The splenic artery is the third most common site of intraabdominal aneurysm formation after the abdominal aorta and iliac arteries. Splenic artery aneurysms (SAAs) constitute approximately 60% of all visceral arterial aneurysms.1 They are usually discovered incidentally, either at autopsy or during imaging studies of the upper abdomen. Rupture is the main complication leading to massive intraperitoneal hemorrhage. This report describes our experience in the diagnosis and management of a ruptured SAA in a young male patient. Case ReportA previously healthy 30-year-old male was brought to the Emergency Department after collapsing at his workplace. Prior to the occurrence of the cardiovascular collapse, he had had a sudden onset of severe pain in the left hypochondrium. There was no significant past history of any medical illness. On admission, he was in shock, dyspneic and hypotensive. His pulse was 135/min. and blood pressure was 80/50 mm Hg. He responded to volemic resuscitation and was urgently assessed by the surgeon. No abdominal mass was palpable on physical examination. A portable bedside ultrasound revealed free fluid in the abdomen. An urgent CT scan of the abdomen was performed which revealed massive hemoperitoneum. A rounded, well-defined 4x5 cm mass with heterogeneous attenuation was seen in the region of the splenic hilum posterior to the gastric fundus ( Figure 1A). In the pre-contrast scan, the lesion was hyperdense. After contrast injection, intense enhancement was seen along the periphery of the lesion, which was in relation to the distal part of splenic artery ( Figure 1B). Large areas of splenic infarction were noted. On the basis of CT findings, a diagnosis of ruptured splenic artery aneurysm with splenic infarction was made. At the subsequent surgery, a partially thrombosed 5 cm aneurysm of splenic artery was removed together with the spleen. The patient's postoperative course was uneventful. Histological examination of the specimen confirmed the diagnosis of aneurysm of the splenic artery. Figure 1A. Pre-contrast appearance of splenic artery aneurysm. High attenuation thrombus is seen in the center of the aneurysm on unenhanced scan.

Background: Breast cancer is the most common cancer in women and the second cause of mortality after lung cancer. Mammography is an effective tool in detecting both clinically occult and palpable breast cancers. However, a good number of breast carcinomas may not appear on the mammogram. The false negative rate for conventional mammography worldwide is 10%-30% 1. There are very few studies addressing the results of mammography in Bahrain. Objective: To estimate the incidence of false negative mammograms and the possible causes of false negative results in our group of breast cancer patients. Setting: Salmaniya Medical Complex (SMC). Design: Retrospective study. Method: One hundred forty-six mammograms for breast cancer patients were reviewed from January 2000 to May 2011. The mammograms were divided into three groups according to the mammographic report, into malignant, suspicious and benign. Both malignant and suspicious (BIRADS 4, 5, & 6) reports were considered positive mammograms and were excluded from the study. The eleven mammograms, which were reported as benign (BIRADS 1, 2, & 3) and considered negative, were included in the study. Result: The false negative mammograms were 11 (7.5%). Conclusion: The incidence of false negative mammograms in this study is lower than international figures. False negative mammograms are more common in small sized tumors, located in upper outer quadrant, big breasts, single or unexperienced mammography reader and mostly in conventional than digital mammography.

This prospective study was conducted to examine the prevalence of cholelithiasis in sickle cell disease and the relationship of its frequency to age and hematological parameters. Sixty-five patients with sickle cell disease attending Salmaniya Medical Center were interviewed and clinically examined. Their hematological parameters were assessed and an abdominal ultrasound examination was carried out. Twenty patients (30.8%) had gallstones, and 2 patients (3%) had biliary sludge. No significant relationship was found between the frequency of cholelithiasis and age or hematological parameters (hemoglobin and hemoglobin F values, microcytosis and reticulocyte count).

A 32-year-old female presented to the surgeon with history of recurrent excruciating pain at the top of middle finger of her right hand for the last two years. There was no history of trauma or infection. Clinically there were no features of cervical spondylosis or carpal tunnel syndrome and the patient did not complain of numbness in the distribution of the median nerve. Physical examination was unremarkable except for local tenderness. No nodule or discoloration of the skin was noticed.Plain x-rays of the hand were normal. A gadolinium-enhanced MRI of the middle finger of the right hand was then performed (Figure 1, A and B).