Azmi A. Haroun

Hereditary Multiple Exostoses with Pseudoaneurysm

A 16-year-old male patient with hereditary multiple exostoses (HME) was found to have a pseudoaneurysm of the left popliteal artery caused by osteochondroma in the lower femur. The diagnosis was confirmed by ultrasound, magnetic resonance imaging and magnetic resonance angiography without the need to perform an angiogram. The osteochondroma was excised and the popliteal artery was repaired with a saphenous graft. Vascular complications are extremely rare in HME, pseudoaneurysm being the most common and mostly located in the popliteal artery. This complication should be considered in young HME patients with a mass at the knee region. The radiological spectrum of investigations allows the diagnosis of this complication with proper and less invasive management procedures for the patient.

Duplex Doppler sonography in patients with acute renal colic: Prospective study and literature review

Purpose:To determine the value of duplex Dopplersonography in the diagnosis of acute urinaryobstruction.Materials and methods:In 46 healthy individuals and 42 patients withurinary obstruction confirmed by intravenousurography, 176 kidneys were examined withduplex Doppler sonography. The meanintra-arterial resistive index value and thedifference of mean resistive index valuesbetween both kidneys were determined for eachperson. Resistive index and delta resistiveindex values were compared with urographicfindings in the 42 patients.Results:In the 46 healthy individuals, the meanresistive index and delta resistive indexvalues were 0.59 ± 0.05 and 0.03 ±0.01. In the 14 patients with complete urinaryobstruction, these values were 0.70 ± 0.06and 0.09 ± 0.02, whereas in the 28 patientswith partial urinary obstruction, these valueswere 0.64 ± 0.06 and 0.03 ± 0.05.Urographic findings and duplex Dopplersonography were correlated in the 42 patients,with a resistive index = 0.65 and deltaresistive index = 0.05 as discriminatorythresholds for obstruction. In patients withcomplete obstruction, the diagnosticsensitivity of these values was 64% and 100%with a specificity of 82% and 89%,respectively. In patients with partialobstruction, the sensitivity of these valueswas 54% and 46% with a specificity of 82%and 89%, with respect to the control group ofhealthy individuals.Conclusion:Delta resistive index is a very sensitive andspecific parameter in the sonographic diagnosisof complete urinary obstruction but insensitivein partial urinary obstruction. Duplex Dopplersonography is recommended in cases whereintravenous urography is contraindicated.

Congenital pseudoarthrosis associated with venous malformation

Congenital pseudoarthrosis is a pathologic entity that may be isolated, or may be associated with neurofibromatosis. We report the case of a 3-year-old female with congenital pseudoarthrosis involving the right tibia and fibula. Magnetic resonance imaging (MRI) and complementary magnetic resonance angiogram (MRA) revealed a lobulated mass with vivid enhancement, which led to the diagnosis of venous malformation. This is the first report of congenital pseudoarthrosis caused by the presence of a vascular malformation.