Intraabdominal Gossypibomas with variable CT appearance: A case report

A retained surgical sponge or gossypiboma is a rare and an underreported complication occurring most commonly after abdominal surgeries. The clinical presentation as well as the time of presentation is variable with about one third of patients being asymptomatic. The diagnosis is challenging because of marked variation in the presentation and imaging plays a crucial role in diagnosis. We report a 30-year old Asian woman with prior history of Caesarean section who presented with persistent abdominal pain since surgery and underwent imaging in December 2012. The case is interesting as she had two intraabdominal gossypibomas with different appearances on computerized tomography. One was suggested to be a retained foreign body while the other was initially misinterpreted as a solid ovarian mass. However, on ultrasound, both lesions showed similar appearance and the left lower abdominal solid mass was also suggested to be a retained foreign body which was then confirmed on laparotomy

Scar endometriosis: an entity not to be forgotten

Scar endometriosis is an uncommon but well-described condition. It is caused by the dissemination of endometrial tissue in the wound at the time of surgery. The deposits can involve uterine scar, abdominal musculature or subcutaneous tissue, with the latter being the most common. It usually presents as a palpable mass at the scar site with or without cyclical pain. We report three cases of scar endometriosis which presented with cyclical pain and swelling at the abdominal wall scar following uterine surgery. The patients underwent imaging which revealed abnormal findings at the scar site suggesting scar endometriosis. In the presence of strong clinical suspicion and supportive imaging, all three of them underwent local excision of the lesion. The diagnosis of endometriosis was confirmed on histopathology

Health Promoting Schools: A Powerful Means of Improving Community Oral Health for Future Generations of Pakistan

Public health has shifted its focus towards social conditions that are responsible for achievement of oral health and preventionof oral diseases like dental caries, periodontal disease and oral cancer. The oral health burden on Pakistani population is alarmingwith children being the most common victim of oral dental diseases. At present knowledge and attitudes of influential professionalssuch as school teachers on oral health and school based preventive programs is poor. Health promoting school is a place whereinstitutional policies, physical and social environment, relation with the community, curriculum and personal skills makes it ahealthy setting for living, learning and working. School serves as a powerful setting for learning of children and healthybehaviors. Lifestyle developed within a school environment are said to be more sustainable. Dental professionals need to workin partnership with school teachers to change attitudes, beliefs and behavior along with provision of knowledg

Tuberculosis of male breast: A rare benign entity.

Granulomatous mastitis is a rare benign condition often seen in young lactating females of reproductive age group. Prepubescent males or elderly women may also be the victim of this infectious disease. Primary infection of the breast may occur through skin abrasions, open wounds or through the lactiferous ducts while secondary spread occurs from an infective focus elsewhere in the body via lymphatic or hematogenous routes. We present a case of breast tuberculosis diagnosed in a 62-year-old man at our institution. The patient presented with a palpable painful mass in the left breast with chronic sinus formation and pus discharge for a month with loss of appetite and weight loss. The etiology was unknown. The imaging features were suggestive of tuberculosis. Histopathology was concordant with imaging and showed chronic granulomatous inflammation with necrosis. The patient received oral anti-tuberculosis therapy for six months with no side effects or any further complications. Breast tuberculosis is a rare entity especially in male breast mimicking carcinoma. The mainstay of treatment is antitubercular therapy if imaging and histopathology confirms the diagnosis. Clinical awareness is necessary during diagnostic workup for establishing the correct diagnosis and treatment

Probably benign solid breast lesions on ultrasound: Need for biopsy reassessed

Objective: To determine the negative predictive value of ultrasound for breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to biopsy. Methods: After Institutional Review Board approval, all solid breast masses categorized as probably benign (American College of Radiology Breast Imaging Reporting and Data System [BI-RADS] 3) on ultrasound from January 2014 to December 2015, and having either tissue diagnosis or imaging stability for 24 months, or downgrading to BIRADS 2 during imaging surveillance were included. Result: A total of 157 lesions in 40 patients constituted the study population. The mean patient age was 31.3 years (range, 20-56 years). Seventeen of these 157 lesions underwent tissue diagnosis with no invasive breast cancer. Out of the remaining 140 lesions, 115 were stable on imaging for 24 months or more. The rest 25 were deemed benign because of decrease in size on follow up (n=1), non-recommendation of further imaging by the second radiologist on follow up ultrasound (n= 13) or presence of benign tissue diagnosis in the largest lesion (n=11). Conclusion: Ultrasound has 100% negative predictive value for breast lesions with probably benign morphology, whether palpable or not. Follow up is an appropriate option to immediate biopsy of such lesions keeping in mind that noncompliance with surveillance may be a potential proble

Antenatal ultrasound diagnosis of congenital high airway obstruction syndrome: A case report and review of literature

Congenital high airway obstruction syndrome (CHAOS) is a rare life-threatening fetal condition resulting from obstruction of the upper fetal airway which may be partial or complete. Prenatal diagnosis is crucial as it usually results in stillbirth or death after delivery if unrecognized. We report a case of CHAOS that was diagnosed prenatally due to characteristic ultrasound features. We also briefly review literature in light of current management options

Breast imaging chameleon: Pseudoangiomatous stromal hyperplasia presenting as breast malignancy

Pseudoangiomatous stromal hyperplasia (PASH) is a benign mesenchymal proliferative lesion of the breast, often an incidental finding on breast biopsy specimens and rarely presents as a palpable lump. The case being reported is interesting as a lactating female presented with gross left breast enlargement due to a huge firm mass with skin thickening and palpable left axillary lymph nodes. A provisional diagnosis of left breast malignancy was made and the patient extensively worked up with ultrasound, CT scan, bone scan and core biopsy. The histopathology, however, revealed PASH of the breast. There was no invasive or in situ malignancy. The patient was successfully managed conservatively

Outcome of non-malignant papillary lesions of the breast on core biopsy: An experience from a tertiary care center in Pakistan

Background: Papillary lesions of the breast constitute a heterogeneous group ranging from non-malignant papillomas to papillary carcinoma. While surgical excision is recommended for atypical papilloma or papillary DCIS/ carcinoma on core biopsy, controversy persists in the management of benign papillomas which are diagnosed with core needle biopsy (CNB) since there are variable reported rates for tumor upgrade. The purpose of this study was to determine the outcome of papillary lesions of the breast diagnosed at image-guided CNB, after surgical excision or follow-up, and to identify potential predictors of high-risk lesions/malignancy on imaging.Materials and methods: We retrospectively identified 52 non-malignant papillary lesions on core biopsy between January 2012 and June 2018. The outcome of surgical excision, as well as clinical and imaging features of these lesions, were assessed. The final histologic upgrade was recorded, and variables were compared between benign and atypical lesions on core biopsy as well as between upgraded and non-upgraded lesions after surgical excision. Results: Thirty-six lesions out of 52 lesions were benign papillomas on core biopsy, while 16 were papillary lesions with ADH/DCIS. All of these lesions except four benign papillomas were excised. Of the 32 benign papillomas excised, 7 were upgraded to papilloma with ADH/DCIS and one to DCIS with the focus of invasion. Among the 16 atypical lesions excised, one was upgraded to papillary DCIS with a final upgrade rate of 17.3%. There was no statistically significant clinical or imaging feature among those that were upgraded on excision from those that were not upgraded. Conclusion: Non-malignant papillary lesions have a significant upgrade rate. There are no reliable clinical or imaging features that can pre-surgically predict upgrade. Therefore, surgical excision of all papillary lesions is recommended for definitive diagnosis

Enhancing cognitive engagement of pre-clinical undergraduate medical students via video cases and interactive quizzes in problem-based learning

Background: Problem-based learning (PBL) is one of the main pedagogical approaches utilized in the undergraduate medical education (UGME) program at a private medical college in Karachi, Pakistan. Video-enhanced cases and formative assessments were introduced at the end of PBL sessions to evaluate their effectiveness in enhancing student engagement.Methods: A mixed methods study was conducted with Year 2 medical students (n=102; divided into 11 groups) and faculty (n=11) facilitating the PBL process. Of the 10 PBL cases, five were converted to video-enhanced cases and five were kept as paper-based, “traditional” cases. “Micro” videos were used to introduce clinical scenarios, augmented by a set of guided questions related to the scenario. In addition, a formative quiz was conducted to assess concepts at the end of video-enhanced PBL sessions. At the end of a module, students and facilitators completed an online survey regarding this modified learning experience, and this was followed by a focus group discussion with the PBL facilitators.Results: More than two-thirds (71%) of the students and all facilitators preferred video-enhanced over paper-based cases. Seventy-nine percent of the students agreed that this method increased peer-peer and peer-facilitator engagement, while 66% (n=68) of the students and 81% (n=9) of the faculty agreed that the end of PBL formative assessment activity would support the Universal Design for Learning framework.Conclusion: Video-enhanced PBL used during the introduction of the case and formative assessment activities at the end of the PBL sessions improved student engagement and contributed positively to the discussions and their understanding

Acquired Uterine Vascular Anomaly: Experience from a tertiary care center in Pakistan

Objective: To retrospectively review imaging findings and the outcomes of uterine artery embolization (UAE) in symptomatic uterine vascular anomalies. Methods: We identified 15 cases of acquired uterine vascular anomaly from 2010 to 2020 who were evaluated with ultrasound, computed tomography, and magnetic resonance imaging, either alone or in combination. All patients had history of dilatation and curettage or uterine instrumentation. They underwent angiography and embolization of the uterine arteries. Primary outcome post embolization was assessed clinically and/or in combination with ultrasound. Post procedure pregnancies were also recorded. Results: Non-invasive imaging was abnormal in all patients, however this pre intervention imaging was unable to accurately classify the type of vascular anomaly except in the case of pseudoaneurysm. Conventional angiography showed uterine artery hyperemia in 6, arteriovenous malformation in 7 and pseudoaneurysm in 2 patients. The technical success rate was 100% with no repeat embolization needed. Follow up ultrasound in 12 patients revealed resolution of abnormal findings, remaining three were normal on clinical follow up. Seven patients (46.7%) had a normal pregnancy, 15.7 months after the procedure (range 4-28 months). Conclusion: UAE is a safe and effective management option for intractable severe bleeding in patients with uterine vascular anomaly post instrumentation and is seen not to impair future pregnancy. Keywords: Uterine artery embolization; Pseudoaneurysm; Arteriovenous malformation; Ultrasound; Computed tomography; Magnetic resonance imaging