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Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic syndrome that is caused by mutations in the tumour suppressor genes TSC1 or TSC2 which causes multiorgan growths. TSC presents at any age as a wide range of clinical and phenotypic manifestations with varying severity. The main goal of this article was to state two cases of TSC and review the most commonly reported major and minor diagnostic clinical features and the most common features that led to an investigation of possible TSC diagnosis. Herein, we report two cases of TSC, which both presented with seizures during the first 6 months of life. Case 1 presented with multiple types of seizures from 6 months of age and was diagnosed by multiple calcified subependymal nodules (SENs) detected by computed tomography and magnetic resonance imaging (MRI). Case 2 presented with seizures from 3 months of age and was diagnosed prenatally when a tumour was seen in her heart during antenatal ultrasonography. In conclusion, the literature review revealed that neurological manifestations (mainly seizures) were the main feature that led to investigation and diagnosis of TSC followed by abdominal manifestations (mainly renal features) and antenatal follow-up imaging. Other manifestations in skin, chest, eyes, teeth and heart rarely led to TSC diagnosis. In some cases, TSC was incidentally discovered by medical imaging. The cortical tubers, SENs, and subependymal giant cell astrocytomas brain lesions were the most commonly reported major features. Skin features including angiofibromas, ungual fibromas and shagreen patch were the second most common major features reported in the literature. However, skin manifestations were not a common led to investigation and diagnosis of TSC. Renal features, mainly angiomyolipomas (AMLs), were the third most common major feature reported. Medical imaging plays an essential role in diagnosis of TSC, and clinical features are important clues that lead to investigation for the disease.

Background and objective Arteriovenous Fistula (AVF) is an essential requirement in Hemodialysis (HD) to remove toxins and excess fluid from the blood of patients with Chronic Renal Failure (CRF). The Blood Flow Rate (BFR) in AVF is an important factor in the success of HD. Due to a lack of studies of low BFR during HD, this study was conducted. The objective of this study was to compare the success rate of HD in patients with a BFR = 400-500 mL min-1 (group-2), in comparison to those of higher BFR (group-1). Materials and methods This prospective cohort study was conducted at the ultrasound Doppler (USD) unit in King Fahad Hospital in Almadinah from July to December, 2019. In this study, 44 patients underwent AVF for HD and were assessed by USD for 2 consecutive visits at 3 months intervals. The success rate of HD was measured in patients with a BFR = 400-500 mL min-1 and in those with BFR>500 mL min-1. A comparison of the success rate in the 2 groups was done. Results Among the 44 patients, 59% were males and 41% were females. The age of participants ranged from 20-80 years (mean: 46.75±13.67 years). The patients underwent HD 3 or 2 session's week-1 for 3 or 4 hrs (mean 3.84±0.36 h) per session. In the first assessment, the success rate was 100% in both groups but it was 88.24% in group-1 and 70% in group-2 in the second assessment. Conclusion The success rate of hemodialysis in patients with BFR 400-500 mL min-1 in AVF was acceptable in comparison to that in patients with BFR>500 mL min-1.

Hydatid cyst (cystic echinococcosis) is a chronic parasitic infection by the larval stage of the cestode that is called Echinococcus granulosus (E. granulosus) resulting in the development of cystic lesions in animals and humans. In this report, we describe a rare phenotype of hydatid cyst in the breast of a 23-year-old female presented with breast mass in the left upper outer quadrant for 3 months with palpable left axillary lymph nodes. Both US and mammography provided a picture of complex suspicious cystosolid lesion with amorphous micro-calcification (BIRAD-4A). Surgical consultation was performed and Tru-Cut biopsy was recommended. Histopathology results revealed multiple viable protoscolices of E. granulosus and suggested the final diagnosis of breast hydatid cyst. The patient returned with ruptured and infected hydatid cyst of the breast and started treatment with Albendazole 400 mg twice daily in addition to antibiotics. Following-up after two months of Albendazole treatment showed a dramatic shrinkage in the size of the cystic lesion. In conclusion, hydatid cyst should be considered as a differential diagnosis of any cystic or cystosolid lesion in the breast and any organ in the body from head to toe apart from the hair and nails. Radiologists should be aware to the benign lesions that may mimic breast cancer to avoid misdiagnosis and unnecessary invasive procedures and consequent complications.

Myxopapillary ependymoma (MPE) is a unique slow-growing benign (WHO grade 1) subtype of spinal cord ependymoma arising predominantly in the filum terminale. Despite its benign nature, it occasionally disseminates through the cerebrospinal fluid and metastasizes to distant sites. Here, we report an extremely rare case of MPE with interval CSF seeding and metachronous metastasis in a 47 -year-old female presented as a gradually increasing low back pain for three months with bilateral radiculopathy down to the knees. Magnetic resonance imaging (MRI) showed an intradural extramedullary spinal mass of iso-intense signal to the cord on T1 weighted-images (WIs), heterogeneous, predominantly hyperintense signal on T2WIs with homogenous enhancement after contrast administration. L2 laminectomy with gross total resection (GTR) was performed, and histopathological results confirmed the diagnosis of MPE. Adjuvant radiotherapy was administered, followed by series of MRI scans. 28 months after GTR, Lumbar MRI showed multiple tiny enhancing nodules in the cauda equina. 44 months follow-up whole spine MRI revealed multiple intradural extramedullary nodules throughout the entire spine. The largest one measures about 1.5cm opposite to T3 -T4 intervertebral disc space. The patient underwent T3 and T4 laminectomy and GTR under general anesthesia using microsurgical techniques, and the histopathological result came with the diagnosis of MPE.

A pharyngeal hairy polyp (HP) is a rare benign mass that can be surgical detached with few complications. In this report, we describe a hairy polyp in a 7-day-old neonate presented with intermittent respiratory distress and feeding difficulties since birth. Neck computed tomography was performed, and demonstrated a well-defined pedunculated heterogeneous mass arising from the right lateral wall of the nasopharynx extending downward and nearly completely obstructing of the nasopharynx and oropharynx. The central part of the mass was found relatively dense surrounded by low attenuation fatty components with enhancement of the outer wall of the mass. The provisional diagnosis was pharyngeal HP. After autoamputation at the seventh day old, HP was analyzed via histopathology examination that showed a mixture of various ectodermal and mesodermal tissues including skin, cartilage, adipose and fibrous tissue. The patient fully recovered with no residual clinical features. We report this case to elucidate the possibility of this strange behavior of pharyngeal HP.

Diffuse astrocytoma is an infiltrating type of glioma (World Health Organization grade II), which even with histopathology, is difficult to diagnose. Magnetic resonance imaging (MRI) is the cornerstone for diagnoses and follow-up of brain gliomas. This report describes a case of diffuse astrocytoma in a 48-year-old man who presented with sudden right-sided weakness and repeated convulsive attacks. On brain computed tomography, the case was diagnosed and treated as an acute infarction. Ten days later, the patient returned with a total loss of consciousness. Brain MRI images revealed an irregularly outlined lesion involving the splenium of the corpus callosum that extended into the left periventricular parietal lobe of the brain with cystic foci in the septum pellucidum. Contrast-enhanced and new sequences of MRI was helpful in approach to diagnosis because of its superior tissue characterization. The histopathology results ultimately confirmed the diagnosis of diffuse astrocytoma. The patient died postoperatively.

Objectives: Hydronephrosis (HN) is dilatation of the collecting system of the kidney due to obstruction of urine outflow. This study intended firstly, to investigate the efficacy of ultrasound (US) imaging to determine the cause of HN, and secondly, to list the causes of HN. Methods: In this retrospective study, 233 patients with HN were scanned to determine the cause of the HN in the period from 1st January 2016 to 31st October 2017. Categorical results were written as frequencies and percentages. Results: Out of 233, 91.41% were adults and 8.58% were children (P

Multivalvular destruction may be a clinical manifestation of infective endocarditis (IE), which is a devastating infection of the heart either alone or superimposed with congenital subaortic membrane as in this case report. Here, we report a case of multivavular destruction with severe vegetation presented as a manifestation of infective endocarditis (IE) in a neglected case of 18-year-old male with previous rheumatic heart disease. Transesophageal echocardiography is an important imaging modality for diagnosis of superimposed aortic and heart lesions. Early necessary investigation and correct diagnosis is mandatory to prevent bad complications. doi: https://doi.org/10.12669/pjms.37.2.2798 How to cite this:Alshoabi SA, Aljaber NN, Gameraddin MB, Omer AM. Multivalvular destruction as the primary presentation of aggressive infective endocarditis with subaortic valve membrane. Pak J Med Sci. 2021;37(2):600-604. doi: https://doi.org/10.12669/pjms.37.2.2798 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pott's disease is a form of spondylodiscitis caused by mycobacterium tuberculosis. It is a serious form of spinal infections that can lead to terrible disabilities in case of undiagnosed and treated early. To document a case of Pott's paraplegia cured after four years. This report details the case of a patient with an undiagnosed case of spinal tuberculosis in a 55-year-old man who had complained of lower back pain and tenderness over the course of several months. The case progressed to the point that he had difficulty standing and numbness, then weakness, of the lower limbs. This patient was only treated with analgesics and antibiotics. Herbal remedies, massage and amulets also played a major role in his treatment. The patient remained bed-bound and paraplegic for four years, after which, he was referred for a thoracolumbar Magnetic Resonance Imaging (MRI) and was diagnosed with tuberculous spondylodiscitis. The patient underwent decompression surgery and started anti-tuberculous drugs. He regained his ability to walk. His lifestyle has improved and he has been living independently for eight years. In conclusion, diagnosis and correct treatment can result in a patient who was previously handicapped becoming independent once again. Medical imaging using MRI can play an essential role in the diagnosis of spinal lesions, including those present in cases of Pott's disease.

Ossified meningioma is a rare type of intradural, extramedullary spinal meningioma which may give a bone density in the spinal canal and complicate surgical removal of the meningioma. This report discusses a case of ossified meningioma in a 60-year-old female patient who presented with paraplegia and uncontrolled urination and defecation. The condition had first appeared 2 years before as insidious thoracic spine pain with a progressive course; at that point, the patient was treated using traditional medicine. Thoracic computed tomography (CT) was conducted, and the results showed an intradural extramedullary calcified spinal tumour causing severe compression of the spinal cord at the level of thoracic vertebrae 8 (T8) and 9 (T9). Spinal magnetic resonance imaging (MRI) confirmed an intradural tumour at the T8 and T9 levels that was causing severe compression of the spinal cord. Total tumour resection was done using standard microsurgical techniques, and histopathological examination results confirmed the final diagnosis of meningioma. In conclusion, in cases like this, correct preoperative diagnosis and planning makes surgery easier and prevents neurological injury. Medical imaging using CT and MRI plays an essential role in this diagnosis and planning the management of ossified meningioma.

Objective: Due to a lack of studies regarding the need for computed tomography (CT) in measuring the size of each urinary calculus before surgery, this study was conducted to elucidate the difference between ultrasonography (US) and CT in measuring the size of urinary stones. Methods: A retrospective review of 100 stones from 83 patients. Each urinary stone was measured using both US and CT; both measurements were then compared. Results: Of 83 patients, the mean age was 39.29 ± 23.76 years; 47 (56.62%) were male and 36 (43.37%) were female. Most of the urinary stones were 21 mm), (P < 0.001). Spearman's rho correlation test revealed strong compatibility between stone diameters measured by US and CT (r = 0.755), (P = 0 < 0.001). T-test for equality of means revealed no significant difference in the measured size using US and CT (mean = 11.80 ± 5.83 vs. 11.65 ± 6.59, respectively), mean difference = 0.15, and P = 0.865, 95% confidence interval: -1.584–1.884. Conclusion: No significant difference in measuring the size of urinary stones using US and CT. However, US may slightly overestimate small stones in some cases.

الملخص: الكيسة العدارية هي عدوى طفيلية بالطور اليرقي للديدان الشريطية المشوكة الحبيبية. عادة تصيب الكبد والرئة ونادرا ما تصيب أعضاء أخرى في الجسم. التصوير الطبي هو الأساس لتشخيص الكيسة العدارية. في هذا التقرير نسجل موقعا نادرا جدا للكيسة العدارية في البطين الأيمن للقلب في مريضة عمرها ٢٣ سنة، قدمت تعاني من ضيق في التنفس مع سعال وبلغم. كشفت الفحوصات المخبرية عن كثرة اليوزينيات مع فقر الدم. تصوير الصدر بالأشعة وتصوير البطن بالموجات فوق الصوتية كانت غير ملفتة. تصوير القلب بالأشعة المقطعية كشف عن وجود كيسين داخل البطين الأيمن. تخطيط صدى القلب عبر الصدر أكد وجود كيسين داخل البطين الأيمن ملتصقين بالحاجز البطيني. الكيسة العدارية كانت هي التشخيص الأول. تم اجراء عملية استئصال للكيسين وكشف تحليل العينات التي تم استئصالها بعد العملية وجود عدة أكياس تحتوي على الرؤيسات الحية للمشوكة الحبيبية. تعافى المريض وخرج من المستشفى واستمر بالعلاج ب ”البندازول“ عن طريق الفم. Abstract: Hydatid disease is a parasitic infection by the larval stage of the tapeworm Echinococcus granulosus. It affects liver, lungs and rarely other organs. Medical imaging provide the basis for diagnosis. This case report describes an extremely rare location of cardiac hydatid cyst in the right ventricle of the heart. We describe a 23-year-old woman who presented with shortness of breath and productive cough. Laboratory investigations showed marked eosinophilia and anemia. Chest radiography and abdominal ultrasonography were unremarkable. Cardiac computed tomography (CT) identified two well-defined fluid densities in the right ventricle without contrast enhancement. A transthoracic echocardiography (TTE) showed two cystic lesions in the right ventricular cavity that was attached to the interventricular septum. Hydatid cyst was the most likely diagnosis followed by the possibility of a congenital cardiac cyst. An open-heart surgery with cardiac cystectomy was performed. Post-operative analysis of the resected specimens showed multiple hydatid cysts with living scolices of Echinococcus granulosus. The patient recovered uneventfully and was discharged on oral albendazole.

Background Hypertension is one of the major world health problems. Ultrasonography plays a useful role in the assessment of morphologicalchanges at the kidneys in hypertensive patients. Aim To assess sonographic findings of the kidneys in hypertensive patients' co-morbidities with type 2 diabetes mellitus and ischemic heart disease (IDH). Materials and methods This was a prospective cross-sectional study involved 100 participants with primary hypertension selected by a method of simple convenient sampling. The patients were examined using ultrasonography to assess the sonographic findings of the kidneys. The renal length, corticomedullary differentiation (CMD), and renal artery diameters were assessed. Statistical Package for the Social Sciences (SPSS version 23.0) was used in data analysis. Results The length of the right kidney was 8.9850 ± 1.01 cm and 9.48 ± 0.98 cm for the left kidney. Among the hypertensive patients, the incidence of hypertension was highest in housewives (27%) and students (23%) as compared with the other groups. The sonographic findings were 18% affected with simple renal cysts, 7% poor CMD, and the majority had normal kidneys. Significant correlation was found between age and sonographic findings of kidneys (r = 0.21, P value = 0.033). Conclusion Simple renal cysts, poor CMD, and stenosis of renal arteries were most common sonographic findings in hypertension. Simple renal cystshad a significant association with hypertension.

Objective: This study aimed to assess the meniscus and cruciate ligament lesions of the knee using magnetic resonance imaging (MRI) and to investigate the correlation between clinical and MRI diagnoses. Patients and Methods: Herein, we reviewed the electronic medical records of 240 patients who underwent knee MRI. The images were evaluated and then the clinical and MRI diagnoses were compared. Results: Of the 240 patients, 66% were male and the mean age was 40.6 ± 15.5 years (range, 2-79 years). Knee pain alone was the most common presenting symptom (50.64%) followed by pain after trauma (47.92%). Majority of the knee lesions were medial meniscus (MM) lesions (63%) followed by osteoarthritis (48%) and ACL lesions (35%). The majority of the MM and ACL lesions were tears (54.6% and 69.41%, respectively) followed by degeneration (33.55% and 17.65%, respectively). However, the MM lesions were predominantly observed in the posterior horn (Odds ratio [OR], 152; 95% confidence interval (CI), 21.550–1072.113; P < 0.001). The ACL lesions were significantly more common in men than in women (OR, 0.355; 95% CI, 0.191-0.661; P = 0.001), and altered signal intensity on T2- and proton density–weighted images was the most common sign (P < 0.001). A strong compatibility was observed between the clinical and MRI diagnoses (Kappa = 0.141; P < 0.001). Conclusion: MM and ACL lesions are the most common injuries of the knee, which can be diagnosed by physical examination in most cases. Further confirmation by MRI should be reserved for doubtful cases only.

Kawasaki disease (KD) is a systemic vasculitis of unknown cause which usually diagnosed in small children. However, KD can be present as coronary disease in adults even with no history of the disease in childhood. Here, we describe a case of KD in a 42-year-old male patient presented with severe retrosternal chest pain radiating to the left arm and provisionally diagnosed as acute coronary disease. Coronary artery ectasia and multiple aneurysms have been confirmed by coronary angiography that led to the diagnosis of KD. The patient was treated with Aspirin 81 mg orally once daily, Apixapan 5 mg orally twice daily, Rosuvastatin 40 mg orally once daily, Bisoprolol 5 mg orally once daily, and omeprazole 20 mg orally once daily. The patient was improved and discharged with anticoagulant drugs for life. Physicians should be aware that KD can be present as coronary disease in adults even with no history of the disease in childhood and has a limited treatment options due to unfavorable coronary anatomy. doi: https://doi.org/10.12669/pjms.37.7.4199 How to cite this:Haider KH, Alshoabi SA, Qurashi AA, Hamid AM. Incidentally discovered Kawasaki disease in an adult man. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4199 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Urinary calculi constitute a significant medical problem worldwide. Due to lack of previous studies on gender and side distribution of urinary calculi, the current study was conducted. Patients and Methods: This retrospective study involved 590 urinary calculi from the electronic reports of 266 patients. Gender and side distribution were compared using Chi-square test. Relationship between gender and side of urinary calculi was analyzed using cross tabulation test. Results: This study involved 590 urinary calculi reported in 266 patients. Among 590 calculi; 565 (95.8%) were in adults, and 25 (4.2%) were in children. Urinary calculi were in male in 397 (67.3%) and in female in 193 (32.7%). Calculi were 304 (51.5%) in right side, and 286 (48.5%) in left side. Exactly 507 (85.9%) of calculi were in the kidneys, and 83 (14.1%) in the ureters. No significant relationship between gender and side of the calculi (P = 0.238), (Odds ratio 0.869, 95% Confidence interval 0.615-1.226). Conclusion: Urinary calculi affect male more than female and adults more than children. No significant relationship between calculi and right or left side of the body.

الخلاصة: الانغلاف المعوي هو دخول جزء من الأمعاء الى الجزء المجاور منها وهو سبب نادر لانسداد الأمعاء عند الكبار. عادة ياتي المريض وفيه علامات البطن الحاد الذي يشمل مجموعة واسعة من الحلات الطارئة. على الرغم انه من الصعب تشخيص الانغلاف سريريا الا انه من السهل تشخيصه عن طريق التصوير الطبي. التصوير بالموجات فوق الصوتية والتصوير المقطعي المحوسب يمكنه بسهولة اكتشاف الانغلاف المعوي. هذا التقرير يصف موقع غير معتاد لانغلاف القولون عند مريض عمره سبعين عاما. كل من عمر المريض ومكان هذه الحالة امر نادر الحدوث. Abstract: Intussusception refers to the telescoping of a bowel segment into the lumen of an adjacent distal bowel. It is a rare entity and an uncommon cause of intestinal obstruction in adults. Approximately 90% of cases of intussusception in adults have an organic cause as a lead point. Usually, the patient presents with signs of acute abdomen with a short history. Although it is difficult to diagnose colonic intussusception clinically, medical imaging by ultrasonography and computed tomography can easily detect this rare but clinically important disease. This case report describes an uncommon location of intussusception in the colon in a 70-year-old female patient. الكلمات المفتاحية: الانغلاف المعوي, مريض مسن, التصوير بالموجات فوق الصوتية, التصوير المقطعي, Keywords: Computed tomography, Elderly patient, Intussusception, Ultrasound imaging

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p < 0.001). The common femoral vein (CFV) was affected in 71.7% of cases. The superficial femoral vein (SFV) was affected in 71.7% of cases. The popliteal vein was affected in 67.4%. The deep femoral vein was affected only in 17.4%. Both CFV and SFV were affected together in 47.8% of cases. Both SFV and popliteal vein were affected together in 50% of cases. The majority of DVT cases (71.1%) were in the acute stage. This study revealed an essential relationship between the acute stage of DVT and distension of the affected veins (p < 0.001) (OR 20.667, 95% CI 3.826 - 111.633). It also detected a significant relationship between the acute stage and absence of venous blood flow (p < 0.001) (OR 90.667, 95% CI 8.303 - 990.114). Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

Background: Breast lesions (BLs) are abnormal swellings within the breast. The importance lies in need to exclude breast cancer. Objective: Due to the role of ultrasound (US) imaging in evaluating of BLs, this study was conducted to evaluate the predictive value of US imaging for differentiating benign from malignant BLs and to assess the need of biopsy in BLs. Method: A retrospective review of diagnostic results of 134 patients with BLs. All patients underwent breast US imaging and US-guided biopsy for cytology or histopathology. The results of both were compared. Results: Out of 134 patients were included in this study, the mean age was 38.45 ± 15.82 years (range, 18–90 years), and all patients were female. BLs were benign in 99 cases (73.9%) and malignant in 35 cases (26.1%). Among 98 patients with BLs diagnosed benign with US, 96.9% were confirmed benign with biopsy results and only 3.1% were malignant. The overall sensitivity of US imaging for discriminating of benign BLs was 95.95%, with a specificity of 91.42%, and positive predictive value of 96.94%. The results revealed strong compatibility between diagnoses by US imaging and biopsy results (P < 0.001), the measure of agreement kappa = 0.866, and the Spearman's correlation coefficient = 0.866. Conclusion: US imaging is a highly valuable imaging method in differentiating benign from malignant BLs. It usually predicts the benign nature of BLs with excellent diagnostic accuracy. US-guided fine-needle aspiration and core-needle biopsies are not necessary in most cases of BLs.

الملخص: فيروس كورونا ٢٠١٩ (كوفيد-١٩) هو مرض وبائي شديد العدوى وفي الغالب يكون مصحوبا بالحمى والأعراض التنفسية، ولكنه قد يأتي متنكرا بمتلازمة الشريان التاجي الحادة، أو ألم أو تورم للساق مع تجلط وريدي، أو فقدان الوعي مع تخثر وريدي دماغي، أو ارتباك، أو ضعف الأطراف مع احتشاء الدماغ، أو ألم العصب الوجهي، أو التهاب ملتحمة العين الحاد، أو ألم الحفرة الحرقفي اليمنى مثل التهاب الزائدة أو ألم الخصية. هنا قدمنا حالة لمريض ذكر في ٤٢ من عمره كان يعاني من أعراض كوفيد-١٩ خفيفة، وتطورت إلى احتشاء في عضلة القلب بسبب تخثر في الشريان التاجي الأيسر. تمت معالجة المريض بالأدوية وتحسنت حالته. يجب أن يكون أطباء الطوارئ يقظين للأعراض غير الاعتيادية التي قد يأتي بها مرضى كوفيد-١٩ وخاصة أثناء الجائحة. Abstract: The coronavirus disease 2019 (COVID-19) is a highly contagious novel infection that predominantly presents with fever and respiratory symptoms. However, COVID-19 can masquerade as an acute coronary syndrome, leg pain or swelling with venous thrombosis, loss of consciousness with cerebral venous thrombosis, confusion, limb weakness with brain infarction, facial neuralgia, acute conjunctivitis, acute appendicitis, and testicular pain. We report on a 42-year-old man who presented with mild symptoms of COVID-19. The patient's electrocardiogram showed an ST-segment elevation myocardial infarction (STEMI) due to a left coronary thrombosis. The patient was managed conservatively with medicines and had an uneventful recovery. Emergency physicians should have a high index of suspicion for the unusual presentations of COVID-19.

Introduction: Early diagnosis of COVID-19 is important for disease treatment and management. Computed Tomography (CT) is a fast and easy modality for diagnosis and management plan of patients with COVID-19. In the literature, several studies were done to assess the sensitivity of CT for diagnosis of COVID-19 infection in comparison to Reverse Transcription Polymerase Chain Reaction (RT-PCR). Some studies stated that CT was more sensitive diagnostic modality for COVID-19 than RT-PCR. However, the sensitivity of CT for COVID-19 varies in these studies. Aim: This literature review and meta-analysis was designed to determine the CT features of COVID-19 pneumonia, to verify the pooled sensitivity of CT for the diagnosis of COVID-19 and to review the different reasons (e.g., the disease stage or severity and the negative or positive RT-PCR results) for the variations in CT sensitivity. Materials and Methods: This review analysed 31 articles selected from the Europe BMC, PubMed, Science Direct, and Scopus databases. Participant gender mean and median age, CT features of COVID-19 pneumonia were sought for and reviewed. The data was analysed using Microsoft excel version 10 and OpenMeta (Analyst) software (http://www.cebm.brown.edu/openmeta/) to verify the pooled sensitivity of CT in detection and diagnosis of COVID-19 pneumonia using meta-analyses forest plot, Receiver Operating Characteristic (ROC) curve, cumulative meta-analyses forest plot and leave one forest plot. Results: The most common CT findings of COVID-19 pneumonia were bilateral lung involvement, Ground Glass Opacity (GGO), and consolidation, and Crazy-paving pattern. The CT finding is more prominent in symptomatic and severe cases than in a symptomatic and mild cases specifically the presence of consolidation and peripherals lesion distribution. The pooled sensitivity of CT is 90% in diagnosis and detection of COVID-19 pneumonia (ranged 60-100%). Conclusion: Combination of CT chest and laboratory tests along with clinical manifestation and epidemiological features should be considered to confirm the final diagnosis of COVID-19 pneumonia.

Background and objective Khat is a plant that contains the alkaloids cathine and cathinone which have some amphetamine-like properties. It is cultivated and it's leaves chewed for their euphoric effect. This study intended to elucidate the effect of khat chewing on blood coagulation by using the International Normalized Ratio (INR) value as a calculable benchmark. Materials and methods In this cohort study, 146 patients with Mechanical Heart Valves (MHV) were assessed for two consecutive visits at one-month intervals. For each visit, the date of surgery, the patient's compliance, the dose of warfarin and the INR reading were assessed by the researcher. Results Out of 146 patients with MHV, the mean age was 33.72±12.43 years (range, 14-65 years); 82 (56.2%) were female and 64 (43.8%) were male. The results revealed that the mean of absolute INR readings was lower in khat-chewers than non-chewers by average 0.2 on the first and second visits (p = 0.038 and 0.002, respectively). Conclusion Khat chewing has a significant coagulant effect. There was a significant decrease in the value of INR for khat chewers patients with MHV when compared to non-khat chewers.

Background and objectives: Ejection fraction (EF) is a measurement of heart function that reflects the portion of pumped out blood from the filled left ventricle per each heartbeat. The current study aimed to investigate the prevalence of left ventricular thrombus in patients with EF lower than 35% by using Transthoracic Echocardiography (TTE). Methods: In this prospective study, 82 cardiac patients underwent TTE procedure in order to assess the presence of left ventricular thrombus (LVT) from January 1st to December 31st 2017 at the Military Cardiac Centre in Sana’a, Yemen. Results: Out of 82 patients enrolled in this study, the mean age was 49.13 ± 14.8 years and 87.8% were male. The mean of EF was 31.16% and LVT was found in 6.1%. The spontaneous contrast was seen in 25.6% of patients indicating strong relationship with low EF (p < 0.001). Among patients with low EF, ischemic heart disease (IHD) was identified in 50%, hypertension in 30.5%, diabetes mellitus (DM) type 2 in 23.2%, and hyperlipidemia 12.2%. Exactly 80% of LVT were detected in IHD patients with dilated cardiomyopathy (DCMP) and 80% of detected LVT were apical in site. Conclusion: Cardiac patients with low ejection fraction developed left ventricular thrombosis, and most of the affected patients were ischemic heart disease with dilated cardiomyopathy. Interestingly, spontaneous contrast was found high significantly in these patients, which may reflect the continuous process of thrombus formation. Abbreviations:EF: ejection fraction, ASE: American society of echocardiography, EACVI: European association of cardiovascular imaging, LV: left ventricle, LVEF: left ventricular ejection fraction, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, MI: myocardial infarction, DCMP: dilated cardiomyopathy, AF: atrial fibrillation, TTE: Transthoracic echocardiography, TEE: trans-esophageal echocardiography, RHD: rheumatic heart disease, HTN: hypertension, DM: diabetes mellitus, CHF: congestive heart failure, JVP: jugular venous pressure, CBC: complete blood count, LFT: liver function tests, RFT: renal function test, LVT: left ventricular thrombus, ECG: electrocardiography, LVT: left ventricular thrombus, EDV: end diastolic volume, ESV: end systolic volume, SPSS: statistical package for the social sciences, IBM: international business machines, SD: standard deviation. doi: https://doi.org/10.12669/pjms.36.4.1972 How to cite this:Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FA. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):673-677. doi: https://doi.org/10.12669/pjms.36.4.1972 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction: Hypertension (HTN) is considered as one of the most common health problems. Doppler sonography plays an effective role in haemodynamic assessment of renal arteries in patients with essential HTN. Aim: To assess renal vascular Resistive Index (RI) in patients with essential HTN in co-existence with Diabetes Mellitus (DM) and Ischaemic Heart Disease (IHD). Materials and Methods: This was a cross-sectional study which involved 100 hypertensive patients selected by a simple, convenient sampling method from June 2014 to August 2016. The participants were categorised into four groups; 55 patients with controlled HTN while the uncontrolled HTN groups included 20 with HTN coupled with DM, 18 with HTN and IHD, and seven patients of HTN accompanied by both DM and IHD. The patients were investigated using Duplex Doppler ultrasonography to assess the RI of the renal arteries. Analysis of variance and Student’s t-test were performed to compare renal RI values between controlled and uncontrolled hypertensives. Results: The mean renal RI in patients with controlled HTN was 0.59±0.093, 0.71±0.035 in DM, 0.70±0.029 in IHD, and 0.72±0.029 in patients with IHD and DM. Controlled hypertension revealed a stable blood RI across the renal arteries (RI=0.59±0.093). The renal RI was significantly higher in patients with DM, IHD and DM+IHD group compared to patients with controlled HTN (p-values=0.004, 0.014 and 0.001). Conclusion: The renal RI is an important parameter which provides useful information about haemodynamics of renal arteries in essential HTN complicated with DM and IHD.

Background and objective Khat has severe adverse socio-economic consequences. It causes serious cardiovascular, neurological and psychiatric problems. The study aimed to evaluate the effect of chewing khat on intima-media thickness (IMT) of the common carotid arteries. Materials and methods This was a descriptive case-control cross-sectional study. A total of 50 participants of chronic regular khat chewers were investigated. B-mode ultrasound 7-10 MHz linear transducers used for assessment of common carotid arteries according to the standard carotid sonography protocol. The IMT was measured and the presence of plaques was assessed. Results The carotid IMT was significantly increased in regular khat chewers more than the controls (p-value = 0.016). The common carotid IMT increased in smokers more than non-smokers among khat chewers (0.6710±0.20687 vs. 0.5789±0.16859 mm). Significant correlations existed between the duration of chewing khat and age with the presence of plaque (p-values = 0.013 and 0.002, respectively). Conclusion There is a significant correlation between carotid plaque and longtime khat chewing. Khat is a contributory factor for increasing carotid intima-media thickness and formation of carotid plaques. A combination of khat and smoking produce more thickening of carotid intima-media.

In this case, a 70-year-old female patient presented with large forehead swelling that occurred 2 years prior, with slow progressive enlargement that mimicked the behavior of a neoplasm. There was severe inferior displacement of the right orbital globe to the level of the nares. Brain computed tomography showed a large expansive lesion in the right frontal sinus with bony wall thinning without destruction or erosion. Brain magnetic resonance imaging showed high signal intensity of the contents in T1- and T2-weighted images with only peripheral enhancement after contrast administration. These features were consistent with a typical right frontal mucocele. Keywords: Giant, Frontal, Mucocele, CT, MRI, Displacement

Background Every year, thirty-five thousand patients receive renal transplants worldwide. Kidney transplant provides better quality of life and reduced morbidity. Doppler and sonography were the best imaging modalities for evaluation. Aims To assess the sonographic findings of renal allograft and to determine the correlation between Doppler resistive index and size of allograft and echogenicity. Methods This was a cross-sectional study conducted in Khartoum State from January to August 2016. A total of 86 patients with known transplanted kidneys were scanned with ultrasound using 3MHz and 5MHz transducers. The age was categorized into four groups and so the Doppler indices. Descriptive statistics used to analyse quantitative and qualitative variables (percent and means ± SD). Spearman's rho test was used to find the correlation between RI of renal vessels and allograft size. The Qui-square test was used to find an association between RI and echogenicity of the graft. Results Renal transplantation was common at the age of 20 to 50 years. The mean Doppler index of the renal artery was 0.68±0.11 in renal allografts. Renal transplantation was common in professionals and homemakers (30.2 per cent and 20.93 per cent respectively). Hypertension and diabetes were the most common causes (44.1 per cent and 18.6 per cent). A significant correlation was found between RI and allograft size (p-value=0.012). There was no statistical association between RI and echogenicity of allograft (pvalue=0.106). Conclusion The Doppler resistive index is significantly correlated with allograft size and had no association with echogenicity. Patients with enlarged allograft had raised resistive indices. The study recommended that Duplex ultrasound should be used in the initial assessment and follow-up of renal transplant.

Background & Objective: Chronic rhino sinusitis (CRS) is an inflammatory condition of the paranasal sinuses and the nasal passage lasting more than three months either with or without sinonasal polyps. This study aimed to report the common sinonasal lesions associated with CRS according to the histopathology results, to compare between clinical and histopathological diagnoses, and to compare between radiological and histopathological diagnoses of the sinonasal lesions. Methods: A retrospective study of the electronic records of 82 patients diagnosed with CRS with nasal polyps. All patients underwent endoscopic sinus surgery and histopathological examination of surgical biopsies. The collected data were analyzed using SPSS program. Coparison between clinical and histopathological diagnoses was done. This study was conducted at Alsafwa Consultative Medical center (ACMC) in Almukalla city, Hadhramout province in Republic of Yemen. Results: Out of 82 patients, the ages ranged from 4 to 90 years (mean: 34.48±17.74 years), and 54.88% were females. Inflammatory polyps were the most common lesion (31.4%), then allergic polyps (30.5%). Nasopharyngeal carcinoma (NPC) was reported in 9.8% of the lesions and all were unilateral. The results revealed strong compatibility between clinical and histopathological diagnoses (p

A 32 years old male patient presented to the emergency room with complete loss of consciousness since three hours. This was after two weeks of night fever, sweating and considerable loss of weight with self-treatment by antipyretic drugs. In the last two days, the patient develops confusion and altered behavior. Clinical examination revealed high-grade fever and coma. CXR revealed mild cardiomegaly. Treatment started with intravenous fluids, antipyretics, and antibiotics. On the next day , Echocardiography revealed mild Mitral regurgitation (MR), mild pericardial effusion with thickening of the pericardial membrane that suggested pericarditis. ESR was significantly elevated (57 mm/hour). After three days of treatment without improvement, Tuberculosis (TB) proposed and laboratory investigations implemented. Brain MRI T1 weighted images with Gadolinium injection revealed basal meningeal enhancement with multiple tiny cerebral granulomas.FLAIR-weighted images revealed multiple small high signal intensity foci in bilateral temporal lobes and the basal ganglia strongly suggesting vasculitis and ischemic lesions. CSF sample and culture was done, and anti-tuberculous drugs started with IV fluids, corticosteroids, and other supportive drugs. The results of CSF culture confirmed the diagnosis of Tuberculous meningitis. After two months of continuous anti-tuberculous treatment, the patient seemed to regain consciousness. The patient continued Rifampicin tab 700 mg, Isoniazid tab 350 mg, Ethambutol tab 400 mg, Pyridoxine tab 80 mg, Aspirin tab 100 mg and other supportive drugs for six months. The patient regained full health without any mental or motor disabilities.

Background and Objective: Thyroid nodules (TNs) are abnormal growths of thyroid cells that form masses within the thyroid gland. TNs are common, and the importance lies in need to exclude thyroid cancer. This study was intended to evaluate the diagnostic accuracy of ultrasonography for differentiating benign from malignant thyroid lesions in comparison with fine-needle aspiration cytology (FNA cytology). Methods: This study involved 133 patients with thyroid lesions. All patients underwent thyroid ultrasonography and ultrasound (US)-guided-FNA cytology and results were compared. Results: Out of 133 patients included in this study, the mean age was 41.2±15 years, and 113 (85%) were female. Thyroid lesions were benign in 126 cases (94.7%) and malignant in nine cases (5.3%). Among 124 patients with thyroid lesions diagnosed as benign with US, 122 (98.38%) were confirmed to be benign with FNA cytology, and only 2 (1.6%) were proved to be malignant. Among nine patients with thyroid lesions diagnosed as malignant by US, 5 (55.6%) were confirmed to be malignant by FNA cytology, and 4 (44.4%) were proved to be benign. The US diagnosed benign thyroid lesions with a sensitivity, specificity, positive predictive value, and negative predictive value of 98.38%, 71.42%, 98.38%, and 55.55%, respectively. The results revealed strong compatibility between diagnosis of benign thyroid lesions by the US and proved diagnosis by FNA cytology (p

The aim of this study was to evaluate the implications of low radiation dose in abdominal computed tomography (CT) when combined with noise reduction filters and to see if this approach can overcome the challenges that arise while scanning obese patients. Anthropomorphic phantoms layered with and without 3-cm-thick circumferential animal fat packs to simulate different sized patients were scanned using a 128-slice multidetector CT (MDCT) scanner. Abdominal protocols (n = 12) were applied using various tube currents (150, 200, 250, and 300 mA) and tube voltages (100, 120, and 140 kVp). MOSFET dosimeters measured the internal organ dose. All images were reconstructed with filtered back projection (FBP) and different iterative reconstruction (IR) strengths (SAFIRE 3, SAFIRE 4, and SAFIRE 5) techniques and objective noise was measured within three regions of interests (ROIs) at the level of L4–L5. Organ doses varied from 0.34–56.2 mGy, the colon received the highest doses for both phantom sizes. Compared to the normal-weighted phantom, the obese phantom was associated with an approximately 20% decrease in effective dose. The 100 kVp procedure resulted in a 40% lower effective dose (p &lt, 0.05) compared to at 120 kVp and the associated noise increase was improved by increasing the IR (5) use, which resulted in a 60% noise reduction compared to when using FBP (p &lt, 0.05). When combined with iterative reconstruction, the low-kVp approach is feasible for obese patients in order to optimize radiation dose and maintain objective image quality.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the novel “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2) and is rapidly spreading worldwide. This review is designed to highlight the most common clinical features and computed tomography (CT) signs of patients with COVID-19 and to elaborate the most significant signs indicative of COVID-19 diagnosis. This review involved five original articles with both clinical and radiological features of COVID-19 published during Jan and Mar 2020. In this review, the most frequent symptoms of COVID-19 were fever and cough. Myalgia, fatigue, sore throat, headache, diarrhea, and dyspnea were less common manifestations. Nausea and vomiting were rare. Ground-glass opacity (GGO) was the most common radiological finding on CT, and mixed GGO with consolidation was reported in some cases. In addition, elevated C-reactive protein and lymphopenia are the pertinent laboratory findings of COVID-19. CT is an effective and important imaging tool for both diagnosis and follow-up COVID-19 patients with varied features, duration, and course of the disease. Bilateral GGOs, especially in the periphery of the lungs with or without consolidation, are the hallmark of COVID-19.

Hyperdense artery sign (HAS) is the earliest sign of cerebral infarction on non-enhanced computed tomography (NECT). HAS can be visible before irreversible cerebral damage. A 70 years old woman presented to the emergency room with left sided weakness and facial drooping since five hours. Head NECT showed HAS in the proximal part (M1) of the right middle cerebral artery (MCA). After 65 hours, follow up, NECT revealed large hypodense area in territory of the right MCA with mass effect in the form of compression of the ipsilateral lateral ventricle. This was a case of right MCA infarction. On follow up, the patient was not improved and discharged with right sided hemiplegia. HAS is a highly valuable marker for diagnosis of early cerebral infarction in patients with acute hemiparesis. The patients of hemiparesis with HAS should be dealing rapidly as acute ischemic stroke.

Objective To correlate between hydronephrosis grades and detection of urinary stones by B-mode ultrasound imaging. Methods This study included 210 ultrasound reports of patients who underwent abdominal ultrasound imaging in the period from 1st January 2016 to 31st October 2017, and diagnosed as hydronephrosis. Data collected from the ultrasound reports. The detection rates of stones using B-mode ultrasound imaging compared in different grades of hydronephrosis. Chi-square test and Odds Ratio (OR) were performed to assess the relationship between variables. Results Of 210 patients, hydronephrosis was unilateral in 91.8% of patients and bilateral in 8.1%. It was distributed in grade 2, grade 3, grade 1 and grade 4 in 58.57%, 20%, 12.38% and 9.1% of the patients respectively. B-mode ultrasound imaging determined the cause of hydronephrosis in 65.2% of cases. Urinary stones were the cause in 60% of the patients. The detection rate of urinary stones was 50%, 61% and 71.4% for grades 1, 2 and 3 hydronephroses respectively. On simple logistic regression analysis, urinary stones detected in Grade-3 were four times more compared to that in grade 4 (P=0.016) (OR 4.125, 95% CI 1.29-13.136%). Conclusion Detection of urinary stones as the cause of hydronephrosis increases with increasing the grade of hydronephrosis from Grade-I to Grade-III and decrease in Grade-IV. Urinary stones were the cause of hydronephrosis in 60% of the patients in this study.

OBJECTIVE: This study intended to assess the occurrence of early signs of middle cerebral artery (MCA) on multidetector computed tomography (MDCT) in correlation with duration of the clinical features of stroke. PATIENTS AND METHODS: This retrospective study analyzed the electronic records of 20 patients with MCA infarction. The detected signs studied according to the onset of the clinical features of stroke to the time of CT imaging. RESULTS: Out of 20 patients with MCA infarction included in this study, the results revealed a significant relationship between the presence of insular ribbon sign and/or subtle hypodensity and hyperacute infarction (P < 0.001 and 0.003, respectively). Results revealed significant relationship between the occurrence of hypodense area, effacement of the cortical sulci, and compression of the ipsilateral lateral ventricle with acute infarction (6–72 h), (P = 0.006, 0.007, and 0.002) (odds ratio = 0.047, 0.050 and 0.028) and (95% confidence interval = 0.004–0.552, 0.004–0.597 and 0.002–0.367) respectively. CONCLUSION: MDCT can detect nearly half of MCA infarctions in the first 6 h. Insular ribbon sign and subtle hypodensity were the most significant findings in the first 6 h of stroke. Hypodense area was a significant sign after 6 h. Diabetes mellitus and ischemic heart disease were the most common risk factors. Hemiparesis was the most common clinical finding in MCA infarction.

Objectives: The study aimed to determine the role of spiral CT Angiography in suspected cases of Acute Pulmonary Embolism. Material and methods: The study was conducted at EL-Nilain center , Royal care center and Faisal center. Fifty patients of suspected pulmonary embolism (PE) from (August –November 2011), had been selected randomly of different ages and genders underwent spiral CT angiography from the level of arch of aorta to the dome of diaphragm. Scanning was done using Siemens CT machine. Results: Out of 50 patients, there were 38 (76%) positively identified with pulmonary embolism, moreover females (68%) were most likely presented with PE, the right pulmonary artery was more affected. The peak incidence age ranged between 40-60years (32%), Shortness of breath is the most clinical indication with (54%) incidence; half of the patient were presented with DVT, Consequently on CTA 12% of patients with PE showed plural effusion, 20%with consolidation collapse and cavities. Conclusion: The study confirmed that, the spiral CT scanner is very effective modality in detection of pulmonary embolism , since it is non –invasive procedure , and has a high specificity , so it is preferred and used as the first line of investigations in diagnosing of Pulmonary embolism . Medical Science INTRODUCTION Pulmonary embolism (PE) was clinically described in the early 1800s, and von Virchow first described the connection between venous thrombosis and PE.( Boyden, 1955 and Mitchell ,1997] In 1922, Wharton and Pierson reported the first radiographic description of PE.[ Wharton and Pierson,1922 ) Imaging has played an important role in the diagnosis of PE. For many years, ventilation-perfusion (V/Q) scintigraphy has been the main imaging modality for the evaluation of patients with suspected PE. However, with the advent of and the widespread availability of faster computed tomography (CT) scanners, CT scanning has emerged as another important diagnostic test for the evaluation of not only PE, but also of deep venous thrombosis (DVT) in select patients. Three primary influences predispose a patient to thrombus formation; these form the so-called Virchow triad: (1) endothelial injury, (2) stasis or turbulence of blood flow, and (3) blood hypercoagulability. More than 90% of all PEs arise from thrombi within the large deep veins of the legs, typically the popliteal vein and the larger veins above it.( Remy-Jardin. et al, 2007 ) The pathophysiologic consequences of thromboembolism in the lung largely depend on the cardiopulmonary status of the patient and on the size of the embolus, which, in turn, dictates the size of the occluded pulmonary artery. Pulmonary embolism is a common cardiovascular emergency. According to data collected between 1979 and 1999, the prevalence among hospitalized patients in the United States was 0.4%.[ Stein et al, 2005] The true prevalence of venous thromboembolism is underestimated, as many cases are not apparent clinically, and unsuspected PE can be found on up to 3.4% of inpatient and 0.9% of outpatient CT scans.[ Storto et al,2005 ] From 2000-2007, the incidence of pulmonary embolism increased from 0.69 to 0.91 per 100 admissions, in strong correlation with increased use of pulmonary CTA.( Sheh and Bellin,2012) Mortality attributable to PE occurs in approximately 2-6% of patients with hemodynamically stable PE and in 30% or more of patients presenting with hemodynamic instability.[ Wood,2002 ] Overall mortality has not changed with the shift to CTA for PE diagnosis; however, the case-fatality rate decreased from 5.7% to 3.3%.[ Sheh, and Bellin,2012]The casefatality rate decrease suggests that the recent shift from V/Q scintography to pulmonary CTA has been associated with a less fatal spectrum of embolic disease. In patients with possible PE, chest radiographic findings may indicate if lung scanning (V/Q) or helical CT scanning should be the next method of evaluation. If the chest radiograph is normal, V/Q findings may be diagnostic; if the chest radiograph is abnormal, helical CT should be performed.[ Patel, 2005 and Stein et al,2007] A quantitative D-dimer assay is reported to have high negative predictive value and may be effective for excluding the need for pulmonary CT angiography (CTA) in selected cases. [ Abcarian et al, 2004] Another study shows that using a clinical decision rule with D-dimer level improved pulmonary CTA and better identified positives for pulmonary embolisms.[ Soo Hoo et al, 2011]. Conventional pulmonary angiography is invasive, time consuming, and more expensive than other tests. The role of conventional angiography is limited to patients in whom other results are nondiagnostic or the clinical suspicion is high.

Aim: The aim of this study is to characterize the site, types and radiological features of gliomas, such as edema, mass effect, and type of enhancement on CT-scan and MRI imaging. Patients and methods: Thirty-three patients were studied retrospectively from the PACS system of multi-slice CT-scanner and MRI using the protocol of imaging of the head and spine. Results: Gliomas involved male patients more than females (60.1% vs. 39.9%). About 96.9% of the gliomas were in the brain and only 3.1% was in the cervical spine. Nearly 51.5% of the gliomas showed radiographic features of low-grade gliomas and 48.5% showed radiographic features of high-grade gliomas. Approximately 30% of gliomas were located at the parietal lobe of the brain. Nearly 45.5% of the gliomas showed heterogenous enhancement, 36.4% marginal enhancement and 5.1% had no enhancement after contrast administration. Conclusion: Gliomas were more common in male than female and high grade in elderly while low-grade gliomas in children. Gliomas were mostly involving the parietal lobes. The majority of gliomas showed heterogeneous enhancement after contrast administration. Magnetic resonance imaging is the most effective imaging method to characterize gliomas.

Cerebral venous sinus thrombosis (CVST) is an uncommon, life-threatening condition with a variable clinical presentation that makes it a challenge of diagnosis. A 39-year-old male patient presented to the hospital with complete loss of conscious and admitted to Medical Intensive Care Unit for investigation without any obvious history that was difficult for diagnosis. In this case, the patient presented with coma that is a rare presentation of CVST with no obvious clinical history and he was male patient that means he is free of all gender-specific risk factors of CVST. The brain computed tomography (CT) scan showed hypodense lesion in the left upper parietal region with no hemorrhage. The lesion was low-signal intensity (SI) on T1WIs and high SI on T2WIs and restricted on diffusion-weighted images like arterial infarctions, but magnetic resonance angiography (MRA) was normal that excluded arterial infarction. Gadolinium-enhanced MR venography (MRV) showed the filling defect of CVST. CVST can be present by a mysterious clinical presentation that makes it as a challenge of diagnosis even by medical imaging by CT and MR imaging (MRI). A combination of MRI and MRV is the best, noninvasive, and nonionizing imaging modality for the diagnosis of CVST.

Determination of the liver size with ultrasound is an important process in patients with Malaria compared with the normal subjects. The purpose of this study was to determine the measurements of liver size by ultrasonography in patients with malaria compared with healthy Sudanese subjects in order to detect extend of liver enlargement. That is many tropical diseases which affect the liver size. The study population composed of 145 cases that had been selected to satisfy the study. They were 105 normal subjects (65 males 40 females) and 40 patients with Malaria from Capital Khartoum were undergone ultrasound examination of the liver. The normal subjects were divided into 5 groups according to their ages (5-102 years). The anteroposterior and craniocaudal dimensions in addition to liver span of the liver with its right and left lobes were measured using the routine ultrasonography and the mean values were recorded. Data was analyzed using statistical software program. There was highly significant difference of mean liver span of normal subjects and patients with Malaria (12.86 vs. 14.272, p-value= 0.000). The mean craniocaudal diameters of the right and left liver lobes were 11.932 ± 2.02 cm and 9.042 ± 2.09 cm for normal subjects and Malaria patients respectively. Highly significant difference existed between anterioposterior diameters of right lobes between the normal subjects and patients with Malaria (12.495 vs. 13.303, p-value= 0.000) There was no significant difference in anteroposterior and craniocaudal dimensions of the left lobe between the normal subjects and patients with Malaria (5.025cm vs. 5.020cm, p-value= 0.938 and 9.079cm vs. 9.042cm, p-value= 0.903). Height was found to have significant correlation for the liver span followed by weight in the normal subjects. Malaria might not have impact on the size of the left lobe. The study concluded that ultrasound is an effective imaging tool and provides valuable data of volumetric analysis of the liver and its lobes in normal subjects and patients with Malaria which is of importance in the daily practice in radiology clinics since it was helpful in diagnosis of hepatomegaly.