Multiple parameters in the diagnosis of ectopic pregnancy

Objective: To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy.Methods: A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml.Results: Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitivity.CONCLUSION: The use of multiple parameters in the diagnosis of ectopic pregnancy resulted in 100% sensitivity and specificity

Safety of percutaneous transhepatic biliary stenting in patients with obstructive jaundice

OBJECTIVE: To determine the safety of percutaneous transhepatic biliary stenting (PTBS) in patients with obstructive jaundice. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Department of Radiology, The Aga Khan University Hospital Karachi, Pakistan, from February 2012 to April 2013. METHODOLOGY: Patients with obstructive jaundice due to any cause referred for percutaneous transhepatic biliary stenting were included in the study. Patients were excluded if they had undergone previous ERCP, had guided transhepatic biliary stenting, previous percutaneous transhepatic biliary stenting and were lost to follow-up. Follow-up was taken at a 2, 4 and 6 week interval and clinical outcome was assessed as the difference between the bilirubin levels at base line and 6 weeks after PTBS, which was measured using Freidman\u27s test. RESULTS: A total of 102 patients were included; 59 (58%) were males and 43 (42%) were females. The age ranged from 21 to 89 years. A total of 30 patients experienced complications making an overall complication rate of 29.4%; 20 experienced minor and 10 experienced major complications. Pain was the most frequent minor complication (n=15 patients, 14.7%) followed by biliary leakage, fever and cholangitis. Major complications included death in 10 (10%) patients followed by biliary peritonitis and septicemia. CONCLUSION: PTBS achieved satisfactory palliation with a low complication rate in patients with obstructive jaundic

Cerebral deep venous thrombosis: case report and literature review

The case of a 28 years old woman presenting with headache, drowsiness and vomiting of a short duration, is presented. She was diagnosed as deep cerebral venous thrombosis on the basis of MRI findings. Treatment with heparin gave completed recovery

Periosteal desmoid

Periosteal desmoid is a benign tumor like reactive fibrous lesion developed by repeated micro trauma. We describe the case of a 14 year old boy with pain in his right knee who underwent plain radiography followed by radionuclide bone scan. The final diagnosis was that of periosteal desmoid

Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis

Objective: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis.Methods: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (\u3e6 mm diameter) and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up.Results: There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%.CONCLUSION: Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis

Role of computed tomography in acute pancreatitis and its complications among age groups

Objective: To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups.Methods: The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients (33 male and 7 female) with age range from 16-71 years were divided in three groups. Group I was less than 40 years (12 patients), Group II was between 40-60 years (17 patients), and Group III was more than 60 years (11 patients). CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index (CTSI) was calculated according to Balthazar\u27s method.Results: In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI.CONCLUSION: The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications

Carotid Intima Media Thickness Percentiles for Pakistani Population

Carotid artery intima media thickness estimation is a well-established way of cardio vascular disease evaluation. The purpose of this cross-sectional study was to develop normal carotid intima media thickness percentile values for a Pakistani cohort. Data was collected at the Departments of Radiology and Family Medicine, The Aga Khan University Hospital, Karachi, from April 2014 to August 2015. High frequency ultrasound of carotid was done in 257 patients [97 male (38%), 160 female (62%)] without any known carotid artery disease. Reference ranges (90% range between 5th and 95th centiles) were constructed for each common carotid and internal carotid artery measurement and displayed in graph form. The mean difference was found in left common carotid artery (0.55 ±0.13) and left internal carotid artery thickness (0.50 ±0.10) significant at p=0.031 and p=0.014, respectively. The IMTpercentile graphs developed in this study for internal and common carotid arteries are exclusive for this population and can be used to assess vascular health from ultrasound measurements

Evaluation of erectile dysfunction with color Doppler sonography

Objective: To assess the role of Color Doppler Sonography in the evaluation of erectile dysfunction.Methods: A cross-sectional study was conducted at the Radiology Department, Aga Khan University Hospital Karachi from 5-6-2002 to 2-9-2003. All consecutive patients presenting with erectile dysfunction and undergoing penile color Doppler evaluation with injection PGE1 20 mcg were included in this study.Results: A total of 70 patients with an age range of 24-70 years (mean 41 +/- 12.25 years) were included in the study. A normal response was noted in 45 (psychogenic) cases. Vasculogenic causes were observed in 23 patients, 12 with arterial insufficiency and 11 with venous leak. Peyronie\u27s disease was diagnosed in 2 patients.CONCLUSION: Color Doppler evaluation of erectile dysfunction is an effective method for differentiating psychogenic and vasculogenic causes of erectile dysfunction

Carotid intima media thickness evaluation by ultrasound comparison amongst healthy, diabetic and hypertensive Pakistani patients

Objective: To compare carotid Intima media thickness and atherosclerosis burden amongst healthy, diabetic and hypertensive Pakistani patients.Methods: A cross-sectional study was carried out at the Department of radiology and family medicine, Aga Khan University Hospital Karachi from April 2014 to July 2015. Bilateral carotid ultrasound was done in 133 healthy adults, 65 hypertensive, 31 type-2 diabetic and 37 hypertensive with type-2 diabetes patients. Normal adults were matched for age and gender. Mean intimal media thickness was measured for common and internal carotid arteries. Presence or absence of atherosclerotic plaque was also identified. Height, weight, ethnicity, socioeconomic status and other risk factors were also assessed. Ultrasound findings were compared between healthy and diseased patients through statistical tests.Results: A total of 266 patients participated (Controls=133, Hypertensive=65, Diabetic=31, and Diabetes with Hypertension=37). There was no significant difference in the baseline characteristics between the four patients\u27 groups for age (p\u3e0.05) and gender (p\u3e0.05). The mean carotid intima media thickenss of right common carotid artery was significantly higher in patients with diabetes along with hypertension as compared to the control group (p=0.03). For (RICA) Right Internal Carotid Artery, (LCCA) Left Common Carotid Artery and (LICA) Left Internal Carotid Artery, there was a significantly higher thickness among patients with hypertension as compared to the control group with p=0.011, p=0.002, and p=0.039 respectively.Conclusion: Increased CIMT is most likely associated with underlying chronic diseases. Ultrasound is a non-invasive, easily available and useful modality for early detection and prevention of vascular atherosclerosis

Direct Observation of Procedural Skills in Radiology

Objective:The Purpose of this perspective is to describe the reliability and feasibility of methods such as direct observation of procedural skills and multisource feedback in assessment of the performance of radiology residents. Conclusion: Workplace-based assessments such as direct observation of procedural skills have a role in the formative assessment of radiology residents. They can be used to evaluate residents\u27 performance, provide feedback, and identify areas for improving performance and filling in identified gaps