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Objectives: To assess urinary calculi and the secondary signs of obstruction in patients referred from the accident and emergency department by unenhanced computed tomography examination and to review the radiation dose the patients received with the use of automatic dose modulation technique care dose 4D. Material and methods Medical records of unenhanced multi-slice computed tomography (MSCT) examinations for 114 patients referred to the emergency department for analysis of suspected urinary calculi were reviewed retrospectively. Their treatment involved automatic tube current modulation a dose reduction method (care dose 4D) in Hamad General Hospital. The cases were analyzed for the presence of stones size site density and the secondary signs of obstruction namely hydronephrosis hydroureter perinephric fat stranding peri-ureteric fat stranding and renal enlargement. A search for alternate diagnosis was made if no stone was found. The final diagnosis was noted from the discharge summary in medical records. The radiation dose Computed Tomographic Dose Index volume (CTDI) and Dose Length Product (DLP) in each patient was recorded from patient protocol. Results Of 114 patients referred to CT scan for suspected urinary calculi between March and June 2008 urinary calculi were noted in 75.4%. An alternate diagnosis was offered to 5.3% and a diagnosis of normal was given to 19.3%. The size of stones detected varied from 2 mm–35 mm. Density of stones varied from 110–1250 hounsfield units (HU). Solitary stones were seen in 54.4% of cases observed and multiple stones in 22%. Renal stones were observed in 6.1% of cases urteric stones in 26.3% vesico-uretric junction stones in 18.4% multiple sites in 23.7%. Hydronephrosis was seen in 68% of cases hydroureter in 63% perinephric fat stranding in 51% periureteral fat stranding in 34% ureteric rim sign in 28% and renomegaly in 24%.

Time interval between onset of symptoms to imaging varied from 4 to 12 hours. The radiation dose CTDI ranged from 6.5–15.8 mGy and DLP from 257 to 918 mGy/cm with the use of automatic tube current modulation care dose 4D. Final diagnosis and MSCT diagnosis were in concordance in 86 (75% of) patients of renal calculi and alternate diagnosis in 6 (5.3%) of patients and normal in rest of the patients. Conclusion In clinically-suspected urinary calculi unenhanced MSCT of abdomen with the use of care dose 4D an automatic tube current modulation technique is a fast and reliable investigation in an emergency setting to detect stones and secondary signs of obstruction. It offers alternate diagnosis with substantial reduction in radiation dose—both the computed tomography dose index (CTDI) and dose length product (DLP).

Malignancy in undescended testis is well documented. We present a rare case—of seminoma in an adult male found in an intra abdominal testis—that is associated with ipsilateral renal agenesis and absence of ipsilateral seminal vesicle.

Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray but diagnosed by computed tomography (CT) is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group and (b) tube thoracostomy group. Results: During the study period 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%) bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.