Behçet’s disease: Spectrum of MDCT chest and pulmonary angiography findings in patients with chest complaints

AbstractObjectiveThe aim of the work was directed to evaluate the value of multi-detector computed tomography pulmonary angiography study in evaluation of known patients with Behcet’s disease.Materials and methodsThis study was done retrospectively and included eighteen known patients with Behcet’s disease and referred for MDCT pulmonary angiography.ResultsPulmonary artery aneurysm was the most common finding as it was found in 16 patients, followed by pulmonary embolism which was found in 14 patients, 12 patients with pulmonary hypertension, right ventricular strain in 6 patients, intracardiac thrombus in 4 patients, dilated bronchial arteries in 8 patients, venous occlusion in 4 patients, mosaic attenuation of the lung in 12 patients, pulmonary infarcts in 4 patients, and pleural effusion in 4 patients.ConclusionMDCT pulmonary angiography is an important diagnostic imaging tool for diagnosis of vascular complications in patients with Behcet’s disease

Ultrasound screening for developmental dysplasia of the hip and its socioeconomic impact: Experience of tertiary care health level

Objective: The purpose of this study was to investigate the usefulness of screening ultrasound to detect developmental dysplasia of the hip in infants with risk factors and to assess its socioeconomic impact. Patients and methods: This is a retrospective study. In the duration of 30 months, all infants born at Hospitals in our region were examined clinically for hip dislocation. All those with clinically dislocated hips were excluded and referred for follow up to a pediatric orthopedic surgeon. After referral to our tertiary care center, a 6 week hip ultrasound scan was performed for those infants with stable hips on examination, having risk factors for dysplastic hips including positive family history, breech presentation and inconclusive clinical findings. We used an ultrasound technique that combines the two known methods (Graf’s technique and Harcke’s method). Results: 3540 Hip ultrasound scans were performed, of those scanned 12 (0.33%) were found to have dislocated hips and 98 (2.8%) to have different grades of dysplastic hips. Among these twelve patients; six of them had a first degree relative with congenital dislocation of hips, three had breech presentation at birth and three had inconclusive clinical findings. Those with dysplastic hips were followed up by serial ultrasound examinations but did not require active intervention. Conclusion: Screening ultrasound is a useful tool for detection of hip dislocation and dysplasia especially among the population of infants at increased risk of developmental dysplasia of the hip. Limitation of screening ultrasound programs for those at risk only reduces the financial burden with better outcome in choosing candidates for further workup especially surgical intervention

MRI features of some uncommon causes of painful knee

Aim of the work: The purpose of this study is to describe the MRI features of some uncommon causes of knee pain. Materials and methods: This is a retrospective study. We reviewed our database including the last 1000 knee MRI examinations done within the period from January 2012 till June 2013. This revision revealed 12 cases with reported variable uncommon diagnoses explaining knee pain. Unenhanced MRI of the knee was performed and included sagittal T1, T2, T2∗ and proton density fat suppression (PDFS), axial T2 and coronal PDFS. Some cases had complementary CT assessment. Results: The selected 12 cases included the following; three cases of supero-lateral Hoffa’s pad of fat edema expressing edema signal at the superolateral aspect of the Hoffa’s pad of fat. Three cases with fabella syndrome with chondral and subchondral edema signal at the posterior aspect of the lateral femoral condyle. Two cases with symptomatic bipartite patella showing marrow edema around the patellar synostosis. One case with proximal tibio-fibular synostosis evident on MRI as bony fusion. Two cases with quadriceps (suprapatellar) fat-pad impingement syndrome manifested as edema signal within the supra-patellar fat-pad and lastly one case with lipoma arborescence seen as frond like projections with fat signal protruding into the supra-patellar bursa. Conclusion: MRI is a useful tool in evaluation of some uncommon causes of painful knee

Osteopontin, osteoprotegerin and musculoskeletal ultrasound findings in first-degree relatives of rheumatoid arthritis: potential markers of preclinical disease

Abstract Background First-degree relatives (FDRs) of rheumatoid arthritis (RA) patients are known to have increased risk of developing the disease. The detection of altered bone metabolism in FDRs could be a predictor of the disease. Musculoskeletal ultrasound (MSUS) is known for its ability to detect subclinical joint inflammation in RA, but changes in FDRs are not yet described. We aimed to study serum Osteopontin (OPN) and Osteoprotegerin (OPG) levels in FDRs of RA patients as markers of altered bone metabolism in relation to clinical, laboratory and musculoskeletal ultrasound (MSUS) findings. Methods Fifty-five individuals were included, 20 had definite RA, 25 were first degree relatives (FDRs) of RA patients, and 10 healthy controls. Clinical evaluation for joint swelling/tenderness was performed for all. ESR, CRP, rheumatoid factor (RF), anti-citrullinated antibodies (ACPA), OPN, OPG, and Musculoskeletal ultrasound (MSUS) by the US7 score were evaluated. Results Osteoprotegerin was significantly higher in RA (143.89 pg/ml ± 365.47) than in FDRs (22.23 pg/ml ± 65.73; p = 0.009) and controls (6.20 pg/ml ± 12.43; p = 0.003). OPN was also higher in RA (3.66 ng/ml ± 4.20) than in FDRs (1.97 ng/ml ± 1.04) and controls (2.81 ng/ml ± 1.31), though not significant (p = 0.102). Eight of 25 FDRs (32%) had arthralgia without clinical arthritis and 17/25 (68%) were asymptomatic. FDRs with arthralgia had significantly higher ESR and CRP levels than asymptomatic FDRs (9.82 mm/h ± 4.13; p = 0.003, and 3.93 mg/l ± 3.58; p = 0.003). Osteoprotegerin was higher in FDRs than in controls, and also in those with arthralgia (51.55 pg/ml ± 114.68) than in those without (8.44 pg/ml ± 9.67), though without significant difference. OPN was higher in FDRs with arthralgia (2.09 ng/ml ± 1.19) than in asymptomatic (1.70 ng/ml ± 0.55), also without significant difference. Pathologic findings by US7 were detected in 10/25 (40%) FDRs, of which three (12%) had arthralgia and seven (28%) were asymptomatic. Conclusions The raised OPG and lower OPN in FDRs than in controls reflect an altered bone metabolism which could precede clinical disease phase. OPN and OPG could serve as markers of altered preclinical bone metabolism in FDRs of RA. US7 score might be a useful screening tool to identify ‘at-risk’ individuals

Mucoid degeneration of the anterior cruciate ligament: frequently under-diagnosed entity in MRI

AbstractObjectiveThe purpose of our study was to describe the MR appearance of mucoid degeneration of the anterior cruciate ligament and to address its clinical significance.Patients and methodsA database search of 2000 knee MRI examinations revealed 32 examinations (Chart 1) with reported mucoid degeneration of the anterior cruciate ligament.ResultsOf 32 examinations that met imaging criteria, all patients (100%) had different degrees of mucoid degeneration. Associated ganglia were seen in eight patients; located in the proximal ligament in four examinations (12.5%) and the distal ligament in two (6%) and involved the mid-portion of the ligament in two (6%).Intra-osseous cysts were noted distally in 15 examinations (47%), proximally in four (12.5%) and on both sides in six (19%). All our patients had accessible medical records; no clinical evidence of instability was reported.Four patients who underwent arthroscopy had an intact anterior cruciate ligament at that time.ConclusionAnterior cruciate ligament mucoid degeneration has specific MRI features and should not be misdiagnosed as partial or total tear, and typically not associated with ligament instability

Multifocal/Multicentric versus Unifocal Breast Cancer: What is the Difference?

Background: Although multifocal and multicentric breast cancers are a common entity, their clinical behavior is not well characterized. With the widespread use of mammographic screening and improved sensitivity of imaging modalities, the detection of multifocal and multicentric breast cancers is likely to continuously increase. Many studies have consistently shown a correlation between multifocality and multicentricity and the rate and extent of lymph node metastases. There is little clinical data on the impact of multifocal and multicentric breast cancers on survival outcomes. This study investigates the difference between multifocal and multicentric breast cancers and unifocal breast cancer regarding pathologic and clinical parameters. We have evaluated the impact of multifocal and multicentric breast cancers on disease-free and overall survival of breast cancer patients. Methods: In this retrospective study, we reviewed the records of female patients newly diagnosed with breast cancer who presented to the department of Cancer Management and Research, Medical Research Institute, Alexandria University in the time period from January 2009 till December 2009. Patients with pathologically proven stages I-III invasive breast cancer were included in this study. Patients’ clinical and pathological characteristics were compared between the two studied groups. The disease free and overall survivals were analyzed using the Kaplan–Meier method. Results: Multifocal and multicentric breast cancers were associated with a number of known adverse prognostic factors such as higher clinical stage, larger tumor size and lymphovascular invasion. There was a significant correlation between multifocal and multicentric breast cancers and increased rate of axillary lymph node metastasis and higher N stage. Multifocal and multicentric breast cancer patients had shorter median 5-year disease free survival and overall survival compared to unifocal breast cancer patients. In multivariate analysis, after adjustment of other factors, only clinical stage and multifocality/multicentricity were independent predictors of poor disease free and overall survival. Conclusion: There is an association between multifocal and multicentric breast cancers and known adverse prognostic factors such as increased incidence of regional lymph node metastases. This association may suggest that multifocal and multicentric breast cancers have an aggressive biology and more propensity for metastasis. Whether multifocal and multicentric breast cancer is an adverse prognostic factor in breast cancer remains controversial

Splenomegaly versus pathological lung volume during COVID-19 infection with or without cytokine storm; a linear regression analysis using CT volumetry

Background: Due to the paucity of scientific evidence, it is unclear among pulmonologists and physicians in critical care units if and when splenomegaly in novel coronavirus disease (2019) (COVID-19) patients is worrisome. This study aims to evaluate the significance of splenic volume during COVID-19 infection with or without cytokine storm and correlates splenic volume to the volume of pathological lung changes through linear regression analysis. Results: A retrospective study collected 509 polymerase chain reaction proved COVID-19 patients (399 males, 110 females; mean age 48 years, age range 24-78 years) between June and November 2021, without a history of splenic pathology. A control group of age and sex-matched 509 healthy subjects was used and analyzed according to the splenic volume. Five consulting radiologists evaluated initial and follow-up computed tomography (CT) examinations using lung CT volumetry and splenic volume calculation in consensus. Three consulting pulmonologists correlated the severity of clinical and laboratory findings, including oxygen requirements and interleukin-6 (IL-6) levels. The T test results for comparison between the COVID-19 patients and the healthy subjects control group regarding the splenic volume were significant (Tvalue was - 4.731452 and p value was 0.00002). There was no significant correlation between the severity of the disease and normal-sized spleen (26% of patients, p= 0.916) or splenomegaly (24% of patients, p= 0.579). On the other hand, all patients with a small spleen or progressive splenomegaly during serial follow-up imaging had clinically severe disease with a statistically significant correlation (p= 0.017 and 0.003, respectively). Ninety-seven percent of patients with clinically mild disease and splenomegaly had 0-20% lung involvement (CT-severity score 1) while all patients with clinically severe disease and splenomegaly had 27-73% lung involvement (CT-severity score 2 and 3) (r = 0.305, p = 0.030). Conclusions: Splenomegaly is a non-specific sign that may be found during mild and severe COVID-19 infection, it was not statistically correlated with the clinical severity and a weak positive relationship was found between the splenic size and the CT-severity score of the pathological lung volume. On the other hand, the presence of splenic atrophy or progressive splenomegaly was correlated with severe COVID-19 presentation and "cytokine storm". Therefore, the splenic volume changes should not be overlooked in COVID-19 serial CT examinations, particularly in severe or critically ill patients with cytokine storms