RESUMEN
Objectives: Pulmonary nocardiosis is a rare opportunistic infection that is often encountered in immunocompromised patients, in particular those with the HIV infection and in solid organ transplant recipients. As the number of immunocompromised patients increase, the number of patients with pulmonary nocardiosis is also expected to increase. This study aimed to analyse both the chest high resolution computed tomography (HRCT) findings of patients with confirmed pulmonary nocardiosis and review the imaging features of pulmonary nocardiosis in the literature. Methods: This retrospective study was conducted at The Royal Hospital, Muscat, Oman, to identify patients with a diagnosis of pulmonary nocardiosis between January 2006 and January 2019. Accordingly, nine patients with pulmonary nocardiosis were identified, but three patients were excluded as no chest HRCT images were available. Patient clinical presentation was recorded and chest HRCT images were retrospectively reviewed. Results: A total of six patients were enrolled in this study. All were male and with a mean age of 41 ± 11 years. Three patients were immunocompromised, two of whom had undergone a renal transplant. The main HRCT findings were cavitary nodules/masses, non-cavitary nodules/masses, septal thickening, centrilobular nodules, ground glass opacities, consolidation, pleural effusion, pleural thickening, enlarged lymph nodes and necrotic lymph nodes. Conclusion: Pulmonary nocardiosis shows various findings in a chest CT, the most common of which are pulmonary nodules and masses. Awareness of these findings can help radiologists with a diagnosis in the appropriate clinical settings.
Asunto(s)
Infecciones por VIH , Nocardiosis , Derrame Pleural , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Objectives: This study aimed to assess the correlation between the severity of the initial chest x-ray (CXR) abnormalities in patients with a confirmed diagnosis of COVID-19 and the final outcomes. Methods: This retrospective study was conducted at the Royal Hospital, Oman between mid-March and May 2020 and included patients who had been admitted with a confirmed diagnosis of COVID-19 and had a final outcome. Serial CXRs were identified and examined for presence, extent, distribution and progression pattern of radiological abnormalities. Each lung field was divided into three zones on each CXR and a score was allocated for each zone (0 is normal and 1-4 is mild-severe). The scores for all six zones per CXR examination were summed to provide a cumulative chest radiographic score (range: 0-24). Results: A total of 64 patients were included; the majority were male (89.1%) and the mean age was 50.22 ± 14.86 years. The initial CXR was abnormal in 60 patients (93.8%). The most common finding was ground glass opacity (n = 58, 96.7%) followed by consolidation (n = 50, 83.3%). Most patients had bilateral (n = 51, 85.0%), multifocal (n = 57, 95.0%) and mixed central and peripheral (n = 36, 60.0%) lung abnormalities. The median score of initial CXR for deceased patients was significantly higher than recovered patients (17 versus 11; P = 0.009). Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement). Conclusion: A higher baseline CXR score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia.
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COVID-19 , Neumonía , Adulto , Anciano , COVID-19/diagnóstico por imagen , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica , Estudios Retrospectivos , Rayos XRESUMEN
Infective endocarditis (IE) is an infection of the heart endocardium with significant morbidity and mortality. Gram negative infection, particularly emphysematous IE, is an extremely rare and life-threatening disease. We report a 59-year-old diabetic female patient who was admitted to a secondary care hospital in Rustaq, Oman, in 2017 with the diagnosis of pneumonia for which she was started on antibiotics. Shortly afterwards, she developed facial and mouth deviation and became more tachypneic. Computed tomography of the brain demonstrated bilateral multiple small infarcts. Pulmonary angiography computed tomography was performed which ruled out pulmonary embolism. Nonetheless, it revealed an air-containing lesion around the mitral valve. Transthoracic echocardiography demonstrated a hyperechoic mobile lesion related to the mitral valve. Blood culture grew Escherichia coli and the diagnosis of E. coli emphysematous IE was made based on modified Duke criteria. The patient's clinical condition deteriorated and she suffered cardiac arrest leading to her death. The recommended treatment for non-HACEK IE includes an extended antibiotic course and surgery for selected patients.
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Enfisema , Endocarditis Bacteriana , Endocarditis , Antibacterianos/uso terapéutico , Enfisema/diagnóstico , Endocarditis/complicaciones , Endocarditis/diagnóstico , Endocarditis/tratamiento farmacológico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Escherichia coli , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss disease, is a rare vasculitis that affects small- to medium-sized vessels and has a propensity to involve the heart. Patients with cardiac involvement have a poor prognosis and usually require immunosuppressive treatment along with corticosteroids. Cardiovascular magnetic resonance (CMR) is a non-invasive diagnostic tool for detecting cardiac involvement and guiding the management plan. We report a 39-year-old male patient with a known history of bronchial asthma who was referred to the chest clinic at a tertiary hospital in 2019 for further assessment of persistent lung parenchymal changes on chest computed tomography. Given the clinical context of the patient and the radiological findings, EGPA was suspected and confirmed with a lung biopsy. CMR was performed for further assessment, which confirmed cardiac involvement. The patient was started on prednisolone and azathioprine and showed significant radiological and clinical improvement.
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Síndrome de Churg-Strauss , Granulomatosis con Poliangitis , Adulto , Síndrome de Churg-Strauss/complicaciones , Síndrome de Churg-Strauss/diagnóstico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/diagnóstico , Corazón , Humanos , Pulmón , Espectroscopía de Resonancia Magnética , MasculinoRESUMEN
Cardiac haemangiomas are rare cardiac tumours that are usually asymptomatic and detected incidentally while imaging the heart with echocardiogram. Cardiovascular magnetic resonance (CMR) is a non-ionising imaging modality that allows the diagnosis of cardiac haemangiomas prior to surgery. We report a 36-year old male patient who was referred to the Adult Cardiology Clinic at the Royal Hospital, Muscat, Oman, in 2006 with a history of a left ventricle mass detected on echocardiogram. Further assessment of the mass by CMR revealed that the mass within the left ventricle apical septum contained features that were consistent with a cardiac haemangioma. Due to the surgical risk of ventricular septal defect and the stability of the mass, the patient was managed conservatively and upon follow-up the patient's condition remained stable.
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Neoplasias Cardíacas/patología , Ventrículos Cardíacos/diagnóstico por imagen , Hemangioma/patología , Adulto , Angiografía Coronaria , Ecocardiografía , Ventrículos Cardíacos/patología , Humanos , Imagen por Resonancia Magnética , Masculino , OmánRESUMEN
Medical imaging, including chest radiography and computed tomography, plays a major role in the diagnosis and follow-up of patients with COVID-19 associated pneumonia. This review aims to summarise current information on this topic based on the existing literature. A search of the Google Scholar (Google LLC, Mountain View, California, USA) and MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) databases was conducted for articles published until April 2020. A total of 30 articles involving 4,002 patients were identified. The most frequently reported imaging findings were bilateral ground glass and consolidative pulmonary opacities with a predominant lower lobe and peripheral subpleural distribution.
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COVID-19/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos X , Humanos , SARS-CoV-2RESUMEN
Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing mesenchymal neoplasm of the dermis and subcutaneous tissues that has a low-to intermediate-grade malignancy. DFSP commonly involves the trunk and extremities, and very rarely the breast skin, mimicking a primary breast neoplasm with few reported cases in the literature. We report a 35-year old female patient who was referred to the Royal Hospital, Muscat, Oman in 2017, with a two-year history of a slow growing left breast lump. Assessment of the breasts with mammography revealed a lobulated lesion in the left-upper-inner quadrant with neither microcalcification nor architectural distortion, mimicking a benign lesion. However, on ultrasound, the lesion had suspicious features with increased vascularity and hence, it was categorised as breast imaging reporting and data system (BIRAD) IV. The patient underwent left breast wide local excision and the histopathological diagnosis was dermatofibrosarcoma protuberans.
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Mimetismo Biológico , Neoplasias de la Mama/fisiopatología , Dermatofibrosarcoma/diagnóstico , Dermatofibrosarcoma/fisiopatología , Adulto , Mama/patología , Neoplasias de la Mama/diagnóstico , Dermatofibrosarcoma/patología , Femenino , Humanos , Mamografía/métodos , Omán , Ultrasonografía/métodosRESUMEN
Pulmonary hyalinising granuloma (PHG) is a rare fibrosclerosing inflammatory lung condition of unknown aetiology. It is characterised by solitary or multiple pulmonary nodules that are usually found incidentally while imaging the chest for other reasons. We report two cases of histologically proven PHG diagnosed at the Royal Hospital, Muscat, Oman. The first case was a 71-year-old male patient who presented in 2010 with a dry cough, weight loss and bilateral pulmonary nodules. The second case was a 58-year-old male patient who presented in 2012 and was found to have incidental bilateral pulmonary nodules on chest X-ray. Both patients were started on prednisolone and on follow-up the PHG nodules remained stable. Although there is no definitive treatment, PHG generally has an excellent prognosis.
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Enfermedad de la Membrana Hialina/diagnóstico , Pulmón/anomalías , Anciano , Broncoscopía/métodos , Humanos , Enfermedad de la Membrana Hialina/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Omán , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVES: Coronary artery anomalies (CAAs) are uncommon congenital abnormalities with a prevalence ranging from 0.2-2%. CAAs can be asymptomatic or less commonly present with life-threatening symptoms. This study aimed to investigate the prevalence and spectrum of CAAs in patients who underwent coronary computed tomography angiography (CCTA) in Oman. METHODS: This retrospective study was conducted at the National Heart Centre, Muscat, Oman between September 2012 and August 2018. All consecutive patients who had undergone CCTA were included. RESULTS: A total of 4,445 patients were included in this study. Of these, 59 patients (1.3%) were diagnosed with CAAs with a mean age of 52.6 years (range: 12-80 years) and an equal gender distribution. Among the patients with CAAs, the majority (69.5%) had anomalous origins from the opposite or non-coronary sinus. Right coronary artery arising from the left coronary sinus was the most common type (33.9%). Fewer patients (18.6%) had left circumflex arising from the right coronary sinus (RCS). Seven patients (11.9%) had left main arising from the RCS. Other CAAs were in the dual left anterior descending artery (8.5%), high coronary artery take-off (6.8%), single coronary ostia (6.8%) and coronary artery fistula (6.8%). CONCLUSION: The prevalence of CAAs was 1.3% which is similar to the literature.
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Angiografía Coronaria/métodos , Corazón/fisiopatología , Prevalencia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Niño , Angiografía Coronaria/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Omán , Estudios RetrospectivosRESUMEN
A dual left anterior descending (LAD) artery is a rare congenital anomaly which is classified into different types based on the origin, course and termination of the short and long LAD arteries. To date, 10 variants of dual LAD artery anomalies have been described. We report a 44-year-old woman who was referred to the Department of Radiology, Royal Hospital, Muscat, Oman, in 2017. Coronary computed tomography angiography revealed a dual LAD artery anomaly in which the short and long LAD arteries shared a common ostium with the right coronary artery from the right coronary sinus. To the best of the authors' knowledge, this type of variant has not been previously reported in the literature.
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Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico , Adulto , Anomalías Congénitas/clasificación , Anomalías Congénitas/diagnóstico , Anomalías de los Vasos Coronarios/clasificación , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Omán , Tomografía Computarizada por Rayos X/métodosRESUMEN
Amyloidosis is a disorder characterised by the extracellular deposition of amyloid, a fibrillary protein, in various organs such as the lungs. Pulmonary nodular amyloidosis can mimic other lung conditions that present with pulmonary nodules, such as metastasis, sarcoidosis and hyalinising granuloma. We report a 60-year-old man who presented to the Royal Hospital, Muscat, Oman, in 2017 with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling. A chest X-ray showed bilateral nodular opacities. Enhanced chest computed tomography revealed bilateral pulmonary nodules with a predominantly perilymphatic and subpleural distribution, giving the impression of a neoplastic nodule. A histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.