Characteristic Findings Research Articles

Inferior glenohumeral joint capsule thickness in frozen shoulder via ultrasonography

BackgroundThe thickening of the inferior glenohumeral joint capsule (IGC) is a characteristic finding in frozen shoulders. However, the relationship between the thickness of the IGC measured using ultrasonography (US) and the range of motion (ROM) remains unclear. This study aimed to investigate a suitable IGC thickness measurement site that can reflect the ROM of frozen shoulders. MethodsThe participants were Twenty-nine patients with frozen shoulder and 20 healthy shoulders of 10 healthy adult. US measurements of the IGC were performed at 80° elevation in the scapular plane, with thickness was measured at three levels in both groups: just above the surgical neck, just above the anatomical neck, and at the parenchymal level. The relationship between thickness and ROM at the three levels was also assessed. The thickness of the IGC was evaluated using MRI and US, as well as the validity of US evaluation. ResultsThere was a positive correlation (r=0.72) between MRI- and US-measured IGC thickness. The IGC was thicker in the frozen shoulder group than in the control group at all three levels (p<0.001). The thickness of the IGC at the parenchymal level showed a significant negative correlation with all ROMs: flexion (r = −0.63), abduction (r = −0.60), external rotation (r = −0.50), and internal rotation (r = −0.52). ConclusionThe thickness of the IGC at the parenchymal level is negatively correlated with the ROM. The evaluation of the IGC in this study will be helpful in selecting treatment options for frozen shoulders.

Frequency of Hypoglycemia in Cirrhotic Patients Undergoing Endoscopy.

Liver cirrhosis isthe replacement of normal liver parenchyma by fibrous tissue and nodularity. Cirrhosis liver has a negative effect on the body's ability to regulate blood glucose levels because the liver cannot release the amount of glucose it wouldultimately cirrhotic patients are atrisk of hypoglycemia. To determine the frequency of hypoglycemia in cirrhotic patients just before endoscopy after being nil per mouth (NPO) for 6 hours. This cross-sectional study was done at the Department of Gastroenterology Lady Reading Hospital, Peshawar from 1st April 2023 to 30th September 2023.Patients aged > 20 years of both genders, having Child-Pugh class C cirrhosis, and undergoing upper gastrointestinal (GI) endoscopy were enrolled in the study while patients with a history of diabetes using oral or parenteral hypoglycemic medications, patients taking steroids, patients with hepatocellular carcinoma and patients with hepatic encephalopathy were excluded. Diagnosis of liver cirrhosis was based on clinical examination, serum albumin level, and prothrombin time followed by characteristic findings on ultrasound. Serum glucose level was determined in the blood sample of the patient from the hospital laboratory. Results:One hundred and ninety-six patients were enrolled including 130 (67.4%) males and 66 (32.6%) females. Age of the patients ranged from 20 to 60 years. The mean age of the participants was 46.68±10.239 years. Hypoglycemia was found in 48% of patients with liver cirrhosis. A significant association of hypoglycemia was found with disease duration and Child-Pugh class. Hypoglycemia is a frequent finding in patients with liver cirrhosis and needs urgent management to prevent complications. Prolonged illness and patients with Child-Pugh class C cirrhosis are more likely to have hypoglycemia.

Preliminary Findings of Vocal Fold Vibratory Characteristics of Singers Analyzed by Laryngeal High-Speed Videoendoscopy

ObjectivesThis study investigates the vocal fold vibratory dynamics of singers, which are postulated to differ from those of normal speakers due to the singers' regular vocal training. The measurement of vocal fold vibration involved the utilization of laryngeal high-speed video endoscopy (LHSV) and subsequent LHSV-based analysis. The focus is to characterize and compare the LHSV-based measures derived from the glottal area waveform (GAW), namely fundamental frequency (F0GAW), glottal perturbation (jitterGAW and shimmerGAW), open quotient (OQGAW), and Nyquist plots, between singers and normal speakers across genders. MethodsParticipants comprised 13 singers from a local cultural and heritage academy and 56 normal speakers from a local university, all were evaluated to have normal voices. Each participant underwent LHSV procedures to capture images of vocal fold vibration, which were subsequently analyzed to generate the LHSV-based measures. ResultsMale singers exhibited lower F0GAW, jitterGAW, shimmerGAW, and OQGAW than female singers. When compared to normal speakers, male singers demonstrated higher F0GAW, and lower jitterGAW and shimmerGAW. No difference in OQGAW was found between male singers and normal speakers. Female singers exhibited lower jitterGAW compared to normal speakers, but no differences were observed in shimmerGAW and OQGAW. The results of Nyquist plots indicated no gender-related associations between types of rim width and among singers. However, for rim pattern, male singers were associated with a higher percentage of clustered rim, suggesting more regular vocal fold vibration, compared to female singers and male normal speakers. ConclusionsSingers, particularly male singers, demonstrate distinct and potentially superior vocal fold vibrations compared to normal speakers, likely attributed to their regular vocal training, resulting in refined vocal fold configurations even during speaking. Despite the limited sample of singers, the study offers valuable insights into the vocal fold vibratory behaviors in singers analyzed using LHSV.

Long-Term Follow-Up of Pediatric Excimer Laser-Assisted Penetrating Keratoplasty for Congenital Stromal Corneal Dystrophy.

The purpose of this study was to highlight characteristic clinical and microscopic findings and report the long-term follow-up of pediatric excimer laser-assisted penetrating keratoplasty (excimer-PKP) for congenital stromal corneal dystrophy (CSCD). A 2-year-old Greek child presented with CSCD at our department. Clinical examination showed bilateral flake-like whitish corneal opacities affecting the entire corneal stroma up to the limbus. Genetic testing identified a mutation of the decorin gene (c.962delA). The variant was not present in the parents and represented a de novo mutation. The uncorrected visual acuity was 20/100 in both eyes. Excimer-PKP (8.0/8.1 mm) was performed on the right eye at the age of 2.5 years and on the left eye at the age of 3 years. Postoperatively, alternating occlusion treatment was performed. The light microscopic examination demonstrated a disorganized extracellular matrix of the corneal stroma characterized by a prominent irregular arrangement of stromal collagen lamellae with large interlamellar clefts containing ground substance, highlighted by periodic acid-Schiff- and Alcian blue-positive reaction detecting acid mucopolysaccharides. Electron microscopy showed disorganization and caliber variation of collagen lamellae and thin filaments within an electron-lucent ground substance. The postoperative course was unremarkable. Both grafts remained completely clear 14 years postoperatively. Corneal tomography showed moderate regular astigmatism with normal corneal thickness. The corrected distance visual acuity was 20/25 in both eyes. Excimer-PKP for CSCD might be associated with excellent long-term results and a good prognosis, particularly when the primary surgery is performed at a very young age. However, this requires close postoperative follow-up examinations by an experienced pediatric ophthalmologist to avoid severe amblyopia.

Imaging the Male Breast: Gynecomastia, Male Breast Cancer, and Beyond.

The number of men undergoing breast imaging has increased in recent years, according to some reports. Most male breast concerns are related to benign causes, most commonly gynecomastia. The range of abnormalities typically encountered in the male breast is less broad than that encountered in women, given that lobule formation rarely occurs in men. Other benign causes of male breast palpable abnormalities with characteristic imaging findings include lipomas, sebaceous or epidermal inclusion cysts, and intramammary lymph nodes. Male breast cancer (MBC) is rare, representing up to 1% of breast cancer cases, but some data indicate that its incidence is increasing. MBC demonstrates some clinical features that overlap with those of gynecomastia, including a propensity for the subareolar breast. Men with breast cancer tend to present at a later stage than do women. MBC typically has similar imaging features to those of female breast cancer, often characterized by an irregular mass that may have associated calcifications. Occasionally, however, MBC has a benign-appearing imaging phenotype, with an oval shape and circumscribed margins, and therefore most solid breast masses in men require tissue diagnosis. Histopathologic evaluation may alternatively reveal other benign breast masses found in men, including papillomas, myofibroblastomas, and hemangiomas. Radiologists must be familiar with the breadth of male breast abnormalities to meet the rising challenge of caring for these patients. ©RSNA, 2024 Supplemental material is available for this article.

The role of radiological imaging in the management of severe and difficult-to-treat asthma.

Radiological imaging has proven to be a useful tool in the assessment of asthma, its comorbidities and potential complications. Characteristic chest radiograph and computed tomography scan findings can be seen in asthma and in other conditions that can coexist with or be misdiagnosed as asthma, including chronic rhinosinusitis, inducible laryngeal obstruction, excessive dynamic airway collapse, tracheobronchomalacia, concomitant COPD, bronchiectasis, allergic bronchopulmonary aspergillosis, eosinophilic granulomatosis with polyangiitis, and eosinophilic pneumonia. The identification of the characteristic radiological findings of these conditions is often essential in making the correct diagnosis and provision of appropriate management and treatment. Furthermore, radiological imaging modalities can be used to monitor response to therapy.

Approach to Acute Traumatic and Nontraumatic Diaphragmatic Abnormalities.

Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors. ©RSNA, 2024 Supplemental material is available for this article.

INTRAOSSEOUS CAVERNOUS HEMANGIOMA OF THE ZYGOMA: A CASE REPORT

The incidence of intraosseous hemangiomas is low; they represent less than 1% of all bone tumors. The most common locations are the calvaria and vertebrae. Lesions affecting facial bones are rare and can involve the maxillae, mandibulae, nasals, and zygomatics. In zygomatic location its a slow-growing tumor that primarily affects adult women. Herein, we report a case of intraosseous hemangioma of the zygomatic bone in a man aged of 55 years old. The diagnosis of intraosseous hemangioma was made following radiological examination due to the characteristic imaging findings and confirmed after surgical excision by anatomopathological exam.

Imaging classification of pancreatic ductal adenocarcinoma with histological large duct pattern.

To investigate the imaging features of pancreatic ductal adenocarcinoma (PDAC) with histological large duct pattern. Our study included 37 patients (mean age, 66.5 years; 22 women) with surgically proven PDAC with histological large duct pattern, whose imaging features were classified into four types: Type I, solid mass; Type II, predominantly cystic mass with intracystic solid components; Type III, predominantly solid mass with intratumoral cysts; and Type IV, solid mass with peritumoral retention cysts or pseudocysts. Two radiologists independently analyzed both CT and MRI images for the morphological type, presence of abrupt main pancreatic duct (MPD) cutoff, adjacent vascular invasion, diffusion restriction, and reached consensus. On CT, 26 patients (70.3%) had Type I tumors, five (13.5%) had Type II, three (8.1%) had Type III, and three (8.1%) had Type IV. Among the 26 patients with Type I tumors on CT, 16 had tumors with multiple intratumoral cysts within the solid mass on MRI and were subsequently classified as Type III. Accordingly, 10 patients (27.0%) were classified as Type I, five (13.5%) as Type II, 19 (51.7%) as Type III, and three (8.1%) as Type IV on MRI. Of the 37 patients, 27 (73.0%) had an abrupt MPD cutoff, 15 (40.5%) had adjacent vascular invasion, and 25 (67.6%) had diffusion restriction on MRI. Predominantly solid pancreatic masses with small intratumoral cysts visualized on MRI may be a characteristic imaging finding of PDAC with histological large duct pattern, and differentiate it from conventional PDAC or other cystic pancreatic tumors. Radiologists should be familiar with the various imaging features of PDAC with histological large duct pattern and should be aware that it may mimic other solid or cystic tumors of the pancreas. Imaging features of pancreatic ductal adenocarcinoma with histological large duct pattern can be classified into four types. This pathology more frequently appears as a predominantly solid masswith intratumoral cysts on MRI than on CT. Adding MRI to CT may help identify pancreatic ductal adenocarcinoma with histological large duct pattern.

Electrocardiographic features in the early differential diagnosis of cardiac amyloidosis from cardiac sarcoidosis

Abstract Introduction Amyloidosis and sarcoidosis are both systemic infiltrative diseases which can cause cardiac involvement. Differentiating early-stage cardiac amyloidosis (CA) from cardiac sarcoidosis (CS) is still challenging, although hypertrophy for CA and septal thinning for CS are characteristic echocardiographic findings in each late-stage. The diagnosis is a time-sensitive issue, given the therapies for CA and CS likely to be effective at early disease stages. Purpose We aimed to evaluate the utility of electrocardiography (ECG) for distinguishing CA from CS before or early in the course of cardiomyopathy. Methods This study enrolled 36 consecutive patients (20 male, 75±13 years) diagnosed with transthyretin-CA in 25 (CA group) and isolated CS in 11 patients (CS group) according to accepted criteria at our institute from July 2014 to July 2023. We retrospectively reviewed electrocardiographic characteristics and clinical outcomes of early-stage CA and CS. Results The CS group were younger than the CA group at the time of diagnosis (59±9 vs 83±7 years, P&amp;lt;0.01) and had a shorter period between the date of their first ECG recording at our institute and the date of diagnosis (18±3 vs 62±67 months, P=0.012). Furthermore, the CA group showed specific P-waves with longer duration (142±19 vs 126±8 ms, P=0.003) and more notches and/or fragmentation (91% vs 33%, P=0.003) in the limb leads on the initial ECG than the CS group, although prolonged PR-interval is common in both CA and CS (191±44 vs. 208±43 ms, P=0.359). Unexpectedly, the CA group had a shorter QRS duration (103±25 vs 123±31 ms, P=0.047) and a higher R-wave in V5 (2.0±0.9 vs 1.3±1.1 mV, P=0.039) than the CS group. In addition, the low voltage in all limb leads, pseudoinfarct pattern and bundle branch block morphology characteristic of CA patients did not differ between diagnosis and initial examination. There were also no differences in atrial and ventricular arrhythmias. During the follow-up period, 5 patients (20%) in the CA group, but no patients in the CS group died. Conclusion CA and CS shares several electrocardiographic features. Prolonged P-wave with notches and fragmentation, suggesting atrial conduction disturbance, may be associated with amyloid deposition in CA. This finding might be useful in the early differential diagnosis for CA from CS.

Massive mandibular ameloblastoma masquerading malignancy: A unique case

Ameloblastomas are odontogenic tumours that arise from the maxilla and mandible. They are mostly benign but can seldom turn malignant. Their low incidence (&amp;#60;1-3%) and ambiguous presentation can often pose a diagnostic dilemma for the clinician. They are mostly diagnosed with the help of contrast-enhanced computed tomography scans and confirmed by characteristic findings on histopathological examination. We present a case of a 14-year-old boy presenting with a firm to hard external swelling on the right side of his face and extensive intraoral mass, which showed features of a bony malignancy but was subsequently diagnosed with ameloblastoma.

Radiological insights into rheumatoid meningitis - a rare central nervous system manifestation of rheumatoid arthritis: a retrospective review of six cases.

The objective is to analyze and review the clinical, laboratory, and neuroimaging characteristics of rheumatoid meningitis (RM) in six patients with known rheumatoid arthritis (RA). We performed a retrospective review of patients diagnosed with RM from August 2012 to June 2023. To identify the cases, we used medical term search engines and the hospital´s radiology case database. Clinical information and laboratory findings were gathered from the medical records. A neuroradiologist with five years of experience reviewed and analyzed the RM to determine the characteristics findings of RM. Six patients with RM are included. Seizures along with headaches were among the clinical signs that were documented. All the patients had high levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (ACPA) in the peripheral blood. Biopsy in two cases confirmed typical rheumatoid nodules. Leptomeningeal enhancement was found bilaterally in all cases and was predominantly found in the frontoparietal region. "Mismatch DWI/FLAIR" was found in five patients. Bilateral subdural collections could be found in two patients. Brain PET scan revealed increased metabolism in two cases. Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA) with challenging clinical diagnosis due to non-specific symptoms. This study highlights the importance of MR in detecting characteristic neuroimaging patterns, including "mismatch DWI/FLAIR", to aid in early diagnosis. Increased awareness of this condition may facilitate timely intervention and improve prognosis. These results still need to be verified by large studies.

Simple Lateral Elbow Dislocation: A Case Report

Elbow dislocations, particularly posterior dislocations, are common injuries, while simple lateral dislocations are rare but can present with significant neurovascular complications, posing challenges to closed reduction. We present a case of a 52-year-old man with a lateral elbow dislocation following a fall, successfully managed with a nonoperative reduction technique and early physiotherapy to prevent joint stiffness. Initial examination revealed characteristic findings, confirmed by radiographs. Closed reduction under sedation was achieved using fluoroscopy guidance, with subsequent stability testing revealing ligamentous injuries. Immobilization and progressive physiotherapy led to satisfactory outcomes, with restored range of motion and resolution of symptoms. Literature review highlights the rarity of lateral elbow dislocations and the importance of prompt intervention and rehabilitation for optimal recovery, emphasizing the need for further understanding and management strategies in such cases.

(What's the story) morning glory? MRI findings in morning glory disc anomaly.

Morning glory disc anomaly (MGDA) is a rare congenital ophthalmologic disorder. Historically it has been diagnosed fundoscopically, with little in the literature regarding its imaging findings. The purpose of this study is to further characterize the orbital and associated intracranial magnetic resonance imaging (MRI) findings of MGDA in our tertiary pediatric center. A retrospective review was performed of fundoscopically-diagnosed cases of MGDA, that had been referred for MRI. All MRI studies were scrutinized for orbital and other intracranial abnormalities known to occur in association with MGDA. 18 of 19 cases of MGDA showed three characteristic MRI findings: funnel-shaped morphology of the posterior optic disc, abnormal soft tissue associated with the retrobulbar optic nerve, and effacement of adjacent subarachnoid spaces. The ipsilateral (intraorbital) optic nerve was larger in one patient and smaller in six. The ipsilateral optic chiasm was larger in two patients and smaller in one. This study represents a comprehensive radiological-led investigation into MGDA. It describes the most frequently-encountered MRI findings in MGDA and emphasizes the importance of MRI in this cohort, i.e., in distinguishing MGDA from other posterior globe abnormalities, in assessing the visual pathway, and in screening for associated intracranial abnormalities - skull base/cerebral, vascular, and facial. It hypothesizes neurocristopathy as an underlying cause of MGDA and its associations. Caliber abnormalities of the ipsilateral optic nerve and chiasm are a frequent finding in MGDA. Optic pathway enlargement should not be labeled "glioma". (239/250).

Hypertrophic Column of Bertin: a renal tumor mimicker

Background: The hypertrophic column of Bertin is one of the congenital variants of the kidney. It's a rare case and is usually found as an incidental finding from renal ultrasound. Its characteristic of the finding may mimic a solid mass from an Ultrasound (US). Further examination may lead to unnecessary interventional or surgical procedures. Case Presentation: We reported a patient with a suspected left renal mass from the ultrasound finding, and the CT urography with contrast revealed that the lesion is a hypertrophic column Bertin (HCB). Conclusion: It's really important for clinicians and radiologists to know the characteristic findings of Bertin's Hypertrophic column to prevent unnecessary biopsy and surgical procedures.

Phenotype and Clinical Outcomes in Desmin-Related Arrhythmogenic Cardiomyopathy

BackgroundDesmin (DES) pathogenic variants cause a small proportion of arrhythmogenic cardiomyopathy (ACM). Outcomes data on DES-related ACM are scarce. ObjectivesThis study sought to provide information on the clinical phenotype and outcomes of patients with ACM caused by pathogenic variants of the DES gene in a multicenter cohort. MethodsWe collected phenotypic and outcomes data from 16 families with DES-related ACM from 10 European centers. We assessed in vitro DES aggregates. Major cardiac events were compared to historical controls with lamin A/C truncating variant (LMNA-tv) and filament C truncating variant (FLNC-tv) ACM. ResultsOf 82 patients (54% males, median age: 36 years), 11 experienced sudden cardiac death (SCD) (n = 7) or heart failure death (HFd)/heart transplantation (HTx) (n = 4) before clinical evaluation. Among 68 survivors, 59 (86%) presented signs of cardiomyopathy, with left ventricular (LV) dominant (50%) or biventricular (34%) disease. Mean LV ejection fraction was 51% ± 13%; 36 of 53 had late gadolinium enhancement (ring-like pattern in 49%). During a median of 6.73 years (Q1-Q3: 3.55-9.52 years), the composite endpoint (sustained ventricular tachycardia, aborted SCD, implantable cardioverter-defibrillator therapy, SCD, HFd, and HTx) was achieved in 15 additional patients with HFd/HTx (n = 5) and SCD/aborted SCD/implantable cardioverter-defibrillator therapy/sustained ventricular tachycardia (n = 10). Male sex (P = 0.004), nonsustained ventricular tachycardia (P = 0.017) and LV ejection fraction ≤50% (P = 0.012) were associated with the composite endpoint. Males with DES variants had similar outcomes to historical FLNC-tv and LMNA-tv controls. However, females showed better outcomes than those with LMNA-tv. In vitro experiments showed the characteristic finding of DES aggregates in 7 of 12 variants. ConclusionsDES ACM is associated with poor outcomes which can be predicted with potentially successful treatments, underscoring the importance of familial evaluation and genetic studies to identify at risk individuals.

Analysis of nutrient loads, heavy metals and physicochemical properties of wastewater, wetland grass, and papaya samples: Gondar Malt factory, Ethiopia with global implication

Robust attention was brought to researchers due to deterioration of wastewater quality of lakes and reservoirs as major global concerns by industrial release. The uncontrolled releases of effluents impose serious impacts for both aquatic and terrestrial environments. In the current study, many parameters like nutrient loads, heavy metals and physicochemical properties of wastewater, wetland grass, and papaya samples were analysed. The investigated nutrients, alkalinity, and total hardness in fresh water samples were within the allowable limits except for phosphate in fresh wastewater and alkalinity in wastewater. The detected levels of heavy metals (mg/L) in wastewater samples were:- Cd (0.386–0.905), Cr (ND-0.074), Cu (0.064–0.096), Mn (0.184–1.528), Fe (0.167–4.636), Zn (0.175–0.333), and Pb (0.044–0.892) (mg/L). The studied metals in the wastewater sample, except Cd, Fe, and Pb were lower than the allowable limit. The level of heavy metals in the grass and papaya samples ranged from Cd (37.14–147.62), Cr (ND-8.82), Cu (3.14–8.33), Mn (2.89–85.46), Fe(5.0–65.15), Zn (3.44–36.84), and Pb (ND-60.36) (mg/kg). The detected metals were below the permissible limits, except Cd, Cr, and Pb. The findings of the physicochemical characteristics in wastewater samples were computed: pH (6.61–8.54), temperatures (21.63–26.57 °C), TDS (205.9–1896 mg/L), EC (359.9–3226.67 μs/cm), BOD (12.0–732.67 mg/L), COD (3.67–1691.33 mg/L). Except for temperature and pH, all levels in the wastewater were above the recommended limit for wastewater discharge by USEPA.

Ectopic Pituitary Neuroendocrine Tumors/Adenomas Around the Sella Turcica

Functional or non-secretory ectopic pituitary neuroendocrine tumors (PitNET) can form around the sella turcica during the development of the adenohypophysis by differentiating and detaching from the pharyngeal roof. These tumors usually appear in the sphenoid sinus, clivus, cavernous sinus, infundibulum, and suprasellar cistern. Ectopic PitNETs typically display the characteristic magnetic resonance imaging findings of pituitary adenomas. However, preoperative diagnosis of PitNETs is usually challenging because of the variety of clinical and imaging presentations, locations, and sizes. Ectopic suprasellar PitNETs resemble mass lesions in the pituitary stalk. Ectopic cavernous sinus of PitNETs are typically microadenomas in the medial wall. Ectopic sphenoclival tumors are characterized by more aggressive tumor activity than the other ectopic PitNETs. Although ectopic PitNETs are exceedingly rare, they should be considered as a differential diagnosis for masses around the sella turcica. Treatment of the disease should be individualized and may include medical care, surgical resection, gamma-knife radiosurgery, and radiotherapy.

Clinical/electrophysiologic characteristics of infranodal Wenckebach in patients with indication for permanent ventricular pacing: A prospective study

BackgroundInfranodal Wenckebach is rare and not well characterized. ObjectiveWe prospectively studied clinical and electrophysiologic characteristics of patients with atrioventricular (AV) Wenckebach with an indication for permanent ventricular pacing. MethodsDuring a 2-year period, all patients with an indication for permanent ventricular pacing underwent targeted preimplantation electrophysiologic study. Clinical and electrophysiologic characteristics at presentation and ventricular pacing percentage at 6-month follow-up were evaluated. ResultsA total of 163 patients (median age, 68 [interquartile range, 60–74] years; male, 59%; median QRS duration, 110 [90–130] ms; complete AV block in 123 [75.5%]) were included. AV Wenckebach was noted in 22 (13.4%) patients (median age, 70 [63–76.5] years; male, 54%; median QRS duration, 120 [110–140] ms) and classified as infranodal (12/163 [7.3%]) vs AV nodal (10/163 [6.1%]). Patients with infranodal Wenckebach (infrahisian in all), compared with AV nodal Wenckebach, demonstrated higher frequency with left ventricular ejection fraction ≤40% (41.7% vs 0%; P = .04), longer median HV interval (90 vs 49 ms; P = .005), lower frequency of isolated first-degree AV block (8.3% vs 60%; P = .02), higher frequency of right bundle branch block with left anterior fascicular block (75% vs 10%; P = .003), lesser PR increment at onset of AV Wenckebach (20.5 vs 80 ms; P = .002), and onset of 2:1 AV block at longer cycle lengths (91.7% vs 20%; P = .002). ConclusionOf patients referred for pacemaker implantation, infranodal Wenckebach was present in 27.5% (11/40) without complete AV block. It was as frequent as AV nodal Wenckebach and associated with characteristic electrophysiologic findings.

Amoebic liver abscess in an adult Nigerian: A case report

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA. Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations. Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment. Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.