Over a 6-year period, in 1425 adult computed tomographic studies, radiological evidence of fatty infiltration of the liver (FIL) was found in 138 patients (9.7%). Patients with FIL had a mean age +/- SD of 45.9 +/- 15.7 years and 57% were males; the majority were Saudis (73%). Most patients (95%) had one or more underlying aetiological causes. Haematological and non-haematological malignancies with or without liver involvement were the most frequently encountered aetiological factors (66% of patients). FIL contributed to hepatomegaly or was associated with abnormality in one or more of the liver function tests in 30% and 39% of patients, respectively. Assessment of the various radiological patterns showed diffuse fatty changes in 68% of patients and solitary or multiple focal changes in 9% and 22%, respectively. 13 patients (9%) showed sparing of the caudate lobe within a diffuse fatty process. Patients with diffuse FIL had significantly higher values for alkaline phosphatase (p = 0.0016) and serum asparate aminotransferase (p = 0.0251) than those who had the focal pattern. FIL in 20 patients (14%) imposed a difficulty in making an appropriate diagnosis, led to inaccurate impressions, or forced unnecessary invasive or non-invasive investigations. We conclude from our large series of patients that FIL is not uncommon in hospital practice and among those at risk should always be considered as an appropriate diagnosis.
Vascular tumours of the nasal cavity are uncommon and are either hamartomas or true neoplasms, mostly benign. We present an unusual case of angiomyolipoma of the nasal cavity. This hamartomatous lesion is often described in the kidney and may be associated with tuberous sclerosis. To our knowledge, there is no previous report of the lesion in the nasal cavity, and no association with tuberous sclerosis has been demonstrated in this case.
Based on certain selection criteria, 300 consecutive mammograms were reviewed, together with other relevant clinical and pathological data. The median age (± SD) of eligible women was 36.11 (± 11.2 years). Saudis represented 65% (196 women) of the study population and non-Saudis 35% (104 women). Seventy-three women (24%) had normal findings but fibrocystic disease was found in 177 (59%), invasive carcinoma in 26 (9%), and fibroadenoma in 24 (8%). Ninety-nine percent of the mammograms were ordered in women who had had breast symptoms for several months. Cancer patients had been aware of their breast lump for a mean of 8.04 ± 2.11 (SD) months. All cancers were invasive and most (92.3%) were advanced at diagnosis. Among the 177 patients with fibrocystic disease, only six (3%) were found to have atypical hyperplasia, but its prevalence is lower than that reported recently. Agreement between final and mammographic diagnoses was significant (P = 0.027). Also shown were the high specificity (79%), sensitivity (100%), and accuracy (89%) of mammograms in cancer patients. The ability of mammography to show malignancy was proven by multiple regression analysis. Our data taken from a sample of women seen at a tertiary care facility shed some light on the pattern of breast disorders in our patient population. The data should be utilized in the planning for a national breast cancer early detection program.AY El-Hassan, FA Al-Mulhim, EM Ibrahim, MS Al-Awami, Retrospective Appraisal of 300 Consecutive Mammograms. 1990; 10(3): 285-290 Radiographic examination of the breast is not a new procedure. The first mammographie study was made by Salomon in 1913 and the first clinical paper on the subject was published in 1930 by Warren.1 Since then, mammography has proved its value in the diagnosis of various breast diseases. However, it was not until 1956 that the procedure was introduced for the mass screening of healthy women in the early detection of breast cancer. 2Analysis of data derived from these major screening projects has shown an unequivocal benefit for women older
Computed tomography (CT) has recently been hailed as the most useful tool in the diagnosis and management of congenital posterior choanal atresia. Our study of 11 patients with posterior choanal atresia by CT does not seem to confirm this claim. CT, which demonstrates very clearly all the anatomical details of the region, does not appear to play any major role in the diagnosis of the condition; nor in the planning of the management of patients in whom posterior choanal atresia is the only major craniofacial abnormality. Since Shirkoda and Biggers [1] first reported the CT findings in a child with posterior choanal atresia, several publications have appeared in the literature detailing the usefulness of CT in the diagnosis and planning of the management of the condition. Most of these reports emphasize the fact that the anatomical details unravelled by CT plays a major role in "dictating the method of treatment" [2][3][4]. Hasegawa et al [5], reporting the findings in a single patient, have recommended that CT should be the first method of choice in the radiological assessment, followed by contrast radiography.In this study we have attempted to answer the following specific questions while investigating patients diagnosed clinically as choanal atresia: (1) does CT add any useful information to that obtained by a thorough clinical examination and simple contrast radiography (rhinogram)?, (2) do CT findings have any influence on the choice of method or on the timing of the treatment offered to patients? Material and MethodsThis study included 11 patients (four males and seven females) with posterior choanal atresia, ranging in age from three months to 59 years. Methods used included plain and contrast radiography, and CT scan and CT scan with contrast instilled in the nose. Table 1 summarizes the results of this study.Prior to radiological studies all patients had a thorough clinical examination, including mirror examination of the postnasal space in older patients. Nasal airflow was assessed using a shiny metallic object and a whisp of cotton wool held at the nares before gently probing the nose using a size 10 FG nasogastric catheter in infants and size 14 FG in children. After spraying the nose with 10% xylocaine, adults were gently probed using an eustachian catheter. Earlier in the study infants and young children were only given suitable sedation prior to radiological studies. During the latter part of the study, immediately prior to radiology, all patients underwent gentle suction to clear accumulated secretions. No vasoconstricting nose drops were used in any of our patients. Every possible attempt was made to complete all the radiological investigations on the same day especially with our younger patients. All radiological films were studied by each author, separately, and then by the two authors together. ResultsAll our patients had unilateral posterior choanal atresia except patient No. 5 who had bilateral choanal atresia. Figure 1 shows the abnormal shadow on CT of patient No. 2 that prompted ENT referr...
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