Abnormal Soft Tissue Density Research Articles

SUBCUTANEOUS ENDOMETRIOSIS: USUAL ENTITY AT AN UNUSUAL SITE

Background: Endometriosis is dened as a chronic, oestrogen- dependent, benign inammatory disease characterized by growth of endometrial glands and/ or stroma outside the uterine cavity. 25% of women affected with endometriosis are asymptomatic, other may present with symptoms like chronic pelvic or abdominal pain and/ or infertility. Common sites or ectopic locations include primarily the pelvic peritoneum, ovaries and rectovaginal septum. We are presenting a case of 30-year-old Indian women with com Case: plains of pain in abdomen and a palpable mass in the anterior abdominal wall in right iliac fossa. Computed Tomography (CT) abdomen and pelvis (Plain and contrast) showed large well dened abnormal soft tissue density mass lesion with inhomogeneous enhancement on contrast – Favouring: ? Infective ? Neoplastic etiology. Result: Excision was done and tissue was sent for histopathology. Histopathological diagnosis was made as Endometriosis. Keeping this case Conclusion: in mind, for patients with subcutaneous mass in anterior abdominal wall and complains of abdominal pain, endometriosis should always be kept as a differential diagnosis. Histopathology stands as a gold standard for the diagnosis as CT (Plain and contrast) is insufcient in the denitive diagnosis of such lesions.

AN UNUSUAL PRESENTATION OF ORBITAL PSEUDOTUMOR

The term orbital pseudotumor refers to a broad category of non-specic idiopathic inammations of the orbit, which may affect any orbital structure. A 28-year-old female presented with swelling in the right upper eyelid for 1 month associated with pain and mild redness of the eye. She was previously been seen by other ophthalmologists and diagnosed as Hordeolum Internum prescribed oral antibiotics and advised incision and drainage. She visited our OPD for secondary opinion and surgical treatment. Best Corrected Visual Acuity- R/E- 6/9, LE -6/6P. No Proptosis. No Limitation of Extra Ocular Movements. Considering the clinical presentation of the patient Computed Tomography orbit was advised, revealed abnormal soft tissue density in lateral aspect of right orbit within extraconal compartment suggestive of Orbital Pseudotumor. The patient was started on oral steroids and had a favourable outcome with no recurrence till date.

1694 Endoscopic Ultrasonography With Fine-Needle Aspiration in the Diagnosis of Metastatic Rectal Adenocarcinoma in Left Atrium

INTRODUCTION: Endoscopic ultrasonography(EUS) of the mediastinum with the use of fine needle aspiration(FNA) or biopsy can be used to characterize lesions that are within or adjacent to the esophageal wall, posterior and inferior mediastinum with minimal risk to the patient. EUS is an underutilized tool for identifying mediastinal masses and can help guide clinical decision making in patients with concerning lesions found on non-invasive imaging modalities. CASE DESCRIPTION/METHODS: A 71-year-old male with history of adenocarcinoma of the rectum with metastases to the liver and lung was treated with surgical resection and adjuvant chemotherapy. Patient responded well and was under regular surveillance when a new irregularly shaped abnormal soft tissue density measuring approximately 5.4 × 3.0 cm adjacent to the aorta and esophagus appearing to invade into the left atrium (Figure 1a) was found on a CT scan and confirmed on PET imaging. These findings favored rectal metastatic disease over thrombus but could not definitively rule out a new carcinoma. For that reason, an endoscopic ultrasonography was performed to determine the nature of the mass. A curvilinear array echoendoscope was used to visualize a 36 × 30 mm exophytic lesion within the left atrium which extended into the posterior mediastinum (Figure 2). Using Doppler to identify a vessel-free path, a 25-gauge needle was passed under ultrasound guidance through the esophagus and directly into the mass with the use of an endoscopic fine needle biopsy (FNB) device for three passes. Histopathological examination confirmed adenocarcinoma (Figure 3) and immunophenotype was compatible with colorectal primary which ruled out a pulmonary adenocarcinoma. DISCUSSION: The patient was determined to not be a surgical candidate due to the location of the mass and high risk nature of the surgery. The multidisciplinary team’s consensus was to repeat chemo-adjuvant therapy since he had responded so well previously. He received treatment and had follow up imaging six months after EUS diagnosis which showed decrease in size (Figure 1b) and activity of the mass. He is planned to have have stereotactic body radiation therapy to further decrease the size of the atrial mass. This case demonstrated how EUS with the use of FNA is a helpful tool in the prompt evaluation and confirmation of a mediastinal mass which allowed all physician’s involved in the care of the patient to develop and implement a treatment plan quickly. Watch the video: http://bit.ly/2Giu99S.

Esophageal perforation and mediastinitis after suicidal ingestion of 4.5% sodium hydrochlorite bleach

A 16-year-old woman deliberately drank 4.5% sodium hypochlorite bleach. She was transferred to the emergency department after gastric lavage was performed at a local clinic. She experienced chest pain and fever after several vomiting episodes and esophagoscopy. Chest computerized tomography (CT) revealed air bubbles and abnormal soft tissue density at the right lateral aspect of the mid esophagus, a small amount of complicated pleural effusion, and pneumothorax. Barium esophagography revealed abnormal leakage of contrast media at the right wall of the mid esophagus, which indicated acute mediastinitis. The patient received intensive care and underwent delayed esophageal repair and colonic transplant. She was discharged 12 weeks after admission.Sodium hypochlorite is found in household bleaching agents used to disinfect dishes and bleach laundry. Poisoning due to ingestion of sodium hypochlorite bleach usually follows a benign clinical course. Few studies report severe complications such as esophageal stenosis or perforation.

Antiperistaltic (retrograde) intussusception after laparoscopic Roux-en- Y gastric bypass procedure

R F t Small bowel obstructions are a well-recognized compliation after Roux-en-Y gastric bypass. Rarely, small bowel ntussusception causes the obstruction [1–13]. The prevailng hypothesis is that postoperative alterations in small bowel otility lead to this unusual complication [1,3,4,7–9]. A 46-year-old woman had undergone laparoscopic, retocolic, retrogastric Roux-en-Y gastric bypass 5 years beore presentation. Her body mass index had decreased from 5 to 26 kg/m. She presented with 8 hours of periumbilical bdominal pain, nausea, and bilious emesis. The physical xamination revealed a distended, tympanitic abdomen with yperactive bowel sounds and mild diffuse tenderness to alpation. Radiographs demonstrated dilated small bowel nd an abnormal soft-tissue density in the mid-abdomen Fig. 1). Contrast-enhanced computed tomography showed small bowel obstruction distal to the jejunojejunal anasomosis with intussusception (Fig. 2). Laparotomy revealed a retrograde intussusception startng 30-cm beyond the jejunojejunal anastomosis (Fig. 3). he common alimentary limb was also herniated through a ransverse mesocolon defect, although no obstruction was resent at this level. The intussusceptum (comprised of ommon channel) was manually reduced. Given the unclear tiology of the obstruction, the intussusceptum was reected. The mesocolonic hernia was reduced, and the meocolic and small bowel mesenteric defects were closed. athologic examination demonstrated mucosal necrosis and dema but no discrete lead point.

Computed tomography in suppurative ear disease: a correlation of surgical and radiographic findings.

Forty-two patients with chronic otitis media underwent preoperative CT scanning followed by surgical exploration of the middle ear and mastoid. The CT finding of abnormal soft tissue density associated with bone erosion was highly correlated with the surgical finding of cholesteatoma. By contrast, the total absence of abnormal soft tissue on CT essentially excluded cholesteatoma. However, 50% of all patients had abnormal soft tissue on CT scan not accompanied by bone erosion. In this largest group of patients it was not possible to diagnose or exclude cholesteatoma on the basis of CT findings alone. Also, CT occasionally gave the erroneous impression of lateral semicircular canal fistulization, tegmen tympani erosion, and facial nerve involvement due to volume averaging of these structures with adjacent soft tissues. CT scan has a role in the evaluation of selected patients with chronic otitis media, but must be interpreted cautiously in view of its limitations and numerous pitfalls.

Computed tomographic findings in carotid-cavernous fistula

Three cases of carotid-cavernous fistula showed characteristic CT findings with evidence of an enlarged superior ophthalmic vein and an abnormal soft-tissue density in the parasellar region. These findings appear to be quite specific for carotid-cavernous fistula.