Mohammed Khalid

Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study

Bronchiolitis obliterans (BO) is a serious noninfectious pulmonary complication following allogeneic bone marrow transplantation (BMT). Azithromycin, a macrolide antibiotic, may have a beneficial effect in BO through its anti-inflammatory effect. The aim of the current study was to investigate the potential effect of azithromycin on pulmonary function tests (PFTs) in BO complicating BMT. PFTs of 153 post-BMT patients were followed; eight patients out of 153 (12%) developed obstructive airway disease on their PFTs, along with characteristic findings of BO on high-resolution computed tomography of the chest. These patients were given azithromycin 500 mg q.d. for 3 days, followed by 250 mg three times a week for 12 weeks. Clinically significant improvements were achieved both in forced vital capacity, where the mean (95% confidence interval) increase reported was 410 mL (0.16–0.65), which was an average improvement of 21.57%, and in the forced expiratory volume in one second, where the mean increase noticed was 280 mL (0.10–0.44), which was an average improvement of 20.58%. In conclusion, the potential role of azithromycin in the treatment of bronchiolitis obliterans is intriguing and it warrants further testing.

Wunderlich syndrome following rupture of a renal angiomyolipoma.

Ann Saudi Med 2006;26(4):310-312 Wunderlich syndrome refers to spontaneous non-traumatic renal bleeding into the subcapsular and/or perirenal space. The appropriate treatment for this condition depends on the diagnosis of perinephric hemorrhage and the determination of its cause. Radiology therefore plays an important role in the evaluation of patients with this clinical problem. We present the case of a lady who had spontaneous perinephric hemorrhage following rupture of a renal angiomyolipoma (AML) along with a short review of this syndrome.

Diagnosis: Pulmonary arteriovenous malformation (PAVM)

Radiological Findings The routine chest radiograph revealed a sharply defined lobulated soft tissue mass of uniform density in the right lower hemithorax with evidence of tubular densities radiating from the hilum. No calcification was noted within the mass. Likely differentials based on chest radiograph would be granuloma, sequestration, metastasis and AVM. The lesions on the contrast-enhanced CT chest were identified as subpleural nodular, lobulated masses of uniform density in the right lower lobe anteriorly, with a single feeding artery and a draining vein consistent with PAVM. Another radiological test that could demonstrate the lesion is pulmonary angiography, which helps in defining the number, size, location and angioarchitecture of individual PAVM. Pulmonary angiography is considered the gold standard in the diagnosis of PAVM.

A 33-year-old male with a chest lesion on a routine chest radiograph. Pulmonary arteriovenous malformation (PAVM).

A 33-year-old Bahraini male presented at the health centre for a chest radiograph as a part of a routine medical check up for employment. He had no complaints. There was no history of a hospital visit or other major illness. After routine chest radiograph (Figure 1) he underwent a contrast-enhanced CT scan (Figures 2a, 2b) of the chest, as a part of further work-up for the lesion detected on the chest radiograph.