Lost and Found : Unusual location of a urinary tract calculus

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Idiopathic Granulomatous Mastitis Diagnostic strategy and therapeutic implications in Omani patients

Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign disorder of the breast whose aetiology is controversial, and is often misdiagnosed clinically and radiologically as mammary malignancy; as a result, it may be incorrectly treated. Although no standard treatment is available for this chronic disease, surgery with or without corticosteroids has been tried with controversial results. This study discusses the clinical presentation, diagnosis, management, recurrence, and follow-up data of IGM with a review of relevant literature. Methods: From 2009–2012, the Breast Unit at Sultan Qaboos University Hospital, Oman, conducted a clinical study on 20 patients with breast lumps. Their clinical and radiological examinations were indeterminate, and a diagnosis of granulomatous mastitis was established only by histopathology. Results: The majority of the patients were cases of unknown aetiology, who presented with a unilateral breast mass. A few patients had a mass with an abscess, along with axillary lymphadenopathy. A total of 4 patients were suspected of malignancy using radiology. In all patients, sterilised pus was sent for culture and sensitivity. Microscopy showed the characteristic pattern of granulomatous inflammation. All patients were treated with antibiotics for 6 weeks, and the mean follow-up period was 15 months (11–33 months). All patients had complete remission with no further recurrence. Conclusion: This single largest study of cases of IGM in Oman highlights the pitfalls in diagnosing this non-neoplastic disease of unknown aetiology and uncertain pathogenesis. It emphasises IGM’s excellent response to antibiotics, which is crucial, as IGM is a disease which is notoriously difficult and controversial to treat

Clinically Significant Anatomical Variants of the Paranasal Sinuses

Objective: Anatomic structural variations of the paranasal sinuses have a practical significance during surgical procedures conducted on the sinuses by otolaryngologists. This study aims to evaluate the prevalence of clinically significant anatomical variations of the paranasal sinuses. Methods: A prospective analysis of 435 computed tomography (CT) examinations of adult Omani patients was conducted to determine the prevalence of clinically significant anatomical variations of the paranasal sinuses. A total of 360 CT scans were included from January 2009 to January 2010. Results: The findings showed abnormal Agger nasi cells in 49% of cases (95% CI: 44-54%), concha bullosa in 49% (95% CI: 44-54%), Haller cells in 24% (95% CI: 18-31%), asymmetry in anterior ethmoidal roof 32% (CI: 29-37%), Onodi cells in 8% (CI: 5%-10%). The type of skull base were as follows; Type 1 was 30% (n=107; 95% CI: 25-35%), Type 2 was 34% (n=123; 95% CI: 29-39), and Type 3 was 36% (n=130; 95% CI: 31-41%). Many other surgically significant anatomical variations in small numbers (1-3) were incidentally identified. Conclusion: Knowledge of the presence of anatomical variations of the sinuses has a clinical significance as it minimizes the potential for surgical complications. There is an ethnical difference in the prevalence of anatomical variations. Further studies of anatomical variations with clinical disease correlations are needed

Metastatic Invasive Lobular Carcinoma of the Breast Masquerading as a Primary Renal Malignancy

Breast cancer is known to metastasise to different organs in the body, but an initial presentation of breast cancer with loin pain secondary to a metastatic renal mass is extremely rare. We report a 58-year-old woman who presented with recurrent left loin pain due to a metastatic deposit of invasive lobular carcinoma of the breast. The detection of a renal mass on computed tomography led to the assumption of a renal pelvic malignancy. The diagnostic dilemma posed by the detection of a breast mass during staging and the usefulness of immunohistochemistry in the confirmation of diagnosis are discussed

Pulmonary Infarction: A rare case of adrenal carcinoma

A case report of unsuspected adrenal carcinoma with pulmonary artery obstruction in a young girl who was admitted with recurrent episodes of hypotension is presented. Computed tomography (CT) scans demonstrated a large right adrenal mass extending into the inferior vena cava (IVC), right atrium, right ventricle and right pulmonary artery. There are many case reports in literature documenting IVC and right atrial thrombus in patients with adrenal carcinoma. To our knowledge, this is the first case report specifically documenting pulmonary infarction secondary to tumour extension into the pulmonary artery

Prenatal MRI Image of a Fetus with Semilobar Holoprosencephaly

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Pulmonary Infarction : A Rare case of Adrenal Carcinoma

A case report of unsuspected adrenal carcinoma with pulmonary artery obstruction in a young girl who was admitted with recurrent episodes of hypotension is presented. Computed tomography (CT) scans demonstrated a large right adrenal mass extending into the inferior vena cava (IVC), right atrium, right ventricle and right pulmonary artery. There are many case reports in literature documenting IVC and right atrial thrombus in patients with adrenal carcinoma. To our knowledge, this is the first case report specifically documenting pulmonary infarction secondary to tumour extension into the pulmonary artery.

Right Aortic Arch with Aberrant left Subclavian Artery

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Behçet’s Disease : Bilateral Pulmonary Arterial Aneurysms Presenting as Pulmonary Embolism

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Behçet’s Disease: Bilateral Pulmonary Arterial Aneurysms Presenting as Pulmonary Embolism

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