The frequency of os acromiale in 751 shoulder MRI of Saudi population.

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25-81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature.

Magnetic resonance imaging evaluation of temporomandibular joint derangement in symptomatic and asymptomatic patients.

OBJECTIVE: To highlight the importance of MRI in evaluation of the tempromandibular joint (TMJ). METHODS: The MRI examination was performed at King Khalid University Hospital, Riyadh, Saudi Arabia with the approval from the local ethics committee, on 34 patients (68 joints) between January 2006 and November 2007, in which 10 were considered asymptomatic subjects (control). The remaining had symptoms and signs of TMJ pain or dysfunction, including limitation of movement and clicking. All our subjects were examined in both closed and open mouth position. Images were obtained by 1.5-T MRI system, in oblique sagittal plane utilizing 3 pulse sequences including T1 and T2 spin-echo, and spoiled gradient recall sequences. The evaluation of the meniscal disc configuration and position was carried out by 2 radiologists. RESULTS: Sixteen out of 20 joints of asymptomatic subjects were normal. In the other 2 asymptomatic subjects, the MRI showed anterior disc displacement with reduction in 3 joints, and degenerative changes in 2 joints. Out of the 48 symptomatic joints, 26 (45%) joints were considered normal, while the other 22 joints showed anterior dislocation without reduction. Degenerative joint disease was also seen in 18 joints. CONCLUSION: The MRI with the use of surface coils markedly improves the delineation of internal derangement of the TMJ, therefore, it enhanced the capability of detecting certain abnormalities, which proved to have a statistical significance in symptomatic patients.

The utility of unenhanced helical CT in assessing the frequency of ureterolithiasis in Saudi patients.

OBJECTIVE: To identify 650 patients who underwent CT for renal colic, and review them for age and gender, in Saudi Arabia. METHODS: Scans were performed on a 16 multislice scanner. A total of 650 patients, with the clinical suspicion of ureteric colic were reviewed; 220 females (33.8%) and 430 males (66.2%), with a female to male ratio of 1:2. Exams were carried out from January 2005 to November 2006, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Three hundred and ninety five patients out of 650 had stones; 2 of 395 (0.5%) had stones in the 5-15 years age group, 28 (7.1%) in the 16-25 years age group, 99 (25.1%) in the 26-35 years, 106 (26.8%) in the 36-45 age group, 84 (21.9%) in the 46-55 age group, 51 (12.9%) in the 56-65 age group, and 25 (6.3%) in the above 66 years age group. The most significant finding in our study is that as the patients age increases so does the percentage of stones up to the age of 56, with a peak at age group of 26-35 where stone percentage reaches 26.8%. CONCLUSION: Unenhanced helical CT is useful for the diagnosis of ureterolithiasis.

Calcific myonecrosis: keys to recognition and management.

OBJECTIVE: Calcific myonecrosis masses can become quite large and worrisome for malignancy. The key to recognition is a combination of radiologic imaging features and remote clinical history of injury associated with compartment syndrome or vascular or neurologic compromise. CONCLUSION: This article will highlight importance of correct diagnosis by identifying the severe and devastating complications following inappropriate management.

Bilateral chronic quadriceps tendon tear secondary to repeated seizures.

Chronic bilateral quadriceps tendon tear is an uncommon clinical entity when it is associated and caused by epilepsy resulting in repeated falls. We describe here a young male who presented with the inability to walk and a long history of seizures. The clinical exam, with plain radiographs and magnetic resonance imaging allowed accurate diagnosis as well as proper management.

Böhler's and Gissane's angles of the calcaneus in the Saudi population.

OBJECTIVE: The purpose of this study is to measure Böhler s angle (BA) and Gissane s angle (GA) in the Saudi population and compare their values to the published data. METHODS: Lateral plain radiographs of 229 normal feet and ankles of 158 females and 71 males, with age range of 15-72 years, were studied retrospectively at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 2002 and 2003. Böhler's angle and GA were measured and the mean and standard deviation of each angle were calculated. The relationship between each angle and age, gender, and side of body was tested, and compared to international figures. RESULTS: The mean BA in the Saudi population was 31.21 degree with a range of 16-47 degree. The mean GA was 116.16 degree with a range of 96-152 degrees. Böhler's angle and GA are not significantly related to age, gender, or side of body. Moreover, the range of both angles was wider than that reported in the literature. CONCLUSION: The study shows the difference between the Saudi and various other populations in regard to BA and GA, and reinforces the need to establish the normal ranges of BA and GA in a given population.

Determining symptoms for chest radiographs in patients with swine flu (H1N1).

BACKGROUND: The question arises about the chest X-ray findings and clinical symptoms in swine flu and about the most important clinical finding when correlated with the chest radiograph. Should physicians order a chest X-ray in each patient suspected of having swine flu? MATERIAL/METHODS: There were 179 patients with a high suspicion of swine flu. All 179 patients had an initial chest radiograph. As many as 65 males (representing 56% of the projected study population) had a normal chest radiograph, while 35 males (representing 55.6% of the study population) had an abnormal chest X-ray. As many as 51 females (representing 44% of the population) had a normal chest X-ray, while 20 females (representing 44% of the study population) had abnormal chest X-rays. RESULTS: Polymerase chain reaction (PCR) was not a determining factor for normal vs. abnormal chest X-ray (CXR). Rapid antigen test was not a determining factor for normal vs. abnormal CXR. Fever was not a determining factor for normal vs. abnormal CXR. Cough appears to be a determining factor for normal vs. abnormal CXR. Sore throat appears to be a determining factor for normal vs. abnormal CXR. Chest pain was not a determining factor for normal vs. abnormal CXR. Presence of cough with PCR was statistically significant. CONCLUSIONS: In my opinion, chest radiographs in patients with suspected H1N1 should only be obtained if there is a cough or sore throat. Other symptoms associated with H1N1 do not warrant a chest radiograph unless absolutely necessary.

Percutaneous vertebroplasty complications.

Percutaneous vertebroplasty, among various other options, has become a mainstay in the management of osteoporotic and malignant vertebral fractures. The purpose of this article is to describe complications arising from the procedure, which can be classified as mild, which may include a temporary increase in pain and transient hypotension; moderate, including infection and extravasation of cement into the foraminal, epidural or dural space; and severe such as cement leakage in the paravertebral veins, leading to pulmonary embolism, cardiac perforation, cerebral embolism or even death. Vertebroplasty is not a procedure without complications. The article defines them and describes methods to minimize them.

Transient osteoporosis of the hip/bone marrow edema syndrome with soft tissue involvement: a case report.

Transient osteoporosis of the hip (TOH) is a rare condition mainly affecting pregnant women in their third trimester and middle aged men. We report a case of TOH/Bone marrow edema syndrome in pregnancy with involvement of the surrounding soft tissues on magnetic resonance image, which has not been previously reported. The presence of such edema in the soft tissues may help to differentiate this condition from early avascular necrosis of the hip, and may also provide an insight into the pathogenesis of the condition. The reported patient was treated conservatively and fully recovered.

Normal knee angles in the adult Saudi population.

OBJECTIVE: To study knee angles in the adult Saudi population and compare their values to the published data from other populations. METHODS: Antero-posterior bilateral radiographs of 333 normal knees of 120 males and 213 females, with age range of 18-65 years, were studied retrospectively at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, from January 2009 to December 2009. Tibiofemoral (TFA), lateral distal femoral (LDFA), and lateral proximal tibial (LPTA) angles were measured and the mean of each angle was calculated. The relationship between each angle and age, gender, and side of the body was tested, and compared with the international figures. RESULTS: The mean for TFA in Saudis was 174.41°, LDFA was 90.07° and LPTA was 89.42°. All angles were not significantly related to gender. Significant relations existed between TFA and side of the body, and between LDFA and age. Variations in means and ranges of knee angles between the Saudi and other populations were determined. A significant difference existed between means of TFA, LDFA, and LPTA of Saudis and those of Caucasians, between mean of TFA of Saudis and that of Chinese, and between mean of LPTA of Saudi males and that of Chinese males. The means of TFA of selected age groups in Saudis differed significantly when compared to those in the corresponding age groups in Japanese and Australian Caucasians. CONCLUSION: Knee angles are like many other skeletal angles that may have ethnic variation between different populations. The study reinforces the need for reference values of knee angles in a given population.

Penile necrosis due to calciphylaxis in a patient of end stage renal disease.

A case of a 72-year-old diabetic, hypertensive male with end stage renal disease as a result of the underlying condition of calciphylaxis, presenting with gangrene of the glans penis is reported. In calciphylaxis, calcification of small and medium-sized arteries occurs, which may result in ischemia and gangrene. A computed tomography scan of the lower abdomen, pelvis, and the upper thigh was performed, which showed diffuse and extensive calcification of the walls of the small and medium-sized arteries, with almost complete obliteration of the lumen of the small arteries. A 3-dimensional reconstruction of the penis using volume rendering technique, demonstrated the ulceration of the glans penis in an exquisite manner. The appearance is so peculiar that no histological confirmation is needed. A review of relevant literature related to the etiopathogenesis, radiological findings, treatment, and prognosis is also discussed.

The role of ultrasonography in portal hypertension.

Portal hypertension is a commonly encountered clinical condition with multiple causes and several squeal. Ultrasound is an accurate non-invasive means of assessing its aetiology, severity and complications. I will review the role of ultrasonography in portal hypertension. The ultrasonic features that help identify its aetiology will be discussed as will the criteria that allow an assessment of disease severity and its complications.

Unenhanced helical CT in the investigation of acute flank pain.

Unenhanced helical CT has emerged as the imaging technique of choice for the investigation of patients presenting with acute flank pain and suspected nephroureteric stone disease. There are several signs identifiable on unenhanced CT that support a diagnosis of stone disease. However, there are many pitfalls, that may confound a correct diagnosis. Some of the common pitfalls, together with methods to avoid such occurrences, will be discussed. A review of some of the common alternative diagnoses that may mimic the symptoms of nephroureteric stone disease is illustrated.

Computed tomography of acute small bowel obstruction: pictorial essay.

In many patients, the diagnosis of SBO can often be made by a combination of clinical history, physical examination and plain radiographs. However, in many cases, the diagnosis of SBO may be difficult. Abdominal radiographs are limited in their ability to diagnose SBO and, more particularly, to identify a specific underlying cause. Although barium studies, ultrasonography and magnetic resonance imaging may all play a role in the evaluation of SBO, CT should be the examination of choice for most patients when the diagnosis and underlying cause of SBO is unclear. It may help differentiate pseudo-obstruction from true obstruction, and a specific underlying cause can often be determined. Signs of closed-loop obstruction, strangulation, perforation or infarction may be detected and allow for more timely and appropriate surgical management. We advocate the use of CT in any patient with SBO where the cause or diagnosis is unclear. We have attempted to demonstrate a range of clinical cases in our practice where CT played an invaluable role in the evaluation of our patients.