TESTICULAR LIPOMATOSIS IN COWDEN DISEASE.

Cowden disease is a genetic syndrome resulting in formation of multiple premalignant hamartomas in different parts of the body with classical radiological features. In this report a case of Testicular Lipomatosis as a result of Cowden disease resulting in primary infertility.

Spontaneous Uterine Rupture Secondary to Morbidly Adherent Placenta in an Unscarred Uterus.

We report a case of spontaneous uterine rupture in a primigravida with an unscarred uterus, which was secondary to morbidly adherent placenta proven on surgery and histology. Although rare, uterine rupture should be considered as a differential diagnosis of acute abdominal pain in pregnancies, especially when associated with free fluid, even with the absence of vaginal bleeding. Abnormal placentation is associated with spontaneous antepartum uterine rupture even in early pregnancy. Most cases in the literature have advocated emergency hysterectomy to arrest life-threatening hemorrhage.

Pure Uterine Lipoma on 18FDG PET/CT: Rare But Easy to Diagnose.

Tumors of the uterus are extremely uncommon. Pure lipomas of the uterus are very rare, and only a few cases have been reported. We are presenting a case of a post-menopausal lady, a survivor of right breast cancer who had an 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) for evaluation of a suspected right lung nodule. The scan was negative for hypermetabolic abnormality. However, a hypodense and non-metabolic lesion was seen in the fundus of the uterus. On subsequent hysterectomy, it was found to be a pure lipoma.

Cholecystocolonic Fistula.

Cholecystocolonic fistula (CCF) is a rare complication of gallstone disease with a variable clinical presentation. It is difficult to diagnose CCF pre-operatively despite modern diagnostic and imaging modalities as they are often asymptomatic or incidentally discovered, often peri-operatively. However, management of this uncommon yet important finding is not very well described in the literature. The most common fistula is the cholecystoduodenal fistula, followed by the cholecystocolonic fistula; the cholecystogastric fistula is reportedly the least commonly reported. We report our experience with three cases of cholecystocolonic fistula discovered on imaging which were subsequently confirmed through surgery.

The Characteristics of Appendicoliths Associated with Acute Appendicitis.

Introduction Differences between appendicoliths associated with appendicitis and those found incidentally have not been studied. The objective of this study was to determine the characteristics of appendicoliths that are associated with acute appendicitis. Methods A cross-sectional study of patients with appendicoliths identified on computed tomographic (CT) scan from January 2008 till December 2014 was conducted. Patients were divided into two group: appendicitis and appendicoliths (AA) and incidentally discovered appendicoliths (IA). Results Overall, 321 patients were included in the study. Of these, 103 (32%) patients were in the AA group while 218 (68%) patients were in the IA group. Both groups were similar in age and gender distribution. Significantly greater proportion of patients in the AA group had more than one appendicolith [AA vs. IA: 63 (62%) vs. 82 (38%), p < 0.001], appendicolith location at the base [AA vs. IA: 34 (33%) vs. 33 (15%), p < 0.001] and appendicolith diameter of 5 mm or more [AA vs. IA: 71 (69%) vs. 28 (13%), p < 0.001]. On multivariate analysis, more than one appendicolith [Odds ratio (OR): 1.9, 95% CI: 1.1-3.4; p = 0.02] and diameter of 5 mm or more (OR: 13, 95% CI: 7.1-23.6; p < 0.001) were independently associated with acute appendicitis. Conclusion Multiple appendicoliths and appendicoliths larger than 5 mm are associated with acute appendicitis.

Jejunoduodenogastric intussusception secondary to percutaneous gastrostomy tube in an adult patient.

Intussusception is the most common abdominal emergency in early childhood, but it is rare entity in adults. Jejenoduodenogastric intussusception is an exceedingly rare retrograde small-bowel intussusception. Percutaneous endoscopic gastrostomy (PEG) has become the preferred procedure for establishing enteral feeding in most clinical situations. Despite the fact that it is relatively safe, a number of complications can occur following PEG placement; jejenoduodenogastric intussusception is one of them, but it is a very rare entity. Here, we report a case of jejenoduodenogastric intussusception secondary to placement of a PEG tube in an adult patient. To our knowledge, this is the third case of isolated duodenogastric intussusception being reported.

Diagnosis of hepatoma using grayscale and Doppler ultrasound in patients with chronic liver disease.

OBJECTIVE: To determine the diagnostic accuracy of liver ultrasound for the detection of hepatoma in chronic liver disease (CLD) patients by either taking histopathology or serum α-fetoprotein levels or a biphasic computed tomography (CT) scan (whichever is available) as the gold standard. STUDY DESIGN: Cross-sectional. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to January 2010. METHODS: A total of 239 patients (156 males and 83 females) with clinical suspicion or surveillance of hepatoma in CLD referred to the radiology department for ultrasound evaluation followed by either liver biopsy and histopathology or serum α-fetoprotein level or biphasic CT scan. RESULTS: The sensitivity of ultrasound for hepatoma detection in CLD was 65%, specificity was 85%, and accuracy was 70%, and positive predictive value and negative predictive value were 92% and 45%, respectively. CONCLUSION: Ultrasound is a relatively quick, safe, reasonably accurate, and noninvasive imaging modality for the detection of hepatoma in CLD and can be complemented with clinical assessment of screening high-risk patients.

Can computer assisted diagnosis (CAD) be used as a screening tool in the detection of pulmonary nodules when using 64-slice multidetector computed tomography?

OBJECTIVES: To evaluate (1) whether or not the addition of computer-assisted diagnosis (CAD) to 64-slice multidetector computed tomography (CT) can be used as a screening tool for detection of pulmonary nodules in routine CT chest examinations and (2) whether or not to advocate the incorporation of CAD as a screening tool into our daily practice. MATERIALS AND METHODS: A retrospective cross-sectional analysis of 109 consecutive patients who had all undergone routine contrast-enhanced CT chest examinations for indications other than lung cancer at the Radiology Department of Aga Khan University Hospital, Karachi, between November 2010 and January 2011. All examinations were evaluated in terms of the detection of pulmonary nodules by a consultant radiologist and CAD (ImageChecker CT Algorithm R2 Technology) software. The ability of CAD software to detect pulmonary nodules was evaluated against the reference standard. In addition, a chest radiologist also calculated the number of pulmonary nodules. The sensitivity and specificity of the CAD software were calculated against the reference standard by using a 2 × 2 table. The Mann-Whitney U test was applied to compare the performances of CAD and the radiologist. RESULTS: CAD detected 610 pulmonary nodules while the radiologist detected only 113. The reference standard declared 198 pulmonary nodules to be true nodules. CAD detected 95% of all true nodules (189/198), whereas the radiologist detected only 57% (113/198). In the detection of true pulmonary nodules, CAD had 98% sensitivity compared with the radiologist who had 57% sensitivity; the statistical difference between their performances had a P value <0.001. CONCLUSION: Considering the high sensitivity of CAD to detect nearly all true pulmonary nodules, we advocate its application as a screening tool in all CT chest examinations for the early detection of pulmonary nodules and lung carcinoma.