mahnoor hafeez - Academia.edu (original) (raw)

Papers by mahnoor hafeez

Rawal Medical Journal, 2021

Personally, it was a great experience to attend these courses. It helped me in rapid revision and... more Personally, it was a great experience to attend these courses. It helped me in rapid revision and built my confidence to speak in front of examiners. Since CPSP had been playing a promising role for residents practice via conducting Pre-Exam Mock Courses for years, ZU faculty has leaded the show in innovation of academic activity of pre-exam voluntary teaching in a unique and nondiscriminatory manner. It’s high time to recognize the value of technology and ensure our maximal participation in such activities to the best of our capacity, for the betterment of our residents and to enhance our own professional excellence, meeting international standards.

Pakistan Journal of Neurological Sciences, 2017

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension,... more We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous aneurysm rupture. Aneurysms of the subclavianaxillary artery are rare in the clinical setting, accounting for less than 1% of all peripheral arterial aneurysms.

JPMA. The Journal of the Pakistan Medical Association, 2018

We report the MRI dorsolumbar spine of 10-year child who was referred to the Civil Hospital in Ju... more We report the MRI dorsolumbar spine of 10-year child who was referred to the Civil Hospital in June 2016 with symptoms of backache for last one month and birth history of congenital discharging sinus. Magnetic Resonance Imaging of his spine revealed type A diastematomyelia, multilevel vertebral segmentation anomalies, anterior and posterior spina bifida and tethered cord, along with dorsal dermal sinus and lipomyelocele. Magnetic Resonance Imaging (MRI) is the investigation of choice for diagnosing occult spinal dysraphisms 1 . We present the rare case of triple occult spinal dysraphic anomaly of different embryological origin in a single patient.

We report the case of 74 years old male Hepatitis C patient who presented to the Civil Hospital K... more We report the case of 74 years old male Hepatitis C patient who presented to the Civil Hospital Karachi with history of repeated episodes of haematemesis, epigastic pain, abdominal fullness, bloating and generalised malaise for 1 year. His Alpha feto-protein levels were 1100 ng/mL; he was suspected of having hepatocellular malignancy, therefore underwent Triphasic CT of the Abdomen. Apart from demonstration of Multicentric Hepatoma, a giant Gastric Diverticulum (8.8 x 12.0 cm- CCxAP dimensions) at pyloric region was incidentally seen at the CT scan. The presence of gastric diverticula in the antrum, prepyloric or pyloric region is extremely rare. To the best of authors’ knowledge, a huge pre-pyloric gastric diverticulum has not been reported previously in the literature. Key words: gastric diverticulum, Computed tomography, CT.

Pakistan Journal of Neurological Sciences, 2016

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood... more Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the Head revealed multiple hyper dense extra-axial nodular masses (with mean value of 48 HU) which showed vivid enhancement on post contrast images, along with multiple subcutaneous enhancing nodules seen in the scalp and maxillofacial region. The CSF cytological examination confirmed presence of immature leukemic cells in the subarachnoid spa...

Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke w... more Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Here, we present a unique manifestation of ICAD presenting as headache in a 53 years old Hypertensive and Diabetic patient. CT demonstrated sulcal sub-arachnoid hemorrhage (sSAH), with no infarct. He was referred to Dow University Hospital for CT Angiography examination, which revealed > 90% narrowing of the supraclinoid segments of Atherosclerotic internal carotid arteries (ICA) with extensive leptomeningeal collaterals, supplied by posterior circulation. To the best of authors’ knowledge, only single case analogous to it, on DSA has been published in the International Radiology literature. Key words: CT angiography, intracranial arteriosclerosis, neuroradiology, non-aneurysmal sulcal sub arachnoid hemorrhage, sSAH.

BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth m... more BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth most common cancer in the world, and develops in a background of cirrhotic liver. Our objective was to determine the diagnostic accuracy of Triphasic MDCT in detection of hepatocellular carcinoma in hepatitis B and C patients, taking histopathology as gold standard. MATERIAL AND METHODS : The Cross Sectional study was performed on 183 patients at Department of Diagnostic Radiology and imaging, Civil Hospital Karachi for a period of eight months from June 2015 to February 2016. Standard MDCT technique is used for evaluation of ultrasound detected hepatic mass in patients with viral hepatitis B or C. Its enhancement pattern on arterial, portal and delayed phase were carefully evaluated and then compared with the histopathology. RESULTS : Mean age of the patients was 52.03±13.42 years. Gender distribution shows 128 patients (69.9%) were male while remaining 55 patients (30.1%) were female. R...

Pakistan Journal of Neurological Sciences, 2016

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years ... more We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the liver, spleen, and lymph nodes.Intracranial extra medullary hematopoiesis is a relatively rare manifestation of Thalassemia. There is paucity of literature for MR findings regarding intracranial EMH. It is essential to distinguish it from other central nervous system tumors, because treatment and prognos...

We report the concurrent occurrence of Hirsch sprung disease and multiple polyposis coli on Bariu... more We report the concurrent occurrence of Hirsch sprung disease and multiple polyposis coli on Barium enema confirmed with histopathology in a 7 year old child who presented to the Civil Hospital Karachi with history of chronic constipation. Hirsch sprung disease is the most common cause of colonic obstruction in a pediatric age population. The polyposis syndromes are rare disorders in which more than 100 gastrointestinal polyps are present throughout the GI tract.. To the best of authors’ knowledge, the concurrent occurrence of these two diseases has not been reported earlier in the literature. Key words: Hirsch sprung disease, Barium enema, and polyposis coli.

We describe the case of a 12-years old male who was referred to the Civil Hospital in August 2016... more We describe the case of a 12-years old male who was referred to the Civil Hospital in August 2016 with symptoms of generalized tonic clonic seizures. His MRI of the brain showed well bilateral lobulated hyperintense lesions occupying the body of the sphenoid bone. The lesion was hyperintense on T1- and T2-weighted sequences with central foci of hypointensity, without enhancement of the lesions after i.v. gadolinium injection. The CT scan revealed bilateral expansile osteolytic hypodense lesions involving the sphenoid body with central foci of calcification and the average Hounsfield Unit value of the lesions ranging from −85 to −90 HU confirming the fatty nature of the tumor. The radiologic features were consistent with intraosseus lipoma of the sphenoid bone, which is extremely rare 1 . To best of our knowledge, we are reporting the first case of bilateral sphenoid intraosseus lipomas with characteristic MR and CT imaging features. Key words: bilateral, Intraosseous lipoma, sphenoi...

We present a rare case of young unmarried women presented left lumbar pain and burning micturitio... more We present a rare case of young unmarried women presented left lumbar pain and burning micturition for one month. The IVP and CTU demonstrated right ectopic triplex kidney and left duplex kidney with staghorn calculus in lower moiety and hydronephrosis in upper and lower moiety. It was associated with bicornuate uterus with single cervix and vagina confirmed on MRI Pelvis. To the best of authors’ knowledge, the Triplex Ectopic Kidney has not been described earlier in the literature.

We report an unusual case of a 2 year child who presented to the Civil Hospital with congenital f... more We report an unusual case of a 2 year child who presented to the Civil Hospital with congenital facial deformity and delayed developmental milestones. His MRI and CT scan demonstrated peri-callosal lipoma with callosal dysgenesis, right parasagittal arachnoid cyst, left para-sellar dermoid with internal carotid artery encasement, falx calcification, right nasal dermoid causing hypertelorism, with ipsilateral nasal cleft, frontal and cribriform plate defects. To the best of authors’ knowledge, this unique combination of Cranio-facial and CNS anomalies has not been described earlier in the literature. Key words: Dermoid Cyst, Peri-Callosal Lipoma, Callosal Dysgenesis, Nasal Dermoid, Falx Calcification.

Pakistan Journal of Neurological Sciences, 2017

Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors' knowledge, the... more Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors' knowledge, the extra-axial CNS histiocytic Sarcoma involving FalxCerebriin the humans has not been described earlier in the literature.We report an unusual case of22 year old male who presented to the Civil Hospital with symptoms of chronic headache and bilateral lower limb weakness. His MRI Brain showed an aggressive heterogeneously enhancing extraaxialfalxtumor with trans-calvarial invasion seen on interim CT scan and demonstration of distant metastases after resection and craniectomy. The immune-histochemical analysis was strongly positive CD68 and S-100 signifying Histiocytic Sarcoma.

15 years old girl was presented to the Plastic Surgery Department with soft tissue lesion of the... more 15 years old girl was presented to the Plastic Surgery Department with soft tissue lesion of the right forearm since birth. Her MRI done shows venous malformation of right antebrachial region with diffuse cutaneous, subcutaneous and intramuscular extension, varicose veins and soft tissue hemihypertrophy of right upper limb. This report highlights the importance of this rare entity in patients presents with congenital vascular limb anomalies.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017

We present a case of 36-year male patient who was referred to the Civil Hospital, Karachi with in... more We present a case of 36-year male patient who was referred to the Civil Hospital, Karachi with intermittent abdominal pain and vomiting for the last 2 years. The contrast enhanced CTexamination revealed changes of acute pancreatitis, CTSI 4/10, pancreatic calcifications along with 22x17 mm partially thrombosed pseudoaneurysm of gastroduodenal artery. The aberrant right hepatic artery was incidentally seen, on the arterial phase acquisition, arising directly from abdominal aorta. Gastroduodenal artery pseudoaneurysm is a rare complication of acute pancreatitis. It can lead to hematemesis, and it can bleed massively into peritoneal cavity. The aberrant origin of right hepatic artery from the aorta is extremely rare. To the best of authors' knowledge, less than five cases have been reported previously in literature.

Rawal Medical Journal, 2021

Personally, it was a great experience to attend these courses. It helped me in rapid revision and... more Personally, it was a great experience to attend these courses. It helped me in rapid revision and built my confidence to speak in front of examiners. Since CPSP had been playing a promising role for residents practice via conducting Pre-Exam Mock Courses for years, ZU faculty has leaded the show in innovation of academic activity of pre-exam voluntary teaching in a unique and nondiscriminatory manner. It’s high time to recognize the value of technology and ensure our maximal participation in such activities to the best of our capacity, for the betterment of our residents and to enhance our own professional excellence, meeting international standards.

Pakistan Journal of Neurological Sciences, 2017

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension,... more We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous aneurysm rupture. Aneurysms of the subclavianaxillary artery are rare in the clinical setting, accounting for less than 1% of all peripheral arterial aneurysms.

JPMA. The Journal of the Pakistan Medical Association, 2018

We report the MRI dorsolumbar spine of 10-year child who was referred to the Civil Hospital in Ju... more We report the MRI dorsolumbar spine of 10-year child who was referred to the Civil Hospital in June 2016 with symptoms of backache for last one month and birth history of congenital discharging sinus. Magnetic Resonance Imaging of his spine revealed type A diastematomyelia, multilevel vertebral segmentation anomalies, anterior and posterior spina bifida and tethered cord, along with dorsal dermal sinus and lipomyelocele. Magnetic Resonance Imaging (MRI) is the investigation of choice for diagnosing occult spinal dysraphisms 1 . We present the rare case of triple occult spinal dysraphic anomaly of different embryological origin in a single patient.

We report the case of 74 years old male Hepatitis C patient who presented to the Civil Hospital K... more We report the case of 74 years old male Hepatitis C patient who presented to the Civil Hospital Karachi with history of repeated episodes of haematemesis, epigastic pain, abdominal fullness, bloating and generalised malaise for 1 year. His Alpha feto-protein levels were 1100 ng/mL; he was suspected of having hepatocellular malignancy, therefore underwent Triphasic CT of the Abdomen. Apart from demonstration of Multicentric Hepatoma, a giant Gastric Diverticulum (8.8 x 12.0 cm- CCxAP dimensions) at pyloric region was incidentally seen at the CT scan. The presence of gastric diverticula in the antrum, prepyloric or pyloric region is extremely rare. To the best of authors’ knowledge, a huge pre-pyloric gastric diverticulum has not been reported previously in the literature. Key words: gastric diverticulum, Computed tomography, CT.

Pakistan Journal of Neurological Sciences, 2016

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood... more Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the Head revealed multiple hyper dense extra-axial nodular masses (with mean value of 48 HU) which showed vivid enhancement on post contrast images, along with multiple subcutaneous enhancing nodules seen in the scalp and maxillofacial region. The CSF cytological examination confirmed presence of immature leukemic cells in the subarachnoid spa...

Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke w... more Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Here, we present a unique manifestation of ICAD presenting as headache in a 53 years old Hypertensive and Diabetic patient. CT demonstrated sulcal sub-arachnoid hemorrhage (sSAH), with no infarct. He was referred to Dow University Hospital for CT Angiography examination, which revealed > 90% narrowing of the supraclinoid segments of Atherosclerotic internal carotid arteries (ICA) with extensive leptomeningeal collaterals, supplied by posterior circulation. To the best of authors’ knowledge, only single case analogous to it, on DSA has been published in the International Radiology literature. Key words: CT angiography, intracranial arteriosclerosis, neuroradiology, non-aneurysmal sulcal sub arachnoid hemorrhage, sSAH.

BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth m... more BACKGROUND: Hepatocellular carcinoma (HCC) is a major health problem worldwide. It is the fifth most common cancer in the world, and develops in a background of cirrhotic liver. Our objective was to determine the diagnostic accuracy of Triphasic MDCT in detection of hepatocellular carcinoma in hepatitis B and C patients, taking histopathology as gold standard. MATERIAL AND METHODS : The Cross Sectional study was performed on 183 patients at Department of Diagnostic Radiology and imaging, Civil Hospital Karachi for a period of eight months from June 2015 to February 2016. Standard MDCT technique is used for evaluation of ultrasound detected hepatic mass in patients with viral hepatitis B or C. Its enhancement pattern on arterial, portal and delayed phase were carefully evaluated and then compared with the histopathology. RESULTS : Mean age of the patients was 52.03±13.42 years. Gender distribution shows 128 patients (69.9%) were male while remaining 55 patients (30.1%) were female. R...

Pakistan Journal of Neurological Sciences, 2016

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years ... more We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the liver, spleen, and lymph nodes.Intracranial extra medullary hematopoiesis is a relatively rare manifestation of Thalassemia. There is paucity of literature for MR findings regarding intracranial EMH. It is essential to distinguish it from other central nervous system tumors, because treatment and prognos...

We report the concurrent occurrence of Hirsch sprung disease and multiple polyposis coli on Bariu... more We report the concurrent occurrence of Hirsch sprung disease and multiple polyposis coli on Barium enema confirmed with histopathology in a 7 year old child who presented to the Civil Hospital Karachi with history of chronic constipation. Hirsch sprung disease is the most common cause of colonic obstruction in a pediatric age population. The polyposis syndromes are rare disorders in which more than 100 gastrointestinal polyps are present throughout the GI tract.. To the best of authors’ knowledge, the concurrent occurrence of these two diseases has not been reported earlier in the literature. Key words: Hirsch sprung disease, Barium enema, and polyposis coli.

We describe the case of a 12-years old male who was referred to the Civil Hospital in August 2016... more We describe the case of a 12-years old male who was referred to the Civil Hospital in August 2016 with symptoms of generalized tonic clonic seizures. His MRI of the brain showed well bilateral lobulated hyperintense lesions occupying the body of the sphenoid bone. The lesion was hyperintense on T1- and T2-weighted sequences with central foci of hypointensity, without enhancement of the lesions after i.v. gadolinium injection. The CT scan revealed bilateral expansile osteolytic hypodense lesions involving the sphenoid body with central foci of calcification and the average Hounsfield Unit value of the lesions ranging from −85 to −90 HU confirming the fatty nature of the tumor. The radiologic features were consistent with intraosseus lipoma of the sphenoid bone, which is extremely rare 1 . To best of our knowledge, we are reporting the first case of bilateral sphenoid intraosseus lipomas with characteristic MR and CT imaging features. Key words: bilateral, Intraosseous lipoma, sphenoi...

We present a rare case of young unmarried women presented left lumbar pain and burning micturitio... more We present a rare case of young unmarried women presented left lumbar pain and burning micturition for one month. The IVP and CTU demonstrated right ectopic triplex kidney and left duplex kidney with staghorn calculus in lower moiety and hydronephrosis in upper and lower moiety. It was associated with bicornuate uterus with single cervix and vagina confirmed on MRI Pelvis. To the best of authors’ knowledge, the Triplex Ectopic Kidney has not been described earlier in the literature.

We report an unusual case of a 2 year child who presented to the Civil Hospital with congenital f... more We report an unusual case of a 2 year child who presented to the Civil Hospital with congenital facial deformity and delayed developmental milestones. His MRI and CT scan demonstrated peri-callosal lipoma with callosal dysgenesis, right parasagittal arachnoid cyst, left para-sellar dermoid with internal carotid artery encasement, falx calcification, right nasal dermoid causing hypertelorism, with ipsilateral nasal cleft, frontal and cribriform plate defects. To the best of authors’ knowledge, this unique combination of Cranio-facial and CNS anomalies has not been described earlier in the literature. Key words: Dermoid Cyst, Peri-Callosal Lipoma, Callosal Dysgenesis, Nasal Dermoid, Falx Calcification.

Pakistan Journal of Neurological Sciences, 2017

Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors' knowledge, the... more Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors' knowledge, the extra-axial CNS histiocytic Sarcoma involving FalxCerebriin the humans has not been described earlier in the literature.We report an unusual case of22 year old male who presented to the Civil Hospital with symptoms of chronic headache and bilateral lower limb weakness. His MRI Brain showed an aggressive heterogeneously enhancing extraaxialfalxtumor with trans-calvarial invasion seen on interim CT scan and demonstration of distant metastases after resection and craniectomy. The immune-histochemical analysis was strongly positive CD68 and S-100 signifying Histiocytic Sarcoma.

15 years old girl was presented to the Plastic Surgery Department with soft tissue lesion of the... more 15 years old girl was presented to the Plastic Surgery Department with soft tissue lesion of the right forearm since birth. Her MRI done shows venous malformation of right antebrachial region with diffuse cutaneous, subcutaneous and intramuscular extension, varicose veins and soft tissue hemihypertrophy of right upper limb. This report highlights the importance of this rare entity in patients presents with congenital vascular limb anomalies.

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017

We present a case of 36-year male patient who was referred to the Civil Hospital, Karachi with in... more We present a case of 36-year male patient who was referred to the Civil Hospital, Karachi with intermittent abdominal pain and vomiting for the last 2 years. The contrast enhanced CTexamination revealed changes of acute pancreatitis, CTSI 4/10, pancreatic calcifications along with 22x17 mm partially thrombosed pseudoaneurysm of gastroduodenal artery. The aberrant right hepatic artery was incidentally seen, on the arterial phase acquisition, arising directly from abdominal aorta. Gastroduodenal artery pseudoaneurysm is a rare complication of acute pancreatitis. It can lead to hematemesis, and it can bleed massively into peritoneal cavity. The aberrant origin of right hepatic artery from the aorta is extremely rare. To the best of authors' knowledge, less than five cases have been reported previously in literature.