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Objective To determine outcomes of isolated sigmoid colon thickening detected on computed tomography (CT) and to evaluate certain clinical and CT findings that could help in diagnoses. Method This retrospective observational study was performed evaluating CT imaging data of all consecutive adult patients who presented with acute lower abdominal pains in emergency departments and were found to have isolated sigmoid colonic thickening on routine venous phase CT studies, between January 2020 to January 2022. Pre- viously operated cases, known inflammatory bowel disease patients, and those with known sigmoid malignancies were excluded. CT findings regarding the length of the sigmoid segment affected (less or more than 10 cm), mucosal pattern (symmet- ric or asymmetric), presence of diverticula, lymph nodes, and additional features (pericolic abscess or fistula formation, extra-luminal air foci or perforation, local invasion) were documented. Two experienced radiologists made consensus report- ing. Final diagnoses were confirmed on (endoscopic) biopsy results. Patients who did not have endoscopies or were medically treated were excluded. Age, gender, and CT findings were compared with outcomes, and any association was determined by the Chi-squared test. Results Out of 30 patients (aged between 20-75 years), the majority were males (n=21) and above 40 years (n=22). Twelve patients had colonic malignancies while 18 had benign findings. Acute presentation, younger patients, and those showing the presence of diver- ticula on CT scans were associated with benign biopsies. Conclusion Younger patients who present acutely and show diverticula on CT imaging may have benign causes of sigmoid thickening.

Organ donation is an integral part of medical ethics worldwide, including Saudi Arabia. Although the Saudi community has a positive attitude toward the concept of organ donation and transplantation, several factors prevent people from agreeing to donate organs and tissues. This study aimed to explore and evaluate the knowledge and attitudes medical students in the Eastern Province of Saudi Arabia have toward organ donation and transplantation.A cross-sectional study among 722 medical students in the Eastern Province. The questionnaire consisted of 3 parts: sociodemographic questions, organ donation and transplantation knowledge questions, and questions on attitudes toward organ donation and reasons for consenting or refusing to donate.Both men and women had positive attitudes toward organ donation. The level of knowledge of organ donation and related procedures did not differ significantly among men (13.07%) and women (13.60%) (P.027). The motives for donation were the desire to help others (88.8%) (P = .02) and sympathy (59.8%). The main source of information on organ donation for respondents was television, followed by the internet and relatives and/or friends.While medical students are generally supportive of organ donation and transplantation, they may lack basic knowledge on organ donation. Due to lack of basic knowledge, they become hesitant to make the decision to donate. It is recommended that additional organ donation modules be included in the student curriculum to increase the knowledge of future health care providers. Most of the participants would not change their attitudes toward organ donation based on the Saudi government initiatives to register for the Saudi Center for Organ Transplantation organ donation program.

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare condition affecting the airways and is characterized by dilatation of the trachea and major bronchi secondary to atrophic or absent elastic fibres of the cartilage and thinning of the muscles.[1] The abnormally enlarged flaccid portions of the bronchial tree collapse and fail to maintain patency during expiration and coughing, predisposing the patient to stagnation of contents and recurrent lower respiratory tract infections, emphysema, bronchiectasis and chronic pulmonary suppuration.[2] The diagnosis is usually made on basis of specific radiographic features,[3] particularly on computed tomography (CT) scan. We report a case of a 69-year-old man who presented with recurrent lower respiratory tract infections and was found to have tracheobronchomegaly as an underlying primary airway abnormality on imaging and bronchoscopy that was initially undiagnosed.

Objective To determine diagnostic ability of brain magnetic resonance imaging (MRI) in detection of idiopathic intracranial hypertension (IIH). Method This descriptive observational study was conducted in radiology department from Jan. 2018 to Jan. 2021, evaluating MR imaging data of all adult patients (n=107) with clinical presentations of headaches. Patients with space occupying lesions, obstructive hydrocephalus and cerebral venous sinus thrombosis were excluded. Presence of all three brain MRI findings of (i) an empty sella (with or without sellar enlargement), (ii) tortuosity of optic nerves (with or without perioptic CSF prominence) and (iii) non-dilated (or slit-like) ventricles was considered positive for IIH. Imaging was reviewed by two neuroradiologists and consensus reporting was made. Findings of IIH were confirmed by presence of high lumbar opening cerebrospinal fluid (CSF) pressure or symptomatic response towards specific medical treatment. Outcomes of brain MRIs were presented on a 2x2 contingency table. Results Sensitivity, and specificity of routine brain MRI findings in detection of IIH were calculated as 76.4% [95% confidence interval (CI), 64.62-85.91%], and 84.6% (95% CI, 69.47-94.14%) respectively. Conclusion: IIH is a known cause of headache. Detection of all three findings of empty sella, tortuosity of optic nerves and non-dilated ventricles on routine brain MRI can predict IIH with greater sensitivity and specificity.

Objective To evaluate the diagnostic utility of ‘Susceptibility Weighted Angiogram’ (SWAN) in brain magnetic resonance imaging (MRI) by identifying venous angiomas causing epileptic seizures. Method and Materials A retrospective observational study was performed in the Radiology department at King Fahad Military Medical Complex (KFMC) hospital in Dhahran from January 2016 to 2021. All consecutive adult patients who underwent brain MRIs for epilepsy with SWAN were included. Patients with brain tumors, traumatic brain injuries, and post-surgical cases were excluded. The presence of tuft of small deep parenchymal veins draining into a more prominent (transcortical or subependymal) collector vein as seen on SWAN image was considered a venous angioma and confirmed on either contrast-enhanced studies or cerebral angiograms. Two experienced neuroradiologists interpreted the studies with mutual consensus. The significance of such finding was considered if SWAN-detected venous malformation corresponded to an epileptiform focus on respective electroencephalogram (EEG). Findings were compared with incidentally detected venous angiomas in normal brain MRIs in patients without indications of seizures (control group, n=112). Proportion analysis (Z-test) was used to determine significance. Results Out of 112 patients, 64 were females (57%), and 48 were males (43%), with a mean age of 19.24 (range, 5-45 years). Twenty-three patients (epilepsy group) were found to have venous malformations while three (control group) had venous angiomas (Z-value, 3.93; P-value, 0.0008). Out of 23 patients, 20.53% were SWAN-detected venous angiomas, 5 corresponded to epileptiform foci on respective EEGs compared to none of 3 incidentally detected venous angiomas in the control group (p-value, 0.0005). Conclusion Venous angiomas are usually asymptomatic when detected incidentally. However, adding a SWAN sequence in routine brain MRI for epilepsy patients may help to detect venous angiomas, which may cause focal seizure activity in these patients.

Iron-refractory iron deficiency anemia (IRIDA) is considered an autosomal recessive iron deficiency anemia due to mutations in the transmembrane protease serine 6 (TMPRSS6) gene. Variations in iron parameters and a higher risk of iron deficiency have been linked to the TMPRSS6 mutations. Furthermore, human genome-wide association studies (GWAS) identified a common mutation (rs855791) linked to abnormal hematological parameters, highlighting the importance of the TMPRSS6 gene in the regulation of iron homeostasis. This is the first study to investigate TMPRSS6 gene mutation in six Saudi families of probands with iron deficiency anemia unresponsive to oral iron and partially responsive to parenteral iron administration. Each participant provided a vacutainer tube with three blood samples (2.5 ml each) and analyzed based on hematological, biochemical iron profiles, and followed by genotyping by PCR. The TMPRSS6 gene was amplified, sequenced, and analyzed in all probands and family members. Statistical analysis was done using SPSS and SHEsis software. Few functional mutations in these families were suggested (p.W73X, p.E523K and p.V736A). The proband of family 6 presented numerous hematological abnormalities upon initial consultation, including normocytic anemia accompanied by low Hb, normal MCV, low serum iron, low serum ferritin, and normal TIBC. While the p.W73X variant was only found in 2 families, the p.V736A variant was found in all examined Saudi families with IRIDA. Given the evidence outlined for these six cases, future genotype-phenotype correlation studies in a large number of IRIDA patients in Saudi Arabia may be very informative for patient management, in addition to increasing knowledge of TMPRSS6 function during development as well as factors in the regulation of TMPRSS6 and its effect on iron levels in the body.

Objectives: To describe radiographic imaging findings and disease course in admitted Coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study was carried in the Radiology Department, King Fahad Military Medical Complex, Dhahran between March to August 2020 (6 months). All laboratory confirmed COVID-19 admitted cases were evaluated for their symptoms, duration of hospital stays (in a ward or intensive care unit [ICU]), and imaging findings (ground-glass opacity [GGO], air-space shadowing/consolidation, and others such as atelectasis, reticulation, peribronchovascular thickening, lymphadenopathy and pleural effusion) on chest radiograph (CXR) and computed tomography (CT) studies. Cavitation, nodularity, bronchiectasis, and embolism detected on CT scans were considered as complications. Disease course in terms of recovery (radiographic regression or resolution of findings), worsening (shifting from ward to ICU), and unfavorable outcome (persistent ICU stay or death) were recorded. Imaging findings were interpreted by 2 experienced radiologists and consensus reporting was made. Chi-square test was used to determine association. Results: Out of 106 patients, majority were males (n=82, 77.4%). Forty-six patients (43.3%) had abnormal imaging with mostly peripheral GGO (56.5%), followed by consolidations (34.7%), and others (26%). Complications were detected in 6 ICU patients. All patients with unfavorable outcomes were above 60 years having comorbidities or complications ( p less than 0.0005). Fatality rate was calculated as 2.8. Conclusion: Coronavirus disease 2019 is seen mostly affecting males, with peripheral opacities as common imaging findings. Elderly patients with co-morbidities may show unfavorable outcomes.

Objectives: To evaluate diagnostic capability of brain magnetic resonance imaging (MRI) in detection of inherited neurometabolic disorders. Methods: This retrospective observational study was performed in Radiology Department at our Hospital in Dhahran, from January 2013 to January 2020. We evaluated brain MRIs of children (under 5) who were referred to pediatric neurology for clinical suspicion of neuro-developmental delay and metabolic disease. Known perinatal ischemia and birth trauma cases were excluded. Imaging criteria included: (i) bilateral symmetric white matter signal abnormality, (ii) diffusion restriction affecting bilateral deep grey nuclei with or without brainstem involvement, (iii) brain atrophy or edema with abnormal white matter signal, (iv) characteristic MR spectroscopic finding. Presence of any one of these findings was considered positive for neurometabolic disease. Two neuroradiologists interpreted MRIs with substantial interobserver agreement. Diagnoses were confirmed on biochemical/ metabolic screening and genetic testing. A 2 × 2 contingency table was used for results. Chi square test was used to determine association. Results: Out of 133 cases, 72 (49 males, 90% AR) were found to have neurometabolic disorders. Sensitivity, specificity, positive and negative predictive values were calculated as 81.94% (CI, 71.11-90.02), 67.21% (CI, 54.00-78.69), 74.68% (CI, 66.96-81.11) and 75.93% (CI, 65.16-84.17) respectively. Findings were found significant (p-value=0.0001). Conclusion: Brain MRI can help to predict inherited neurometabolic disorders considering certain findings.

Objective To highlight detection of left ventricular thrombi on cardiac magnetic resonance (CMR) viability studies. Method This retrospective observational study was conducted in the Radiology Department at our Hospital in Dhahran, from April 2015-2019. All recently re-perfused (post-percutaneous coronary intervention/PCI) patients with ST-segment elevation myocardial infarctions (STEMI), having low ejection fractions (

Objectives: To highlight and compare spectrum of hysterosalpingography (HSG) findings in primary and secondary infertility patients. Methods : This retrospective record-based cross-sectional study was performed in the Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia between August 2016 and 2018. All patients (N=303) who underwent successful HSGs were included, and grouped under primary and secondary infertility cases. Patients with failed, limited or incomplete studies were excluded. Imaging findings were documented as N (Normal) or Ab (Abnormal). Abnormal HSG findings were further categorized as: C=congenital malformation, I=infection or inflammation, S=surgery, T=tumor or tear. Abnormal findings were confirmed on further imaging or intervention. Chi-square test was used to determine any association of HSG findings with type of infertility, and p -value less than 0.05 was considered significant. Results : Of the 303 patients, 166 patients (54.8%) had primary infertility while the rest had secondary infertility. Abnormal studies were found in less than one-third of patients (n=93, 30.7%). Primary infertility patients exhibited more congenital (C) malformations, while surgery (S) was seen more in secondary infertility patients ( p =0.01). Conclusion : Congenital malformations are commonly found abnormalities on HSGs in primary infertility patients, while surgery related findings are seen in secondary infertility cases. Saudi Med J 2019; Vol. 40 (10): 1067-1071 doi: 10.15537/smj.2019.10.24538 How to cite this article: Waheed KB, Albassam MA, AlShamrani AG, Aloumi SA, Amin MS, Rashid L, AlGodayan SM, Ahmad SB. Hysterosalpingographic ndings in primary and secondary infertility patients. Saudi Med J 2019; 40: 1067-1071. doi: 10.15537/smj.2019.10.24538.

Objective To evaluate the use of duplex carotid artery screening in patients undergoing coronary artery bypass graft (CABG). Methods This descriptive, observational study was conducted in Radiology Department at King Fahad Military Medical Complex, Dhahran, Kingdom of Saudi Arabia from April 2015-2018. All Saudi patients (n=178) who underwent duplex carotid sonography prior to CABG were retrospectively reviewed for essential morphologic and hemodynamic information to estimate severity of extra-cranial internal carotid artery (ICA) stenosis. Patients with combined CABG and cardiac surgery, and those with limited carotid studies were excluded. Advancing age (65 years or above), gender, smoking, obesity, diabetes (DM), hypertension (HTN), dyslipidemia, coronary vessel disease, cardiac disease and previous stroke were recorded. Post-coronary artery bypass graft neurologic event (namely, transient ischemic attack [TIA] or stroke) was recorded. Chi-square test was used to determine association of stenosis degree with post-CABG neurologic event. Results One hundred twenty eight patients (72%) were having ICA disease, while significant carotid artery stenosis (>70%) was seen in 11 patients (6.2%). Post-coronary artery bypass graft neurologic event was seen in 4.5% of patients. Advancing age, significant ICA stenosis and multi-vessel coronary disease were seen associated with a post-CABG event. Conclusion Significant ICA stenosis on duplex screening in elderly patients with multi-vessel coronary artery disease or certain risk factors may predict post-CABG stroke.

Objectives To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis. Methods This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association. Results Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery. Conclusion Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.

BACKGROUND: Crohn's disease (CD) is a serious cause of perianal disease and the incidence is increasing in Saudi Arabia. MR imaging may document specific features that may help to foresee Crohn's disease in patients making an initial presentation. OBJECTIVE: Present MR imaging findings of perianal fistulas in patients making an initial presentation. DESIGN: Retrospective, observational. SETTING: Radiology clinic in in Dhahran. PATIENTS AND METHODS: All previously undiagnosed and untreated patients who presented for the first time to the outpatient clinics from September 2015-2018 with perianal fistulas were retrospectively evaluated. Previously diagnosed CD patients, post-surgical or intervention cases were excluded. Fistulas were categorized as low or high anal, simple or complex, and were graded per St. James University Hospital Classification. Imaging was interpreted by two experienced readers based on the Van Assche score. MAIN OUTCOME MEASURES: Fistula features on MR imaging and diagnosis of CD. SAMPLE SIZE: 171 patients. RESULTS: Of 171 patients, 139 (81.3%) were males with mean age of 37.2 (12.7) years; the 32 females had a mean age of 35.8 (10.6) years. Twenty-one patients (12.3%) had CD. Fourteen (40.4%) patients with complex fistulas had CD in comparison to only 5 (4.8%) simple fistula patients (P=.0005). More than half of patients with complex and high anal fistulas had CD (P=.0005). Females were more affected than males (P=.0005). CONCLUSION: Complex or high anal fistula on MR imaging may be the initial presentation of CD and warrant further work up to establish the diagnosis. LIMITATIONS: Retrospective, small sample, single center, and short duration study. CONFLICT OF INTEREST: None.

Objectives: To compare use of ultra-fast high-pitch dual-source free-breathing computed tomography pulmonary angiogram ( CTPA) with conventional standard-pitch single-source breath-hold CTPA. Methods: This retrospective comparative study was conducted in Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia from July 2016 to December 2017. Patients (N=130) were divided into 2 groups, each having 65 consecutive patients; Group-1 (single-source CT) and Group-2 (dual-source CT). Previously treated pulmonary embolism cases, pregnant patients and those with incomplete data were excluded. Image quality was subjectively assessed by 2 readers for adequacy of contrast opacification and pulmonary vessel outline, and presence of artifacts (breathing motion, cardiac pulsation, and contrast related). Scan acquisition times and radiation doses were also compared. Chi-square and t-test were used to determine association. Results: Improved image quality (optimal studies without artifacts 91%) was seen in Group-2 compared to Group-1 (optimal studies without artifacts 75.4%). Also, reduced scan time (1-2 sec.) and radiation dose (mean dose length product (DLP)-248 mGy-cm) were observed in Group-2 compared to Group-1 (scan time- 6.5 sec, mean DLP-375). Results were found significant ( p less than 0.05). Conclusion: High-pitch dual-source CT with free-breathing yields better image quality, reduces image acquisition time and radiation doses. Saudi Med J 2019; Vol. 40 (3): 230-237 doi: 10.15537/smj.2019.3.23940 How to cite this article: Al Hassan DA, Waheed KB, El Sirafy MN, Khattab MA, Al-Hammadi HI, Ibrahim MF, et al. Computed tomography pulmonary angiography using high-pitch dual-source scanner technology. Saudi Med J . 2019 Mar;40(3):230-237. doi: 10.15537/smj.2019.3.23940.

Objectives : To determine the diagnostic accuracy of Focused Assessment with Sonography for Trauma (FAST) in blunt abdominal trauma caused by motor vehicle accidents at our Hospital in Dhahran city. Methods : This descriptive, observational study was conducted in the Radiology Department at King Fahad Military Medical Complex Dhahran, Saudi Arabia between September 2016 and September 2017. All adult patients (n=105) involved in motor vehicle accidents with blunt abdominal injury on presentation were retrospectively reviewed for FAST and CT scans for detection of free fluid. Focused assessment with sonography for trauma studies were conducted or supervised by senior registrar of general surgery (trauma team leader). Computed tomography findings were reviewed by 2 experienced radiologists. High and low-grade solid abdominal visceral (liver, spleen, kidney) injuries were identified on CT scans. Focused assessment with sonography for trauma and CT scan findings were identified as ‘positive’ and ‘negative’ for presence and absence of free fluid respectively. Outcomes of FAST were presented on a 2x2 contingency table. Results : Sensitivity of FAST in detecting intraperitoneal free fluid was calculated as 76.1% (95% confidence interval [CI], 64.14-85.69%), specificity 84.2% (95% CI, 68.75-93.98%) and accuracy 79% (95% CI, 70.01-86.38%). Focused assessment with sonography for trauma detected free fluid in most cases of high-grade solid visceral injuries. Nearly half of true-negative cases were having low grade visceral or other injuries. Conclusion : Focused assessment with sonography for trauma is an important tool in initial assessment of suspected blunt abdominal injury patients with high sensitivity and specificity. A negative FAST does not exclude low grade solid visceral or other injuries. Saudi Med J 2018; Vol. 39 (6): 598-602 doi: 10.15537/smj.2018.6.22031 How to cite this article: Waheed KB, Baig AA, Raza A, Ul Hassan MZ, Khattab MA, Raza U. Diagnostic accuracy of Focused Assessment with Sonography for Trauma for blunt abdominal trauma in the Eastern Region of Saudi Arabia. Saudi Med J . 2018 Jun;39(6):598-602. doi: 10.15537/smj.2018.6.22031.

Background: Breast cancer is a major health concern all over the world, and also in the Kingdom of Saudi Arabia. Despite availability of modern facilities in diagnosis and improvements in healthcare systems, still many of the breast cancers are missed. Careful understanding of situation may help to minimize and even stop such unfortunate outcomes. Aim: To highlight various aspects of missed breast cancers on mammography based on their cause and course of disease. Methods: We retrospectively reviewed clinical information, imaging data and outcomes of mammography in patients who presented for both screening and diagnostic mammography in our hospital. Although we found less number of patients having diagnosed or developed breast cancer (on follow-up mammography and biopsy results) with initial negative mammogram studies. Careful analysis of clinical and imaging findings were made and interviews with the patients conducted to sort out cause of such unfortunate outcome (of missed breast cancer). Results: We found important aspects of missed breast cancers because of patient factors (lack of awareness for importance of regular check-up, social factors, inertia for access to care and late check-up), imaging related (suboptimal acquisition of mammogram views), physician related (unfamiliarity with rad-reports and BIRADS classification, late referral) and natural causes (rapid course of disease). Conclusion: Causes of missed breast cancers may be simple to understand but sometimes overlooked by anyone in the chain of process (from technician, patient, radiologist and physician). Careful analysis, creating awareness and implementing standardized practice may help to overcome such unwanted events.