Mohammad Ali Husainy

Typical and atypical benign liver lesions: A review

Focal liver lesions are routinely encountered by clinical radiologists and represent a wide spectrum of pathology. Majority of these lesions are likely to be benign in nature, especially in the absence of chronic liver disease or primary cancer. A radiologist must be aware of common and uncommon imaging features of benign lesions across the various imaging modalities. This review discusses pathognomonic imaging features of common benign focal liver lesions seen on ultrasound, computed tomography and magnetic resonance, and adds to existing knowledge with the recent updates to have emerged in this area.

Acute aortic syndrome—pitfalls on gated and non-gated CT scan

Acute aortic syndrome (AAS) is a life-threatening condition which includes aortic dissection (AD), penetrating aortic ulcer (PAU) and intramural hematoma (IMH). Multi-detector computed tomography (MDCT) plays a crucial role in the diagnosis of this condition and for further clinical follow-up. It is important for radiologists to be aware of common pitfalls in cardiac-gated and non-gated CT in diagnosing AAS. They should also be wary of common mimics of AAS which may make a significant difference towards management of these patients. In this review, we present from our practice some of the common pitfalls and mimics of AAS on MDCT.

Success in adrenal venous sampling between two protocols: experience at a tertiary centre

Adrenal venous sampling (AVS) is currently the best available confirmatory test for lateralising aldosterone production in proven primary aldosteronism (PA).1 AVS is an invasive procedure, which carries a small risk of complications, but requires skilled radiologist to obtain biochemically selective samples.2 The technical success rate of AVS has been cited up to 96% in specialised centres,3 whereas unsuccessful AVS is primarily due to failure in cannulating the right adrenal vein, because of its challenging anatomy. Furthermore, in spite of ‘radiologically successful’ cannulation of both adrenal veins, the samples obtained can still be non-diagnostic due to dilution and lack of selectivity. Following a revision of our AVS protocol (both radiological and biochemical) in 2012, we assessed its impact on the success rate of the procedure. We carried out a retrospective review of all AVS performed in the interventional radiology department since 2008. Prior to 2012 (pre-2012 protocol), three interventional radiologist (IR) performed AVS in randomly allotted slots without cosyntropin stimulation using a size 5 French (Fr) SIM2 Glidecath (Terumo, Somerset, New Jersey) as the preferred catheter for cannulation. As per the revised protocol (post-2012 protocol), two IR (combined experience of >24 years) were designated to perform all AVS procedures and patients were booked as the first case in the morning list. All received cosyntropin bolus intravenously (250 μg in 5 mL of 0.9% saline) an …

Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage

We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.

OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers

Purpose: The OUTBACK® catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK® catheter in cases where other techniques were unsuccessful. Material and Methods: All cases where recanalization was performed using the OUTBACK® reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. Results: The OUTBACK® catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK® catheter due to patients intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. Conclusion: The OUTBACK® catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail.

Positive computed tomography rate for lone acute severe headache: a potential quality marker for emergency care?

increased intracranial pressure in meningitis may lead to the displacement of CSF from the subarachnoid spaces by the oedematous brain tissue and engorged superficial veins [4] in accordance with the Monroe–Kellie doctrine. Engorged veins appear hyperdense relative to the low-attenuating oedematous brain. This, coupled with the displacement of hypodense CSF, may account for the hyperdensity observed in pseudo-SAH [1]. However, neither mechanism explains why CT findings are most often normal in meningitis.