Inter observer reliability for peritoneal carcinomatosis at computed tomography.

OBJECTIVE: To determine whether there is inter-observer reliability between radiologists for reporting peritoneal carcinomatosis and computed tomography peritoneal carcinomatosis index estimation. METHODS: The retrospective, cross-sectional study was conducted at Dow Institute of Radiology, Dow University of Health Sciences (DUHS), Ojha campus and comprised computed tomography scans done between December 1, 2019, to May 31, 2020, that were extracted from the institutional database searched using key words 'peritoneal carcinomatosis' and/or 'serosal deposits'. The first readers had 1-4 years of post-fellowship experience, while the 2nd readers were senior radiologists. Inter-observer reliability was assessed quantitatively and qualitatively for 15 peritoneal sites using, among other tolls, the Sugarbaker computed tomography peritoneal carcinomatosis index. Data was analysed using SPSS 21. RESULTS: Out of 236 subjects with mean age 53.6±13.6 years, there were 173(73.3%) females and 63(26.7%) males. The most common primary cancer was ovarian 145(61.4%), followed by colon 26(11%). The size of peritoneal deposit was not reported in 75(31.8%) cases. Of the 15 sites analysed, good agreement was not found in 7(46.7%). There was an excellent intra-class correlation for measuring computed tomography peritoneal carcinomatosis index scores among the radiologists irrespective of the grade of the faculty (>0.90). CONCLUSIONS: The inter-observer reliability was low, but good agreement for computed tomography peritoneal carcinomatosis index would encourage radiologists to use it in peritoneal cancer reporting.

Benign and malignant breast diseases during pregnancy and lactation: a diagnostic challenge.

OBJECTIVE: To determine the frequency of breast cancer associated with pregnancy and lactation, and to evaluate the lesions on ultrasound. Methods: The descriptive, observational study was conducted at the Dow Institute of Radiology, DUHS, Karachi from December 2020 to August 2021, and comprised of pregnant and lactating women with clinically palpable breast lumps and/or painful breast. The margins, orientation, echo pattern and associated features of the lesions were studied on ultrasound and were assigned a Breast Imaging Reporting and Data System grade. All the lumps were followed and ultrasound-guided core needle biopsy for histopathology was done of grades IV and V cases. Incidence and Accuracy of ultrasound for diagnosis of pregnancy-associated breast cancer was estimated. Data was analysed using SPSS 26. RESULTS: Of the 237 women, 19(8%) were pregnant and 218(92%) were lactating. The overall mean age was 28.4±5.5 years. Ultrasound findings for lactating and pregnant women were significantly different (p=0.05). Significant association of Breast Imaging Reporting and Data System grades III, IV and V lesions with heterogeneous echo texture of mass was seen (p<0.001). Biopsy was performed in 20(8.4%) cases, and 12(60%) of them had benign results on histopathology. CONCLUSIONS: A variety of benign and malignant breast diseases were found in women during pregnancy and lactation phases.

The Asymptomatic Dissecting Aortic Aneurysm: An Incidental Finding on CT.

We report a case of 65-year male patient, a known hypertensive and a chronic smoker, who presented to the Civil Hospital, Karachi with complaints of cough, hemoptysis and shortness of breath for three weeks. The chest radiograph showed left apical solitary pulmonary nodule (SPN) and aneurysmal dilatation of the descending thoracic aorta. He was further investigated with contrast enhanced computed tomography (CECT) scan of chest, which apart from demonstrating malignant pulmonary lesion, surprisingly revealed Stanford type B descending thoracic aortic dissecting aneurysm with intramural hematoma, jeopardising renal and splanchnic circulation. An asymptomatic dissecting aortic aneurysm is relatively rare. To the best of authors' knowledge, less than 15 case reports have been published in the international literature.

Gastroduodenal Artery Pseudoaneurysm and Aberrant Right Hepatic Artery.

We present a case of 36-year male patient who was referred to the Civil Hospital, Karachi with intermittent abdominal pain and vomiting for the last 2 years. The contrast enhanced CTexamination revealed changes of acute pancreatitis, CTSI 4/10, pancreatic calcifications along with 22x17 mm partially thrombosed pseudoaneurysm of gastroduodenal artery. The aberrant right hepatic artery was incidentally seen, on the arterial phase acquisition, arising directly from abdominal aorta. Gastroduodenal artery pseudoaneurysm is a rare complication of acute pancreatitis. It can lead to hematemesis, and it can bleed massively into peritoneal cavity. The aberrant origin of right hepatic artery from the aorta is extremely rare. To the best of authors' knowledge, less than five cases have been reported previously in literature.