IntroductionVenous thromboembolism (VTE) requires urgent diagnosis and treatment to avoid related complications. Clinical presentations of VTE are nonspecific and require definitive confirmation by imaging techniques. A clinical pretest probability (PTP) score system helps predict VTE and reduces the need for costly imaging studies. d-dimer (DD) assay has been used to screen patients for VTE and has shown to be specific for VTE. The combined use of PTP and DD assay may improve exclusion of VTE and safely avoid imaging studies.Materials and methodsWe prospectively used the Wells PTP score and a DD test to evaluate 230 consecutive patients who presented with VTE symptoms. The receiver operating characteristic curve was used to identify a new DD cutoff value, which was applied to VTE diagnosis and compared with the upper limit of locally established reference range for prediction of thrombosis alone and in combination with the clinical PTP score.ResultsWe evaluated 118 patients with VTE symptoms fulfilling the inclusion criteria, 64 (54.2%) with clinically suspected deep vein thrombosis (DVT) and 54 (45.8%) with symptoms of pulmonary embolism (PE). The PTP was low in 28 (43.8%) and moderate/high in 36 (56.25%) of the suspected DVT patients, and low in 29 (53.7%) and moderate/high in 25 (46.3%) of the suspected PE patients. Eighteen cases were confirmed by imaging studies: 9 DVT and 9 PE. The agreement between confirmed cases and PTP was significant with PE but not DVT. The negative predictive value for both DVT and PE with current DD cutoff value of <250 μg/L DDU was 100%, whereas with the calculated cutoff the NPV was 88%.ConclusionsWe confirm that PTP score is valuable tool for medical residents to improve the detection accuracy of VTE, especially for PE. The DD cutoff value of 250 μg/L FEU is ideal for excluding most cases of low PTP; however, the calculated cutoff was less specific for the exclusion of VTE.

BACKGROUNDThere is a growing concern that renal impairment may develop in patients with renal angiomyolipomas (AMLs) associated with tuberous sclerosis complex (TSC) as a consequence of the disease itself and/or the interventions to mitigate the risk of hemorrhage.OBJECTIVETo assess the estimated glomerular filtration rate (eGFR) in patients with bilateral renal AMLs and the impact of tumor burden and intervention on renal function.DESIGNRetrospective study.SETTINGUrology department of a tertiary care hospital.PATIENTS AND METHODSAll adult patients (≥18 years of age) with TSC-associated renal AMLs seen from October 1998 to June 2015. We included only patients with bilateral tumors or solitary kidneys at the last follow-up.MAIN OUTCOME MEASURESThe eGFR, renal volume, and number and type of interventions.RESULTSWe identified 12 patients (median age 27.6, interquartile range 23.7–39.9 years), a median follow-up period of 1266 days (33–3133), and a median renal size of 454.7 mL (interquartile range 344.7–1016.9 on the right side; 558.1 mL, interquartile range 253.7–1001.4 on the left). In 11 (91.7%) patients, the eGFR was >60 mL/min/1.77 m2. Six patients had three total nephrectomies, one had a contralateral partial nephrectomy, and seven had selective arterial embolizations. Intervention was associated with a significantly reduced eGFR. The renal size did not correlate with the eGFR.CONCLUSIONSTSC-associated renal AMLs may attain a large size but normal renal function is maintained in 92% of patients. Interventions to mitigate the risk of hemorrhage are associated with decreased renal function.LIMITATIONSThe renal size was used as a surrogate for tumor size. Other limitations were the limited number of patients and lack of split renal function testing.

Background: COVID-19 caused by SARS CoV-2 involves respiratory system leading to respiratory failure and Acute Respiratory Distress Syndrome (ARDS) in critical patients. Several chest imaging features have been reported in patients with COVID-19 ranging from focal to diffuse lung opacities. There is no data from Saudi Arabia on the chest imaging findings in these patients. Material and Methods: CT chest data of 29 patients who were admitted with confirmed diagnosis of COVID-19 by real-time reverse transcriptase polymerase chain reaction (RT-PCR) was reviewed. Radiology abnormality was categorized based upon pattern and distribution. Clinical and laboratory data of patients were collected by reviewing the electronic medical record. Patients were divided into mild and severe group based on clinical assessment and laboratory criteria. Radiology changes were compared with disease severity. Results: Median (Q1, Q3) age was 58 (41,70) years and median (Q1, Q3) time from symptom onset to CT scan was 6.5 (3.0, 9.75) days. Bilateral ground glass opacities were the most common CT scan feature in patients with COVID-19 (76%). Opacities were dominant in the lower zone (72%) and frequently distributed peripherally (48%). Severe disease was most likely to have bilateral opacities compared with mild (p = 0.001) and it was correlated with rise of inflammatory markers, Ferritin (p=0.014) and C-reactive protein (p=0.0003). Conclusion: Most patients with COVID-19 who have abnormal CT scan of chest show ground glass opacities. Bilateral opacities are more common in severe disease and is correlated with elevated inflammatory markers.

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