A 45 years old gentleman presented to Medical Clinic of Naval Hospital (PNS Hafeez) Islamabad in January 2001 with choreform movements of the body and early dementia of six months duration. He had a strong family history of similar disease, which included his father and two brothers. On neurological examination he had choreoathetoid movements and features of early dementia. His chest was clinically clear and examination of heart and abdomen was normal. Eye examination did not reveal any evidence of Kayser-Fleischer rings (seen in Wilson`s disease). Laboratory investigations showed haemoglobin 13.8 Gm/dl, WBC 7.7 x10e9/L, serum urea 32 mg/dl, serum sodium 139 mmol/L serum potassium 3.8 mmol/L, ASO titre less than 200 IU/ml, serum bilirubin 6 umol/L, ALT 102 U/L, serum alkaline phosphatase 155 U/L, serum caeruloplasmin 42 mg/dl and serum copper 164 mmol/L (WNL). X-ray chest was normal and CT scan brain showed early generalized cerebral atrophy. He was managed with haloperidol (0.5mg) 12 hourly, Procyclidine (kemadrin, 5mg) 8 hourly and Propranolol (Inderal 10mg) 8 hourly. He was discharged from hospital with relative improvement after 2 weeks.

Objectives: To evaluate breast lesions with doppler ultrasound and calculated the diagnostic accuracy of resistive index as a predictor of malignancy, taking histopathology as gold standard. Study Design: Cross-sectional study. Setting: Radiology Department, CMH Multan. Period: December 2015 to May 2016. Material & Methods: 150 female patients, having age between 20 – 60 years, with palpable breast lumps were admitted in the study. Doppler ultrasound of the lesion was performed with emphasis on the vascularity and resistive index was formulated. Categorization as malignant or otherwise was declared as established by doppler ultrasound. Patients then underwent biopsy followed by histopathology. Correlation of doppler ultrasound and histopathological findings was done with calculation of diagnostic accuracy of doppler ultrasound, keeping histopathology as gold standard. Results: The mean of age was 40.23 ± 5.75 years. In 81 breast doppler ultrasound positive patients, 73 (True Positive) showed malignant lesions in breast while 08 (False Positive) did not have malignancy on biopsy. Among 69 Breast Doppler Ultrasound negative patients, 06 (False Negative) demonstrated malignancy on biopsy whereas 63 (True Negative) did not have any malignant lesion. Overall specificity was 88.77%, sensitivity 92.40%, negative predictive value 91.30%, positive predictive value 90.12% and diagnostic accuracy of Doppler Ultrasound came out 90.67%. Conclusion: Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Doppler ultrasound is a safe and effective modality which shows acceptable diagnostic accuracy for noninvasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.

Objective: To determine the diagnostic accuracy of plain computed tomography using the ratio between hounsfield unit and hematocrit of cerebral venous sinuses in cases of acute cerebral venous sinus thrombosis taking magnetic resonance venography as the gold standard. Method: The cross-sectional validation study was conducted at the Department of Diagnostic Radiology, Combined Military Hospital, Rawalpindi, Pakistan, from March 9 to September 8, 2021, and comprised patients regardless of age and gender presenting with acute neurological and visual signs and symptoms of cerebral venous sinus thrombosis for <5 days. The patients were brain-imaged on 128-slice computed tomography scanner, and the image was assessed and the attenuation values in terms of Hounsfield unit of dural venous sinuses were calculated by taking appropriate region of interest. Haemoglobin and hematocrit values were noted from blood reports, and then the ratio between Hounsfield unit and hematocrit ratio was calculated. Magnetic resonance venography of the patients were performed and the patients were assessed for dural venous thrombosis. Data was analysed using SPSS 23. Results: Of the 201 patients, 98(48.8%) were males and 103(51.2%) were female. The overall mean age was 35.32±19.707 years (range: 1 month-70 years). According to the Hounsfield unit-hematocrit ratio, acute cerebral venous sinus thrombosis was detected in 173(86.01%) patients, while magnetic resonance venography detected 178(88.6%). The Hounsfield unit-hematocrit ratio had sensitivity 91.01%, specificity 52.17% and diagnostic accuracy 86.57%. Conclusion: Computed tomography attenuation value and Hounsfield unit-hematocrit ratioon unenhanced computed tomography could be used as a reliable method to detect acute cerebral venous sinus thrombosis in emergency settings. Key Words: Computed tomography, Acute cerebral venous sinus thrombosis, Magnetic resonance venography.

Klippel-Trenaunay-Weber syndrome is a rare congenital syndrome characterized by capillary, venous or lymphaticmalformation and hemihypertrophy. Only 1000 cases of this syndrome have been reported in the literature. A rare case of this syndrome is presented here, who presented with its visceral and vascular complications and was diagnosed for the first time.