Maurice C. Haddad

CT findings of omental torsion and infarction Case report and review of the literature

A 37-year-old woman presented with progressive diffuse abdominal pain. Computed tomography (CT) showed diffuse streaking of the greater omentum with a mass of fat density located anteriorly just below the umbilicus, showing a whirling pattern of concentric streaks. Surgery and pathology revealed torsion and infarction of the greater omentum. Because of its rarity and nonspecific clinical features, the diagnosis is seldom made preoperatively. We describe a patient with characteristic CT findings of omental torsion. Preoperative diagnosis is important since conservative management has been suggested.

Incidence of urinary tract infection following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

OBJECTIVE To determine the incidence of urinary tract infections (UTIs) following transrectal ultrasound guided needle biopsy of the prostate (TRUBP) and the bacteriology of these infections. DESIGN Retrospective evaluation of the charts and records of all patients who underwent TRUBP between June 1, 2002, and August 31, 2003. SETTING American University of Beirut Medical Center, a tertiary-care center in Lebanon. PATIENTS Two hundred seven patients underwent TRUBP. All received prophylactic antibiotics. One hundred twenty (58%) received ciprofloxacin alone, whereas 87 (42%) received both ciprofloxacin and gentamicin. Sixty-one patients (29.5%) had an enema prior to the procedure, whereas 146 (70.5%) did not. RESULTS Thirteen patients (6.3%) were admitted with UTI. All had rigors and fever on admission. Symptoms appeared at a mean of 2.7 days and the mean hospital stay was 9.2 days. The mean duration of antibiotic treatment was 23.2 days. Ten (77%) of the patients had positive bacteriology. Urine cultures were positive in 8 (61.5%) of the patients and blood cultures in 6 (46.2%). All positive cultures grew Escherichia coli resistant to ciprofloxacin, with 5 isolates producing extended-spectrum betalactamases. CONCLUSIONS TRUBP continues to be associated with significant infectious complications, especially UTI. Given the increasing incidence of antibiotic resistance mainly among the Enterobacteriaceae, antimicrobial prophylaxis practices should be reevaluated and the universal administration of quinolones alone or in combination with aminoglycosides should be reconsidered.

MR, CT, and ultrasonography of splanchnic venous thrombosis

Nine patients with splanchnic venous thrombosis are presented and the value of noninvasive imaging in their initial diagnosis and subsequent follow-up is emphasized. Angiography, traditionally the definitive investigation in such cases, can be reserved for preoperative assessment in those patients considered candidates for surgery. The age of venous thrombi can be estimated by computed tomography (CT) and magnetic resonance imaging (MRI) which aids selection of therapy, and in those anticoagulated, prediction of prognosis.

Juvenile ossifying fibroma: CT and MR findings

Abstract. We describe the CT findings in four patients and the MR imaging in one patient with juvenile ossifying fibroma. Three lesions involved the maxillary sinus and extended to the surrounding structures; one lesion was confined to the maxillary bone. CT scan revealed well-defined, expansile lesions with variable amount of calcifications. On MRI one lesion had intermediate signal intensity with significant contrast enhancement.

Thoracic spinal intradural arachnoid cyst: report of two cases and review of literature

Abstract. We report two cases of spinal intradural arachnoid cyst at the thoracic level, presenting with long-standing symptoms of spinal cord compression and MRI findings that were overlooked for sometime initially. Because of the rarity of this disease, and because of the subtle changes on MRI, there was a definite delay in the diagnosis. In this report we emphasize the value of MRI and CT myelography in this disorder, and the need for them to be strongly correlated with the progression of the clinical picture.

Percutaneous treatmerit of heterogertous predorninantly solid echopattern echinococcal cysts of the liver

AbstractPurpose: We report our technique for and results of percutaneous treatment of heterogenous, predorninantly solid echopattem hepatic hydatid cysts (HHC), i.e., complex type IV cysts according to Gharbi’s sonographie Classification of HHC. Methods: Eight patients with nine complex type IV HHC were treated by percutaneous aspiration followed by hypertonic saline ablation, using a 14 Fr van Sonnenberg sump drainage catheter under Sonographie and fluoroscopic guidance. Results: Successful drainage of cysts contents was achieved in all eight patients. No major complications, such as anaphylaxis, abdominal dissemination, cyst recurrence, or death. oecurred. Minor complications including pain (n=4), mild fever (n=5), right reactive pleural effusion (n=4), and transient hypernatremia (n=2) vvere observed and managed conservatively. Follow-up imaging studies for an average period of 15 months (range 1–48 months) showed either complete healing (n=3) or significant reduetion in the size of the cyst with solidification (n=6). Conclusion: Nine complex type IV HHC were effectively treated by suction of the membranes and hypertonic saline ablation using a 14 Fr sump drainage catheter, without major complications.

Bone mineralization in newborns whose mothers received magnesium sulphate for tocolysis of premature labour.

Prolonged maternal magnesium sulphate infusion therapy for tocolysis of premature labour may result in secondary fetal hypermagnesaemia, which has been associated with bony abnormalities in the newborn. We report on four infants, members of two twin pregnancies, who were exposed to prolonged fetal hypermagnesaemia. Three of the infants, all appropriate for gestational age, showed abnormal radiological findings consisting of abnormal mineralisation of long-bone metaphyses owing to fetal hypermagnesaemia. The fourth infant, who was growth retarded, had normal bones. Intrauterine growth restriction appears to be protective against magnesium sulphate-induced abnormal bone mineralisation in the newborn.

Echinococcal cysts of the liver A retrospective analysis of clinico-radiological findings and different therapeutic modalities

The clinico-radiological findings and management of 61 patients with proven hepatic echinococcal cysts (HEC) examined over the past 5 years were retrospectively analyzed. The sonography and computed tomography (CT) scan findings were studied before and after therapy. The indications, healing, and complications rates for each therapeutic modality were recorded. There is a predominance of HEC in adult females (female to male ratio, 1.77:1). The majority of patients complained of abdominal pain (39/61; 64.4%), and the majority of cysts were solitary (43/61; 70.5%), localized in the right lobe (47/61; 77.0%), and superficial (57/61; 93.4%). Few cysts were complicated by rupture, intraperitoneal (2/61; 3.2%), or intrabiliary (5/61; 8.2%). Medical treatment consisted of antihelmintic chemotherapy alone in eight patients with an adequate response in seven patients (7/8; 87.5%). Thirty-two patients had open or laparoscopic surgery with a cure rate of 50%. The other 50% had major complications requiring a further adjuvant therapy for a complete cure. Nine patients underwent percutaneous catheter ablation combined with adjuvant chemotherapy; healing was observed in eight patients (8/9; 88.8%). HEC are best treated by nonsurgical minimally invasive techniques combined with adjuvant antihelmintic chemotherapy, while surgery should be reserved for complicated HEC by intraperitoneal rupture.

Primary epiploic appendagitis: a report of two cases

Primary epiploic appendagitis (PEA) is a rare benign self-limiting inflammatory process of the colonic epiploic appendices. Patients present with acute abdominal pain, often misdiagnosed clinically as acute appendicitis or diverticulitis. Computed tomography (CT) scan findings of this condition are characteristic and can confidently suggest the diagnosis avoiding unnecessary barium enemas and colonoscopy, biopsy, or surgery.

Metastastic rhabdomyosarcoma to the breast

Abstract Rhabdomyosarcoma is a common extramammary primary malignancy in childhood that rarely metastasises to the breast. We present a patient with primary sinonasal rhabdomyosarcoma who was in remission when she developed breast metastases. We describe particular imaging findings of this disease, using ultrasound and MR imaging. To our knowledge, MR findings have only been described in one previous case report in the literature.