CT Scan Findings Research Articles

Outcome of head injury in motorbike riders.

To determine the impact of helmet wearing on traumatic brain injury. We analyzed 400 cases of traumatic brain injury (TBI) in motorbike riders with and without helmet, from July 2017 to December 2020 presenting to the neurosurgery department at Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. The medical records were analyzed for CT scan findings, length of hospital stay, complications (mortality and disability), Glasgow Coma Scale (GCS) and Glasgow outcome score (GOS) at time of discharge. A total of 400 patients with head injury due to motorbike accidents were included and all were male patients. They were equally divided into two groups, 200 in Group-A (with helmet) and 200 in Group-B (without helmet). Majority of the unhelmeted patients i.e. 102 (51%), needed admission in the Intensive Care Unit (ICU) compared to 70 (35%) in helmeted. When comparing non-helmeted patients to helmeted patients, the total median length of hospital stay was greater among non-helmeted patients (10 vs 05 days). Mortality was higher among non-helmeted patients seen in 50 (25%) as compared to 14 (7%) in helmeted patients. Overall, the good outcome was observed in 119 (59.5%) patients in Group-A as compared to70 (35%) patients in Group-B while 81 (40.5%) showed bad outcome in Group-A and 130 (64%) in Group-B. The failure to wear a helmet was found to be strongly linked with abnormal neuroimaging more complications, poor outcome and lower GCS on discharge as compared to patients using helmet. Lack of helmet use is linked to abnormal brain imaging, more complications, and a longer stay in the hospital after a head injury.

Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study

BackgroundPopulation distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe...

Blood Glucose Level as a Predictor of Abnormal Brain Computed Tomography Scan Findings in Patients with Mild Traumatic Brain Injury.

This study aimed to investigate blood glucose levels in patients with brain injury caused by mild traumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan or not. This cross-sectional study was conducted on patients with mild TBI, who were referred to the emergency department from March 1, 2022, to September 1, 2022. After the confirmation of mild TBI by an emergency medicine specialist, blood samples were taken from the patients to measure blood glucose levels. Then a brain CT scan was performed, and blood glucose levels were compared between patients with and without CT indications of brain injury. A checklist was used to collect data, and the data were analyzed using SPSS software (version 23). In the CT scans of the 157 patients included in the study, 30 patients (19.2%) had a brain injury in the CT scan. The mean blood glucose level was significantly higher in patients with brain injury, especially in the presence of vertigo and ataxia, than patients without brain injury in the CT scan (p<0.0001). There was a significant positive correlation between age and blood glucose level (r=0.315, p<0.0001). Patients with mild TBI who had signs of brain injury in the CT scan had significantly higher blood glucose levels than patients with normal CT scan findings. Although indications for performing a brain CT scan are usually based on clinical criteria, blood glucose levels can be helpful in determining the requirement for a brain CT scan in patients with mild TBI.

Redefining “indeterminate” ground glass opacities in SARS-CoV-2

Background: Isolated ground glass opacities are often seen in the lungs and these are a diagnostic challenge. There are numerous different causes of ground glass opacities in the lungs. The broad list of etiologies are infectious causes, interstitial disease, alveolar disease, neoplastic, and drug toxicity. In the era of SARS Cov-2, it becomes very difficult to differentiate the ground glass opacities due to inflammatory bronchiolitis and other viral pneumonitis from those which are due to SARS CoV-2. Aims and Objectives: We aim to look for vascular signs seen in association with ground glass opacities which increase our level of confidence to call them ground glass opacities due to SARS-CoV-2 as an etiology. Materials and Methods: We present an observational study on 34 patients who presented with only patchy focal ground glass opacities in the lungs. All these patients were also subjected to nasopharyngeal swab test. The vascular signs seen on CT scan were of help to establish definite diagnosis of SARS-CoV-2 only on the basis of ground glass opacities. Results: Out of 31 patients showing CT scan finding of prominent intralesional vessel, 27 were positive for COVID-19 on reverse transcription-polymerase chain reaction (RT-PCR) test. Four patients showing prominent intralesional vessel on CT scan were negative for COVID-19 infection on RT-PCR test. These four patients who were tested negative on RT-PCR were treated symptomaticaly for inflammatory bronchiolitis. Follow-up CT scan of two such patients were done after 4 days, which showed resolution of the focal ground glass opacities. Conclusion: The parenchymal imaging findings of SARS-Cov-2 are well described as ground glass opacities associated with septal thickening and consolidation. However, in some cases, only few focal isolated ground glass opacities are seen without any other typical features. In such cases, the vascular signs are of help to increase our level of diagnostic confidence.

Treatment of intra articular fracture calcaneus using sinus tarsi approach, bone block substitute, and screws

Abstract Objective To evaluate the results of fixation of intra articular calcaneus fracture using Sinus Tarsi Approach, bone block substitute, and screws fixation. Background Minimal invasive techniques for treatment calcaneus fractures have developed to overcome soft tissue complications associated with the traditional lateral approach. Sinus Tarsi approach has the advantage of visualization of posterior part of subtalar joint. Methods All patients underwent preoperative calcaneal lateral and axial radiographs and CT scan of the injured foot. The injured type was graded according to the Sanders classification on the basis of the CT scan findings. Bohler and Gissane angles were measured as anatomical parameters before surgery. Sinus Tarsi Approach was done for all patients, in addition to use of percutaneous screws fixation and bone block graft substitute. Results A total of 17 patients were included in our study. The mean age was 37.8 years. At the end of follow-up, radiological evaluation was done by measuring the Bohler angle and the angle of Gissan. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score was calculated at the end of the follow-up for all cases. Excellent results were found in7 patients, good results in 8 patients and fair results in only 2 patients. There was a statistically significant improvement of Bohler angle at the end of the follow-up. Conclusion Treatment of intra articular calcaneal fractures using Sinus Tarsi Approach with a bone block substitute and screws can provide satisfactory clinical outcomes.

Chest CT Scan In Patients With Contusion and COVID 19 A Comparative Study With Pure Lung Contusion

Resource allocation for traumatic patients who are positive/negative for COVID-19 challenges the diagnosis. This study aims to compare the chest CT of COVID-19 associated with lung contusion versus those with lung contusion only. CT-scans of 9 RT-PCR positive patients with lung contusion due to MVA (CC group) and 16 patients with lung contusions from pre-COVID-19 (CO group) were revaluated. The distribution and characteristics of presenting CT-scan findings; including presence, shape, distribution of GGO, consolidations, subpleural sparing, crazy-paving and Atoll sign. Presence of effusions and cavities were compared. Time course of the opacities was compared. Bilateral distribution of opacities was noted in 100% of CC and 87.5% of CO group. There was no significant difference between GGO or consolidation shapes (P=0.44 and P=0.66). Both GGO and consolidations were more diffusely distributed in CC, a predominantly peripheral distribution was more commonly seen in the CO group (P=0.03 and P=0.01). Subpleural sparing was noted in 93.8% of CO as compared to 44% of CC group (p=0.04). Time to resolution was significantly longer in CC (15±6days) comparing to CO patients (P=0.02). 'Typical' chest CT findings including bilateral peripheral GGO and consolidations, crazypaving, Atoll signs and also less typical findings e.g. subpleural sparing is seen in lung contusion and COVID-19 pneumonitis. Lesion Time course might be a better radiologic discriminator between the two entities.

Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Objective: To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI).&#x0D; Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0.&#x0D; Results: Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035).&#x0D; Conclusion: Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes.&#x0D; Keywords: Midline shift, CT scan, Glasgow Coma Score, Head Injury.

Factors associated with nonunion of the posttraumatic subtalar arthrodesis after displaced intra-articular calcaneal fractures

BackgroundThis study investigated the incidence of and risk factors for nonunion in patients with posttraumatic subtalar arthrodesis (SA). MethodsWe retrospectively reviewed 165 posttraumatic SA cases. Nonunion was diagnosed at 6 months after surgery based on the findings of clinical evaluations, plain radiographs, and CT scans. Patient-specific factors and surgeon-specific factors were evaluated as potential risk factors. ResultsThe overall nonunion rate was 13.3 % (22 of 165 cases). In the final multivariate logistic regression analysis, smoking (odds ratio [OR] = 3.64; 95 % confidence interval [CI] = 1.23–10.75), parallel screw configuration (OR = 5.70; 95 % CI = 1.62–20.06), and freeze dried iliac crest (OR = 9.16; 95 % CI = 2.28–36.79) were demonstrated as risk factors for nonunion of posttraumatic SA. ConclusionPatients with a history of smoking, parallel screw configuration fixation, and those who received freeze dried iliac crest as an interpositional graft, had a significantly higher rate of nonunion.

Rare presentation of low-grade appendiceal mucinous neoplasms (LAMN) as an appendicular lump: A case report

The prevalence of appendiceal mucinous neoplasms (AMN) is about 0.2%-0.3% in the specimens of the appendix. The LAMN may appear unremarkable or can present as mucin-filled, crystally dilated tissues. The diagnosis of early-stage AMN is mostly incidental. It is of vital importance to know the features of LAMN for a timely diagnosis. A 46-year-old male came with the complaint of right iliac fossa swelling along with severe intensity pain and a single episode of vomiting. A 4×4cm tender, soft, cystic, mobile swelling was found upon the examination. Contrast-enhanced Computerized tomography (CT) scan of the abdomen revealed the appendix diameter of 10mm well-circumscribed cystic measuring 2.1×2 cm. Therefore, an open resection surgery was performed. The histopathological report revealed an intraepithelial lesion composed of flat mucinous epithelial cells having eosinophilic cytoplasm and low-grade nuclear atypia. The AMNs are very rare neoplasms. The imaging modalities that can be diagnostic methods are abdominal and transvaginal ultrasonography (US), and abdominal computed tomography (CT). The low-grade features of the appendiceal mucinous neoplasms have the possibility of recurrence. The CT-scan findings of appendiceal lump>1.3cm along with cystic dilation and the calcification of the wall are the suggestive features of AMN. There is a high chance of dissemination and port site seeding in case of pneumoperitoneum. This rare case suggests the significance of adding AMNs as a differential diagnosis in patients with abdominal pain and choosing the right approach to treat such patients to avoid complications.

An Evaluation of the Role of the Radiologist and Surgeon in the Management of Hepatic Trauma at Qazi Hussain Ahmad Hospital, Nowshera, kpk

Aim: This study aims to compare the surgical results and CT scan findings in patients with hepatic trauma to evaluate the sensitivity and usefulness of sonographic data. Study Design: A Single-center study. Study duration : From Jan 2020 to Feb 2021, the Radiology and Surgery Divisions at Qazi Hussain Ahmad Hospital in Nowshera. Methods: There will be a retrospective chart review of all patients suspected of having sustained hepatic injuries admitted to the surgical department From Jan 2020 to Feb 2021 and subsequently present to the department of Radiology. There were two groups of patients: Group I, who had surgical intervention, and Group II, who were hospitalized and treated non-operatively. Prospective cohort research in which the sonographer and clinicians who analyzed emergency sonograms compiled data from all patients. Patients injured in their livers within this time frame were tracked down. Results: Overall, 291 patients (72% of the sample) were included in the study, with 83 patients (29% of the sample) requiring surgical intervention and 208 patients (71% of the model) being handled conservatively. All Group-06 patients had CT scans. Of the 83 patients who had surgery, 11 were classified as having a Grade-1 complication, 12 as having a Grade-11 difficulty, 44 as having a Grade-Ill complication, 18 as having a Grade-IV complication, and three as having a Grade-V complication. In a study with 208 patients who did not have surgery, 15 (73%) had a Grade-I fall, and 56(28%) experienced a Grade-11 fall. Sonographic data and surgical results in individuals who have had surgery, and how they compare and contrast. Cconclusion: Ultrasonography is the most sensitive method for determining the severity of liver damage caused by forceful abdominal trauma. Since it may be done at the bedside and repeated as needed, it serves as a primary diagnostic strategy in these patients and helps when paracentesis is necessary. Keywords: Abdominal injury, Shortened Surgical Terminology for Liver Trauma (AST), liver trauma grades, CT scan, bleed, liver injury,

Assessment of biochemical outcomes in patients with primary aldosteronism after adrenalectomy based on CT scan diagnosis of unilateral adenoma without adrenal vein sampling.

The purpose of this study was to assess the surgical outcomes of patients with primary aldosteronism when surgery was based only on CT finding of unilateral adenoma without adrenal vein sampling (AVS). This is a retrospective review of the records of patients who had undergone retroperitoneal laparoscopic adrenalectomy for primary aldosteronism based on CT scan finding of unilateral adenoma and had a follow-up of at least 6-12 months from January 2012 to December 2020 in a single center; decision for adrenalectomy was based on CT scan, and AVS was not used. The clinical and biochemical outcomes were accessed using the standardized primary aldosteronism surgical outcome (PASO) criteria. Patient's demographics and preoperative factors were analyzed to assess for independent predictor of surgical success. According to the PASO criteria, 172 patients finally enrolled in the training dataset, and 20 patients enrolled in the validation dataset. In the training dataset, complete clinical success was achieved in 71 patients (41.3%), partial success in 87 (50.6%), and absent success in 14 (8.1%). Biochemical outcomes showed that 151 patients (87.8%) were completely cured, 14 patients (8.1%) got a partial biochemical success, and an absent biochemical success was found in seven patients (4.1%). Multivariate logistic regression analysis showed that age, body mass index (BMI), tumor size, mean arterial pressure (MAP), and serum potassium were the most independent factors for incomplete biochemical success. Based on the results of statistical analysis, our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. Laparoscopic adrenalectomy for patients with primary aldosteronism base on CT scan finding of a unilateral adenoma without AVS had a high rate of complete biochemical cure at 12 months. Risk factors for incomplete biochemical success include age, BMI, tumor size, MAP, and serum potassium. Our study constructed a nomogram prognostic evaluation model for patients after unilateral primary aldosterone surgery. The nomogram accurately and reliably predicted the incomplete biochemical success.

Posterior fossa epidural hematoma: A 6-year management experience.

Through this study, we sought to evaluate the management of posterior fossa extradural hematoma (PFEDH). An observational study was conducted at the Neurosurgery Department of Lady Reading Hospital in Peshawar from January 2015 to December 2020. All patients who had a traumatic acute extradural hematoma (EDH) of the posterior fossa were included, irrespective of age and gender. The clinical predictors and outcomes were assessed, including the CT-scan findings and Glasgow Coma Scale (GCS) score. A total of 104 cases with posterior fossa extradural hematoma were identified from 1252 extradural hematoma patients admitted during the study period. The mean age of the enrolled patients was 18.17 ± 14.31 years. Most of the patients were male (65.39%) and belonged to the pediatric age group, i.e., < 15 years (60.6%). CT scan brain was done in all the cases for diagnosis. In 68.3% of cases, an associated occipital bone fracture was observed. Surgery was done in almost 71.2% of cases, and most of the patients experienced good recovery after surgery, as indicated by the GOS score. Linear regression model revealed that treatment (β=-0.20, p=0.038), time duration between surgery and trauma (β=0.43, p=0.000) and GCS category (β=-0.47, p=0.000) were significantly associated with PFEDH outcomes. In conclusion, PFEDH was frequent among males and the pediatric age group. Serial CT brain is highly recommended in all suspected cases for early diagnosis.

Clinical diagnosis of endocarditis

Endocarditis is an entity witch severity and outcome are time related. Sometimes its presentation is linear, such as the one we present on this image, and the echocardiogram is not needed to do the diagnosis. However sometimes this isn’t possible. With this image we pretend to show some typical findings of objective exam and CT scans, so if this appears on emergency department, endocarditis diagnosis is assumed, and prompt treatment is started in order to achieve a good outcome.

Clinical features and survival analysis of microscopic polyangiitis-associated interstitial lung disease:a retrospective study of 28 patients

Objective: To explore the clinical features, laboratory examination and imaging features of microscopic polyangiitis (MPA)-associated interstitial lung disease (ILD), and to perform survival analysis. Methods: The records of 28 patients with MPA-ILD who were treated at the Affiliated Hospital of Medical School of Ningbo University were reviewed retrospectively from August 2014 to November 2021. The patients' clinical features, laboratory parameters, pulmonary function test, echocardiography, chest CT scan findings and therapeutic regimen were analyzed, and the relevant data were statistically analyzed. Results: There were 18 males and 10 females, with an average age of (70.1±9.3) years. Among them, 13 patients had a history of smoking. The main clinical manifestations were cough (14/28), fever (12/28), chest tightness, shortness of breath (12/28) and hemoptysis (3/28). Sixteen patients had renal involvement, and 78.57% (22/28) and 89.28% (25/28) of the patients had elevated C-reactive protein (CRP) and ESR respectively. Sixteen (16/28) patients had increased rheumatoid factor (RF), and the positive rate of myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) was 82.12% (23/28). 96.43% (27/28) of ILDs were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly usual interstitial pneumonia (UIP) or UIP-like (15/28), followed by nonspecific interstitial pneumonia (NSIP) (8/28). Compared with non-UIP-like patients, UIP or UIP-like patients were older (P=0.018), and had higher serum LDH level (P=0.041), but serum creatinine level was significantly lower (P=0.041). Univariate and multivariate survival analysis showed that inappropriate treatment (HR=9.81, 95%CI: 1.68-57.29, P=0.011) and elevated serum LDH (HR=4.11, 95%CI: 0.99-17.00, P=0.051) were independent risk factors for shortened survival of MPA-ILD, while elevated RF (HR=0.22, 95%CI: 0.06-0.91, P=0.037) was a protective factor for prolonged survival. Conclusions: MPA-ILD patients had fewer systemic vasculitis symptoms. Most of the ILD patients were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly UIP or UIP-like, followed by NSIP. Early use of glucocorticoids combined with immunosuppressant or rituximab could improve the survival rate of MPA-ILD. The elevated serum LDH was an independent risk factor for shortened survival of MPA-ILD, while elevated RF was a protective factor for prolonged survival.

AML-372 Acute Promyelocytic Leukemia: A Case of Pseudotumor Cerebri Syndrome During Treatment Consolidation

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia with distinctive morphological, clinical, and genetic features. Pseudotumor cerebri, also known as idiopathic intracranial hypertension, describes a neurologic syndrome characterized by headache, visual changes, papilledema without cerebral mass lesion, venous sinus thromboses, or obstructive hydrocephalus. Risk factors for the development of pseudotumor cerebri are obesity, women in the childbearing years, and hypervitaminosis A. The modified Dandy criteria are used for pseudotumor cerebri syndrome (PTCS) diagnosis. This complication has a high incidence in the pediatric population, particularly within 2-3 weeks of induction treatment for APL. Pseudotumor cerebri is a rare complication during consolidation therapy for APL. The reported incidence of "probable" PTCS is 1.7% in APL patients treated with ATRA. Case Report: We report here the case of a 20-year-old woman, obese with a BMI of 34.5 kg/m2, diagnosed with low-/intermediate-risk APL and treated with ATRA and ATO as induction treatment. After induction, she achieved MRD-negative complete morphological remission. During the first 2 weeks of the first cycle of consolidation-ATRA and ATO-the patient developed progressive diplopia and headaches without response to standard analgesic therapy. Additionally, she complained of nausea and vomiting. The ophthalmological exam with fundus examination revealed bilateral papilledema. The neurological exam was normal. There were no abnormal findings in the head CT scan or MRI of the brain. Thus, a diagnosis of "probable" pseudotumor cerebri was established. ATRA was discontinued and she received acetazolamide and dexamethasone with resolution of neurological symptoms within the next 7 days. Upon the next consolidation ATRA and ATO, the headaches resumed. The patient received all the ATRA consolidation cures as scheduled but with a dose reduction to 80% of the initial dose and in association with acetazolamide. She completed consolidation treatment and continues to be in molecular complete remission. Conclusions: This case report highlights the possibility of pseudotumor cerebri development in young adult patients with APL during consolidation therapy. The neurological symptoms were reversible, and the patient received all the ATRA consolidation. It is important to exclude other causes of intracranial hypertension including thromboses, infections, and disease involvement.

S2449 A Unique Case of Simultaneous Anal Squamous Cell Carcinoma and Esophageal Squamous Cell Carcinoma

Introduction: Anal cancer (AC) is uncommon and comprises only 3% of all digestive system malignancies. It is associated with HPV, tobacco use, and HIV. Esophageal cancer (EC) is the 8th most common cancer and 6th most common cause of death worldwide. Among other associations, HPV and tobacco use has been strongly linked to development of esophageal SCC. Though they have similar risk factors, the literature is limited when it comes to cases of simultaneous anal SCC and esophageal SCC. Case Description/Methods: A 50-year-old male with history of tobacco use presented with dysphagia, dyspnea, and weight loss. His symptoms were progressive with 20 lbs. of weight loss in 3 months. He initially had solid food dysphagia which progressed to liquids and constant regurgitation of food. His cough and dyspnea were acute and worsened 1 week prior to his presentation. He endorsed a bulging growth around his anus that grew over several months. He was found to have a left lower lobe necrotizing pneumonia (NP) on CT scan as well as thickening of the esophagus with liver lesions suspicious for metastatic disease. Labs showed leukocytosis, macrocytic anemia, and a mild transaminitis. He was tested for tuberculosis and HIV which was negative. He underwent an EGD which showed a large, friable, fungating esophageal mass whose biopsies showed SCC. For his anal lesion, he underwent an excisional biopsy which was positive for SCC as well. The patient was treated with antibiotics for his NP with a plan of 6 weeks of therapy followed by repeat imaging to determine if any surgical interventions would be needed. Oncology planned for palliative chemoimmunotherapy once his NP resolved. To improve his dysphagia, a palliative esophageal stent was placed (Figure). Discussion: This patient had both a primary anal SCC and esophageal SCC with his only risk factor being tobacco use. Though both AC and EC commonly metastasizes to the liver, EC is more likely to metastasize. For esophageal SCC, local lymph node invasion typically occurs early since the lymphatics are in the lamina propria rather than beneath the muscularis mucosa. In this case, the patient presented with a NP and though no definitive fistula was noted on imaging, local invasion of esophageal SCC can present with fistulizing disease. Unfortunately, Stage 4 esophageal SCC is incurable though systemic therapies may provide a palliative effect and survival benefit. In this case, an endoscopic esophageal stent was placed for palliation of his dysphagia while awaiting chemoimmunotherapy.Figure 1.: Image A demonstrates the CT scan finding of esophageal wall thickening. Image B is the EGD finding of a large, friable, fungating, circumferential esophageal mass. Image C shows the successful placement of an esophageal stent for palliative treatment of the patient’s dysphagia.

S2888 A Case of a Completely Migrated Gastric Toothpick Caught by EUS

Introduction: Foreign body ingestion is a common cause for medical emergencies. Once they reach the stomach, roughly 80% of foreign bodies pass uneventfully through the GI tract. Sharp objects, such as toothpicks, are more likely to cause injury throughout the GI tract. Toothpick ingestion is associated with high rates of mortality and morbidity, with estimated 79% of ingestions leading to gut perforation. Initial diagnosis can be difficult, as ingestion has been found to mimic other conditions, such as renal colic. Endoscopy is warranted in roughly 20% of cases, with about 1% requiring surgical intervention. Case Description/Methods: A 63-year-old male with a history of HTN and DM presented with a 1-week history of altered mental status, fevers, nausea, vomiting, and melena. CT revealed a linear density extending from the lumen of the distal gastric antrum to the posterior wall of the stomach traversing the pancreas in the expected location of the SMV. Follow up EGD and MRI failed to reveal foreign body. He subsequently developed actinomyces bacteremia, was treated with antibiotics along with dental extraction, and was discharged home. The patient later returned with septic shock, found to have recurrent Actinomyces bacteremia. CT re-demonstrated suspicious thin linear density as well as multiple liver abscesses. Again, EGD failed to reveal foreign body. This time, an EUS was performed, and the foreign body was localized to the antrum, 2.4 mm below the luminal surface. Endoscopic mucosal resection was attempted but was unsuccessful. The patient then underwent an exploratory laparotomy with the retrieval of a wooden toothpick. He discharged in stable condition. Discussion: In this case, original CT scans revealed a possible foreign body, the object being localized as expected near the SMV. Given original negative EGD and MRI, it was felt that CT scan findings represented vasculature. When patient returned in septic shock with recurrent actinomyces bacteremia, a second EGD was performed and was negative. A decision was made at that time to investigate with EUS as a diagnostic tool, which ultimately revealed the location of the foreign body. What makes our case particularly unique is the degree of foreign body migration into the gastric wall, causing difficulty in diagnosis through EGD. This case highlights EUS as an important diagnostic modality in cases of foreign body ingestion.

Relationship Between Recurrence of Chronic Subdural Hematoma with its Preoperative Volume

Background: Chronic subdural hematoma (CSDH) is commonly encountered in neurosurgical practice. However, surgical evacuation remains complicated by a high rate of recurrence. Objective: To assess the relationship between preoperative volume of chronic subdural hematoma and its post-operative recurrence. Methods: This hospital based prospective observational study was carried out in the Department of Neurosurgery, Chittagong Medical College Hospital (CMCH), Chattogram during April 2017 to October 2018. A total of 130 patients clinically and radiologically diagnosed with CSDH and underwent surgery were enrolled in the study. Patients were followed up for 6 months postoperatively to observe the recurrence rate by symptom evaluation and radiological investigation. Results: Mean age of the study population was 65.77 (±14.83) years with a range of 18-95 years where 81.5% were male. Among the patients, 51.5% (n=67) had history of trauma and 16.2% (n=21) used anti-coagulant. CT scan finding showed that 20.8% (n=27) had bilateral hematoma, 73.8% (n=96) had e”2 cm thickness of hematoma whereas 70.8% (n=92) had e”1 cm midline shifting. The mean pre-operative volume was 133.36 (±60.26) ml where 40.0% (n=52) had &lt;115 ml and 60.0% (n=78) had e”115 ml of pre-operative volume. Recurrence of CSDH was observed in 10.8% (n=14) patients. Patients with bilateral hematoma collection, e”2 cm hematoma thickness , e” 115 ml pre operative volume and patients who used anti- coagulants significantly (p &lt; 0.05) more recurrence of CSDH. There was a moderate correlation between pre operative CSDH volume and post operative recurrence , which was significant (rs = .598, p&lt;0.001). Conclusion: There is a significant moderate correlation between pre operative CSDH volume and postoperative recurrence Bang. J Neurosurgery 2022; 11(2): 107-113

Kidney Transplantation in Patients With the History of SARS-CoV-2 Infection

Background. The aim of this study is to present the experience and results of kidney transplantation in patients with the history of SARS-CoV-2 infection.Methods. We retrospectively analyzed waitlisted patients who had a history of SARS-CoV-2 infection and offered a kidney transplant between March 2020 and December 2021.Results. Of the 97 waitlisted potential kidney transplant recipients who were offered a kidney, 13 (13.4%) had a history of SARS-CoV-2 infection. All patients were tested negative for SARS-CoV-2 at the time of the kidney offer. Successful transplantation was performed in 9 patients (5 male; average age was 40.8 years), with the average time between SARS-CoV-2 infection and transplantation of 8 months. Four of 13 patients with a history of SARS-CoV-2 infection were finally not transplanted, with 2 patients not eligible for transplantation due to significant post-COVID findings in routine pretransplant chest CT scans, and 2 patients were not transplanted because of poor donor organ quality.Conclusions. Kidney transplantation after SARS-CoV-2 infection is possible in a setting of full recovery from acute infection, negative PCR test, and no pneumonic infiltrates on chest CT scan. A growing number of waitlisted patients with a history of SARS-CoV-2 infection imposes the need for decision-making tools and guidelines for risk/benefit assessment in these patients.

Imaging Aspects (Chest Radiographic and CT Scan Findings) of COVID-19 with Clinical Classifications

Imaging Aspects (Chest Radiographic and CT Scan Findings) of COVID-19 with Clinical Classifications