Biomedical subjects
Publications and source records attributed to Maurice C Haddad.
We report a case of aortic dissection causing hypertension in a neonate, which occurred following iatrogenic intimal injury during umbilical arterial cannulation. The intimal flap was diagnosed by color Doppler sonography, and treated by conservative management with complete spontaneous healing of the intimal injury.
Prolonged maternal magnesium sulphate infusion therapy for tocolysis of premature labour may result in secondary fetal hypermagnesaemia, which has been associated with bony abnormalities in the newborn. We report on four infants, members of two twin pregnancies, who were exposed to prolonged fetal hypermagnesaemia. Three of the infants, all appropriate for gestational age, showed abnormal radiological findings consisting of abnormal mineralisation of long-bone metaphyses owing to fetal hypermagnesaemia. The fourth infant, who was growth retarded, had normal bones. Intrauterine growth restriction appears to be protective against magnesium sulphate-induced abnormal bone mineralisation in the newborn.
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We describe the CT findings in four patients and the MR imaging in one patient with juvenile ossifying fibroma. Three lesions involved the maxillary sinus and extended to the surrounding structures; one lesion was confined to the maxillary bone. CT scan revealed well-defined, expansile lesions with variable amount of calcifications. On MRI one lesion had intermediate signal intensity with significant contrast enhancement.
The perinephric spaces consist of the subcapsular, perirenal, anterior and posterior pararenal spaces. Fluid may collect in one or more of these compartments; this can be readily demonstrated by cross-sectional imaging, particularly computed tomography (CT). This pictorial review illustrates the radiological manifestations of perinephric fluid collections with their differential diagnosis including perinephric abscess, perirenal urine collection, subcapsular and perirenal hematoma, renal lymphangiomatosis, pancreatic pararenal fluid collections and transudate fluid associated with nephropathies.
We report two cases of spinal intradural arachnoid cyst at the thoracic level, presenting with long-standing symptoms of spinal cord compression and MRI findings that were overlooked for sometime initially. Because of the rarity of this disease, and because of the subtle changes on MRI, there was a definite delay in the diagnosis. In this report we emphasize the value of MRI and CT myelography in this disorder, and the need for them to be strongly correlated with the progression of the clinical picture.
BACKGROUND: The aim of this retrospective study is to assess the accuracy of single slice helical CT scan with intravenous, and rectal contrast (CTRC) in the diagnosis of acute appendicitis (AA) in patients with suspected AA, with particular analysis of the diagnostic signs. PARTICIPANTS AND METHODS: Abdomino-pelvic helical CTRC was performed on 75 consecutive patients with suspicion of AA. Radiologic diagnosis was compared with surgical/pathologic results and clinical follow-up. In addition, the CTRC examinations were retrospectively reviewed independently by two experienced radiologists using predefined diagnostic criteria. The sensitivity, specificity, and frequency of each diagnostic sign were calculated. The interobserver agreement and the statistical significance of the frequency for each diagnostic criterion were assessed using the Kappa and Fisher tests, respectively. RESULTS: The accuracy of helical CTRC in the diagnosis of AA was 94.7%, sensitivity 100%, specificity 90%, PPV 89.7%, and the NPV 100%. Wall enhancement and nonopacification of the appendix recorded the highest sensitivity and specificity (97% and 100%, 94% and 95%, respectively). Appendiceal thickness greater than 6 mm was present in 100% of true-positive cases. However, 26.5% of true-negative cases had also an appendiceal diameter exceeding 6 mm, a value used as a cut-off for normal appendiceal diameter. The highest interobserver agreement was recorded for appendiceal wall enhancement and for nonopacification of the appendix (K=0.97 and 0.88, respectively). CONCLUSIONS: CTRC is an accurate and relatively fast technique for investigation of patients with suspected AA. A negative CTRC can exclude completely the diagnosis of AA. Nonopacification of the appendix and appendiceal wall enhancement are highly sensitive, specific, and reproducible, signs representing major criteria for the diagnosis of AA.
PURPOSE: The aim of this study was to study the imaging findings of familial Mediterranean fever (FMF). MATERIALS AND METHODS: We performed a retrospective review of the medical records and imaging studies of 38 patients with proven FMF, diagnosed between 1992 and 2002. RESULTS: The most common clinical manifestation was recurrent peritoneal attacks with abdominal pain (76.3%) and fever (42.1%). Abdominal imaging findings included ileus (n=12), splenomegaly (n=5), hepatomegaly (n=2), ascitis (n=2), focal peritonitis (n=2), mesenteric streaking (n=1), and enlarged mesenteric lymph node (n=1). One patient developed fatal peritoneal mesothelioma, and 13.1% of the patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency, occurring in 34.2% of patients; radiographs were normal (n=4) or showed joint effusion and periarticular soft tissue swelling (n=4) due to synovitis. One patient developed seronegative destructive arthropathy. Skin lesions were noted in 23.6% of patients. Pleuritis was encountered in 13.1% and pericarditis in 5.2%. Polyarteritis nodosa (PAN) was present in two patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. CONCLUSION: FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings, and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. PAN, multiple sclerosis, and autoimmune hemolytic anemia are probably rare associations or rather than coincident with FMF.
OBJECTIVE: Transrectal ultrasound (TRUS)-guided prostate needle biopsy is the standard procedure to diagnose prostate cancer. It can be associated with significant discomfort and pain. We evaluated if periprostatic infiltration with local anesthetic reduces this discomfort. MATERIAL AND METHODS: 72 patients underwent TRUS-guided prostate needle biopsy. All patients had 12 cores, with four prostatic zones of biopsies. In 25 consecutive patients (G1) with a median prostate size of 47 cc, no anesthesia was given; while in 47 sequential patients (G2) with a median prostate size of 50 cc, 2 ml of 2% lidocaine was infiltrated in the periprostatic area around the neurovascular bundle using 20-cm-long, 22-gauge needle on both sides as guided by color Doppler. Biopsies were performed in standard fashion. Discomfort was graded on a scale from 0 to 10 with 0 meaning no discomfort, 1-3 mild, 4-6 moderate, and 7-10 severe. RESULTS: 12/25 (48%) of G1 patients reported no discomfort compared to 70% in G2 (P=.025). Mild discomfort was reported in 5/25 (20%) patients of G1 and 9/47 (19%) patients of G2. Moderate or severe discomfort was reported in 8/25 (32%) patients and 5/47 (11%) patients in G2 (P=.039). Prostate size did not affect degree of discomfort within each group and between both subgroups. No adverse reactions were observed secondary to lidocaine infiltration. CONCLUSION: Periprostatic infiltration with local anesthesia at the time of TRUS-guided prostate needle biopsy significantly reduces discomfort. It is easy to perform, safe, and should be considered in all patients irrespective of the prostate size.
We report three patients with midline prostatic cysts (simple, n=1; complex, n=2) that presented with low ejaculate volume and hematospermia. Transrectal ultrasound (TRUS) revealed a midline prostatic cystic structure that could represent either an ejaculatory duct cyst or a Müllerian duct cyst. In one patient, the ejaculatory duct cyst was confirmed by identification of spermatozoa at microscopic analysis of fluid obtained by TRUS-guided needle aspiration. The two other patients underwent transurethral incision of the cyst with complete resolution of symptoms.
A 37-year-old woman presented with progressive diffuse abdominal pain. Computed tomography (CT) showed diffuse streaking of the greater omentum with a mass of fat density located anteriorly just below the umbilicus, showing a whirling pattern of concentric streaks. Surgery and pathology revealed torsion and infarction of the greater omentum. Because of its rarity and nonspecific clinical features, the diagnosis is seldom made preoperatively. We describe a patient with characteristic CT findings of omental torsion. Preoperative diagnosis is important since conservative management has been suggested.
PURPOSE: To present the imaging findings of the wide spectrum of musculoskeletal diseases causing back pain in children and adolescents. DISCUSSION: Back pain in children is a rare condition but may denote a serious health problem; hence, full clinical history, physical examination, and appropriate laboratory studies should be obtained. In this scientific exhibit, we present the imaging findings of the variable musculoskeletal diseases that are associated with back pain in children and adolescents. These disease processes include scoliosis of various causes; spondylolysis; spondylolisthesis; traumatic injuries; disc degeneration and herniation; Scheuermann's disease; spondylodiscitis; tumors (primary, secondary, hematogenous); and miscellaneous conditions (eg, metabolic disorders, sickle cell disease, osteoporosis). CONCLUSION: A wide spectrum of diseases causing back pain in children is presented. Radiologists should be aware of the imaging findings of this rather uncommon entity to help in reaching the appropriate diagnosis.
Hepatobiliary parasitic diseases are rare in Lebanon. We recently encountered biliary fascioliasis in a Lebanese native. The clinical and laboratory findings were nonspecific. The biliary parasite (Fasciola hepatica) was identified by sonography and confirmed at ERCP that has retrieved the parasite from the common bile duct.
The imaging modalities currently used for radiologic detection and characterization of hepatic neoplasms include color Doppler sonography, helical computed tomography (plain, biphasic enhanced CT), magnetic resonance imaging (plain, gadolinium enhanced MR), radionuclide scintigraphy (Technetium RBC, sulfur-colloid, IDA scan), angiography, and image-guided percutaneous needle biopsy. MR imaging is probably better at characterizing lesions than CT scan, but the latter remains the modality of choice at many institutions due to the speed of acquisition and good contrast resolution inherent in the technique. Each of these modalities is useful, but accurate lesion detection and specific radiologic diagnosis is most often made in many patients with typical imaging features using a combination of examinations rather than with a single modality. In the remaining patients with atypical features, a definitive diagnosis is usually obtained by a needle biopsy. Table I summarizes the typical clinical and imaging findings of common benign solid liver tumors, with suggested further work-up and management. Future developments will focus on the use of special contrast agents in sonography and MRI for further evaluation and characterization of focal hepatic lesions. Emerging clinical applications of these special contrast agents have shown a promising future role for contrast-enhanced sonography and MRI as problem-solving examinations after inconclusive ultrasound and helical CT.
In this article, we attempted to present an overview of uncommon and rare benign solid liver tumors. Table I summarizes some clinical and imaging characteristic features with a suggested diagnostic work-up and management. While clinical history and certain radiologic appearances can help making a confident diagnosis in some of these tumors, the majority requires histologic examination for a definitive diagnosis.
Cystic lesions of the liver are a common finding and the differential diagnosis is wider than often considered. Awareness of the radiologic key features allows a correct presumptive diagnosis in a lot of cases. Diagnostic accuracy is increased when combining the characteristic radiologic features to the clinical history and laboratory findings as summarized in Table I. Further useful information can be obtained in the most difficult cases with atypical findings by means of fine needle aspiration performed under imaging guidance. In endemic regions, hepatic echinococcal cyst should be always kept in mind and excluded from the differential diagnosis of HCL.
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