Internal mimics hernias and their mimics: How would radiologists help?

AbstractPurposeTrying to define the most valuable radiological sign(s) for the diagnosis of internal hernias and their mimics; mainly cocoon syndrome and adhesions.ReviewNowadays with the increasing number of bariatric surgeries, the number of diagnosed internal hernias has increased significantly. Adhesions and cocoon syndrome are among the differential diagnosis. Although many signs were suggested for the diagnosis of such conditions, yet no single sign is enough to diagnose each of the above.Method and subjectsThis is a retrospective study. In a period of 32 consecutive months, from June 2010 to February 2013 a total of 240 patients were admitted with abdominal pain with signs of remittent or persistent intestinal obstruction. All cases are subjected to multislice CT examination. Several criteria are used to diagnose internal hernia. Informed consents were taken from all patients and organizational ethics committee were informed.ResultsThe age of the patients varies between 22 and 63years with average age of 36±2.3years. Most of the patients were females with ratio of 2:1. Commonest presentation was abdominal pain present in all cases. The study diagnosed 13 cases/internal hernias, 14/adhesions, two cases/cocoon syndrome, two cases/intussusceptions and one case/malrotation. The most important signs used are Swirl’s sign, localized bowel gathering and segmental bowel dilatation.ConclusionA single sign is not enough for the diagnosis of internal hernia, rather the use of more than one sign is essential to narrow the differential diagnosis.Clinical relevance/applicationThe prevalence of internal hernia is increasing due to increased rate of operative abdominal intervention. Prompt radiological diagnosis is crucial to avoid unwanted surgery in a non-virgin abdomen

MERS-CoV: Middle East respiratory syndrome corona virus: Can radiology be of help? Initial single center experience

Human infection with a novel coronavirus named Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012. The aim of this study was to establish the most pathognomonic radiological sign(s) to diagnose MERS CoV. Patients and methods: This is a retrospective descriptive study. All patients were subjected to serial X-ray. High resolution non-contrast CT chest was also obtained for 10 patients. The scans were reviewed for findings including consolidation, ground-glass opacities, nodules, reticular opacities and hilar and mediastinal adenopathy. Results: A total of 12 patients were included in our study with prevalence of males (2:1) with ages ranging between 18 and 76 years having an average age of 36 ± 2 years. The outcome of these patients was as follows: 6 were treated with average hospital stay ranging between 21 and 35 days, one case died after 14 days, and 5 cases were transferred to Central Governmental hospital according the local authority rules. Conclusions: MERS CoV virus may have a specific pattern in chest X-ray and CT developing a single or multiple opacities progressing into a widespread multifocal bilateral patches of ground glass opacities or confluent consolidation resembling organizing pneumonia

What are the most reliable signs for the radiologic diagnosis of uterine adenomyosis? An ultrasound and MRI prospective

Aim of the work was to revise the literature to define the most appropriate signs for diagnosis of uterine adenomyosis using transvaginal ultrasound (TVUS) and MRI and what of those signs are more specific/sensitive for the diagnosis of such common condition in actual practice and in our community. Patients and methods: A retrospective study. Within three year period 60 women were referred to the radiology department; among which 45 cases were clinically diagnosed uterine adenomyosis. The diagnosis was established by hysterectomy in 5 cases, hysteroscopy in 30 cases and clinic-radiological consensus in 10 cases. Results: In 9 out of 45 cases the adenomyosis was focal while in the rest of cases it was diffuse. We can conclude from the tables that regarding ultrasound, heterogeneous myometrium and ill definition of endometrial–myometrial interface are statistically significant good indicator for the diagnosis of adenomyosis. Considering MRI, widened junctional zone and heterogeneous myometrium are statistically significant better indicators of adenomyosis. Conclusions: MRI is superior to sonography in the diagnosis of uterine adenomyosis though we still recommend to start with the latter owing to its availability

MSCT renal stone protocol; dose penalty and influence on management decision of patients: Is it really worth the radiation dose?

Purpose of this study to evaluate the usefulness of low dose CT renal stone protocol as a prime and sole diagnostic tool for assessment of patient with renal colic in consideration with dose penalty and comparing with other radiological procedures for the timing and decision of line of management. Methods: In a period of 36 months between June 2010 and June 2013, a total of 1500 cases admitted to emergency department were subjected to CT examination of the abdomen and pelvis for investigation of urinary complaint. Results: Patients ages ranged between 15 and 77 years with average age of 38 ± 2.4 years. Most of the patients were males with a ratio of 7:3. There is a statically significant difference regarding radiation dose between regular and low dose techniques with no difference in stone detectability. There was a statistically significant difference regarding the time needed for intervention between CT and combined US/X-ray. Conclusions: Considering time is of the essence; MSCT renal stone protocol using low dose technique is crucial in the management of renal stone in acute setting including the diagnosis and management decision

Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it?

Review: The differentiation between benign and malignant vertebral compression fractures is a daily encountered problem particularly in elderly patients. It is important to differentiate between malignant and osteoporotic compression fractures. Aim of the work: To study the different MRI signs allowing to differentiate between benign and malignant vertebral fractures. Methods: A total number of 150 collapsed vertebrae (120 patients) were collected during a period of 40 months. All were subjected to MRI evaluation. For half of patients diffusion weighted imaging was performed. Biopsy was taken from 45 vertebrae. Results: Average age of patients was 65 ± 2.3 years. The ratio of men to women was 1:1. Metastases were seen in 70 and osteoporosis in 80 vertebrae. Signs that showed statistically significant value were Water line sign and sharp wedging in favor of osteoporotic fractures and pedicle involvement, non signal drop in out of phase sequence, homogenous T1 hypointensity and restriction in DWI favoring malignancy. Conclusions: Several signs are found to favor osteoporotic or malignant vertebral fractures. Chemical shift and DWI are strong allies to morphological signs in differentiating between both entities. Depending on a group of signs rather than one sign alone would increase the diagnostic accuracy

Large-scale geological structures of the Egyptian Nubian Shield

Abstract Integration of potential field- and structural data make it possible to trace surface and subsurface large-scale geological structures of the Egyptian Nubian Shield (ENS). Obtained results indicate that the Northern Eastern Desert (NED) of the ENS is dominated by relatively younger (c. 580 Ma) E–W and NE–SW trending extensional structures that were controlled by the evolution and retreat of the Cadomian Arc. Density of such extensional structures increases with depth as displayed by the potential data. The prevailing structural trends in the Central Eastern Desert (CED) are NW–SE and WNW–ESE. Both trends are highly prompted by the timing of deformation upon the Najd Fault System, and are themselves dissected by a relatively younger NE–SW shearing trend. Lineament density in the CED is subordinate for both subsurface and near surface structures. The South Eastern Desert exhibits compressional and extrusion-related structures of two main prominent trends; WNW-to-NW (to the western part) and the N-, NNE- to NE (to the eastern part). The previously mentioned Neoproterozoic trends are remarkably influenced by the Oligocene–Miocene Red Sea-Gulf of Suez rift related fractures in the vicinity of the rift shoulder. The remarkable change in trends and densities of structural trends, especially in the NED, is interpreted in terms of concealing of the older structures by the younger extensional structures which in turns reflect an N-ward progressive deformation in the entire ENS. Gravity data are more appropriate in delineating the structural trends compared to the magnetic data which are largely affected by lithological variations and/or alteration zones and magnetic mineralogy

Is diffusion weighted imaging adding value in diagnosis of focal hepatic lesions? Experience in 50 patients

Introduction: Diffusion weighted imaging (DWI) offers molecular information that complements the morphologic information obtained with conventional magnetic resonance imaging (MRI) and can reflect the functions and structures of the body without trauma. Aim of the work: To assess the role of DWI as a routine sequence in a MRI study to help in differentiating liver lesions. Patients and methods: The study included 50 patients referred to do a MRI study to diagnose and/or to confirm the ultrasonographic or CT findings of focal hepatic lesions. The examination was done on 1.5T superconducting magnet MRI machines; Philips Gyroscan Intera version 12.1.1.2 (Best, The Netherlands) and Siemens Magnetom Avanto (Erlangen, Germany) machine. Results: All studied patients had a focal hepatic lesion either on top of cirrhotic liver or non cirrhotic liver. DWI was found to be helpful with the routine MRI sequences to reach the diagnosis. The final diagnosis was confirmed by histopathological examination or follow up. A cutoff value of ADC for benign lesions was found to be 1.25 × 10−3 mm2/s. Conclusions: DWI should be included as a basic sequence in the routine MRI study of the liver as it helps in diagnosis and so reaching a final diagnosis or at least trying to narrow the list of differential diagnosis

Prevalence of Mutated Colistin-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

The emergence of genetic mutations in chromosomal genes and the transmissible plasmid-mediated colistin resistance gene may have helped in the spread of colistin resistance among various Klebsiella pneumoniae (K. pneumoniae) isolates and other different bacteria. In this study, the prevalence of mutated colistin-resistant K. pneumoniae isolates was studied globally using a systematic review and meta-analysis approach. A systematic search was conducted in databases including PubMed, ScienceDirect, Scopus and Google Scholar. The pooled prevalence of mutated colistin resistance in K. pneumoniae isolates was analyzed using Comprehensive Meta-Analysis Software (CMA). A total of 50 articles were included in this study. The pooled prevalence of mutated colistin resistance in K. pneumoniae was estimated at 75.4% (95% CI = 67.2–82.1) at high heterogeneity (I2 = 81.742%, p-value < 0.001). Meanwhile, the results of the subgroup analysis demonstrated the highest prevalence in Saudi Arabia with 97.9% (95% CI = 74.1–99.9%) and Egypt, with 4.5% (95% CI = 0.6–26.1%), had the lowest. The majority of mutations could be observed in the mgrB gene (88%), pmrB gene (54%) and phoQ gene (44%). The current study showed a high prevalence of the mutation of colistin resistance genes in K. pneumoniae. Therefore, it is recommended that regular monitoring be performed to control the spread of colistin resistance