4], ultrasound and has replaced excretory urography in the detection of urinary tract calculi in …

Embolization Of An Intracranial Arteriovenous Malformation Followed By Immediate Surgical Resection: A Case Report, Imaad Ur Rehman, Tanveer Ul Haq, Rashid Jooma, Muhammad Azeemuddin, Zafar Sajjad

Department of Radiology

Intracranial arteriovenous malformations (AVMs) are now a recognized entity because of improvements in imaging diagnosis. They are relatively uncommon but can cause serious neurological symptoms or death. We report a case of a 22- year-old man who presented with left parietal hemorrhage and on cerebral angiography was found to have a small AVM in the left middle cerebral artery (MCA) territory. Glue embolization followed by immediate surgical resection of the AVM was carried out, resulting in complete cure.

Breast Cancer In Pakistan - Awareness And Early Detection, Saba Sohail, Shams Nadeem Alam

Department of Radiology

No abstract provided.

Perforated Appendicitis: Accuracy Of Ct Diagnosis And Correlation Of Ct Findings With The Length Of Hospital Stay, Asma Hina Siddiqui, Shaista Afzal

Department of Radiology

Objective: To determine the sensitivity and specificity of CT findings in the differentiation of perforated from nonperforated appendicitis and correlate CT diagnosis with the length of hospital stay.STUDY Design: An analytical study.PLACE AND DURATION OF STUDY: This study was conducted at Radiology Department of Aga Khan University Hospital, Karachi, from January 2004 to June 2005.PATIENTS AND Methods: The study included 70 patients who presented with right lower quadrant abdominal pain and underwent pre-operative CT scan followed by appendectomy. Patients were divided into two groups of having perforated and nonperforated appendicitis on the basis of CT scan findings. The surgical and …

Traumatic Carotid-Cavernous Fistula: Clinical Presentation And Outcome, Atta A. Bhatti, S. Soulat Raza, Muhammad Ehsan Bari, S. Ather Enam, Tanveer Ul Haq, Zafar Sajjad

Section of Neurosurgery

Objective:To evaluate the presentation, clinical course and outcome of traumatic carotid-cavernous fistula (CCF) withendovascular treatment at our institution during the last five years.
Design: Retrospective descriptive study.
Setting: The study included patients seen at Aga Khan University Hospital from January 2000 to December 2005.
Methods: Retrospective analysis based on data retrieval from medical records using ICD coding system. Only those cases who had traumatic CCF and underwent endovascular treatment were included in the study.
Results: A total of 8 patients were diagnosed with post-traumatic CCF and 11 procedures were done. Mean age at presentation was 35.6 years; …

Ct Scan Of Body Packers: Findings And Costs, Saba Sohail

Department of Radiology

Objective: To determine the CT features of intra abdominal illicit drug packs used for trafficking, by using scout CT scan image and describe its cost re-imbursement
Methods: An observational study was conducted from January to December 2005, at the CT scan department, Civil Hospital, Karachi. The study subjects included alleged drug traffickers smuggling by body packing, intercepted at Karachi International Airport and referred for CT scan of abdomen by the Anti Narcotic department. Those with suspected body pack rupture were excluded. Scout CT image of the abdomen was taken. Scans were read on console as well as hard copy for …

Clinical Features And Management Of Merkel Cell Carcinoma, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Merkel cell carcinoma (MCC) is an aggressive dermal tumour of neuroendocrine origin. MCC is a rare tumour and all information pertaining to its behaviour, therapy and prognosis is based on retrospective reports. The two potentially curative treatment modalities are surgery and radiotherapy. It is a rare, highly malignant primary skin tumour, originally called "trabecular carcinoma" of the skin. MCC poses a challenge to the clinician because of its rarity and poor prognosis. The optimal therapy is customised and tailored for each individual patient with the appropriate use of operative resection and radiation therapy. This review covers reports from several authors …