BACKGROUNDHigh resolution computerized tomography (HRCT) is valuable for detection of early erosive changes suggestive of cholesteatoma. The aim of our study was to determine characteristic CT findings in patients with middle ear cholesteatoma.METHODSWe conducted a retrospective review of CT scans and surgical and histopathological reports in 64 patients with middle ear cholesteatoma (35 male, 29 female; age range, 7–80 years, median age, 22 years). CT scans were evaluated for the presence of intra-tympanic non-dependent soft tissue density, the extent of middle ear involvement, bone expansion and thinning, and bone erosions involving the ossicles and adjacent structures.RESULTSMiddle ear cholesteatoma was more common in male patients and in patients aged 20–35 years. All patients had soft tissue density in the middle ear. Fifty-nine (92%) had expansion of the aditus and mastoid antrum, 59 (92%) had erosions of the ossicles, with involvement of the long process of the incus in 48 (75%), 55 (86%) had an eroded scutum, 55 (86%) an eroded facial nerve canal, 57 (89%) an eroded Koerner’s septum, which was totally destroyed in 19 (27%), 48 (75%) had tegmen erosion, and 63 (98%) had erosions of the antral walls. The correlation of pre-operative CT with surgical and histopathological findings was 97%.CONCLUSIONMiddle ear cholesteatoma is a distinct clinical entity with characteristic findings that may be suggested by CT imaging. These findings should alert the clinician to the possibility of cholesteatoma, which will guide in the surgical approach and treatment plan.

Allergic bronchopulmonary mycosis (ABPM) is a known complication of asthma and can result in progressive lung damage, respiratory failure and death. Asthma is a common disease in Saudi Arabia and until now the prevalence of ABPM has not been investigated. The aim of this study was to estimate the period prevalence of ABPM due to Aspergillus and Candida in patients with asthma. The setting was an outpatient pulmonary clinic at a university hospital in the central region of Saudi Arabia. Two hundred and sixty-four consecutive patients with asthma (150 or 57% females) were evaluated. All patients were screened for ABPM with skin prick test (SPT) using a panel of fungal antigens. Those with positive skin reactions had further clinical, immunological, respiratory and radiological assessment. ABPM was diagnosed by the presence of a minimum of five of the major criteria suggested by Rosenberg in 1977. Of the 264 patients, 62 (23%) had a positive SPT for at least one fungal allergen, of whom 44 (71%) were females (P=0.01). Seven patients (six females) were diagnosed with ABPM due to Aspergillus and (or) Candida species. Therefore, we estimate the period prevalence of ABPM to be 2.7% (95% confidence interval 1.3-5.4%). A. niger was the commonest fungal species isolated in our group. In conclusion, ABPM is not uncommon in Saudi Arabia and females seem to be more at risk. Because asthma is common, physicians need to have high index of suspicion for this disease and pursue the diagnosis with the appropriate tests.

Sixty-five patients with a clinical suspicion of peptic ulcer disease were evaluated with fluid-aided sonography (US). The results were compared with endoscopic and upper gastrointestinal (UGI) series findings. Fifteen normal volunteers were examined by US only. The stomach and duodenum were both adequately visualized in 12 of the normal volunteers and in 51 of the study patients. US detected wall abnormalities in 21 of 23 patients (91%) with abnormal UGI series and endoscopy in the antropyloric and duodenal regions, although none of the 17 documented ulcers were visible by US. Abnormalities detected with US included increased wall thickness (mean, 12.85 mm), asymmetric thickening of the mucosa and muscularis, spasm, and deformity. US was considered normal in 25 of 28 patients (89%) with normal UGI series and endoscopy. The results suggest that US may be a useful nonstressful procedure in the evaluation of peptic ulcer disease previously diagnosed by UGI series or endoscopy.

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