Medical doctor, trained at Cambridge University, now working as a Consultant Radiologist.Wide experience in most areas of diagnostic imaging with an interest in biopsies and basic interventional procedures.Particular interest in Body Imaging (GI and HPB), MSK and cardiac imaging with a burgeoning interest in Prostate imaging
Cholecystocolic fistula is the most infrequent biliary enteric fistula, causing significant morbi... more Cholecystocolic fistula is the most infrequent biliary enteric fistula, causing significant morbidity and representing a diagnostic challenge. Modern diagnostic tools, like crossectional imaging is required preoperatively. These fistulae are treated mostly by open as well as laparoscopic surgery. We report an imaging review of Cholecystocholic fistula. Patient present with abdominal pain & bleeding per rectum. Previous ultrasound was done few months ago with cholelithiasis, because of acute abdomen we directly precede with Computed Tomography abdomen with I/V contrast. The case was finally diagnosed on the CT scan abdomen as Cholecystocolic fistula in the background of Acute cholecystitis. Computed Tomography is the best tool not only to diagnose but findings the complication associated with Cholecysto-Colic /Enteric Fistula. Keywords: Biliary-enteric fistula, Complicated acute cholecystitis, Cholecystocolic fistula
To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid... more To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in ad... more Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in adults. The incidence in children is not established. There is limited literature available in children with insulinoma, and only one case is reported in association with Down’s syndrome in adults. Insulinoma diagnosis is frequently missed in adults as well as in children. The Whipple triad is the most striking feature although it has limited application in young children. Hypoglycaemia with elevated insulin, C-peptide and absent ketones is highly suggestive of hyperinsulinism. We present a case of 10-year-old boy with Down’s syndrome with recurrent insulinoma. He was initially misdiagnosed as having an adrenal insufficiency and developed cushingoid features and obesity secondary to hydrocortisone treatment and excessive sugar intake. The tumour was successfully localised in the head of the pancreas with an MRI and octreotide scan on first presentation. Medical treatment with diazoxide and...
British Journal of Medical and Surgical Urology, 2011
ObjectiveTo determine the diagnostic accuracy of ultra-low dose contrast-enhanced CT (ULDCECT) an... more ObjectiveTo determine the diagnostic accuracy of ultra-low dose contrast-enhanced CT (ULDCECT) and its ability to measure differential renal function (DRF) in patients presenting clinically with acute ureteric colic by comparison to IVU (using an equivalent radiation exposure) and DMSA, respectively.
Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in ad... more Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in adults. The incidence in children is not established. There is limited literature available in children with insulinoma, and only one case is reported in association with Down’s syndrome in adults. Insulinoma diagnosis is frequently missed in adults as well as in children. The Whipple triad is the most striking feature although it has limited application in young children. Hypoglycaemia with elevated insulin, C-peptide and absent ketones is highly suggestive of hyperinsulinism. We present a case of 10-year-old boy with Down’s syndrome with recurrent insulinoma. He was initially misdiagnosed as having an adrenal insufficiency and developed cushingoid features and obesity secondary to hydrocortisone treatment and excessive sugar intake. The tumour was successfully localised in the head of the pancreas with an MRI and octreotide scan on first presentation. Medical treatment with diazoxide and...
To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube.... more To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube. Tubeless ureteral stent insertion was attempted in 41 (30 men, 11 women; eight, benign obstruction; nine outpatients) of 97 adults (56 excluded). Patients were clinically stable with known ureteral obstruction and had been referred for antegrade ureteral stent insertion. Exclusion criteria were infection, coagulopathy, or emergency cases. After renal access was achieved, ureteral stents were inserted. If drainage was satisfactory and there was no marked procedural bleeding, all access was removed without leaving a nephrostomy tube behind. Technical and clinical success rates and complications were assessed with review of radiologic and clinical notes. If one-stage stent insertion was unsuccessful, a nephrostomy tube was inserted and two-stage stent placement was performed. All 56 patients excluded from this study underwent two-stage stent placement. Major complication rate was assessed (Fisher test). One-stage stent insertion was technically successful in 36 (88%) patients; two with an identifiable risk factor (recent bladder operation, retrograde ureteral instrumentation) developed septicemia that required repeat nephrostomy tube insertion and 2-8 extra days of hospitalization. Clinical success rate was 83% (34 of 41). No major bleeding occurred. In 13 (36%) of 36 patients, hematuria lasted longer than 24 hours but resolved without further intervention or blood transfusion. In those who underwent two-stage stent placement (n = 61), technical success rate was 100%, but clinical success rate was 98%; one patient developed septicemia, and no major hemorrhage occurred. Difference in major complication rate between groups was not significant (6% [two of 36] vs 2% [one of 61]; P =.55). One-stage tubeless antegrade ureteral stent insertion in selected cases showed 88% technical success rate and 83% clinical success rate, with no major hemorrhage.
We report our experience with a combined approach of endovascular biopsy followed by immediate st... more We report our experience with a combined approach of endovascular biopsy followed by immediate stenting in the management of superior vena cava (SVC) syndrome secondary to obstructing mediastinal masses. A diagnosis of malignancy was obtained in six of eight (75%) biopsies and symptomatic relief was accomplished in all patients. We have found this to be a rapid, safe and effective management strategy that we now consider for all patients presenting with de novo SVC syndrome.
To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid... more To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Cholecystocolic fistula is the most infrequent biliary enteric fistula, causing significant morbi... more Cholecystocolic fistula is the most infrequent biliary enteric fistula, causing significant morbidity and representing a diagnostic challenge. Modern diagnostic tools, like crossectional imaging is required preoperatively. These fistulae are treated mostly by open as well as laparoscopic surgery. We report an imaging review of Cholecystocholic fistula. Patient present with abdominal pain & bleeding per rectum. Previous ultrasound was done few months ago with cholelithiasis, because of acute abdomen we directly precede with Computed Tomography abdomen with I/V contrast. The case was finally diagnosed on the CT scan abdomen as Cholecystocolic fistula in the background of Acute cholecystitis. Computed Tomography is the best tool not only to diagnose but findings the complication associated with Cholecysto-Colic /Enteric Fistula. Keywords: Biliary-enteric fistula, Complicated acute cholecystitis, Cholecystocolic fistula
To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid... more To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in ad... more Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in adults. The incidence in children is not established. There is limited literature available in children with insulinoma, and only one case is reported in association with Down’s syndrome in adults. Insulinoma diagnosis is frequently missed in adults as well as in children. The Whipple triad is the most striking feature although it has limited application in young children. Hypoglycaemia with elevated insulin, C-peptide and absent ketones is highly suggestive of hyperinsulinism. We present a case of 10-year-old boy with Down’s syndrome with recurrent insulinoma. He was initially misdiagnosed as having an adrenal insufficiency and developed cushingoid features and obesity secondary to hydrocortisone treatment and excessive sugar intake. The tumour was successfully localised in the head of the pancreas with an MRI and octreotide scan on first presentation. Medical treatment with diazoxide and...
British Journal of Medical and Surgical Urology, 2011
ObjectiveTo determine the diagnostic accuracy of ultra-low dose contrast-enhanced CT (ULDCECT) an... more ObjectiveTo determine the diagnostic accuracy of ultra-low dose contrast-enhanced CT (ULDCECT) and its ability to measure differential renal function (DRF) in patients presenting clinically with acute ureteric colic by comparison to IVU (using an equivalent radiation exposure) and DMSA, respectively.
Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in ad... more Summary An insulinoma is a rare tumour with an incidence of four cases per million per year in adults. The incidence in children is not established. There is limited literature available in children with insulinoma, and only one case is reported in association with Down’s syndrome in adults. Insulinoma diagnosis is frequently missed in adults as well as in children. The Whipple triad is the most striking feature although it has limited application in young children. Hypoglycaemia with elevated insulin, C-peptide and absent ketones is highly suggestive of hyperinsulinism. We present a case of 10-year-old boy with Down’s syndrome with recurrent insulinoma. He was initially misdiagnosed as having an adrenal insufficiency and developed cushingoid features and obesity secondary to hydrocortisone treatment and excessive sugar intake. The tumour was successfully localised in the head of the pancreas with an MRI and octreotide scan on first presentation. Medical treatment with diazoxide and...
To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube.... more To evaluate one-stage antegrade ureteral stent placement without postprocedural nephrostomy tube. Tubeless ureteral stent insertion was attempted in 41 (30 men, 11 women; eight, benign obstruction; nine outpatients) of 97 adults (56 excluded). Patients were clinically stable with known ureteral obstruction and had been referred for antegrade ureteral stent insertion. Exclusion criteria were infection, coagulopathy, or emergency cases. After renal access was achieved, ureteral stents were inserted. If drainage was satisfactory and there was no marked procedural bleeding, all access was removed without leaving a nephrostomy tube behind. Technical and clinical success rates and complications were assessed with review of radiologic and clinical notes. If one-stage stent insertion was unsuccessful, a nephrostomy tube was inserted and two-stage stent placement was performed. All 56 patients excluded from this study underwent two-stage stent placement. Major complication rate was assessed (Fisher test). One-stage stent insertion was technically successful in 36 (88%) patients; two with an identifiable risk factor (recent bladder operation, retrograde ureteral instrumentation) developed septicemia that required repeat nephrostomy tube insertion and 2-8 extra days of hospitalization. Clinical success rate was 83% (34 of 41). No major bleeding occurred. In 13 (36%) of 36 patients, hematuria lasted longer than 24 hours but resolved without further intervention or blood transfusion. In those who underwent two-stage stent placement (n = 61), technical success rate was 100%, but clinical success rate was 98%; one patient developed septicemia, and no major hemorrhage occurred. Difference in major complication rate between groups was not significant (6% [two of 36] vs 2% [one of 61]; P =.55). One-stage tubeless antegrade ureteral stent insertion in selected cases showed 88% technical success rate and 83% clinical success rate, with no major hemorrhage.
We report our experience with a combined approach of endovascular biopsy followed by immediate st... more We report our experience with a combined approach of endovascular biopsy followed by immediate stenting in the management of superior vena cava (SVC) syndrome secondary to obstructing mediastinal masses. A diagnosis of malignancy was obtained in six of eight (75%) biopsies and symptomatic relief was accomplished in all patients. We have found this to be a rapid, safe and effective management strategy that we now consider for all patients presenting with de novo SVC syndrome.
To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid... more To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Uploads
Papers by Ziyad Abubacker