CT Scan Findings Research Articles

Assessing the Predictive Factors for Bleeding in Esophageal Variceal Disease: A Systematic Review.

Esophageal varices, dilated submucosal distal esophageal veins, are a common source of upper gastrointestinal bleeding in patients with portal hypertension. This review aims to comprehensively assess predictive factors for both the first occurrence and subsequent risk of esophageal variceal bleeding. A systematic search was conducted in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) and Cochrane databases. A total of 33 studies were selected using rigorous inclusion and exclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa Scale. Several predictive factors were identified for esophageal variceal bleeding, including the Child-Pugh score, Fibrosis Index, specific endoscopic findings, ultrasound parameters, portal vein diameter, presence and size of collaterals, CT scan findings, ascites, platelet counts, coagulation parameters, albumin levels, Von Willebrand Factor, bilirubin levels, diabetes mellitus, and the use of b-blocking agents in primary prophylaxis. The findings of this systematic review shed light on multiple potential predictive factors for esophageal variceal bleeding. Endoscopic findings were found to be reliable predictors. Additionally, ultrasound parameters showed associations with bleeding risk. This systematic review identifies multiple potential predictive factors for esophageal variceal bleeding in patients with portal hypertension. While certain factors exhibit strong predictive capabilities, further research is needed to refine and validate these findings, considering potential limitations and biases. This study serves as a critical resource for bridging knowledge gaps in this field.

A Study to Detect Risk Factors of Chronic Subdural Hematoma Recurrence

Introduction: Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. The risk factors for recurrence of chronic subdural hematoma (CSDH) after surgical evacuation has not been completely understood until now, but several risk factors for recurrence have been reported. Meanwhile, the definitive risk factors have not been defined until now. The aim of this study was to study the potential risk factors, including preoperative, operative and post-operative ones for CSDH recurrence. Materials and Methods: The study population comprised of all > 18 year age group patients who were operated for chronic subdural hematoma in Neurosurgery Department of tertiary care center. It was prospective cohort study. Patients who met inclusion criteria, postoperative outcomes were assessed at discharge, then at one month and three months afterwards in the neurosurgery OPD. Both the treatment options i.e. BHC Burr hole craniotomy and minicraniotomy as required as per CT scan or MRI findings. Results: 7 patients (10.7%) had recurrence, of CSDH. All the reoccurrences occurred in burr hole operated patients. There was no recurrence in mini craniotomy operated group. Conclusions: Many risk factors for recurrence of CSDH have been found, including old age, cerebral atrophy, large hematoma, bilateral hematomas, hematoma density, inflammation markers, alcohol ingestion, bleeding tendency, and some technical aspects of surgery such as irrigation with small amount of fluid, not excising thick membrane preventing brain expansion.

Epidemiological and clinical characteristics of esophageal carcinoma: An experience from tertiary care hospital of Karachi, Pakistan.

To describe current trends and characteristics of esophageal cancer (EC) over the past ten years largest tertiary care hospital of Karachi, Pakistan. This single center retrospective study was conducted at the Department of Gastroenterology and Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan, between the period of ten years from 1st January 2010 to 31st December 2019. Patient data including epidemiological characteristics such as age, gender, education, residence, occupation, addictions, comorbidities, symptoms, location of EC, laboratory parameters and histopathological type were recorded. All patients with missing histological and radiological findings were excluded. The mean age of all patients was 49.26±14.24 years and among them majority were females 566 (56.1%). Almost, 834 (82.7%) patients had SQC and 175 (17.3%) presented with ADS. Most common presenting symptom was dysphagia in both groups 327 (32.4%) followed by vomiting (22.8%) and weight loss 196 (19.4%). The Esophagogastroduodenoscopy (EGD) findings showed the distal esophagus involvement in most of the patients (36.3%) in both groups. CT scan findings showed that the lower region was the most involved region in 367 (36.4%) patients, followed by middle and upper in 227 (22.5%) and 156 (15.5%) patients respectively. The thickening of mass on CT- scan was circumferential in most of the patients (42.7%) in both groups. According to our findings, SQC is more prevalent than ADC. Female predominance especially at younger age was most common as compared to past studies. No significant association between a single risk factor has been found in our study however smoking and betel nut chewing were found as known putative risk factors.

Development of a Scoring Method Based on a Chest CT Scan to Determine the Outcomes of COVID-19 Patients.

Introduction As COVID-19 shifts from pandemic urgency to endemic management, healthcare systems are faced with the evolving challenge of providing optimized care and adept resource allocation in this evolving landscape of the disease. However, the timely management and accurate assessment of disease severity remains a cornerstone of effective treatment. This study presents a pioneering scoring system, based on the primary chest CT scan findings, to predict patient outcomes and to equip clinicians with a tool that can expedite decision-making. Method A retrospective cohort study was conducted involving 406 confirmed COVID-19 cases referred to two of our hospitals in Tehran, between February and April 2020. Radiographic and CT scan data were sourced from the imaging archive system and evaluated by a certified radiologist. We devised distinct severity scores for CT findings, demographic factors, and clinical indicators. These were synthesized into a comprehensive severity score to forecast critical patient outcomes, such as mortality, ICU admission, intubation, or extended hospitalization. Of the total cases, 161 (39.7%) were classified as severe, while 245 (60%) fell into the low or moderate severity category. Results The mean score of demographic, CT scan, and clinical characteristics was significantly higher for those in the severe COVID-19 than the non-severe group. The cutoff score for predicting the outcomes in COVID-19 patients for demographic, clinical, and chest CT scan factors was 2.5, 9.5, and 8.5, respectively. Multivariate analysis indicated that each unit increase in these scores elevated the odds of fatal outcomes by 24%, 2.8%, and 12%, respectively. Then, using the comprehensive severity score, which is the sum of the above scores, we further predicted the disease severity. Conclusion The findings suggest that our innovative scoring system, based on initial chest CT scan findings, serves as a robust predictor of COVID-19 outcomes.

Accuracy of Multi-Detector Computed Tomography In the Diagnoses of Adnexal Masses

Background: Ovarian cancer is the 5th common cause of death in women. patients older than 30 years are high malignant potential group. The lifetime risk of dying from invasive ovarian cancer is about 1 in 95. Modern imaging techniques have demonstrated significant accuracy in the diagnosis and staging of adnexal masses that help the clinician in surgical and post-surgical treatment planning. Objective: To determine the accuracy of multidetector computed tomography (MDCT) in diagnoses of benign and malignant adnexal masses, compare it with histopathological diagnoses and find out the sensitivity, specificity, positive predictive value, negative predictive value of MDCT in diagnoses of benign and malignant adnexal masses. Materials and Methods: This cross-sectional observational study was carried out between January 2013 to December 2014 with 45 patients referred for an MDCT scan of the pelvic organ with a suspicion of adnexal mass in Dhaka Medical College, Dhaka. All the patients were evaluated by detailed history and clinical examination. CT scan of the pelvic organ was performed in all cases and the report was checked by the radiologists of DMCH. Operated patients were followed up after surgery up to histopathological diagnosis and correlated with CT scan findings. Results: CT diagnosis for evaluation of benign adnexal mass, sensitivity was 90.0%, specificity 92.0%, accuracy 91.1%, PPV was 90.0% and NPV 92.0%. In the case of malignant mass, sensitivity is 92.0%, specificity 90.0%, accuracy 91.1%, PPV 92.0% and NPV 90.0%. Conclusion: MDCT is a valuable modality in the diagnosis of benign and malignant adnexal masses.KYAMC Journal Vol. 14, No. 02, July 2023: 74-78.

SAT241 Severe Hypercalcemia Secondary To Likely Sarcoidosis

Abstract Disclosure: N. Nair: None. A 42 year old gentleman with no known past medical history initially presented to the Endocrinology office referred from his primary care provider for the evaluation of severe hypercalcemia. He initially presented to his PCP with 8 months of progressive tachycardia, shortness of breath and persistently elevated blood pressures but was noted with a serum calcium of 14.9. On my initial evaluation, patient was well appearing, tachycardic with normal rate and rhythm with otherwise no abnormal findings. His blood pressure was elevated to 150s systolic from a baseline of less than 120. Based on the severity of the initial hypercalcemia, an extensive workup was sent to rule out potential etiologies for his hypercalcemia including Vitamin D, PTH, PTHrp, serum free and light chains, CMP, ionized calcium, and serum protein electrophoresis. The initial workup revealed a calcium improved to 12.1 from the initial 14.9, with significant elevation in ionized calcium. PTH and 25 hydroxyvitamin D were suppressed, ruling out primary hyperparathyroidism. Interestingly, 1,25 dihyroxyvitamin D levels were within the upper limit of normal, raising the possibility of granulomatous disease. PTHrp was elevated. Serum protein electrophoresis had revealed mild elevations in beta immunoglobulins. Based on the findings of the initial workup, concern remained for granulomatous disease and malignancy, and a CT of the chest, abdomen and pelvis was ordered. CT showed bilateral perihilar interstitial nodules, mildly enlarged mediastinal and hilar lymph nodes, and splenomegaly with ill defined splenic lesions. No mass or tumor was identified in this study. Although the potential for monoclonal gammopathies and malignancy remain in the differential diagnosis, his presentation, CT scan, and lab findings may be explained by sarcoidosis. While the normal 1,25 Vitamin D levels in the setting of suppressed PTH and 25 Vitamin D may be more classically associated with granulomatous disease, significant renal impairment, elevations in PTHrp and immunoglobulins are not uncommon, making sarcoidosis a likely explanation for his symptoms short of obtaining a biopsy. He was subsequently referred to pulmonology to evaluate for sarcoidosis and to oncology to evaluate further the elevations in serum immunoglobulins. This patient presentation is unique as it is not common to encounter cases of severe hypercalcemia in the outpatient setting. Here, it is important to note that PTHrp elevations and elevations in light chains may be seen in sarcoidosis as well as malignancy. This case illustrates the importance of a wide differential diagnosis in order to avoid the pitfall of prematurely determining a working diagnosis. Presentation: Saturday, June 17, 2023

Rituximab Monotherapy Is Effective as First-Line Treatment for Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in CVID Patients

Granulomatous lymphocytic interstitial lung disease (GLILD) represents a fatal immune dysregulatory complication in common variable immunodeficiency (CVID). Evidence-based diagnostic guidelines are lacking, and GLILD treatment consists in immunosuppressive drugs; nonetheless, therapeutical strategies are heterogeneous and essentially based on experts’ opinions and data from small case series or case reports.We aimed to evaluate the efficacy and safety of first-line Rituximab monotherapy for CVID-related GLILD, by assessing symptoms and quality of life alterations, immunological parameters, pulmonary function tests, and lung computed tomography.All six GLILD patients received Rituximab infusions as a first-line treatment. Rituximab was administered at 375 mg/m2 monthly for six infusions followed by maintenance every 3 months; none of the patients experienced severe adverse events. Symptom burden and quality of life significantly improved in treated patients compared to a control group of CVID patients without GLILD. Rituximab treatment indirectly caused a trend toward reduced T-cell activation and exhaustion markers sCD25 and sTIM-3. Lung function improved in treated patients, with statistically significant increases in TLC and DLCO. Lung CT scan findings expressed by means of Baumann scoring system displayed a reduction in the entire cohort.In conclusion, first-line monotherapy with Rituximab displayed high efficacy in disease remission in all treated patients, with improvement of symptoms and amelioration of quality of life, as well as restoration of PFTs and lung CT scan findings.

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria havehigher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Comparison between CT-Scan Finding and Operative Finding of Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery

Background: Chronic rhinosinusitis is a group of disorders characterized by inflammation of the mucosa of the nose and Paranasal sinuses for at least 12 consecutive weeks. It is a common clinical problem that has a significant impact on quality of life. CT-scan has become the modality of choice for assessment of CRS and Endoscopic sinus surgery is a minimally invasive technique and the surgical management of choice for chronic rhinosinusitis.
 The Aim of this Study: To verify the agreement and associations between preoperative CT-scan and intraoperative ESS findings in patients with CRS and to evaluate the types and frequency of anatomical variants in the nasal fossa and paranasal sinuses as well as their clinical correlations in chronic rhinosinusitis.
 Patients and Methods: This study is experimental study in which 50 subjects were collected by simple randomization technique as they visited our department in a period from January to December 2015. All the participants were guided to conduct a coronal, axial, and sagittal CT scan of the nose and paranasal sinuses before functional endoscopic sinus surgery. The anatomical variations and mucosal abnormalities on CT Scan & ESS were studied and analyzed.
 Results: Septal deviation is the most common anatomical abnormality, 37(74%) of the participants have these abnormalities. The presence of agar nasi cells 34(68%), and chonca bullosa 28(56%) are the second and third most common anatomical variants found on CT-scan images. There is a high level of agreement between both the diagnostic tools at the high numbers of both positive and negative results for each abnormal finding.
 Conclusions: There was a good correlation between CT and ESS findings and there was a slight difference between the diagnostic characteristics of these different tools.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Comparison of Preoperative Computerized Tomograghic Scan of Temporal Bone Findings with Intra Operative Findings in Patients with Chronic Otitis Media Undergoing Tympanomastoidectomy: A Descriptive Study

Background: Since ancient times, chronic suppurative otitis media (CSOM) has been a significant contributor to middle ear illness. Antibiotics have been extremely helpful, but (CSOM) is still a frequent condition, and its consequences present a challenge to both otologists and radiologists. Due to the intricate anatomical nature of the middle ear and inner ear, radiological assessment of the temporal bone is challenging.
 Aim of the Study: To compare between preoperative CT scan findings of the temporal bone with the operative findings in patients with CSOM undergoing tympanomastoidectomy.
 Methodology: A Descriptive cross-sectional prospective has been adopted and 35 patients with Chronic Suppurative Otitis Media were admitted at the Department of Otolaryngology/ Alsulaymaniyah Teaching Hospital of Otolaryngology, Head and Neck Surgery, and Zhian Hospital during the period from February to December 2015. A detailed history and careful physical examination, clinical tests revealed that all of the patients had Chronic Suppurative Otitis Media, typically with discharge from the ear and hearing loss. Each patient had their clinical history collected, and they all underwent a thorough ear, nose, and throat examination as well as an attentive otoscopic and microscopic ear examination. Additionally, all patients underwent an audiological evaluation that included pure tone audiometry, tympanometry, and HRCT.
 Results: Thirty -five patients were included in this study. The mean age of the patients was 33 years; 51.4% were males and 48.6% were females. The most common presenting symptom was aural discharge in 71.4%; the second one was hearing loss in 28.6%. Mastoid pneumatization was found in 82.9% by CT while by surgery, it was found in 17.1%. CT findings showed that middle ear involvement in 11.4%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 54.3%, and EAC, mastoid, and middle ear involvement in 17.1%. While the surgical findings showed middle ear disease in 20%, mastoid involvement in 11.4%, mastoid with middle ear involvement in 57.1%, and EAC, mastoid and middle ear involvement in 11.4%. The CT findings for eroded Malleus, Incus integrity, and stapes in 31.4%, 37.1%, not visualized while surgical findings showed eroded Malleus, Incus, and stapes integrity that 28.6%, 54.3%, and 28.6% respectively. The CT findings for an eroded facial canal, the lateral semicircular canal, the posterior external auditory canal wall, and sigmoid sinus plate integrity were 12.4%, 8.6%, 22.9%, and 11.4% in that order, while the surgical findings of the eroded facial canal, the lateral semicircular canal, and the posterior external auditory canal wall were found in 20.0%, 5.7%, 17.1%, and 14.2% respectively. Both CT and surgical findings of Integrity of the tegmen showed that 32 patients (91.4%) were found to have intact tegmen, and 3 patients (8.6%) had eroded tegmen and both showed that the eroded scutum found in 25.7%.
 Conclusions: The current study concluded a positive correlation between CT and surgical findings that has many advantages in preoperative planning for the eradication of the disease, choosing the best approach & has a very important role in the orientation of the surgeon during the surgery to avoid any possible complications.

Serum interleukin-6 level and its association with pulmonary involvement in progressive systemic sclerosis; a case-control study

BackgroundPrimary Systemic Sclerosis (PSS) is a connective tissue disorder characterized by excessive collagen deposition in the skin and internal organs. Interstitial lung disease (ILD) is a late demonstration of PSS and cytokines can contribute to the disease pathology. The purpose of the current study was to determine the association between serum interleukin-6 level and pulmonary involvement in progressive systemic sclerosis.Methods and materialsDemographic data and serum interleukin-6 levels were measured for 30 PSS patients with pulmonary involvement (case group) and 30 PSS patients without pulmonary involvement (control group) following informed consent. The disease duration and activity, C-reactive protein (CRP), chest x-ray and highresolution CT scan (HRCT) findings, ejection fraction (EF) and echocardiography findings, and pulmonary artery pressure (PAP) were also determined in both groups.ResultsThe age of patients in case and control groups was 52.5 ± 9.3 and 43.9 ± 9.7 years, respectively (p = 0.001). No significant difference was found between serum levels of IL-6 in case and control groups (73.1 ± 95.4 vs 46.7 ± 83.6 pg/ml, p = 0.267). However, IL-6 level was significantly higher in male case patients compared to male controls (p = 0.007). The duration of PSS was 11.6 ± 6.4 and 7.4 ± 4.2 years in case and control groups, respectively (p = 0.002). The quantitative CRP and PAP was also significantly higher in case patients (p = 0.01 and p < 0.001, respectively). There was found reticulonodular pattern in 20 (66.7%) of the cases, whereas 28 (93.3%) of the controls had normal Chest X-rays (CXR) (p < 0.001). EF was significantly lower in case patients compared to control patients (p = 0.001).ConclusionThe serum level of IL-6 did not appear to have a relationship with pulmonary involvement, hence it could not be regarded as a potential therapeutic target.

Management of adhesive small bowel obstruction: the results of a large retrospective study

BackgroundPostoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial.MethodsWe conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet.ResultsSeventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia.ConclusionsOur protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

Exploring the Role of MRI in the Detection of Atypical Liver Hemangiomas and Exclusion of Metastases

Background: In this article, we highlight the importance of utilizing multiple imaging modalities, including CT, MRI, and abdominal Doppler ultrasound, to accurately differentiate between atypical liver hemangiomas (LH) and metastases. Case report: We introduce a 57-year-old male patient who presented with severe abdominal pain. Initial CT scan findings showed hypodense liver lesions and a well-defined hypodense mass in the sub-diaphragmatic region, raising suspicion for metastatic liver lesions, and prompting further evaluation. To differentiate between atypical hemangiomas and metastases, an MRI scan was performed, revealing a hyperintense signal on T2-weighted images and a hypointense signal on T1-weighted images, consistent with the characteristics of LH. These characteristic signal intensities aided in ruling out metastatic liver lesions, which typically present with a more solid and homogeneous appearance. Contrast-enhanced MRI played a crucial role in confirming the diagnosis. The liver lesions demonstrated moderate vascularization during the early phase of contrast enhancement, followed by progressive centripetal filling during the portal venous and delayed phases. This enhancement pattern is consistent with the slow flow within the dilated vascular spaces of liver hemangiomas. The lesion in the right liver lobe is almost completely filled with contrast, further supporting the diagnosis of hemangioma. Abdominal Doppler ultrasound can provide additional information regarding the vascularity of liver lesions. In this case, the Doppler examination likely helped to further confirm the presence of a hemangioma, as these lesions typically demonstrate increased vascularity compared to metastatic lesions. Conclusion: The comprehensive imaging evaluation utilizing CT, MRI, and abdominal Doppler ultrasound allowed for the confident differentiation of atypical liver hemangiomas from metastatic liver lesions in this case. This emphasizes the importance of a multimodal imaging approach in cases of liver lesions with overlapping features, leading to improved patient management and outcomes.

Revisiting the orbital complications of acute rhinosinusitis

ObjectiveThe present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. MethodsClinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. Results143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler’s and Mortimore & Wormald’s classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. ConclusionsARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima’s classification system proved valid, simple, and effective for categorizing orbital complications of ARS. Level of evidence3.

Clinical and Diagnostic Findings Among Tubercular Meningitis Patients without Pulmonary Signs and Symptoms

Background: Tubercular meningitis (TBM) is the most frequent one among the different forms of CNS tuberculosis. Early diagnosis, as well as treatment of tubercular meningitis (TBM), can give an excellent outcome with minimal residual morbidity. Clinical and diagnostic findings of patients without pulmonary signs and symptoms may be useful for the treatment of suspected tubercular meningitis patients. Aim of the study: This study aimed to make a patient profile on the clinical and diagnostic findings of tubercular meningitis patients without pulmonary signs and symptoms. Methods: This cross-sectional study was conducted in the Department of Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from September 2020 to August 2021. A total of 77 confirmed cases of tubercular meningitis without pulmonary signs and symptoms admitted to the mentioned hospital were enrolled in this study as the study population. A purposive sampling technic was used in sample selection. Along with the clinical and diagnostic findings, all relevant information was recorded in a data collection sheet. Results: In this study, 61% of the study population had a family history of TB. Among all the patients, all had fever, 80.5% had headache, 68.8% had altered sensation, 62.3% had anorexia and nausea, 55.8% had vomiting, 19.5% had a convulsion and 15.6% had neck stiffness. In our settings, the majority (46.8%) of the respondents had TBM Grade II. The mean WBC count was 134.80±34.59 106/L, Lymphocyte (%) was 79.49±11.77, Glucose was 26.49±5.43 mg/dl, Protein was 142.8±72.5 and ADA level was 12.08±1.29 U/L. In our settings, 58.4% of the respondents had Mantoux test and 36.4% showed chest X-ray positive. In this study, 22.1% of the respondents had CT scan or MRI findings normal. Conclusion: A family history of tuberculosis may be a potential factor for TBM. Fever, headache, altered sensation, anorexia/nausea and vomiting are very common clinical features in such patients. Chest X-ray ..

Relationship between CT-Scan Findings and Longitudinal Blood Markers with the Occurrence of Death among Comatose Patients Due to Traumatic Brain Injury: Retrospective Longitudinal Study

Relationship between CT-Scan Findings and Longitudinal Blood Markers with the Occurrence of Death among Comatose Patients Due to Traumatic Brain Injury: Retrospective Longitudinal Study

Role of diagnostic laparoscopy in comparison with CT scan finding of patients presenting with abdominal trauma-A cross-sectional study

Background: Trauma is a critical and urgent surgical condition that we encounter on a regular basis. Blunt trauma mechanisms account for 78.9–95.6% of all injuries, with the abdomen being affected in 6.0–14.9% of all traumatic injuries. Diagnostic laparoscopy (DL) for blunt abdominal trauma (BAT) is safe and feasible. Prerequisites are the hemodynamic stability of the patient and surgical expertise in advanced laparoscopy. Aims and Objectives: To find out the role of DL in the diagnosis and management of abdominal trauma patients. Effect on the length of hospital stay and rate of reduction of non-therapeutic laparotomy in the patients with trauma abdomen. Materials and Methods: This cross-sectional study was conducted with 50 patients of abdominal trauma with pre-structured pro forma and Written informed consent. A contrast-enhanced computed tomography (CECT) scan of the abdomen was done in hemodynamically stable patient and injury was noted. Patients meeting the inclusion criteria underwent DL. Results: The duration of hospital stay was lower in laparoscopically managed patients than in laparotomy patients. Most of the patients were managed conservatively 37 (74%) and thus by reducing non-therapeutic laparotomy. Overall recovery was 86% which signifies the reduction in mortality rate with the use of DL. In this study, clear diagnosis was obtained in 88% of the cases, so the efficacy is 88%. Conclusion: Laparoscopy and CECT abdomen has an effective diagnostic and management role in patients with BAT. The therapeutic value of DL is also accepted, well appreciated, and it cannot be underestimated.

Trans-Arterial Chemoembolization for the Treatment of Hepatocellular Carcinoma: A Single Tertiary Care Institute Experience

Introduction: Trans-arterial chemoembolization (TACE) is a mainstay therapeutic option indicated in early-stage non- resectable hepatocellular carcinoma (HCC) and has been shown to be associated with survival improvements. This study aimed to evaluate the radiological and clinical response of those who underwent TACE. Aims &amp; Objectives: We aimed to evaluate the radiological and clinical response in patients who underwent Trans- arterial chemoembolization. Place and Duration of Study: This study was conducted in the Vascular Interventional Radiology Department, Dow Institute of Radiology, Dow University of Health Sciences, Ojha Campus Karachi for a period of 18 months between January 2021 and June 2022. Material &amp; Methods: HCC patients (n=181) who underwent TACE as their primary treatment at Dow Hospital Ojha Campus Karachi between January 1st, 2021, and June 30th, 2022 were included. Inclusion criteria followed the Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh staging systems. Tumor response was evaluated using “modified Response Evaluation Criteria in Solid Tumors (mRECIST)”, and patients were categorized into complete response (CR) or partial response (PR) groups. The study compared background, clinico-laboratory, and radiological features between these groups, including HCC sizes and CT scan findings before and after TACE. The retrieved data was entered and analyzed using SPSS version.21. Results: Of the total 118 patients, 51.70% showed CR to the TACE, while PR was noted in 48.30%. Age, sex, viral hepatitis, and co-morbids showed no intergroup differences. However, Child-Pugh stage and BCLC were significantly associated with tumor response. Similarly, laboratory parameters revealed significant mean differences between the two groups (p&lt;0.001), except international normalized ratio and alanine transaminase. Those who had achieved CR had a mean number of tumor less than that of PR. Similarly, tumor size significantly decreased post-TACE (p&lt;0.0001). Moreover, arterial-phase enhancement and portal venous and delayed phases washout tumors before TACE were reported in 76.30%. Over half of the patients had no residual tumor tissue after TACE. Tumors with arterial-phase enhancement and portal venous and delayed phases washout were highly susceptible to TACE.Furthermore, Child-Pugh classA had a greater estimated mean survival than class B (p&lt;0.001). Conclusion: Over half of the patients showed complete response to the TACE. BCLC staging (B), Child-Pugh (stage A), and small tumors had a favourable effect on the radiological and clinical response in the early-stages of HCC. Tumors with an arterial-phase enhancement and portal venous and delayed phases washout were more susceptible to TACE.

Bronchopulmonary sequestration A rare congenital anomaly presented in an adult female patient

Pulmonary sequestration is a congenital anomaly of lung parenchyma without a normal connection to the tracheobronchial tree and an anomalous systemic arterial supply. The presentation of this condition is variable ranging from no symptoms to hemoptysis. We report a case of pulmonary sequestration in an adult female who presented with recurrent chest infections. Her chest x-ray showed non-homogenous opacity in left lower lobe of lung and CT scan findings were suggestive of intralobar pulmonary sequestration in left lower lobe having arterial blood supply from the descending aorta and venous drainage in left inferior pulmonary vein. She subsequently underwent resection of the left, lower lobe of the lung.