Clinical Radiological Findings Research Articles

Procalcitonin Levels in Pulmonary Tuberculosis and Bacterial Pneumonia: A Cross-Sectional Study at a Tertiary Hospital in Indonesia

Background: Pulmonary tuberculosis (TB) and bacterial pneumonia are respiratory infections with high morbidity and mortality rates. Despite having similar clinical symptoms and radiological findings, these conditions require different treatment approaches. Procalcitonin is a potential biomarker to differentiate these conditions, as its levels tend to increase in bacterial infections but not in TB. This study aims to compare procalcitonin levels in patients with pulmonary TB and bacterial pneumonia. Methods: This research employed an observational analytic design with a cross-sectional approach conducted at Dr. Mohammad Hoesin General Hospital (RSMH), Palembang. The study subjects were patients with pulmonary TB and bacterial pneumonia who met the inclusion and exclusion criteria. Procalcitonin levels were measured using ELISA methods. Data were analyzed to determine differences in procalcitonin levels between the two groups. Results: The study found that procalcitonin levels in bacterial pneumonia patients were significantly higher than those in pulmonary TB patients (p<0.05). These findings indicate that procalcitonin levels can serve as a diagnostic parameter to distinguish between the two conditions. Conclusion: Procalcitonin levels can be a useful biomarker for differentiating pulmonary TB from bacterial pneumonia. This biomarker is expected to assist clinicians in making more accurate diagnoses and expediting clinical decision-making.

Aberrant Immunohistochemical stains among 573 cases of Diffuse Mesothelioma

Background: Diagnosis of malignant mesothelioma often requires differentiating it from other metastatic malignancies including breast cancer, lung cancer, ovarian cancer, colorectal cancer, etc. Immunohistochemical stains (IHC) are important means to assist in confirming mesothelioma and ruling out metastatic cancers. Although mesothelial specific markers have been used for diagnosis, aberrant immunostains were also observed in clinical practice which often confounded the diagnosis. In this study, we analyzed the positive rate of commonly used IHC markers in the diagnosis of mesothelioma among 573 patients. Design: 427 cases of epithelioid mesothelioma, 87 cases of biphasic mesothelioma and 59 cases with sarcomatoid mesothelioma were retrieved from the pathology consultation files between 2020-2023. The positive rates of over 50 IHC markers including over 30 aberrant IHC markers were analyzed. Results: The positive rates of mesothelial markers, such as calretinin, WT-1 and D2-40, and epithelial markers, such as cytokeratins, were highest in epithelioid type, intermediate in biphasic type and lowest in sarcomatoid type mesothelioma. The mesenchymal marker vimentin and additional marker GATA-3 were highly expressed in sarcomatoid mesothelioma. The highest loss rate of BAP-1 was in epithelioid type, while the highest loss rate of MTAP was in sarcomatoid type. The CDKN2A (p16) deletion was observed equally in both epithelioid and sarcomatoid/biphasic types. Over 30 aberrant markers were observed. For epithelioid type, commonly observed aberrant IHC markers included MOC-31, BerEP4, PAX-8, p63, CK20, NKX3.1 and ER. For biphasic type, significant aberrant IHC markers included MOC-31, Ber-EP4, PAX8, CK20 and p40. For sarcomatoid type, notable aberrant IHC markers included p63, SMA, ERG and CD31. Among these aberrant IHC markers, MOC-31, Ber-EP4 and p63 were more commonly observed in pleural epithelioid mesothelioma, whereas PAX-8 in peritoneal epithelioid mesothelioma. Conclusions: Our data demonstrated that aberrant immunostains were common in all of the histological types of mesothelioma. Therefore, the diagnosis of mesothelioma should be based on correlation of clinical presentation, radiological findings, and selective panel of immunostains, and should not be distracted by aberrant immunostains.

Young Onset Chronic Inflammatory Back Pain: A Diagnostic Dilemma Between Axial Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.

Diffuse idiopathic skeletal hyperostosis (DISH) and axial spondyloarthritis (axSpA) share similarities in both clinical presentation and radiological findings, making the diagnostic process challenging. We report the case of a 30-year-old male with a longstanding history of back pain with an initial diagnosis of young-onset DISH. However, a diagnosis of axSpA was ultimately pursued based on his age and clinical presentation. This was further supported by improvement in both ASDAS-ESR and ASDAS-CRP scores at his 6- and 12-month follow ups on ixekizumab. Early and accurate diagnosis of axSpA, followed by appropriate treatment, is essential in preventing complications and improving patient outcomes.

Falciform Ligament Abscess Causing Acute Abdomen: Unveiling the Enigma with Review of Literature

ABSTRACT Introduction: Falciform ligament abscess (FLA) is a rare type of intra-abdominal abscess which has been sporadically reported. Diagnosis of FLA can be challenging without typical image findings of an abscess. This study publishes the varied clinical presentations, radiological findings, and management of FLA. Materials and Methods: All patients who were diagnosed and operated for FLA between May 2022 and May 2024 are included in the study. Relevant investigations were done preoperatively. Results: A total of six patients were operated for FLA. The mean age of presentation was 30 days. There were no major perioperative complications in five patients. One patient had pyopericardium which required pericardiocentesis and catheter drainage preoperatively. Conclusion: FLA should be considered in children, especially in infants with vague abdominal symptoms and failure to respond to conservative management. Due to its obscure location, it often causes delay in diagnosis and inadequate treatment. Hence, early consideration of this pathology is crucial for timely diagnosis, proper surgical treatment, and decreased morbidity and mortality.

A Case Series of Appendicitis and Pseudo-appendicitis in a Paediatric Intensive Care Unit.

Appendicitis is a common childhood condition that can be diagnostically challenging. Severe cases may necessitate support in the critical or intensive care unit. These "critical appendicitis diagnoses" have rarely been described. We retrospectively reviewed the Paediatric Intensive Care Unit (PICU) database of the Hong Kong Children's Hospital and identified cases of suspected and confirmed appendicitis. Clinical features, radiologic findings and final diagnosis of each case were summarized and reported in this case series. We review six anonymized cases of appendicitis managed in a PICU to illustrate the different age spectrum and clinical manifestations of the condition. Rupture of the inflamed appendix, peritonitis and pancreatitis were some of the complications encountered. Crohn's disease was found in one case as an underlying diagnosis. Also, one girl clinically diagnosed with appendicitis was found to be a case of ruptured hepatoblastoma with no appendicitis (i.e., pseudoappendicitis). Prompt diagnosis, surgical removal of the inflamed appendix, and use of appropriate antimicrobials when indicated are essential in reducing mortality and morbidity associated with severe appendicitis. Significant premorbid conditions such as acute myeloid leukemia, Mitochondrial Encephalopathy Lactic Acidosis Syndrome (MELAS), inflammatory bowel disease and complications may be present in patients needing intensive care as is illustrated in the present cases. Pseudoappendicitis is an important differential diagnosis. Imaging is crucial and useful in establishing and confirming the diagnosis of appendicitis and pseudo-appendicitis in these PICU cases.

Do Variations in Frontal Recess Anatomy Predispose to Mucocele Formation?

Introduction Mucoceles are benign expansile cystic lesions commonly seen in the frontoethmoidal region. Objective To see if the distribution of frontal air cells predisposes to mucocele formation. Methods Retrospective review of all cases of paranasal sinus mucocele from 2011 to 2021. Data on demographics, history of surgery or trauma, clinical features, radiological findings, and outcome were collected and analyzed. Results Of the 28 cases, 19 (67.9%) were male and 9 (32.1%), female, with a mean age of 40.75 years. Mucocele was unilateral in 26 (92.9%) patients. Twenty patients (71.43%) presented with primary mucocele. The distribution of mucocele was frontal and frontoethmoidal in 8 (28.6%) patients each, maxillary in 6 (21.4%), and ethmoid and sphenoid sinus in 3 (10.7%) patients each. Sixteen (57.1%) patients had frontal sinus involvement. At presentation, 13 (46.4%) patients had nasal symptoms, 17 (60.7%) had orbital symptoms, while 16 (57.1%) had headache. Pain (12; 70.59%) was the predominant orbital symptom, followed by proptosis and diplopia (8; 47.06%). The most common sites of bony erosions were along the frontal sinus floor (14; 50%), followed by lamina papyracea (13; 46.43%), and frontal sinus anterior wall (10; 35.71%). The agger nasi and suprabullar cells were the most common frontal cells encountered in mucoceles involving the frontal sinus, with no significant difference in frontal cell distribution between involved and uninvolved sides. The frontal cell distribution was similar in mucoceles with and without frontal sinus involvement too. Conclusion Though frontal and frontoethmoidal mucoceles were the most encountered, the type and distribution of frontal cells did not predispose to mucocele formation.

Inflammation of adenohypophysis is commonly associated with headache in surgically managed Rathke's cleft cysts.

Rathke's cleft cysts (RCC) are present in up to 20% of autopsy studies but only a minority necessitate surgical treatment. Inflammation of RCC is thought to be significant in three processes: the development of classical symptoms, a predisposition to rupture or apoplexy, and increasing the rate of RCC recurrence. We aim to characterize clinical presentation, histological and radiological findings in patients with surgically managed RCC. We conducted a retrospective case series of 31 RCC, which had undergone surgical management between April 2016 and April 2024. Histopathology and radiology were independently reviewed by neuropathologist and neuroradiologist, and case notes were reviewed for clinical and biochemical data. Median age was 43 years (IQR 32-63); 77% were female. 23/31 demonstrated inflammation of RCC cyst epithelium (n = 13), cyst wall (n = 20) or anterior pituitary (adenohypophysitis) (n = 12). 8 cases were not inflamed. Preoperative features included pituitary dysfunction (70%), headache (65%), visual disturbance (26%) and polyuria/polydipsia (7%). Six patients presented with features of apoplexy. Headache was more prevalent (92%) in patients with adenohypophysitis vs. those without (47%), p = 0.020, and present in all 11 cases where inflammation in the adenohypophysis was chronic. Pituitary dysfunction was not associated with inflammation overall (76% vs. 70% p = ns), nor specifically within the adenohypophysis (75 vs. 63% p = 0.69). Histological inflammation was associated with radiological loss of posterior bright spot (70% vs. 14% p = 0.024). Headache but not pituitary dysfunction was associated with adenohypophyseal inflammation. A trend of increasing headache prevalence was seen with increasing degree of inflammatory infiltrate within RCC.

Ascorbic Acid Supplementation on D-dimer Levels in COVID-19 Patients

Background: D-dimer is a potential biomarker for COVID-19 severity, correlated with the clinical outcomes and radiological findings. This research investigates the effect of ascorbic acid, an antioxidant and immunomodulator, on D-dimer levels in COVID-19 patients. Methods: The research design is prospective, randomized controlled, and conducted from January to March 2021 at Rumah Sakit Umum Daerah Tebet, Jakarta. Overall, 150 confirmed COVID-19 patients were randomized into two groups using a computer-generated block randomization technique. The intervention group received high-dose ascorbic acid (2 grams orally every 6 hours for seven days), while the control group received a placebo. Outcomes were assessed in changes in D-dimer levels, clinical severity, and radiological abnormalities. Statistical analyses included the Mann-Whitney, Wilcoxon signed-rank test, and logistic regression. Results: The patients treated with ascorbic acid showed a significant reduction in D-dimer levels compared to the placebo group. Additionally, these patients demonstrated notable improvements in clinical severity and radiological outcomes. The Wilcoxon signed-rank test demonstrated significant reductions in D-dimer levels within the ascorbic acid group (p < 0.001) and significant increases within the placebo group (p < 0.001). Conclusion: Ascorbic acid supplementation was associated with lowered D-dimer levels in COVID-19 patients, pointing to its potential therapeutic benefits in moderating disease severity. These results strongly support further research into ascorbic acid's benefits during COVID-19, especially for those at increased risk of severe disease progression.

Study of histopathological spectrum of lesions of gall bladder with clinico radiological correlation

The gallbladder is frequently affected by a spectrum of diseases, ranging from benign inflammatory conditions to aggressive malignancies.Histopathological examination is the cornerstone of diagnosing gallbladder diseases, providing detailed insights into the cellular and tissue-level changes that occur in various conditions. However, the diagnostic process is significantly enhanced when histopathological findings are correlated with clinical and radiological data. Such a multidisciplinary approach not only improves diagnostic accuracy but also improves treatment strategies, leading to better patient outcomes. This study aims to investigate the histopathological spectrum of gallbladder lesions and to establish correlations with clinic-radiological findings, thereby advancing the understanding of gallbladder pathology and its management.To study the histopathological spectrum of lesions of gall bladder with clinic radiological correlationThe most common histopathological diagnosis was chronic non specific cholecystitis with cholelithiasis seen in 48 cases out of 100 cases (48%). Total 70 cases out of 100 (70%) were calculous out of which 65.71% cases were of chronic cholecystitis, 24.28% cases were of acute cholecystitis and 10% cases were of gall bladder carcinoma with n=70. Out of 100 cases, 90% cases had mixed stones, 7.15% cases had cholesterol stones and 2.85% cases had pigment stones.There were 7 cases (7%) of gall bladder carcinoma amongst 100 cases. All 7 cases were of adenocarcinoma of the gall bladder out of which 2 cases showed serosal invasion and infiltration. Multidisciplinary approach is required in the diagnosis and management of gall bladder diseases, integrating clinical, radiological and histopathological findings to ensure accurate diagnosis. Each and every cholecystectomy specimen must be sent for histopathological examination and studied meticulously, as some unusual findings bearing implications on treatment and prognosis may be seen, regardless of the reason for which cholecystectomy is performed.

Unilateral nasal mass beyond 4th decade: A comprehensive clinicopathological study

Unilateral nasal mass may be a common presentation in children and young adults, and the majority of them are inflammatory polyps. But as the age advances, unilateral nasal complaints should alert the physician to the possibility of an underlying neoplastic mass lesion. To study the etiopathology and clinical features of unilateral nasal mass in patients above 40 years of age. The study was conducted in the department of otorhinolaryngology, Tezpur Medical College & Hospital. A total of 27 patients with unilateral nasal mass who are above 40 years of age are included in the study. The clinical features, radiological findings, and histological findings of all the patients were evaluated. Among the 27 patients, 14 had non-neoplastic lesions compared to 13 neoplastic lesions. Inflammatory polyp was the most common non-neoplastic pathology, whereas inverted papilloma was the most common neoplastic lesion. Nasopharyngeal carcinoma was the commonest malignancy detected in the study. Though inflammatory polyp constitutes the majority of cases of unilateral nasal mass, there is a considerable number of neoplastic lesions, especially when considered age above 40 years. Therefore, one should not directly jump into the conclusion of inflammatory polyp when an elderly patient presents with unilateral nasal mass; rather, a thorough diagnostic protocol should be employed to rule out any neoplastic lesion. The diagnosis of inflammatory polyp should be a diagnosis by exclusion only after other possible causes are excluded.

Clinical features and treatment of stroke-like episodes in mitochondrial disease: a cohort-based study

BackgroundStroke-like episode (SLE) is a subacute evolving brain syndrome in patients with primary mitochondrial diseases. Despite previous research, the understanding of the clinical spectrum, treatment, and outcomes of mitochondrial SLEs is far from complete. In this single centre study, we report the clinical symptoms and radiological findings as well as the medical treatment and outcomes of SLEs in patients with mitochondrial disease.MethodsThis retrospective, observational study during years 2000–2023 was based on a cohort of patients diagnosed with mitochondrial disease at Turku University Hospital (TUH; Turku, Finland) in the region of Southwest Finland. Data were obtained from the hospital electronic medical record system.ResultsThe investigated cohort consisted of 76 patients (37 men, 39 women) with a diagnosis of mitochondrial disease. Among these, 12 patients had a history of at least one SLE; the total number of SLEs was 20. The most common genetic aetiology among patients with SLEs was m.3243A > G (N = 7). The mean age at first SLE was 40 years (range: 5–66 years), and the mean interval between episodes was 4.8 years (range: 4 months—10 years). The duration of episodes varied between 1 and 193 days (median 14 days, mean 37 days); 10 patients needed intensive care unit (ICU) treatment. The mean survival time between the first SLE and death was 3.6 years (range: 0–16 years).ConclusionOur study highlights the importance of early recognition and prompt management of SLE symptoms, especially epileptic seizures, in this life-threatening entity.

Bullet Penetration In The Face Caused By Accidental Gunshot: A Case Report

Background: Clinical and radiological examinations are used to predict the location of the bullet in bullet penetration injury. The maxillofacial region had a variety of structure which could make the bullet deviate from its normal trajectories. Patient and Methods: A rare case of bullet penetration in the face caused by accidental gunshot is described. A 32 year-old male was hit by a bullet in the face with entrance wound on the left temporal region. Radiologic examination showed a bullet in the left inferior orbita. Treatment was exploration and extraction of the bullet. In this case we observe the difference between the clinical examination, radiological diagnosis and intraoperative findings Result: The patient underwent an explorative operation based on the prediction of location of the bullet from the clinical and radiological examination. The bullet was found in the inferior rectus muscle which the location is out of the prediction of clinical examination and radiologic findings. Summary: Clinical and radiological examination do not always give the accurate prediction regarding the location of bullet in penetrating bullet injury of the face because the face has a variety of bone, muscle and soft tissue structure.

Clinical features, radiological findings and prognosis of microscopic polyangiitis with interstitial lung disease: a retrospective matched control study

BackgroundThe association between interstitial lung disease (ILD) and microscopic polyangiitis (MPA) has received increasing attention in recent years. However, there are still no studies comparing clinical characteristics and prognoses between MPA-ILD patients and patients with ANCA-negative ILDs. Therefore, the purpose of this study was to analyse a group of patients presenting MPA-ILD matched with patients exhibiting ANCA-negative ILDs to identify differences in their clinical characteristics and survival.MethodsThis study retrospectively reviewed the data of 60 patients with MPA-ILD and 60 patients with ANCA-negative ILDs who were matched for age, sex, and patterns on chest high-resolution CT (HRCT) images. The baseline clinical information, laboratory parameters and chest CT data were collected and analysed at each patient’s initial diagnosis.ResultsSixty of the 682 (8.8%) ILD patients were diagnosed with MPA-ILD. MPA-ILD patients tended to be older and have higher CRP and ESR levels. ILD antedated MPA in 61.7% (37/60) of the patients, and MPA occurred on average (45.1 ± 33.4) months after the ILD diagnosis. Compared with matched ANCA-negative ILD patients, MPA-ILD patients had higher CRP and serum creatinine levels and lower haemoglobin levels. UIP (63.3%) was the most common chest HRCT pattern, and the proportion of patients with oddly shaped cysts (P = 0.04) was significantly greater in the MPA-ILD group than in the matched ANCA-negative ILD group. The number of MPA-ILD patients was significantly shorter than that of ANCA-negative ILD patients (P = 0.005). Survival analysis revealed that acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.03–5.59, P = 0.043) and diffuse alveolar haemorrhage (HR 3.42, 95% CI 1.09–10.73, P = 0.036) were independently associated with shorter survival and that receiving glucocorticoids combined with immunosuppressants (HR 0.11, 95% CI 0.03–0.37, P < 0.001) was independently associated with prolonged survival in MPA-ILD patients.ConclusionsThe proportion of MPA-ILD patients with total ILD is not low, and ANCA testing of ILD patients is necessary. Oddly shaped cysts with a UIP pattern may be a characteristic chest imaging manifestation of MPA-ILD. The prognosis of MPA-ILD is poor, especially for patients who are older, have DAH, and have experienced AEs.

Recurrent Submandibular Mass and Bilateral Periorbital Edema in IgG4-Related Disease: A Case Report

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated systemic disorder characterized by inflammatory, proliferative, and fibrotic lesions that can affect any body organ. The severity and extent of organ involvement vary significantly among individuals. Diagnosis of IgG4-RD necessitates a comprehensive assessment, including clinical presentation, radiological findings, laboratory tests, and histopathological examination. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria offer a valuable framework for diagnosing IgG4-RD. Although glucocorticoids and rituximab are the primary treatment options, the optimal long-term management strategy for IgG4-RD remains undetermined.

Clinical management of hypophosphatemic osteomalacia induced by adefovir and tenofovir: Insights from a case report.

Hypophosphatemic osteomalacia is a rare chronic metabolic bone disease characterized by low serum phosphate levels owing to genetic or acquired causes. This article presents a case report of the clinical management, challenges encountered, and prognosis of secondary hypophosphatemic osteomalacia induced by defovir and tenofovir. A 55-year-old male patient had been experiencing persistent dull chest pain and fatigue for more than a year. The patient had chronic hepatitis B infection for over 10 years, with regular use of adefovir dipivoxil capsules for more than 10 years. Five months before admission, the patient was switched to tenofovir alafenamide fumarate tablets. After obtaining clinical manifestations, medical history, and examination results, tumor-induced osteomalacia was excluded, and the final diagnosis was drug-induced hypophosphatemic osteomalacia. Adefovir dipivoxil and tenofovir alafenamide were discontinued, and the patient was switched to entecavir disintegration tablets for antiviral therapy. He was advised to follow a high-phosphate diet, receive phosphorus supplementation and calcitriol capsules to promote calcium absorption, obtain moderate sun exposure, and take measures to prevent falls and fractures. Serum phosphate levels showed a gradual upward trend, with the most recent measurement being 0.85 mmol/L. The bone density gradually improved and reached normal levels in the most recent assessment. The symptoms of fatigue and chest pain were resolved. Accurate diagnosis requires a combination of clinical presentation, medical history, biochemical and radiological findings, and, if available, measurement of fibroblast growth factor 23 (FGF 23). The role of national, provincial, or regional centers for rare diseases is crucial for conducting unconventional tests and providing access to rare medications.

The not so 'simple' laparoscopic nephrectomy: Experience with 3D laparoscopy from a tertiary care centre.

Laparoscopic simple nephrectomy (LSNx) is among the gold standard options for management of selected poorly functioning and most non-functioning kidneys (PFK/NFKs). Our objective was to audit our patients who had undergone LSNx for benign causes and assess their perioperative outcomes and analyse the factors correlating with these outcomes. We reviewed our prospectively collected data of patients with PFK/NFKs due to benign causes who underwent a LSNx on a three-dimensional (3D) system via a transperitoneal approach between January 2017 and June 2023. Details on clinical profile, radiological findings and peri-operative details were recorded and analysed. A total of 302 patients underwent LSNx in the study duration. Urolithiasis was the most common cause of PFK/NFKs in 66.5% of patients followed by pelvi-ureteric junction obstruction in 14.9%. Rate of conversion to open surgery was 5.3%. Final histopathology revealed chronic pyelonephritis in 82% patients and Xanthogranulomatous pyelonephritis (XGPN) in 14%. Multivariate analysis revealed presence of pre-operative fat stranding on imaging, larger kidney size, presence of XGPN and pyonephrosis to be significantly associated with longer operation times. Prior renal surgery, positive urine culture, presence of XGPN and a higher body mass index was associated with a longer hospital stay and increased rate of post-operative complications. LSNx is commonly employed for management of PFK/NFKs from various aetiologies, the most common of which is urolithiasis in our experience. Multiple clinico-radiological factors as described correlated with longer operative times and prolonged hospital stay, which aids in surgical planning and patient counselling.

Lumbar Facet Joint Disease: What, Why, and When?

Low back pain (LBP) affects over 60% of individuals in their lifetime and is a leading cause of disability and increased healthcare expenditure. Facet joint pain (FJP) occurs in 27% to 40% of LBP patients but is often overlooked or misdiagnosed. Additionally, there is no clear correlation between the clinical examination, radiological findings, and clinical presentation, complicating the diagnosis and treatment of FJP. This narrative review aims to provide an overview of the literature regarding facet joint pain and discusses the utility of medial branch blocks (MBBs) and intra-articular (IA) injections as diagnostic and therapeutic tools prior to radiofrequency ablation (RFA). RFA is considered the gold standard for managing FJP, employing techniques that include precise needle placement and stimulation parameters to disrupt pain signals. Promising alternatives such as cooled RFA and cryodenervation require further research on their long-term efficacy and safety. Endoscopic denervation and multifidus stimulation are emerging therapies that may benefit chronic LBP patients, but additional research is needed to establish their effectiveness. When conservative management fails, RFA provides significant and lasting relief in well-selected patients and has a favourable safety profile. The current literature does not support surgical interventions for FJP management.

Comprehensive Analysis of Liver Biopsies in a Tertiary Care Hospital: A Retrospective Histopathological and Clinical Correlation Study

Liver biopsy (LB) served as a vital diagnostic tool for cases with notable alterations in liver function tests and for diagnosing a range of liver diseases, including chronic liver disease, cirrhosis, primary biliary cirrhosis, and hepatic neoplasms. Patients presenting with liver pathology often exhibited nonspecific symptoms, such as abdominal discomfort, nausea, vomiting, fever, indigestion, and flatulence. Based on patients' clinical history and radiological findings that suggested liver disease, a liver biopsy was frequently recommended, as it provided definitive diagnostic insights. Histopathological analysis of liver biopsies offered critical information on disease severity, grading, staging of liver tumors, and the presence of any coexisting hepatic conditions.This study retrospectively examined liver biopsies submitted to the Department of Pathology, correlating histopathological findings with clinical and radiological data. Through this integration, the research contributed to improved diagnosis, management, and follow-up of liver disease cases in a tertiary care setting.

Correlation of Clinical, Radiological and Endoscopic Grading of Adenoid Hypertrophy in Paediatric Population: A Cross-sectional Study

Introduction: Adenoid hypertrophy is one of the most common conditions encountered by Ear, Nose and Throat (ENT) surgeons in the paediatric age group. Clinical assessment of adenoid hypertrophy is the first step, but to confirm the degree of adenoid hypertrophy, both X-ray soft-tissue neck and endoscopy are needed. Aim: To correlate the clinical grading of adenoid hypertrophy with endoscopic and radiological findings. Materials and Methods: This was a hospital-based cross- sectional analytical study conducted at Chhatrapati Shivaji Subharti Hospital Meerut, Uttar Pradesh, India from August 2023 to January 2024. A total of 50 children aged between 4 and 15 years, who presented to the outpatient department of ENT with signs and symptoms of adenoid hypertrophy, were evaluated. These children underwent clinical evaluation, followed by endoscopy and X-ray lateral view of the soft-tissue neck. Adenoid hypertrophy was graded clinically, endoscopically and radiologically. Statistical analysis was performed using Kendall’s tau correlation analysis. Results: In the study population, the majority of children 17 (34%) were between the ages of 7 and 9 years, with a male predominance of 32 (64%). Grade-3 adenoid hypertrophy was the most common finding, observed in 21 (42%) based on clinical grading, 26 (52%) on endoscopy, and 19 (38%) on X-ray lateral view of the soft-tissue neck. There was a strong correlation between endoscopic and clinical grading (p-value=0.001), and the correlation between radiological and endoscopic grading was highly significant (p-value=0.001). Clinical grading and radiological findings also showed a significant correlation (p-value=0.002). Conclusion: All three modalities of adenoid grading are correlated and reliable. They can be used in different combinations for grading adenoid hypertrophy and determining the management plan.

A Case of Torsion of the Undescended Testis

This article presents the case of a 14-year-old male who experienced acute torsion of an undescended testis located in the right inguinal canal. The patient presented with severe right inguinal pain. Imaging studies, including CT and MRI, revealed the underlying pathology. Intraoperative findings confirmed testicular necrosis, necessitating an orchiectomy. This report aims to highlight the clinical presentation, radiological findings, and surgical management of this condition, supplemented with relevant images.