Background: Management of patients in the critical care setting is crucial. The availability, the absence of ionizing radiation and the non invasive nature of chest ultrasonography (US) have currently increased its use in the up-to-date work-up of various pleuropulmonary abnormalities in the critical care setting. Objective: To evaluate the sensitivity, specificity and diagnostic accuracy of chest US for various pleuropulmonary abnormalities in intensive care unit (ICU) patients. Materials and methods: Ninety consecutive patients admitted in chest ICU with respiratory distress were assessed clinically and by chest radiography (CXR). They were suspected to have a provisional diagnosis of any of the following pathological entities: pneumonic consolidation, bronchogenic carcinoma, metastatic pulmonary nodules, pleural effusion, pneumothorax, hydropneumothorax and mesothelioma. These patients were scheduled for chest computed tomography (CT) and prospectively reviewed using chest US. The results of chest US were compared with these of chest CT for each encountered pathological entity using chest CT as the diagnostic standard of reference to subsequently calculate the sensitivity, specificity and diagnostic accuracy of chest US. Results: The sensitivity, specificity and diagnostic accuracy of chest US were 100%, 96% and 97% for pneumonic consolidation, 71%, 100% and 98% for bronchogenic carcinoma and 92%, 100% and 99% for pneumothorax respectively. The sensitivity, specificity and diagnostic accuracy of 100% for the rest of the included pathological entities were obtained. Conclusion: Chest ultrasonography has a considerable diagnostic performance for various pleuropulmonary pathological conditions that may be encountered in the ICU patients making it as an adjunct tool in the up-to-date work-up of the ICU setting.

Background: pericardial diseases are important causes of morbidity and mortality in cardiovascular diseases. CT and MRI are more than adjuncts to echocardiography in pericardial diseases assessment, as they provide an excellent pericardial anatomy delineation and precise pericardial lesions evaluation including; effusion, constrictive pericarditis, thickening, masses and congenital anomalies. Ideal management needs the proper imaging modality choosing ability. Aim of the Study: this study aimed to evaluate the role of CT and MRI versus echocardiography in the diagnosis of pericardial diseases and to show the limitations of each modality. Conclusion: tissue characterization with CMR is superior to cardiac CT and echocardiography. CMR can differentiate tumor from thrombus and is often helpful to assess the perfusion of a pericardial mass with the use of gadolinium contrast. The final diagnosis depends on typical pathologic features.

Background: Diffusion-weighted magnetic resonance imaging (DWI) with quantification of apparent diffusion coefficient (ADC) values is well established in the diagnosis of a variety of abdominal abnormalities. Regarding pancreatic disease, several investigators have shown that DWI with ADC measurement helps detect and characterize focal pancreatic lesions, as well as assess the severity of other pancreatic conditions. Objective: The study aimed to evaluate the diagnostic role of both normalized and mean apparent diffusion coefficient in discrimination between pancreatic lesions. Patients and Methods: Thirty-one participants presented with pancreatic lesions using clinical examination and ultrasound. Dynamic contrast MRI abdomen with diffusion-weighted MR imaging (DWI) on a 1.5-Tesla MRI machine was done. Mean ADC and normalized ADC (as the ratio of ADC of the lesion to the adjacent normal pancreas) were measured and compared. Results: Our study reported a mean ADC cut value of ≤1.47 while the cut-off value for normalized ADC was ≤ 0.96. Normalized ADC revealed a higher sensitivity 92.31%, specificity 88.89%, PPV 85.71, NPV 94.12%, accuracy 90.32%, positive likelihood ratio 8.31 and negative likelihood ratio 0.09 as compared to mean ADC, which revealed sensitivity 84.62%, specificity 77.78%, PPV 73.33%, NPV 87.5%, accuracy 80.65%, positive likelihood ratio 3.81 and negative likelihood ratio 0.2 respectively. Conclusion: Measuring the mean and normalized ADC value in pancreatic focal lesions can significantly differentiate between benign and malignant pancreatic lesions. However, normalized ADC has a higher sensitivity, specificity, PPV, and NPV than mean ADC value and could be used to differentiate between pancreatic lesions with higher accuracy than mean ADC.

Background: Massive hemoptysis is an emergent and lifethreatening condition with a high mortality rate. Bronchoscopy and MDCT scanning show significant contributing roles in delineating the etiology and the source of hemoptysis prior to bronchial artery arteriography. Aim of the work:To validate the role of the trans-catheter bronchial artery embolization in management of massive hemoptysis.Patients and Methods: Our study is a prospective cohort study that was held during the period between April 2017 and April 2019. The study included 20 patients who presented with massive hemoptysis refractory to supportive treatment measures with nonidentifiable source of bleeding on fiber-optic bronchoscope. Patients were referred from chest department to angio unit.Results: Our findings are in accordance with the current literature supporting bronchial artery embolization as a safe and long-term non-invasive effective method of treatment for massive hemoptysis with a high initial rate of success. BAE may help to avoid surgery in patients who are not good surgical candidates. If hemoptysis recur in these patients, embolization can be safely performed with good response rate. If surgery is indicated, BAE can stabilize the patient prior to surgery. Conclusion:Advancements in angiographic equipment and technique continue to improve success rates, and with careful technique, it can be performed safely and with minimal risk. Embolization distal to the spinal artery may significantly decrease the number of complications and may allow a more thorough embolization.

Background: Pulmonary embolism patients with contraindication to radiation exposure and contrast injection. Objective: comparative study between the non-contrast Magnetic Resonance Pulmonary Angiography (MR PA) and the Computed Tomography Angiography (CTA) in diagnosis of pulmonary embolism (PE). Patients and methods: twenty-one patients were included in our study. All patients were admitted and/or referred to Ain Shams University Hospital Departments, Kasr El Ainy Hospital and private centers confirmed to have pulmonary embolism (PE) by CTA. All patients underwent CTA and non-contrast MR-PA in the same day or within three consecutive days. The radiological examinations were interpreted by two different radiologists. The results were compared and statistically analyzed. Results: The mean age of the selected patients was about 49.43years old. 16 cases showed positive PE in both MR-PA and CTA. The 5 cases showed negative results in both. Conclusion: The non-contrast MR-PA has a reasonable sensitivity and specificity in the diagnosis of PE especially in major branches. So, it can be used as an alternative to the CTA especially when the CTA and the use of gadolinium are contraindicated.