Cross-Sectional Imaging Evaluation of Vascular Lesions in the Gastrointestinal Tract and Mesentery.

Gastrointestinal (GI) tract and mesenteric vascular lesions can have various clinical presentations, of which GI bleeding is the most common. This collection of pathology is highly variable in etiology ranging from occlusive disease to vascular malformations to trauma to neoplasms which makes for a challenging workup and diagnosis. The advent of multiple imaging modalities and endoscopic techniques makes the diagnosis of these lesions more achievable, and familiarity with their various imaging findings can have a significant impact on patient management. In this article, we review the gamut of GI tract and mesenteric vascular lesions and their associated imaging findings.

Bispectral index as a predictor of unsalvageable traumatic brain injury.

PRIMARY OBJECTIVE: We aimed to assess the utility of bispectral index (BIS) monitoring to diagnose brain death (BD) in patients with severe traumatic brain injury (TBI). RESEARCH DESIGN AND METHODS: A prospective observational study was conducted for patients with severe TBI between 2012 and 2014. MAIN OUTCOMES AND RESULTS: This study included 62 patients with a mean age of 32.5 ± 10.5 years. Nine patients had BD on admission with a sustainable BIS value of 0. Fifty-three patients were not initially diagnosed with BD with BIS values of 2-56. Forty-four patients deteriorated to BD, and their respective BIS values progressively decreased to 0. Nine patients with mean BIS of 39.2 ± 9.0 recovered and were transferred to a specialized high dependency unit. BIS values showed positive correlation with the Glasgow Coma Score (GCS) on admission (r = 0.43, p = 0.001). Survivors had higher BIS values than those who were initially declared BD or those who died during the hospitalization course (p = 0.001). CONCLUSION: BIS values have a significant correlation with initial GCS and can assist in the early detection of BD in patients with severe acute TBI. Further larger studies are needed to support our findings.

Superior mesenteric artery thrombosis and small bowel necrosis: An uncommon thromboembolic manifestation in COVID-19 pneumonia.

Thromboembolism is a recognized complication in patients with COVID-19 infection. It is believed that coagulopathy results secondary to severe inflammatory response syndrome with release of cytokines, viral activation of coagulation cascade or viral related vasculitis. Both arterial and venous thromboembolic complications have been described, however venous thromboembolic complications are much far common. We present an uncommon thromboembolic complication of the superior mesenteric artery in a 49-year-old male with COVID-19 pneumonia. The patient also developed segmental infarct of his renal transplant. Patients with SARS-COV-2 infection should be closely evaluated and monitored for the development of thromboembolic complications. Prompt evaluation with CT angiography of suspected thromboembolism could help early diagnosis and treatment which can reflect better patients' outcomes.

Rat Bite Fever: The First Case Report from Qatar.

BACKGROUND Rat bite fever (RBF) is a rare but fatal zoonotic disease caused by infections with various bacteria, which are transmitted from rats or other rodents. Only a few patients worldwide are diagnosed with RBF annually. RBF can be fatal if left untreated, with a mortality rate of about 10% in patients with severe RBF. CASE REPORT A case 37-year-old previously healthy man presented to the emergency department with acute gastroenteritis, sepsis and multi-organ failure requiring ventilatory support. He was later diagnosed with RBF due to Streptobacillus moniliformis. He recovered rapidly after administration of intravenous penicillin G and was discharged from the hospital 10 days later. CONCLUSIONS This report describes a patient with RBF and multi-organ involvement requiring ventilatory support. He was successfully treated with intravenous penicillin G. To our knowledge, this is the first report of a patient from Qatar with RBF.

Arnold-Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report.

The authors urge clinicians to consider the possibility of Arnold-Chiari Malformation type 1 with other central causes especially in cases where acute respiratory failure is unexplainable.

A case of retrograde venous air embolism causing cerebral infarction following upper gastrointestinal endoscopy: A novel pathophysiological mechanism.

The incidence of cerebral infarction following upper gastrointestinal endoscopic procedures is well described in the existing literature, with most mechanisms involving arterial travel of the embolus. We describe a case of cerebral infarction not explained by previously described mechanisms and detail the proposed occurrence of retrograde venous air embolism causing cerebral infarction following an upper gastrointestinal endoscopic procedure.

Role of Sonoelastography in the Differentiation between Benign and Malignant Breast Lesions.

PURPOSE: To prospectively evaluate the accuracy of real time elastography (ultrasound strain imaging) for distinguishing between benign and malignant solid breast lesions with the pathologic results as the reference standard. We also evaluated if the fat÷lesion ratio could semiquantitatively evaluate the stiffness of breast lesions. PATIENTS AND METHODS: Conventional ultrasonography (US) and real time elastography were performed in 100 women with breast masses with the mean age is 50 years. Elasticity images were given an elasticity score according to the degree and distribution of the strain induced by light compression with 1-3 is benign and 4-5 is malignant. We also calculated the ratio of the normal breast tissue to that of the lesion (fat÷lesion ratio) of the different breast lesions with the fat as the reference. The cutoff point was 4.8 with ratio below this level is considered benign and above this level is considered malignant. RESULTS: For elasticity score, the mean standard deviation was 4.1 for malignant lesions and 2.1 for benign lesions (p<0.001). When a cutoff point between 3 and 4 was used, elastography had 87.2% sensitivity, 90.6% specificity and 90% accuracy. The fat÷lesion ratio (F÷L ratio) of the benign lesions was different from that of the malignant ones. CONCLUSION: US strain imaging can facilitate improved classification of benign and malignant breast masses and has the potential to aid their diagnosis. By using the F÷L ratio, the stiffness of breast lesions could be semiquantitated and this method may provide another diagnostic method in addition to the scoring system. KEY WORDS: Breast - Sonoelastography - Strain imaging - Fat-lesion ratio.