Radiology Commons^™

Cerebral Toxoplasmosis In A Patient With Acquired Immunodeficiency Syndrome, Rohana Naqi, Muhammad Azeemuddin, Humera Ahsan

Department of Radiology

Cerebral toxoplasmosis commonly affects patients with advanced HIV immunodeficiency. Toxoplasmosis in patients who are immunocompromised can be severe and debilitating in patients with Central Nervous System (CNS) involvement and the condition may be fatal. We report the case of a 40-year-old man who was a known case of HIV and presented with cerebral toxoplasmosis. His Magnetic Resonance Imaging (MRI) scan showed multiple ring enhancing lesions with extensive surrounding oedema in supratentorial as well as infratentorial region. Lesions were mainly located in the periventricular region as well as at the grey-white matter junction and showed enhancement in the periphery as well …

Ewing's Sarcoma/Pnet Of Kidney In 13-Year-Old Girl, Quratulain Badar, Nasir Ali, Nadeem Abbasi, Shamvil Ashraf, Farrok Karsan, Raheel Hashmi

Department of Radiology

Ewing's sarcoma is the second most common primary tumour of bone in childhood. Less frequently it occurs in soft tissues. Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) is an extra ordinarily rare primary tumour in the kidney. Only very few cases of primary renal Ewing's sarcoma have been reported in the literature to date. We present a case of primary right renal Ewing's sarcoma in a 13-year-old girl who was diagnosed as a case of stage IV ES/PNET of kidney with metastases to lung and liver. Right nephrectomy was done followed by adjuvant radiotherapy and chemotherapy with complete response to local and …

Hydatid Disease Of The Breast, Imrana Masroor, M. Azeemuddin, S. Khan, A. Barakzai

Department of Radiology

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. Humans are the accidental intermediate hosts of this organism. Hydatid disease is endemic in countries in which raising sheep and cattle constitutes an important means of livelihood. The most commonly affected organs are the liver and lungs. Involvement of the kidney, bone, brain and other organs is rare. Breast involvement in this disease is also very rare. A case of isolated hydatid cyst of the breast is presented, along with a review of the literature and a discussion on the pertinent clinical and radiological aspects of the disease.

Neovascularity Patterns In Breast Carcinoma: Correlation Of Doppler Ultrasound Features With Sonographic Tumour Morphology, Riffat Shaheen, Saba Sohail, Kauser Jahan Siddiqui

Department of Radiology

Objective: To determine the association and correlation between morphologic features of breast cancer on gray scale ultrasound, and vascularity patterns and indices on color and spectral Doppler ultrasound.
Study design: Cross-sectional, analytical study.
Place and duration of study: Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi, from August 2006 to June 2007.
Methodology: Fifty adult female patients with histopathological proven breast cancer underwent ultrasound for evaluation of morphologic features on gray scale mode; vascularity patterns on color Doppler scan and flow indices measurement on spectral Doppler ultrasound. Regression analysis was conducted to determine correlation between the …

Magnetic Resonance Imaging Findings In Patients With Schizophrenia, Waseem Akhtar, Haider A Naqvi, Sajjad Hussain, Arif Ali, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging (MRI).

STUDY DESIGN: Comparative study.

PLACE AND DURATION OF STUDY: The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008.

METHODOLOGY: Thirty-three cases of schizophrenia (n=33) and thirty-three age-matched controls, (n=33) were enrolled for this study. Screening Magnetic Resonance Imaging (MRI) of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p < 0.05.

RESULTS: Among the total of 66 (n=66) …

Postmortem Computed Tomography For Diagnosis Of Cause Of Death In Male Prisoners, Saba Sohail, Farhat Hussain Mirza, Qamar Salam Khan

Department of Radiology

Objective: To determine the utility of postmortem CT (PMCT) examination in establishing the cause of death among male prisoners dying in Karachi jails.
Methods: A descriptive study was carried out from February 2006 to September 2007, CT Scan section, Civil Hospital Karachi and the Mortuary, Dow Medical College, Dow University of Health Sciences, Karachi. Adult male prisoners dying in the Karachi central prison and referred to the study setting for determining the cause of death for medico legal purpose were included. Female prisoners and those cases where the final report of cause of death was not available were excluded. CT …

A Doppler-Based Evaluation Of Peripheral Lower Limb Arterial Insufficiency In Diabetes Mellitus, Riffat Shaheen, Saba Sohail

Department of Radiology

Objective: To determine the frequency, level and flow patterns of lower limb arterial insufficiency in diabetic patients on Doppler ultrasound study.
Study Design: Cross-sectional study.
Place and Duration of Study: Radiology Department, Civil Hospital, Karachi, from February 2007 to September 2008.
Methodology: One hundred adult diabetic patients with suspected peripheral vascular insufficiency irrespective of gender were included. Demographic data, presenting complaints, treatment history, and level of HbA1c were recorded. Doppler evaluated arterial status and ankle brachial index (ABI) were recorded on proforma. Statical analysis were done on SPSS version 12.
Results: The mean HbA1c was 8.4 ± 1.4gm/dl, a majority …

Guyon's Canal Syndrome Due To Tortuous Ulnar Artery With Dequervain Stenosing Tenosynovitis, Ligamentous Injuries And Dorsal Intercalated Segmental Instability Syndrome, A Rare Presentation: A Case Report., Muhammad Zeeshan, Farhan Ahmed, Darakhshan Kanwal, Qazi Saad Bin Khalid, Muhammad Nadeem Ahmed

Department of Radiology

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on Patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery. Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve Patient's …

Carotid Artery Disease In Patients Undergoing Elective Coronary Artery Bypass Surgery, Waseem Akhtar, Ayan Sabih, Arif Ali, Mubashir Aslam, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting (CABG) using Doppler sonography.STUDY DESIGN: Observational study.

PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008.

METHODOLOGY: Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. …

The 'Molar Tooth Sign' In Joubert Syndrome, Imaad Ur Rehman, Zablon Bett, Yousuf Husen, Ali Syed Muhammad Akhtar, Faisal Aziz Khan

Department of Radiology

The molar tooth sign is seen in very few conditions and is a very rare paediatric central nervous system congenital anomaly. Molar tooth sign is the result of cerebellar vermis hypoplasia, thick and maloriented superior cerebellar peduncles, and an abnormally deep interpeduncular fossa. In Joubert syndrome this is seen in about 85% of patients. We present a case of 13 months old baby boy with recurrent episodes of fits and hyperpnoea, regression of milestones and developmental delay. MRI examination showed the characteristic molar tooth sign with apposition of cerebellar hemispheres, batwing-shaped fourth ventricle communicating through a thin fissure with foramen …

Malignant Phyllodes Tumour As An Intracystic Growth With Osteosarcomatous Differentiation, Shaista Afzal Saeed, Imrana Masroor

Department of Radiology

Phyllodes tumour is an uncommon fibro epithelial tumour of breast that often presents clinically as a rapidly enlarging lump. On mammography it appears as a soft tissue density well circumscribed mass. Ultrasound shows it to be a solid hypoechoic mass with small cystic spaces. A case of malignant phyllodes tumour with an atypical appearance of intracystic tumour on sonography is reported with pertinent imaging features and histopathological diagnostic criteria. The tumour had undergone osteosarcomatous differentiation.

Application And Advantage Of Functional Magnetic Resonance Imaging And Blood Oxygen Level Dependant (Bold) Imaging Modality, Humera Ahsan, Muhammad Akbar, Atta-Ul-Aleem Bhatti

Department of Radiology

The objective of the study was to introduce the availability of bold imaging facility at Aga Khan University Hospital Karachi for the first time in Pakistan and also to review the practical application and advantages of functional magnetic resonance imaging (fMRI) and blood oxygen level dependant (BOLD) Imaging Procedures. The study was conducted at Aga Khan University Hospital, Karachi from August 2008 to November 2008 .Three patients were selected that had presented with intracranial space occupying lesions. They underwent Functional Magnetic Resonance Imaging (fMRI). The findings of the images were important to describe and localize the eloquent brain areas and …

Staging Of Endometrial Carcinoma By Magnetic Resonance Imaging: Correlation With Surgery And Histopathology, Fatima Mubarak, Mirza Waseem Akhtar, Gul-E-Khanda, Yusuf A Husen

Department of Radiology

OBJECTIVE: To evaluate the accuracy of MRI in staging of endometrial carcinoma, and comparison with surgery and histopathological findings.

METHODS: A one year prospective cross-sectional study was conducted from 10/3/2005 to 31/5/2006, at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty two patients with diagnosis of endometrial carcinoma, referred to radiology department for preoperative staging by MRI and had undergone surgery were included.

RESULTS: MRI was found to be 79% sensitive, 85% specific and 80% accurate for staging endometrial carcinoma while PPV and NPV were 97% and 66% respectively.

CONCLUSION: Magnetic resonance imaging is a good, safe, accurate …

Negative Predictive Value Of Mammography And Sonography In Mastalgia With Negative Physical Findings, Imrana Masroor, Shaista Afzal, Saima Sakhawat, Nadir Khan, Mirza Amanullah Beg, Darakhshan Kawal

Department of Radiology

OBJECTIVE: To determine the negative predictive value of mammography and sonography in patients with focal/ diffuse breast pain with negative physical examination of the breasts.

METHODS: A descriptive study, conducted at Radiology Department ofAga Khan University Hospital from 2006-2007 for a period of 2 years. A total of 207 women were referred for mammography and sonography because of focal or diffuse breast pain. Complete follow-up was available only in 55 patients. The outcome or gold standard was mammograms or ultrasound after an average follow-up period of 18 months with negative/benign findings or histopathology of the suspicious lesion or imaging which …

Clinical Radiology Research In Pakistan: From Evidence To Practice, Waseem Akhtar, Arif Ali, Mubashir Aslam, Gul-E-Khanda

Department of Radiology

OBJECTIVE: To assess the clinical radiology research productivity in Pakistan by type of publication, sources of funding and name of journals.

METHODS: A systematic search strategy using key words related to techniques and type of clinical radiology was carried out to identify various studies published in Indexed (Medline) and non-indexed (Pakmedinet) medical journals.

RESULTS: Total of 397 studies were identified out of which 173(43%) from Medline (indexed database) and 220 (57%) from pakmedinet (Indexed and non- indexed database of Pakistan Medical journals). Original articles were 294 (74%) but most of them (68%) were published in non-indexed journals and significantly different …

Arterio-Venous Fistula Of Upper Arm Observed With Injection Abscess, Saba Sohail, Misbah Talpur

Department of Radiology

No abstract provided.

Chorioangioma Of The Placenta With Hydrops Foetalis, Gulnaz Shafqat, Farah Iqbal, Farhan Rizvi

Department of Radiology

Chorioangioma, the non trophoblastic tumour, constitutes the commonest benign growth of the placenta. Though benign, 30% rate of maternal or foetal complications are associated with large masses. Sonography including colour Doppler imaging provides the best modality not only for its diagnosis but also the foetal status. A case of large placental chorioangioma has been reported here resulting in dismal foetal outcome diagnosed on antenatal ultrasound.

Diffusion Weighted Image (Dwi) Findings In Methanol Intoxication, Humera Ahsan, Muhammad Akbar, Aamir Hameed

Department of Radiology

Methanol is a toxic substance with extremely devastating effects upon exposure. The case described suffered from such kind of poisoning. MRI brain demonstrated necrosis bilaterally in the Putamen areas which is a classic hallmark finding. Additional Diffusion weighted imaging showed abnormal signal bilaterally in the putamen areas along with Diffusion positive bilateral lesions (possibly infarctions) in both the frontal and occipital lobes that were not evident on MRI with or without contrast.

To Evaluate The Role Of Sonography As An Adjunct To Mammography In Women With Dense Breasts, Imrana Masroor, Mohammad Nadeem Ahmed, Sajida Pasha

Department of Radiology

OBJECTIVE: To assess the role of sonography as an adjunct to mammography in women with dense breast tissue by determining yield and validity of sonography using histopathology/follow-up mammography as gold standard.

METHODS: It was a descriptive analytical study conducted at the Radiology Department of Aga Khan University Hospital, from September 2005 to April 2007. A total of 76, mammographically dense breasts were evaluated with ultrasound. Of these 32 had palpable lumps on mammography, and were excluded from the study. A total of 44 patients had either symptoms of vague nodularity, nipple discharge, mastalgia or had no symptoms and the mammograms …

Instituting An Undergraduate Core Clerkship In Radiology: Initial Experiences In Pakistan, Naila Nadeem, Abdul Mueed Zafar, Muhammad Nadeem Ahmad

Department of Radiology

Utilization of radiology as an educational resource carries great potential. Accreditation bodies, physicians and medical students deem it important for a well rounded medical curriculum. Unfortunately this resource is yet to be developed and implemented to an optimal extent. We share the experiences from the first radiology core clerkship in Pakistan at the undergraduate level. An overview of clerkship objectives and structure is followed by discussion on lessons learnt during the initial three years of institution. Development of assessable objectives, integration of radiology with other specialties, and supervised andragogical learning tailored for undergraduate students are emphasized.

Doptaus - A Simple Criterion For Improving Sonographic Diagnosis Of Acute Appendicitis, Saba Sohail, Kausar Jehan Siddiqui

Department of Radiology

Objective: To determine the efficacy of 'Detection Of Pin-point Tenderness on the Appendix on abdominal UltraSound' (DOPTAUS) for improving sonographic diagnosis by junior and senior ultrasound operators.
Methods: An analytical study was done at the Radiology Department, Dow University of Health Sciences and Civil Hospital Karachi from March 2005 to December 2006. Adult patients of either gender with clinically suspected acute appendicitis referred to the department during regular working hours and later operated in the same hospital were included. Each patient was scanned by a junior and a senior ultrasound operator using the conventional criteria first and later focused ultrasound …

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 …

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 …

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.