Radiological Investigation Of Patients Research Articles

Sub-Septate Uterus: An Incidental Radiological Finding in a Woman with History of Recurrent Miscarriage. A Case Report

Background: The septate uterus, which is the most common Mullerian duct anomaly, results from the abnormal fusion of the Mullerian duct during embryonic life, and it is usually associated with poor obstetric outcomes such as recurrent spontaneous abortions, subfertility, preterm labour, and reproductive failure. A large proportion of the patients that are affected remain asymptomatic owing to lack of indication for abdominal ultrasound before conception, and the problems are mainly detected after several pregnancy losses. The exact aetiology of the septate uterus is unknown but is caused by incomplete resorption of the uterovaginal septum after fusion of the Mullerian duct during embryogenesis. Case Presentation: We present a 32-year-old Para 0+3 woman referred to the radiology department for ultrasonography and hysterosalpingography (HSG) on account of recurrent miscarriage, which occurs within the first trimester of gestation. She has had three (3) consecutive miscarriages within the last 4 years, of pregnancies which were achieved spontaneously and were lost between the gestational ages of 9-12 weeks. She was investigated with ultrasonography, which demonstrated a bulky uterine appearance with two endometrial cavities that is connected to one cervical canal. Hysterosalpingography (HSG) showed a contrast-filled partly divided uterus with inter-cornual angles of 34º and intercornual distance of 1.92cm. The patient had hysteroscopic septum resection with a satisfactory outcome given addressing other medical problems that could militate against conception and has been on monthly follow-up. Conclusion: Radiological investigation of patients with recurrent miscarriages is indispensable for optimal evaluation to achieve accurate diagnosis and identify women whose problems are amenable to specialized treatments.

Role of FNAC in Early Detection and Diagnosis of Lung Lesions with Histo-radiological Correlation and Clinical Insights in a Tertiary Care Centre

Background: Carcinoma of lung has now become increasingly frequent during the last 60 years; this increase is seen in males and especially in the females. Cytological evaluation from respiratory tract is the initial investigation along with radiological investigations in patients suspected to have pulmonary diseases. The various cytological samples included transbronchial needle aspiration, guided fine needle aspiration cytology (FNAC) smears and pleural fluid. Present study was undertaken to study the spectrum of lesions diagnosed by cytomorphological analysis of various cytological samples and correlation of the histopathology, cytology and radiology of lung lesions. Materials and Methods: Centrifuged and direct smears from received samples were stained with MGG and PAP stain. Cytohistological correlation was done when biopsy was available with radiological correlation & comparison of topographic display. Results: Present study was carried out during the period of December 2018 to November 2019. During this period, of total 52 cases, 36 (69.2%) were males and 16 (30.8%) were females. Their age ranged from 26 years to 73 years, most patients (53.8) belonged to the age group of 56 – 65 years. The literacy status of the patients was assessed. 2 out of 52 (3.8%) patients were illiterate, 8 out of 52 (15.4%) patients were educated above H.S. level. Adenocarcinoma was seen to be the most prevalent 29 (55.7%) followed by squamous cell carcinoma 12 (23.0%) among the cases studied. Smoking was seen to be the most common addiction i.e. 34 out of 52 cases (65.4%). Among non-smokers 66.7% presented with adenocarcinoma and 16.6% cases with squamous cell carcinoma. The topography of the neoplasms within the lungs was assessed radiologically. On chest X ray (82.6%) lung lesions were identified; (48%) of patients were found to have pleural effusion. By using CT SCAN, all masses were located definitely. Conclusion: A good correlation between cytology and histopathology is revealed in our study. Guided FNAC helps in early detection and diagnosis of lung lesions and facilitates appropriate management of patients. Keywords: Lung, Carcinoma, Detection, Diagnosis, Fine needle aspiration, Cytology, Histopathology, Radiology, Correlation

Portal venous deprivation in patients with portosystemic shunts and its effect on liver tumors

AimsTo outline the use of radiological investigations in patients with congenital portosystemic shunts (CPS) and to assess the degree of portal venous deprivation in relation to the development of liver tumors. MethodsSingle center retrospective cohort study of all patients with CPS referred from 1990 to 2016. Radiological investigations were reviewed for the presence of intrahepatic portal veins. Two groups were defined: Group 1 — without evidence of preservation of an intrahepatic portal venous system and, Group 2 — with evidence of intrahepatic portal venous flow. These groups were compared for the development of liver tumors, serum ammonia, and nature of subsequent surgical intervention. The ratio of infraceliac to supraceliac aortic diameter and hepatic enhancement in biphasic CT scans were also used to infer hepatic arterial in-flow and compared to age matched controls. Nonparametric tests were used throughout. A P value of 0.05 was considered significant. Data are quoted as median (IQR). Results45 patients (Group 1, n = 12: Group 2, n = 33) were investigated for CPS at a median age of 8 months (1 month–14 years). Liver tumors were more common in Group 1 than Group 2 [11/12 (92%) versus 10/33 (29%); P < 0.001]. Aortic ratio was significantly lower in patients with CPS compared to control (0.82 versus 0.96; P < 0.001), but there was no difference between patients with or without tumors (0.82 versus 0.82; P = 0.52). Enhancement of the liver parenchyma was greater in portal venous rather than arterial phases by a median difference of 28 (15–50) Hounsfield units in controls, compared to 15 (8.5–23.5) in CPS patients (P = 0.04). A single stage closure was possible in 2/6 (33%) operated patients in Group 1 and 14/20 (70%) in Group 2 (P = 0.32). ConclusionsPatients without radiological evidence of intrahepatic portal venous flow were significantly more likely to have associated hepatic tumors with a relative risk 3.1. Levels of evidenceThis manuscript includes data that are III and IV Levels-of-Evidence.

Ultrasound Elastography-A Useful Tool in Assessment of Diffuse Liver Disease

Background: Diffuse liver diseases are commonly encountered in clinical practice and on radiological imaging .Early detection and accurate diagnosis are extremely important in the definitive management of such patients. Ultrasonography is the widely used and the first line of radiological investigation in patients suspected with diffuse liver disease. Ultrasound elastography is a recent advance in the field of ultrasonography which has reportedly improved the accuracy in the assessment of severity of liver fibrosis in diffuse liver diseases. Objectives: 1.To evaluate the role of elastography for evaluation of diffuse liver disease. 2. To evaluate the sensitivity and specificity of sonoelastography in detection and characterisation of diffuse liver disease and correlation with other clinical diagnostic modalities and histopathology as gold standard. Subjects and Methods: Study was conducted from from August 2014 to August 2016.Based on inclusion and exclusion criteria, 30 cases of diffuse liver diseases were included in the study.The ultrasound and ultrasound elastography were done in the AJ Institute of Medical Sciences. These 30 cases were subjected to FNAC/Tru-cut Biopsy for the confirmation of ultrasound and ultrasound elastography finding and establishment of final diagnosis. Results: In our study of 30 cases of diffuse liver lesions ,after Metavir scoring 13% were F1,16% were F2, 23% were F3,and 46% were F4.The sensitivity and specificity for F1 and F2 were 100% and 100%, for F3 was 71% and 91%, for F4 85 and 87%.the mean cut off value for the cirrhosis was found to be 18kPa. Conclusion: Ultrasound elastography is a recent advance in the field of ultrasound, which is a non invasive method in assessment of severity of liver fibrosis and end stage cirrhosis.

P.290 - Clinical, molecular, radiological investigations in patients with SURF1 mutations and muscle biopsy findings

P.290 - Clinical, molecular, radiological investigations in patients with SURF1 mutations and muscle biopsy findings

PTH-075 The effect of storage conditions on the stability of faecal calprotectin

Introduction Faecal calprotectin (f-Cp) is a sensitive non-invasive marker of intestinal inflammation used to help distinguish between inflammatory bowel disease (IBD) and functional bowel disorders such as IBS, thereby reducing the number of unnecessary endoscopic and radiological investigations in patients presenting with chronic diarrhoea. It has previously been reported that calprotectin is stable in faeces for up to seven days at room temperature (RT). A nationwide study was undertaken via the UK NEQAS Faecal Markers of Inflammation external quality assessment (EQA) programme in order to further investigate the stability of f-Cp. Method Complete 24 h stool collections were provided by three IBD patients. Each stool was homogenised and split into six portions, each of which was stored under different conditions: i) RT (∼20˚C) for seven days; ii) RT for 14 days; 4°C for seven days; 4°C for 14 days and; two portions immediately frozen at –40°C. Following storage, the portions not already in the freezer were frozen at –40°C. Sub-aliquots of each of the six portions from each patient were dispatched to the participants of the UK NEQAS Faecal Markers of Inflammation EQA scheme for analysis. Results Forty-four scheme participants returned results. Mean f-Cp concentrations in the baseline specimens were 9.3–95.4 µg/g [patient 1], 204–449 µg/g [patient 2] and 5.5–66.4 µg/g [patient 3]. F-Cp levels decreased over the period of 14 days when the stool samples were stored at RT but to varying degrees depending upon the initial concentration and the assay used for analysis. For the most severely-affected method (Thermo Fisher ELiA) f-Cp levels decreased by ∼50% following storage at RT for 14 days in the specimen from patient 2. No decrease was observed for the same assay at lower f-Cp concentrations [patients 1 and 3] under the same conditions. No effect of storage was observed at either RT or 4°C for the users of the Buhlmann, Immundiagnostik, Calpro (ELISA) and Buhlmann Quantum Blue assays at lower f-Cp concentrations [Patients 1 and 3]. Storage for 14 days at 4°C had no significant effect for the Buhlmann ELISA, Calpro ELISA and Quantum Blue users at higher f-Cp concentrations (Patient 2). A decrease of ∼10% was observed for the Thermo Fisher ELiA and Immundiagnostik ELISA assays stored under the same conditions. Conclusion The conditions under which stool samples are transported and stored prior to calprotectin analysis can affect the results obtained in the laboratory depending upon the baseline f-Cp level and the particular assay being used for analysis. Our data also further highlights the between-assay variability that exists amongst f-Cp kits. Disclosure of interest None Declared.

Depressive symptomatology and pineal epidermoid cyst: a case report.

Introduction Intracranial epidermoid cysts are congenital cysts. They comprise 0.2-1.8% of primary intracranial tumours and are four to nine times as common as dermoid cysts. Case report We here in present the case of a 32-year-old man who reported sudden onset of symptoms of a depressive symptomatology and particularly severe headache, accompanied by fatigue, depressed mood most of the day, marked diminished interest or pleasure in all or almost all activities, insomnia and diminished ability to think or concentrate. Brain magnetic resolution imaging examination revealed a pineal epidermoid cystic lesion, visualised in the posterior part of the third ventricle, with a maximum diameter of ∼2.8 cm and obstructing the aqueduct of Sylvius, causing obstructive hydrocephalus. Discussion Pineal cysts may enlarge over time, because of either increased cyst fluid or intracystic haemorrhage, and become symptomatic. Brain radiological investigations in patients with depressive symptomatology may be substantial.

Analysis of the impact of digital tomosynthesis on the radiological investigation of patients with suspected pulmonary lesions on chest radiography

To assess the impact of digital tomosynthesis (DTS) on the radiological investigation of patients with suspected pulmonary lesions on chest radiography (CXR). Three hundred thirty-nine patients (200 male; age, 71.19 ± 11.9 years) with suspected pulmonary lesion(s) on CXR underwent DTS. Two readers prospectively analysed CXR and DTS images, and recorded their diagnostic confidence: 1 or 2 = definite or probable benign lesion or pseudolesion deserving no further diagnostic workup; 3 = indeterminate; 4 or 5 = probable or definite pulmonary lesion deserving further diagnostic workup by computed tomography (CT). Imaging follow-up by CT (n = 76 patients), CXR (n = 256) or histology (n = 7) was the reference standard. DTS resolved doubtful CXR findings in 256/339 (76 %) patients, while 83/339 (24 %) patients proceeded to CT. The mean interpretation time for DTS (mean ± SD, 220 ± 40 s) was higher (P < 0.05; Wilcoxon test) than for CXR (110 ± 30 s), but lower than CT (600 ± 150 s). Mean effective dose was 0.06 mSv (range 0.03-0.1 mSv) for CXR, 0.107 mSv (range 0.094-0.12 mSv) for DTS, and 3 mSv (range 2-4 mSv) for CT. DTS avoided the need for CT in about three-quarters of patients with a slight increase in the interpretation time and effective dose compared to CXR.

Value of initial radiological investigations in patients admitted to hospital with appendicitis, acute gallbladder disease or acute pancreatitis

ObjectivesTo determine the value of abdominal radiography (AXR) for investigating patients attending hospital with a first episode of appendicitis (requiring appendicectomy), acute gallbladder disease or acute pancreatitis, and to identify...

Small-Bowel Obstruction: State-of-the-Art Imaging and Its Role in Clinical Management

Small-bowel obstruction (SBO) is a common clinical condition with signs and symptoms similar to other acute abdominal disorders. The radiologic investigation of patients with SBO as well as the indications and timing of surgical intervention have changed over the past 2 decades. This review focuses on modern imaging techniques and their role in both the diagnosis and treatment of patients with SBO.

An unusual case of laryngeal spindle cell carcinoma metastasising to the orbit and heart

We report the first case in the world literature of laryngeal spindle cell carcinoma metastasising to the orbit. A 65-year-old woman was previously treated for T3 N0 Mx laryngeal spindle cell carcinoma, with laryngectomy and post-operative radiotherapy. Five months following this treatment, she developed proptosis, diplopia and reduced right visual acuity, secondary to an enlarging mass within the right orbit. This was biopsied, and subsequent histology confirmed a diagnosis of metastatic spindle cell carcinoma. Subsequent post-mortem examination demonstrated additional pulmonary, hepatic and cardiac metastatic disease, in the absence of any other primary tumour or locoregional disease. The radiological investigation of patients with laryngeal spindle cell carcinoma is discussed and contrasted with that of laryngeal squamous cell carcinoma.

Delayed diagnosis of appendicitis in children treated with antibiotics

The diagnosis of appendicitis in children can be difficult. Misdiagnosis may result in empirical treatment with antibiotics. The aim of this study was to determine whether initial treatment with antibiotics hindered subsequent diagnosis of appendicitis. Retrospective review of 311 children treated for appendicitis between 1999 and 2004. Patients were divided into two groups: Group 1: (n = 45) received antibiotics prior to a definitive diagnosis of appendicitis. Group 2: (n = 266) did not receive antibiotics prior to a diagnosis of appendicitis. Group 1 patients were significantly younger and more likely to be female than in group 2. Abdominal tenderness was less marked and there was a greater reliance on radiological investigations in patients receiving antibiotics. C-reactive protein and pre-operative temperature were significantly higher in group 1 patients compared to group 2. The perforation rate and complication rate were significantly greater in group 1. The commonest misdiagnoses were urinary tract infection and respiratory infection. Initial misdiagnosis results in significant delay before appendicectomy. This study shows that the clinical signs of acute appendicitis can be masked by prior treatment with antibiotics. The diagnosis of acute appendicitis must be considered and, if necessary, excluded in all children seen with abdominal pain who have recently been treated with antibiotics.

Odontoid lateral mass asymmetry: do we over-investigate?

Objectives: This study aimed to evaluate the necessity for further radiological investigation in patients with suspected traumatic rotatory subluxation of the atlanto-axial complex on plain radiography following acute cervical trauma...

Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis.

Surgical treatment of carcinoma of the distal third of the rectum with anal sphincter preservation is increasingly used in accredited cancer centers. This study aimed to evaluate the diagnostic usefulness of radiological investigations in the management of patients who had undergone resection with coloanal anastomosis for carcinoma of the rectum, in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients. A total of 175 patients who had undergone total rectal resection with end-to-side anastomosis for carcinoma of the distal third of the rectal ampulla, most of whom had received postoperative radiotherapy, were evaluated radiologically. In the postoperative period radiological investigation was ordered only for symptomatic patients to detect pathology of the anastomosis and the pouch sutures and was used direct film abdominal radiography and contrast-enhanced radiography of the rectal stump with a water-soluble radio-opaque agent. Before closure of the colostomy, 2 months after rectal excision or approximately 4 months after if postoperative radiotherapy was given, the anastomosis and pouch of all patients, even asymptomatic ones, were studied with water-soluble contrast enema to check for normal canalization. In the follow-up after recanalization radiological examinations were done to complete the study of the large intestine if the endoscopist was not able to examine it up to the cecum. Of the 175 patients examined radiologically during the postoperative period and/or subsequent follow-up, 95 showed no pathological findings. Seventy-nine patients had fistulas of the coloanal anastomosis or the pouch, 23 of which supplied a presacral collection. In the absence of severe sepsis, the only therapeutic measures were systemic antibiotics and washing of the surgical catheters to maintain efficient operation. In 2 patients in whom transanal drainage was performed radiologically the fistula was cured in 1 week. In 36 cases of cicatricial stenosis, 17 at the coloanal anastomosis and 19 at the pouch, radiological examination always detected the lesion, correctly defining its anatomical characterisitics, nature and extension. Of the 19 cases of stenosis treated radiologically, 15 recovered an adequate intestinal calibre for tients operated on, 21 cases of reccurrence were detected. Radiological examination was requested as the first investigation in only one of these cases, for a patient with subocclusion. Radiological investigations in patients who have undergone colonanal anastomosis are of read diagnostic value in the immediate post-operative period, during closure of the protective colostomy and in the follow-up of symptomatic recanalized patients.

The value of intubation dacryocystography after dacryocystorhinostomy.

We retrospectively reviewed 104 dacryocystograms carried out on 72 patients who had previously undergone dacryocystorhinostomy, to assess the diagnostic contribution of the radiological investigation in patients with persistent or recurrent symptoms. In patients whose symptoms were referable to the operated side, dacryocystography was performed as part of further pre-operative assessment. In 42% of these patients it demonstrated an anatomical or physiological abnormality that explained the symptoms. However, no clear reason for the recurrence of symptoms was demonstrated in 58% of cases.

Calcified Leiomyosarcoma Simulating Uterine Myoma in a Patient with Long-standing Anaemia

A case of small bowel leiomyosarcoma in a 75-year-old woman is reviewed. The patient had an unexplained anaemia with occult blood in the faeces for at least 15 years. The value of different radiological investigations in patients with suspected gastrointestinal bleeding is discussed. The possible significance of calcifications visible on plain abdominal films is emphasized.

Die laterale Thoraxaufnahme auf der Intensivstation als digitale Lumineszenzradiographie (DLR)

The digital luminescence radiography (DLR) technique is being used increasingly for clinical diagnosis, particularly in intensive care . Since the installation of a DLR unit, we have carried out more than 20,000 examinations of the chest on patients in intensive care. 12.1% of these were lateral radiographs. In this way, the diagnosis can be made of the extent of a pleural effusion, the presence of a ventral pneumothorax or of atelectasis. Using DLR, these examinations can be carried out at the bedside and have improved the radiological investigation of patients in intensive care.

Transrectal ultrasound in the investigation of haemospermia

The transrectal ultrasound findings in 52 patients with haemospermia were reviewed. Scan abnormalities were demonstrated in 43 patients (83%). These included benign prostatic hyperplasia (24 patients), seminal vesicle abnormalities (10 patients), prostatic calcification (32 patients) and two patients with prostatitis. No patient was proven to have prostatic malignancy. Transrectal ultrasonography can suggest a cause of haemospermia in the majority of patients without resort to invasive investigations, and can exclude underlying prostatic malignancy. It is recommended as the first radiological investigation in patients presenting with haemospermia.

Budd-Chiari syndrome: Shunt selection and post-operative assessment

Radiological investigation of patients with the Budd-Chiari syndrome is helpful in making the diagnosis and to determine the most suitable method of surgical decompression of the portal venous system where this is indicated. The radiological findings in four patients with Budd-Chiari syndrome who were treated by meso-atrial shunt operations are described. The key pre-operative investigation is inferior vena cavography with pressure measurements. Postoperatively shunt patency is most reliably assessed by dynamic CT scanning. Doppler ultrasound studies may detect flow within the shunt but patency may be inferred by observing reversal of blood flow within the portal vein.

Diuresis urography in equivocal pelvi-ureteric obstruction.

In 43 patients with equivocal pelvi-ureteric obstruction, conventional urography was supplemented with diuresis urography. After peroral hydration with 0.5 liters fluid, a large volume of urographic contrast medium was administered and increased diuresis provoked by intravenous injection of furosemide. A relative obstruction of flow was then accentuated by increased dilatation of the renal pelvis. The technique deserves a wider use in the radiologic investigation of patients with equivocal obstruction at the pelvi-ureteric junction.