Ahmad Mahamid

Giant colon diverticulum: clinical and imaging findings in 17 patients with emphasis on CT criteria.

PURPOSE The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). METHODS Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. RESULTS CT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients. CONCLUSION Our experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.

Computed tomographic diagnosis of traumatic fetal subdural hematoma.

Intrauterine subdural hematoma (SDH) is a rare event; maternal trauma, especially during the last trimester of pregnancy, is the best documented cause of fetal SDH. We report an extremely rare case of fetal SDH due to maternal trauma diagnosed by multidetector computed tomography. We also discuss the clinical and imaging features of fetal SDH which can be used to assist in diagnosis with emphasis on CT criteria.

Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls

Background: Blunt traumatic diaphragmatic injury (BTDI) is an uncommon injury and one which is difficult to diagnose. The objective of this study was to identify features associated with this injury. Methods: This was a retrospective study based on records of 354 307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry. Results: BTDI was reported in 231 (0.065%) patients. Motor vehicle accidents were responsible for 84.4% of the injuries: 97 (42.0%) were reported as drivers; 54 (23.4%) were passengers; 34 (14.7%) were pedestrians hit by cars; and 10 (4.3%) were on motorcycles. There were more males than females (2.5:1) compared with blunt trauma patients without BTDI (p < .001). Patients with BTDI were significantly younger than blunt trauma patients without BTDI (p < .001). ISS was 9–14 in 5.2%, 16–24 in 16.9%, 25–75 in 77.9%. Urgent surgery was performed in 62% of the patients and 79.7% had surgery within 24 h of admission. Mortality was 26.8%. Over 40% of patients with BTDI had associated rib, pelvic and/or extremity injuries. Over 30% had associated spleen, liver and/or lung injuries. Nevertheless, less than 1% of patients with skeletal injuries and less than 2.5% with solid organ injuries overall had associated BTDI. Despite hollow viscus injury being less prevalent, up to 6% of patients with this injury had associated BTDI. Conclusions: BTDI is infrequent following blunt trauma. Hollow viscus injuries were more predictive of BTDI than skeletal or solid organ injuries.

Diagnosis of gallbladder perforation by ultrasound

PURPOSE The aim of this study was to identify possible pitfalls in the sonographic evaluation of perforated gallbladders. METHODS This is a retrospective analysis of sonograms of 11 patients diagnosed by surgery or pathology with perforated gallbladder. Sonograms were evaluated for multiple sonographic features. RESULTS Only three patients (27%) were diagnosed correctly with gallbladder perforation by ultrasonography prior to surgery. Gangrenous cholecystitis was reported in 10 cases (90%). Visualization of a wall defect was demonstrated in only five cases (45%) and was associated with a focal echogenic soft-tissue mass. CONCLUSION Missed perforations by ultrasound may partially result from technical inadequacies.

Computed Tomographic Diagnosis of Incarcerated Meckel’s Diverticulum in a Patient with Bilateral Spigelian Hernia

IntroductionSpigelian hernia is an uncommon abdominal wall hernia occurring through the linea semilunaris located near the lateral border of the rectus abdominis muscle.Case reportWe report an extremely rare case of incarcerated Meckel’s diverticulum within a Spigelian hernia diagnosed by multidetector computed tomography.

Sonographic Diagnosis of Complicated Cholecystitis.

Early detection of the complications of cholecystitis is important for clinical management, yet only a small percentage of patients have a correct diagnosis before surgery. The purpose of our study was to identify sonographic findings that are associated with complicated cholecystitis.

The diagnostic accuracy of pericolonic fat extension and attenuation for colorectal tumors

OBJECTIVE To evaluate the utility of quantitative analysis of the extension and attenuation of pericolonic fat in the local staging of colorectal cancer (CRC) using multi detector computed tomography (MDCT). MATERIALS AND METHODS This was a retrospective study of 110 patients who were operated due to pathologically proven CRC from January 2007 to January 2010, and who underwent preoperative MDCT of the abdomen and pelvis with administration of intravenous contrast material and image acquisition during the portal venous phase. The mean age was 69 years (range of 38-90 years). Pathological reports were reviewed for TNM staging. All MDCT studies were reviewed by two certified radiologists for maximal and minimal tumor diameter, extent of the infiltrated pericolonic fat (measured in mm), attenuation of the infiltrated pericolonic fat (measured in Hounsfield units), and attenuation of normally appearing fat next to the tumor. The sensitivity and specificity of these parameters in detecting patients with ≥ T3 CRC were calculated. RESULTS The overall sensitivity, specificity, and accuracy of pericolonic fat infiltration in detecting patients with ≥T3 stage were 95% (95% CI, 89.0-98.7%), 20% (5.8-43.7%), and 81.9% (74.7-89%) respectively. The mean extent and attenuation of the infiltrated pericolonic fat, in addition to the maximal tumor diameter, were higher in the ≥T3 group (p<0.05). By defining threshold values to these parameters, the positive predictive value for detecting ≥T3 stage tumors approaches 100%. CONCLUSION Quantitative analysis of pericolonic fat increased the accuracy of MDCT in the detection of local tumor spread in CRC.