HRCT Scan Research Articles

Management of tegmen defects with mastoid and epitympanic obliteration using S53P4 bioactive glass.

ObjectiveTo evaluate the surgical results and complications in a cohort of patients operated on to repair a tegmen bony defect using either transmastoid approach with obliteration using S53P4 bioactive glass granules (TMA‐O), or the classic middle cranial fossa approach (MCFA).Study designA retrospective monocentric study.MethodsTwenty‐five cases (24 patients) were included. Data regarding patient demographics, etiology, intraoperative findings, complications, recurrences, audiometric data, and follow‐up were analyzed.ResultsSeven patients were operated with MCFA and 17 patients with TMA‐O. One patient was operated on using a combined approach (MCFA + TMA‐O). In the preoperative HRCT scan, the size of the defect was estimated to be 6 ± 3.8 mm in the TMA‐O group and 6 ± 3.5 mm in the MCFA group (P = .969). Intraoperatively, in the MCFA group, the location of the defect was mostly anterior (86%) with an intact ossicular chain (86%). A discontinuous chain was observed in 15 patients (88%) in the TMA‐O group. The mean follow‐up time was 22 ± 14 months in the TMA‐O group and 24 ± 15 months in the MCFA group (P = .762). In both groups, there were no early postoperative complications or recurrences during follow‐up.ConclusionRepair of a tegmen bony defect with S53P4 bioactive glass granules seems to be safe and effective, limiting the use of the middle cranial fossa approach to cases with epitympanic defects and with an intact ossicular chain, and it could be used whatever the size of the defect and/or the presence of meningoencephalocele.Level of evidence4.

Visual and quantitative assessment of HRCT pulmonary changes in idiopathic interstitial pneumonia with PFT correlation

BackgroundOur study was designed to correlate the degree of parenchymal affection in idiopathic interstitial pneumonia using visual and semi-quantitative HRCT assessment with pulmonary function test results.The study involved 50 patients diagnosed as idiopathic interstitial pneumonia. They were referred from a chest outpatient clinic to the Radiology Department in the Faculty of Medicine, Cairo University for HRCT assessment in the period from January 2017 to March 2019. Variable lung parenchymal affection was studied using HRCT and variable post acquisition processing (multi-planar reconstruction, volumetric assessment, 3D color-coded images).ResultsUsual interstitial pneumonia was the most common type of IP, found in approximately 40 patients (80% of cases) followed by nonspecific interstitial pneumonia found in 5 patients (10% of cases) and lymphocytic interstitial pneumonia found in 3 patients (6% of cases), and desquamative interstitial pneumonia was the least common type of IP, found only in 2 patients (4% of cases).Honeycombing was significantly correlated with FVC%, FEV1%, and FEV1/FVC% (p = 0.013, p = <0.001, p = 0.002 respectively). Also, reticular was significantly correlated with FVC% (p = 0.041).ConclusionSemi-quantitative image analysis, including the use of machine learning, provides a great deal of promise in the ILD field; such methods may be used together with visual analysis to obtain the most accurate diagnostic and prognostic information.Summary/keywordsHRCT is most sensitive in the detection of ILD than chest radiography or conventional chest computed tomography (CT). Advances in HRCT scanning and interpretation have facilitated and improved accuracy for use in diagnosing idiopathic pulmonary fibrosis (IPF), eliminating the need for a surgical biopsy in many patients. Consequently, HRCT scans became sufficient to allow a confident IPF diagnosisIt is important to note that there are potential differences in interpretation of HRCT patterns between thoracic radiologists. However, these differences seem to be in general within a clinically acceptable range of observer variation and can be partially mitigated by review of difficult cases at ILD referral centers.Semi-quantitative CT assessment is increasingly being used in ILD to identify pulmonary abnormalities and diagnose specific ILDs; recent studies showed that outcomes of computer-assisted imaging can be correlated with lung function tests and degree of dyspnea and functional disabilityThis study was designed to correlate the degree of parenchymal affection in IP using visual and semi-quantitative HRCT assessment with PFT results. Semi-quantitative imaging, including color-coded images (HU related), is a new and promising approach in the field of ILD diagnosis and prognosis.

Evolution of high-resolution CT-scan in systemic sclerosis-associated interstitial lung disease: Description and prognosis factors

ObjectiveThe aims of our study were to describe the evolution of interstitial lung disease (ILD) extent on HRCT scan in systemic sclerosis (SSc), to identify baseline prognostic factors associated with ILD evolution and to assess whether the evolution of pulmonary function tests (PFTs) correlated with this evolution. Methods58 SSc with ILD (SSc-ILD) patients were included. All HRCT scans and PFTs available were collected. We modelized PFTs and HRCT scans evolution using linear mixed model with random effect. ResultsPatients underwent a median number of 3 HRCT scans (total n = 203) and 5 PFTs (total n = 329), during a mean follow-up of 5.3 ± 4.9 years. Mean SSc duration was 2.5 ± 3.1 years at the diagnosis of ILD. Mean baseline ILD extent was 32.3 ± 28.7%. We found a significant mean progression of ILD extent on serial HRCT scans of 0.92 ± 0.36% per year (p = 0.018). Male sex, diffuse cutaneous SSc (dcSSc), presence of anti-topoisomerase 1 antibodies, a higher DLCO, limited ILD and a low coarseness score at baseline in bivariate analysis, and presence of antitopoisomerase 1 antibodies and a coarseness score of 0 in multivariate analysis, were associated with faster progression of ILD extent over time There was a significant correlation between the progression of ILD extent and the decline of DLCO but only a trend for FVC. ILD extent at baseline and during follow-up was associated with survival. ConclusionMale sex, dcSSc, anti-topoisomerase 1 antibodies and a less severe ILD at baseline were associated with a faster progression of ILD over time. Evolution of DLCO significantly correlated with change in ILD extent on HRCT scan. Our study helps defining the profile of patients at risk of experiencing a progression of ILD on HRCT scans.

Analysis of early chest high resolution CT images of novel coronavirus pneumonia

Objective To investigate the first chest HRCT imaging manifestations infected with novel coronavirus pneumonia (NCP). Method A retrospective analysis of the first chest HRCT images of 106 patients with NCP clinically diagnosed in our hospital from January 3 to 25, 2020. Lesion distribution, morphology and surrounding involvement were analyzed. Result Lesions were found in the first lung HRCT of 106 patients, with unilateral lung distribution in 11 cases (10.4%), bilateral lung distribution in 95 cases (89.6%), and peripheral distribution of lung in 65 cases (61.3%). 41 cases (38.7%) were distributed at the same time; 8 cases (7.5%) were 1 lesion, 5 cases (4.7%) were 2 lesions, 93 cases (87.8%) were multiple lesions, and 12 cases were nodular lesions (11.3%). 94 cases of ground-glass lesions (88.7%), 7 cases of cord-like lesions (6.6%), 15 cases (14.2%) of coexisting lesions of two or more forms; 10 cases (9.4%) involving one lung lobe There were 96 cases (90.6%) involving two or more lung lobes; 24 cases (22.6%) with enlarged mediastinal lymph nodes (19 cases over 60 years old, accounting for 79.2%); 3 cases with pleural effusion (2.8 %), 1 case had pericardial effusion (0.9%), and 2 cases had pleural involvement / thickening (1.9%). Patients over 60 years of age mostly present with multiple lesions, multiple morphology, peripheral and central distribution of lungs, involving multiple lung lobes, and enlarged mediastinal lymph nodes. Conclusions Lung lesions of NCP patients can be detected for the first time by chest HRCT, which is the preferred imaging method. Thoracic HRCT scans play an important role in the early diagnosis of new coronavirus (NCP). . Key words: Coronavirus infection; Pneumonia; Tomography, X-ray computd

Severe Leptospirosis with Pulmonary Hemorrhage; The Role of Intravenous Hydrocortisone

Leptospirosis is an endemic zoonosis caused by spirochetes of the genus Leptospira that typically occurs in tropical regions. Pulmonary hemorrhage which is the frequent cause of mortality in leptospirosis is either underdiagnosed or only discovered at autopsy. In this paper, we present a 23 year old male presenting with five days history of fever with anuria, dyspnea and hemoptysis. Leptospira IgM was positive. Chest Xray and HRCT scan showed diffuse bilateral infiltrates with pulmonary hemorrhage. Patient was treated with antibiotics, renal replacement therapy and steroids. However, methylprednisolone was unavailable thus, a high dose of hydrocortisone was used as an alternative. Leptospirosis has an immune phase which damages the endothelium affects organs like the liver, kidneys, heart, lungs and meninges. Immunomodulation with high-dose steroids may be used. Methylprednisolone is the ideal steroid given and is proven to weaken the inflammatory response and ameliorate the adverse effect of immune mediated response. In our case, a hydrocortisone equivalent of methylprednisolone was used which was unconventional but is cheaper and more available. Early recognition is important as administration of corticosteroid in addition to broad-spectrum antibiotics and early supportive care can lead to successful treatment, shortened hospital stays, reduction of morbidity and mortality. Thus, targeting the pulmonary involvement of leptospirosis with methylprednisolone equivalent hydrocortisone has demonstrated to be effective as evidenced by our patient’s response. Hence, it can be used to treat Leptospirosis with pulmonary hemorrhage at a lesser cost which is more practical to use in areas with limited resources.

Does Bronchiectasis Affect Chronic Obstructive Pulmonary Disease Comorbidities?

COPD and bronchiectasis, chronic inflammation disorders of the bronchial tree through the mechanism of 'spill-over' of inflammatory mediators, may lead to systemic manifestations of illness of the respiratory system and comorbidities. The aim of the study was to evaluate the frequency of coexisting chronic obstructive pulmonary disease and bronchiectasis and influence of bronchiectasis on COPD comorbid diseases. A post-hoc cross-sectional analysis of cohort study of 288 consecutive patients hospitalized due to acute exacerbation of COPD was performed. 177 males (61.5%) and 111 females (38.5%) with mean age = 71.0 8 ± 8.9 yrs, FEV1 % pred. = 34.6 ± 16.8 with COPD diagnosis were studied. In this group, 29 (10.1%) patients presented with bronchiectasis confirmed by HRCT scan. COPD patients with and without bronchiectasis had similar Charlson index results (2.5 vs 2.1, p=0.05). COPD patients with bronchiectasis required longer hospitalization during exacerbation. COPD patients with bronchiectasis significantly more often than patients without this comorbidity revealed the features of colonization with P. aeruginosa (OR = 4.17, p = 0.02). Bronchiectasis is a relatively common comorbidity in COPD patients. COPD patients with bronchiectasis are more frequently colonized with P. aruginosa comparing to non-bronchiectasis COPD patients. We did not confirm the influence of bronchiectasis on COPD comorbidities.

Canal cholesteatoma in canal stenosis: a case report

Purpose :&#x0D; We present a-12-year old female with canal stenosis and canal cholesteatoma. We discuss the clinical, radiological and treatment option for canal cholesteatoma in canal stenosis&#x0D; Discussion :&#x0D; Congenital canal atresia is a failure of the development of the external auditory canal which comprises anomalies of variable severity involving pinna, external acoustic canal, middle ear structures and rarely inner ear leading to hearing impairment. Congenital canal stenosis is considered to be a subset of congenital canal atresia. This malformation results in mild to severe conductive hearing loss. Furthermore, risk of cholesteatoma increased when it is associated with stenotic ear. Radiological evaluation in the form of HRCT scan of temporal bones should always be done in these patients during their initial presentation and surgery should be planned accordingly. Their presence should be rule out prior any corrective surgery.&#x0D; Conclusion :&#x0D; Although the incidence of canal cholesteatoma is rare in congenital canal stenosis, all patients presenting with canal atresia or stenosis should be evaluated thoroughly due to their potential to develop cholesteatoma as it may be challenging to treat at an advanced stage in view of morbid complications.

Clinical application of HRCT three-dimensional reconstruction in traumatic ossicular chain interruption

Objective:To investigate the clinical value of HRCT three-dimensional reconstruction technique in traumatic auditory chain traumatic fracture. Method:The clinical data of 14 patients with traumatic ear ossicular chain interruption were analyzed retrospectively. To evaluate the injury site and degree of the auditory chain before surgery, all the 14 patients underwent,HRCT scanning and three-dimensional reconstruction. The reconstructed auditory chain was observed from multiple angles and compared with the surgical exploration results under microscope. Result:The coincidence rate between ossicular chain injury observed by temporal bone HRCT scan before operation and ossicular chain injury observed during surgery was only 28.57%, the coincidence rate between ossicular chain injury observed during surgery and ossicular chain injury observed by three-dimensional reconstruction is 85.71%.Therefore, three-dimensional reconstruction imaging technique could give the doctor more clearly and stereoscopic images for the destruction of ossicular chain. Conclusion:Preoperative three-dimensional reconstruction can display and diagnosis of auditory ossicular chain destruction more clearly. It can be used to accurately evaluate auditory ossicular chain pathological changes, to develop individualized surgical plans and assess the risk of surgery.

Quantitative Emphysema Measurement On Ultra-High-Resolution CT Scans.

PurposeTo evaluate the advantages of ultra-high-resolution computed tomography (U-HRCT) scans for the quantitative measurement of emphysematous lesions over conventional HRCT scans.Materials and methodsThis study included 32 smokers under routine clinical care who underwent chest CT performed by a U-HRCT scanner. Chronic obstructive pulmonary disease (COPD) was diagnosed in 13 of the 32 participants. Scan data were reconstructed by 2 different protocols: i) U-HRCT mode with a 1024×1024 matrix and 0.25-mm slice thickness and ii) conventional HRCT mode with a 512×512 matrix and 0.5-mm slice thickness. On both types of scans, lesions of emphysema were quantitatively assessed as percentage of low attenuation volume (LAV%, <−950 Hounsfield units). LAV% values determined for scan data from the U-HRCT and conventional HRCT modes were compared by the Wilcoxon matched-pairs signed rank test. The association between LAV% and forced expiratory volume in 1 s per forced vital capacity (FEV1/FVC) was assessed by the Spearman rank correlation test.ResultsMean values for LAV% determined for the U-HRCT and conventional HRCT modes were 8.9 ± 8.8% and 7.3 ± 8.4%, respectively (P<0.0001). The correlation coefficients for LAV% and FEV1/FVC on the U-HRCT and conventional HRCT modes were 0.50 and 0.49, respectively (both P<0.01).ConclusionCompared with conventional HRCT scans, U-HRCT scans reveal emphysematous lesions in greater detail, and provide slightly increased correlation with airflow limitation.

A HEATED SITUATION: THERMAL INJURY INDUCING AN IDIOPATHIC PULMONARY FIBROSIS EXACERBATION

A HEATED SITUATION: THERMAL INJURY INDUCING AN IDIOPATHIC PULMONARY FIBROSIS EXACERBATION

2. Two cases of anti-MDA5 positive dermatomyositis with rapidly progressive interstitial lung disease

2. Two cases of anti-MDA5 positive dermatomyositis with rapidly progressive interstitial lung disease

Mastoid Osteoma

Introduction&#x0D; Osteoma of the mastoid region is an uncommon benign tumor of bone. Osteomas may occur in the external auditory canals but are reported to be very rare in the mastoid region, with about 150 cases reported in literature.&#x0D; Case Report&#x0D; A 20-year-old man presented with painless lump behind the right ear since last 2 years. On examination a 3x3 cm tumour was present in the right post-auricular region. HRCT scan showing hyper-attenuating area close to the right mastoid cortex, measuring approximately 3x3cm, spherical, with cleavage areas between the tumour and the mastoid external cortex. Surgical excision was performed on cosmetic grounds. Postoperative period was uneventful.&#x0D; Discussion&#x0D; Osteoma over the mastoid region is rare and mainly asymptomatic with excellent prognosis after complete removal of the lesion.

Association Between Antinuclear Antibodies and interstitial lung Diseases in patients with Systemic Lupus Erythematosus

AbstractIntroduction: Systemic Lupus Erythematosus (SLE) is adisease primarily affecting women in their child-bearing years. SLE can affect any component of the respiratory system and manifest with pleuritis (with or without effusion), interstitial lung disease (ILD), alveolar hemorrhage, diaphragmatic weakness, pulmonary hypertension, airways disease, or pulmonary embolism. ILD occurs with a lower frequency in SLE compared with other connective tissue disease (CTD) subtypes. It is not known whether SLE-ILD differs from ILD in other CTD subtypes. Aim of the work: estimate the possible relationship between interstitial lung diseases and different antinuclear antibodies among patients with systemic lupus erythematosus.Patients and Methods: Cross sectional clinical study. A total of 100 SLE patients attending to Sohag University Hospitals will be included in the study. Patients included in this study will be classified as SLE patients according to either the 2012 SLICC criteria or the new 2017 ACR/EULAR SLE classification criteria. Results: ANA (antinuclear antibody) positivity, chest manifestations like (cough, dyspnea, expectoration, fever&hemoptysis) are predictive variates for SLE-ILD. Conclusion: We observed a population of SLE-ILD and concluded that ANA (antinuclear antibody) positivity, chest manifestations like (cough, dyspnea, expectoration, fever&hemoptysis) are predictive variates for SLE-ILD. Also ANAIF speckled pattern has specificity to SLE-ILD and AntiSS-A/Ro52KD antibody is more specific to SLE-ILD. We recom‌mend HRCT and PFT scan in these SLE patients.

Characterization of interstitial lung disease using HRCT in clinically suspected cases

Interstitial lung diseases are characterized by anatomical distortion of peripheral airways and interstitium, determined by a first stage of alveolitis followed by a stage of fibrosis. The natural history of several interstitial lung diseases is characterized by slow and progressive destruction of alveolar-capillary functional units, often with respiratory failure and death. For their smoldering evolution and non-specificity of symptoms (exertional dyspnea and cough), they may remain undiagnosed and not treated for a long time. Each patient underwent a thorough clinical evaluation including a detailed history and physical examination. The duration of the complaints were noted in each patient. All the patients were made to undergo HRCT scan as the radiological examination after taking an informed consent for the same. Out of total of 40 patients 22(55.0%) patients showed HRCT pattern reflecting UIP and IPF, 8(20.0%) patients showed NSIP, 6(15.0%) patients had HSP as well as 3(7.5%) patients had COP while only 1(2.5%) patient showed changes of RB-ILD. The findings of this study correlate well with many other studies reported in literature.

Familial pulmonary fibrosis: a heterogeneous spectrum of presentations.

ABSTRACTObjective:To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods:We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as undergoing pulmonary function tests and HRCT of the chest. In 6 cases, lung tissue samples were obtained: from surgical biopsies in 5 cases; and from an autopsy in 1 case. Results:A history of smoking and a history of exposure to birds or mold were reported in 45.7% and 80.0% of the cases, respectively. Cough and marked dyspnea were reported by 62.8% and 48.6% of the patients, respectively. Fine crackles were detected in 91.4% of the patients. In 4 patients, the findings were suspicious for telomere disease. The median FVC and DLCO, as percentages of the predicted values, were 64.9% (range, 48.8-105.7%) and 38.9% (range, 16.0-60.0%), respectively. Nine patients had reduced DLCO despite having normal spirometry results. Regarding HRCT, patterns typical of usual interstitial pneumonia were found in 6 patients (17.1%). In 25 cases (71.5%), the HRCT features were consistent with a diagnosis other than idiopathic pulmonary fibrosis. In 11 cases (31.4%), the radiological patterns were uncharacteristic of interstitial lung disease. Of the six lung tissue samples analyzed, four showed interstitial pneumonia with bronchiolocentric accentuation, and, on the basis of the clinical and radiological data, the corresponding patients were diagnosed with hypersensitivity pneumonitis. Conclusions:Patients with FPF can present with a wide variety of clinical features. Most HRCT scans of these patients exhibit patterns not typical of usual interstitial pneumonia. The family history of fibrotic lung diseases should be investigated in all patients under suspicion, regardless of their age.

Three-Year Hospitalization and Mortality in Elderly Smokers with Chronic Obstructive Pulmonary Disease or Chronic Heart Failure

Background: In elderly smokers, chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) usually present with dyspnoea. COPD and CHF are associated ­almost invariably with concomitant chronic diseases, which contribute to severity and prognosis. Objectives: We investigated similarities and differences in the clinical presentation, concomitant chronic diseases and risk factors for ­mortality and hospitalization at 3-year follow-up in elderly smokers/ex-smokers with a primary diagnosis of COPD or CHF recruited and followed in specialized centers. Methods: We examined 144 patients with COPD and 96 with CHF, ≥65 years, ≥20 pack/years, and measured COPD Assessment Test (CAT) score, modified Medical Research Council, NYHA, and Charlson Index, routine blood test, estimated glomerular filtration rate, HRCT scan, 6-min walk test. In addition, in each patient we actively searched for CHF, COPD, peripheral vascular disease, and metabolic syndrome. Results: COPD and CHF patients had mild to moderate disease, but the majority was symptomatic. Comorbidities were highly prevalent and often unrecognized in both groups. COPD and CHF patients had a similar risk of hospitalization and death at 3 years. Lower glomerular filtration rate, shorter 6MWT, and ascending aorta calcification score ≥2 were independent predictors of mortality in COPD, whereas previous 12 months hospitalizations, renal disease, and heart diameter were in CHF patients. Lower glomerular filtration rate value, higher CAT score, and lower FEV₁/FVC ratio were associated with hospitalization in COPD, while age, lower FEV₁% predicted, and peripheral vascular disease were in CHF. Conclusions: There are relevant similarities and differences between patients with COPD and CHF even when admitted to specialized outpatient centers, suggesting that these patients should be manage in multidisciplinary units.

Prediction of IPF within 1–2 year with the early changes in quantitative imaging patterns using high resolution computed tomography

IntroductionHigh resolution computed tomography (HRCT) plays an indispensable role in the diagnosis of Idiopathic Pulmonary Fibrosis (IPF). Due to the short median survival of 2 to 5 years, understanding the chance of progression in the next follow-up of a patient is critical. The aim of this study is to test the predictability of progression in IPF of the near follow-up of a patient using the early quantitative changes in HRCT scans. MethodsVolumetric anonymized HRCT scans were obtained. Two data sets were collected: a pilot study with 35 subjects in three sequential scans (baseline, 6 and 12 month scans) and validation study involving 157 subjects with clinical information. Quantitative lung fibrosis (QLF) scores were calculated for HRCT scans using an automated system. A log-rank test and Cox regression were used to test a prediction with early changes in QLF. ResultsIn the pilot study mean changes in QLF increased by 4.33% at 6 months and 14.83% at 12 months, when the visual assessments changed from stable to worse. Mean QLF changes were ~1% for the stable cases during 12 months. Using 4% QLF differences at 6 months in the validation cohort, significant differences in progression were found (p < 0.001). ConclusionEarly changes in a quantitative score from HRCT can predict progression in lung function. A quantitative texture-based score can play a pivotal role for informed and timely management decision for patients with IPF.

Role of high resolution computed tomography of temporal bone in preoperative evaluation of chronic suppurative otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic suppurative otitis media (CSOM) is a common condition seen in patients attending ENT department. The diagnosis of cholesteatoma is usually made on otologic examination. The necessity for HRCT imaging in an uncomplicated case is controversial. The objective was&lt;strong&gt; &lt;/strong&gt;to evaluate preoperative HRCT temporal bone and to determine its’ usefulness in patients with Chronic suppurative otitis media (CSOM) undergoing surgery.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was a prospective study involving 30 cases of CSOM with cholestaetoma. All the patients underwent pre-operative HRCT screening followed by surgical exploration of middle ear cleft. Pre-operative CT scan and intra-operative findings recorded and compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of total 30 patients of CSOM, 16 (53%) were males and (90%) presented with chief complaints of otorrhoea. HRCT scan was found to be very sensitive (100%) in detecting cholesteatoma in middle ear cleft but differentiation between granulations or cholesteatoma wasn’t possible. HRCT satisfactorily delineated ossicular erosion except stapes suprastructure erosion which had 81.8% sensitivity and specificity 88.88%. For bony boundaries of middle ear, HRCT showed very high sensitivity and specificity for detecting scutum erosion, tegmen erosion, mastoid cortex erosion, jugular bulb dehiscence and bony external auditory canal erosion. It was moderately sensitive for LSCC Erosion (75%), Facial canal erosion (80%) and Sinus plate erosion (85.7%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; These results indicate that preoperative CT temporal bone scan of patients with CSOM serves as an important guide in surgical approach for otolaryngologists, although there are limitations in evaluation of the CT results.&lt;/p&gt;

Comparison of brain CT angiography/venography and temporal bone HRCT scan findings in patients with subjective pulsatile tinnitus in affected side and unaffected side

Introduction: Pulsatile tinnitus (PT) is a discrete repetitive sound that is synchronous with the patient’s pulse. Incidence of abnormal, often treatable and structural findings in patients with PT has been noted to be high, ranging from 44% to 91%. So, accurate diagnosis of pathologic causes is important for treatment and prognosis.&#x0D; Objective: The main objective of our study was evaluation of abnormal findings in temporal bone HRCT scan and CTA/CTV in patients affected by pulsatile tinnitus, and comparing these findings with unaffected ear of the same individuals.&#x0D; Methods: A case-control study was conducted and all the patients who had subjective pulsatile tinnitus with normal physical examinations among outpatient individuals referred to our institution; Rasoul Akram Hospital from September 2015 to august 2017 was included in this study. All patients underwent brain CT Angiography/Venography (CTA/V) and temporal bone high resolution CT scan (HRCT), and their findings were compared.&#x0D; Results: Thirty patients consist of 20 females and 10 males with mean age of 50.83 years were evaluated in this study. Pulsatile tinnitus was unilateral in all patients except one. Comparing results of CTA/V and temporal HRCT scan in the affected ear showed that temporal HRCT scan in 19(63.3%) out of 30 patients reported normal, while CTA/V only in eight (26.6%) of these patients reported normally. So, capability of CTA/V is statistically significant in diagnosis of abnormalities in the affected ear (P=0.012).&#x0D; Conclusion: Our findings demonstrate that CTA/V can be a more accurate imaging tool than temporal bone HRCT in initial assessment of patients with subjective pulsatile tinnitus and normal physical examination, and should be done as the first imaging tool in these patients.

Leukocyte- and platelet-rich fibrin: a new graft material in endoscopic repair of spontaneous CSF leaks.

Spontaneous CSF leak is a challenging condition, with frequent recurrences following attempted surgical closure. The selection of graft materials depends on the experience of the operating surgeon. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation platelet concentrate that has currently invaded every surgical specialty. To our knowledge, no previous reports about the use of L-PRF in repair of CSF leak were published. The study was conducted to assess the potential role of L-PRF in spontaneous CSF leaks repair. This prospective controlled study was conducted on 40 patients who were randomly divided into 2 groups: In group A, L-PRF was used in addition to another layer, while patients in group B underwent multilayer repair using traditional graft materials. Preoperative HRCT scan showed bony dehiscence (n = 30) and opacity in a nearby sinus (n = 9). MRI findings varied between empty sella in 28 patients, and meningocele in 19 patients. Mean preoperatively measured CSF pressure was 26.6cm H2O. Cribriform plate was identified as the commonest site of leaks. Multiple skull defects were detected in 2 cases. Failure of repair was found in 3 patients (15%) of group B and 1 patient (5%) of group A, this difference was statistically insignificant (P value = 0.28). Significance correlation between recurrence of CSF leak and elevated intracranial pressure was observed (P value; 0.04). L-PRF was found to be a good adjunct material in endoscopic spontaneous CSF leaks repair. It helps in decreasing the number of layers needed for defect closure.