Calcified Mass Research Articles

An Unusual Finding on a Plain Abdominal Radiograph

Question: A 65-year-old woman presented with epigastric pain and fever for 3 days. A plain abdominal radiograph revealed massive calcification spots over the epigastric area (Figure A). She had a history of intermittent epigastric pain, which was relieved by medications prescribed by local clinics. A chest radiograph conducted 19 years ago at our hospital had revealed no calcification spot in the epigastric area (Figure B). An abdominal computed tomography (CT) scan revealed a low-density zone with calcified content on the left hepatic lobe, with marked atrophy and mild enhancement in some areas of the low pole after postcontrast study (Figure C, D). Laboratory findings indicated an increase in serum gamma glutamyl transferase (82 U/L; reference range, 9–64 U/L) and C-reactive protein (10.8 mg/dL; reference range, <1 mg/dL) levels. Total bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase levels were all within normal ranges. What was the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The patient underwent a left lobectomy after her fever subsided. Pathology revealed left intrahepatic calcification stones and atrophy (Figure E). The patient was discharged on postoperative day 7 without any complications. Primary hepatolithiasis is defined as the presence of stones in the intrahepatic ducts (IHD) of the liver. This condition is endemic in the Asian population, and its prevalence is increasing in Western countries. Although hepatolithiasis is benign, the frequent development of biliary obstruction and cholangitis can lead to sepsis. Early diagnosis and aggressive treatment are key to a good prognosis. Ultrasound examination remains the method of choice for detecting gallbladder stones, but relatively low sensitivity in detecting IHD stones. CT scans can detect IHD stones, but their positivity rate (63%–81%) is unsatisfactory. Magnetic resonance cholangiopancreatography is the gold standard for evaluating IHD stones. Only approximately 15% to 20% of IHD stones contain sufficient calcium to be visible on plain radiographs.1Mikolajčík P. Ferko A. Demeter M. et al.The difficult path to correct diagnosis of hepatolithiasis: a case report.Acta Medica. 2021; 64: 125-128Google Scholar,2Kim T.K. Kim B.S. Kim J.H. et al.Diagnosis of intrahepatic stones: superiority of MR cholangiopancreatography over endoscopic retrograde cholangiopancreatography.AJR. 2002; 179: 429-434Crossref PubMed Scopus (65) Google Scholar In our case, IHD stones could be easily detected through plain radiography and confirmed through a CT scan. Endoscopic retrograde cholangiopancreatography is applied to remove IHD stones is difficult and may lead to recurrence. The definitive treatment for IHD stones is surgery, which can relieve abdominal pain and prevent recurrence and disease progression.3Hong K.S. Noh K.T. Min S.K. et al.Selection of surgical treatment types for intrahepatic duct stones.Korean J Hepatobiliary Pancreat Surg. 2011; 15: 139-145Crossref PubMed Google Scholar

LINC-09. Coexisting glioneuronal tumor and adrenal ganglioneuroma

BACKGROUND: While both glial/glioneuronal neoplasia and ganglioneuroma have been reported as components of multiple primary neoplasms, no patient has been diagnosed with multiple primary neoplasms of cerebral glial/glioneuronal tumors with oligodendroglioma-like features and adrenal ganglioneuroma up to now. CASE: A previously healthy five-year-old girl was admitted with a two-week history of headaches and vomiting. Brain Magnetic resonance imaging (MRI) showed a massive heterogenous multi-cystic enhancing lesion in the right temporoparietal area with substantial vasogenic edema. The patient underwent craniotomy and tumor gross total resection. The intra-operative histomorphological assessment of the tumor was well-matched with a glial tumor. The patient developed systolic hypertension during postoperative care in the Intensive Care Unit. Subsequent abdominal CT scan unveiled a calcified mass of the left adrenal gland origin. Blood and urine catecholamine tests, vanillylmandelic acid (VMA), were within the normal range. The surgical excision specimen exhibited a clear cell neoplasm with diffuse infiltrative growth. A distinguishing combination of oligodendroglioma-like perinuclear haloes, clear cell appearance and vascular proliferation rendered the diffuse Glioneuronal tumor with Oligodendroglioma-like features. With the combination of oligodendroglial-like appearance, negative 1p/19q codeletion, Wild IDH, no BRAF mutation, weak GFAP, and positive synaptophysin altogether, the tumor was compatible with the novel diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (DGONC). The patient underwent laparotomy and tumor resection subsequently. Morphologic histopathological examinations of the adrenal mass were in line with ganglioneuroma. After discharge, no pathological uptake was identified with iodine-131 meta-iodobenzylguanidine scan (MIBG scan). No tumor residue was apparent on postoperative brain MRI. The patient received no adjuvant therapy for brain and adrenal tumors and underwent close surveillance for both tumors. No clinical or radiologic recurrence was recognized after six months of follow-up. CONCLUSIONS: Concurrent glioneuronal tumor and ganglioneuroma can be managed safely when diagnosed timely, leading to favorable outcomes.

About a misleading calcified mass of the elbow: Soft tissue osteochondroma: A case report.

IntroductionSoft tissue osteochondromas are rare lesions, with a misleading radiology, that can present diagnostic dilemma.Case presentationWe report the case of 16-year-old girl who presented an anterior swelling in his left elbow, slightly painful on palpation, with no signs of inflammation. Elbow mobility was normal. Standard radiographs showed a globular calcified mass. CT scan revealed a well-defined lobulated soft tissue mass with extensive flaky calcification. Magnetic resonance imaging (MRI) showed lobulated and intermuscular non-enhancing mass. The lesion had a low heterogeneous signal on T1 images, and a high heterogeneous signal on T2 FAT-SAT images, with low signal areas suggesting calcifications. There was no continuity to the adjacent ulna and radius. The patient first underwent image-guided core needle biopsy and histological examination concluded to chondroma. The tumour was then resected by anterior approach and the final histological diagnosis was osteochondroma of soft tissue.DiscussionA diagnosis of extraskeletal osteochondroma should be considered when an ossified mass is localized in the soft tissue particularly on the elbow. Excision is the treatment of choice when the function is reduced and the nature of the tumour remain uncertain.ConclusionOrthopedic surgeons should know about elbow localization of osteochondromas to help in accurate diagnosis and management of the tumour, to avoid overtreatment.

Retained appendicolith: Some things work themselves out

Management of perforated appendicitis has been debated for decades, remaining controversial today. Data is scarce regarding the approach to retained appendicolith after appendectomy. A 14-year-old girl presented with perforated appendicitis and an extraluminal appendicolith. IV antibiotics were initiated and drain placed until resolution of intraabdominal abscess. The drain was removed, and she was discharged on oral antibiotics. Ten days later she developed pain and purulent drainage from the drain site and was found to have a reaccumulated collection, so antibiotics were restarted, and she improved. Weeks later interval laparoscopic appendectomy ensued; the appendix was inflamed, and purulent fluid was noted in the pelvis. She initially recovered until multiple abscess recurrences, first temporized by percutaneous drainage, and subsequently by 6 weeks of antibiotics. Finally, workup of progressive right hip pain and swelling revealed a subcutaneous collection containing a shadowing echogenic lesion, consistent with the appendicolith from initial CT. Incision and drainage yielded pus and a 12 mm brown calcified mass; packing was placed. She was discharged on amoxicillin and continued wound care. Pathologic evaluation described a mass of calcified degenerated vegetable matter and food particles consistent with an appendicolith. Two years later she is without recurrent symptoms.

High-grade endometrial stromal sarcoma: A case report

Background: High-grade endometrial stromal sarcoma (HG-ESS) is a homologous uterine sarcoma of a mesenchymal origin. Its natural course is poorly understood, making preoperative diagnosis difficult.&#x0D; Case presentation: A 55-year-old nulliparous presented to the gynecological oncology ward as a referral with progressive abdominal distension and pain, constipation, and postprandial vomiting. Computed tomography (CT) scan of the abdomen revealed a bulky uterus with multiple calcified masses with cystic degeneration. A chest CT scan revealed bilateral upper and lower lobe nodules with mediastinum and hilar adenopathy. She was scheduled for total abdominal hysterectomy and bilateral salpingo-oophorectomy. A histopathological examination confirmed HG-ESS. The patient survived for three months following surgery.&#x0D; Conclusion: HG-ESS is rare. This case highlights the nonspecific presentation, aggressive nature of the tumor, rapid progression of the disease, and the challenges clinicians face in managing patients who do not honor their appointments with resultant poor overall survival in the late stage.

Long follow-up of Multiple Recurrent Calcific Masses–A rare case report of Hyperphosphatemic Familial Tumoral Calcinosis

Hyperphosphatemic familial tumoral calcinosis (HFTC) is an autosomal recessive benign condition of dysregulated phosphate metabolism (biallelic mutation in GLANT3, KLOTHO or FGF23) due to deficiency or resistance of intact fibroblast growth factor 23 resulting in deposition of large amount of ectopic calcium salts in periarticular soft tissues. We present a 21-year male with multiple recurrent masses around both hips, feet, left knee, and left elbow. His serum inorganic phosphate levels and ratio of renal tubular reabsorption rate of phosphate to corrected glomerular filtration rate were markedly elevated. Medical treatment to lower serum phosphate levels by placing him on tablet sevelamer hydrochloride and acetazolamide and surgical excision of the periarticular masses lead to disease remission. At 4 years follow up he has no recurrence and his functional scores (SF 36 and Harris Hip Score) have tremendously improved. Tumoral calcinosis, though rare must be kept in mind as a differential in abnormal calcific masses and with good radiological and laboratory support can be diagnosed early.

Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis

The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation. We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis. Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3-40.7%). Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.

Extensive intra‐myocardial calcifications: Value of multimodality imaging

BackgroundMassive myocardial calcification is a very rare finding.IntroductionAccurate identification and characteriation may help the clinicians to determine the etiology and clinical significance.ResultsIn this case, the diagnostic pathway excluded previous myocardial infarction, myocarditis, and calcium‐phosphate disorders. A possible dystrophic etiology was considered.DiscussionThere are no standardized imaging features available to classify specific subtypes of intra‐myocardial calcifications. The relative merits of computed tomography and cardiac magnetic resonance (CMR) in providing complimentary diagnostic information in the evaluation of calcific myocardial lesions are shown.ConclusionKnowledge of the potential etiology and their imging patterns are important to provide a concise and accurate differential diagnosis.

A case of Tophaceous Pseudogout: A Rare Crystalopathy Particularly Afflicting the Temporomandibular Joint

<h3>Introduction</h3> Tophaceous pseudogout is a rare variant of CPPD crystal deposition disease presenting with a soft- tissue calcified mass. Temporomandibular joint is a common site of involvement of tophaceous pseudogout. Mu- tations in gene ANKH (inorganic phosphate transport regulator) are involved in crystal related inflammatory reac- tions. <h3>Materials and Methods</h3> We report a case of Tophaceous CPPD crystal deposition disease. A 77-year old female with no pertinent past medical or drug history, presented with persistent dull pain in her left TMJ and gradual change in occlusion over two years with intermittent trismus. Clinical examination revealed a left pre-auricular swelling with compression of the left EAC. CT imaging showed a radiopaque expansile mass encompassing the left TMJ. Surgical removal was performed together with alloplastic reconstruction using a TMJ Concepts Total Joint Replacement prosthesis. <h3>Results</h3> Microscopic examination revealed a low-grade cartilaginous proliferation with intensely basophilic calcified crys- tal deposits which were rhomboidal in appearance and polarized weakly. Few areas showed atypical, occasional binucleated chondrocytes interpreted as chondroid metaplasia. No significant bone or soft tissue invasion was identified. The clinical, histological and radiographic findings were consistent with tophaceous pseudogout (mas- sive CPPD deposition with cartilaginous metaplasia). Post-operatively the patient was pain-free with normalized occlusion and function. <h3>Conclusions</h3> Distinction from other benign chondroid neoplasms such as osteochondroma, synovial chondromatosis which may mimic CPPD disease is important. Low grade chondrosarcoma should be excluded, especially in decalcified sec- tions from which the CPPD crystals may be lost leaving behind only the atypical features in metaplastic chondro- cytes. Tophi of gout needs to be discriminated too, where monosodium urate crystals are more needle shaped and negatively birefringent under polarized light microscopy, besides hydroxyapatite crystals which appear as non- birefringent clumps. Correct identification of the type of crystal deposition is paramount to the treatment of crystal arthropathy as the underlying metabolic disturbances may be quite specific.

Association of ANK2 Mutation and Massive Myocardial Calcification: A Case Report

<h3>Introduction</h3> A 35-year-old man with no prior history of cardiovascular diseases was admitted with progressive exertional chest discomfort. Physical examination revealed irregular heart rhythm and an ejection murmur at the aortic area. EKG showed atrial fibrillation, and chest X-ray, calcification within the cardiac silhouette. Laboratory tests were all within normal ranges, including serological and inflammatory tests. <h3>Case Report</h3> An echocardiogram demonstrated diffuse myocardium calcification and intense mitral- aortic fibrocalcification, causing severe stenosis and moderate regurgitation, with a dilated left ventricle (LV) and moderate systolic dysfunction, akinesia of the inferolateral walls and hypokinesia of the anterior walls. A 128-row multidetector CT showed massive calcification affecting the aortic and mitral valves, the right ventricle, the left atrium wall and all the segments of the LV, preserving only the basal septum. Cardiovascular magnetic resonance imaging 1.5T revealed diffuse myocardial thickening, matching the areas seen on CT (figure). These areas were hypointense on the SSFP cine images and on T1- and T2-weighted images and had no late gadolinium enhancement (LGE). However, there was LGE in the underlying myocardium, in a non-ischemic distribution. Pericardium and coronary arteries were preserved. Genetic analysis identified a rare heterozygous variant of uncertain significance, c.10702C>T(p.Arg3568Trp), in ANK2 gene. <h3>Summary</h3> Ankyrin-B, also known as Ankyrin-2, is encoded by the ANK2 gene, which plays critical roles in the localization and stabilization of ion transporters and ion channels in cardiomyocytes. The Ankyrin-B syndrome has been associated to long QT syndrome and torsades depointes, but there are no reports of myocardial calcification. The patient was found to be a candidate for cardiac transplantation and is currently on the waiting list.

RARE CAUSE OF LEFT VENTRICULAR CALCIFIED MASS

RARE CAUSE OF LEFT VENTRICULAR CALCIFIED MASS

The histological and immunohistochemical features of a metastatic mammary carcinosarcoma in a dog - a case report

A carcinosarcoma is a tumor composed of cells morphologically resembling both malignant epithelial and mesenchymal components. An 11-year-old, female, mixed-breed terrier was referred to the clinic with complaints of anorexia, vomiting and exercise intolerance. Clinically, tumoral masses were seen in the mammary glands. During necropsy, multilobulated calcified masses were observed in several visceral organs (the liver, kidneys, lungs, small intestines, lymph nodes and thyroid) and both right and left (3rd and 4th) mammary glands. Immunohistochemically, Thyroglobulin, SMA, TTF-1, S100, CD34, and p53 were negative in both epithelial and mesenchymal areas, however, Ki-67 showed high proliferation, especially in the mesenchymal areas. While the positivity of vimentin expression was high in the mesenchymal component of the tumor, the positivity of cytokeratin (CK7 and CK19) expressions was high in the epithelial component of the tumor. In the case of a carcinosarcoma, there is a probability that not only the carcinomatous part, but also the sarcomatous part will metastasize. Despite being uncommon, canine carcinosarcomas should always be considered in the differential diagnosis of mixed mammary tumors, if they include both components. There have not been many previous studies dealing with the metastasis of a mammary carcinosarcoma in dogs as an aggressive tumor. Therefore, we consider this report a worthy contribution and have defined the multiple organ metastasis of a mammary carcinosarcoma.

Effect of ethanol washing on porcine pulmonary artery wall decellularization using sodium dodecyl sulfate.

To determine the effectiveness of ethanol (EtOH) washing on porcine pulmonary artery (PA) wall decellularization using sodium dodecyl sulfate (SDS), we compared three different washing methods (phosphate-buffered saline [PBS], pH 9 alkali, and EtOH washing). Fresh porcine PA walls were decellularized using 0.5% SDS and 0.5% sodium deoxycholate (SDC). The decellularized tissues were rinsed using three different washing techniques. Histological, biochemical, and mechanical analyses were conducted. Implantation into the subcutaneous tissue of rats and patch implantation into the carotid artery of dogs were performed as preliminary in vivo studies. The decellularization protocol based on SDS and SDC effectively removed the cells. The major extracellular matrix (ECM) structures (collagen, elastic fiber, and glycosaminoglycan) were properly preserved with the 75% EtOH-washing method. Significantly reduced residual SDS content was identified in EtOH-washed tissues compared to that in the other methods. No significant difference in the mechanical strength test was observed between the washing methods, and the EtOH-washing method showed better results in the metabolic activity test compared to the PBS-washing method. In the rat study model, no acute rejection or massive calcification was observed. The in vivo preliminary canine study showed better cell repopulation in the EtOH-washed group. EtOH washing of SDS-based decellularized porcine PA wall can reduce the residual SDS content and preserve ECM structures, especially the elastin content, and could also enhance cell repopulation after re-implantation.

Renal artery aneurysm misdiagnosed as a pelvic stone: A case report.

Introduction and importanceRenal artery aneurysm (RAA) is an extremely rare condition that is usually symptomless and may be diagnosed by a chance in imaging. However, misdiagnosis is not out of mind and few cases of misdiagnosis of RAA with renal stone have been reported. Misdiagnosis leads to wrong treatment, so it is very important for the correct diagnosis.Case presentationWe reported a similar case in a 57 years old female that referred with right flank pain and ultrasonography and computed tomography (CT) scan reported a calcified mass, resembling renal stone. Through the operation the RAA was diagnosed; however, the mass was damaged and the patient underwent aneurysmectomy. Although she was a single kidney case, collateral circulation saved the kidney.Clinical discussionThe patients may be asymptomatic or may present symptoms like treatment-resistant hypertension, hematuria, thrombosis, renal infarction, abdominal, or flank pain. As literature shows the diagnosis of RAA is challenging and affects patients' timely treatment. Our patient, who was a single kidney person, also survived the condition with no nephrectomy. The case of our study was single kidney and the collateral vessels give a further chance to kidney for survival. Although the affected artery was not further used, the collateral vessels circulation helped the kidney and the patient survived nephrectomy. She was discharged with a normal state and normal urination.ConclusionThe timely diagnosis may help the patient with less invasive treatments.

Detecting calcified pulp stones in patients with periodontal diseases using digital panoramic and periapical radiographies

Background/purposePulp stones are discrete calcified masses appearing in the dental pulp of healthy, disease and unerupted teeth. They are presented freely within the pulp tissue or attached and embedded in any part of coronal and radicular dentin. Here, the purposes of this study were to identify the presence of pulp stones in periodontal patients using digital panoramic and periapical radiographies, and to determine the association with gender, age, tooth type and dental arch.Materials and methodsThis is a retrospective study on selected records of 465 dental samples obtained between January and December, 2020. Data were collected from patients diagnosed with generalized chronic periodontitis and accepted the full periodontal treatment covered by the Government's Periodontal Health Care Program. Their digital panoramic (DPR) examination and full mouth periapical radiographic (DPA) examination (including 12 periapical and 4 bitewing images) were performed at the Outpatient Clinics of the Department of Stomatology, Taichung Veterans General Hospital. Patients were segregated into various groups according to their age, gender and tooth locations. All radiographic images were examined by a dental radiologist and two dentists to identify the presence of pulp stone calcifications and their associated factors using the Sirona applications software. Records were analyzed using SPSS version 22.0 based on tests of Pearson Chi-square and McNemar correlation.ResultsFrom 271 males and 194 females, a total of 465 DPR and 7440 DPA radiographs were studied. Pulp stone calcifications were identified in 270 (58.0%) subjects in DPR images and 348 (74.8%) subjects in DPA images (for 1 or more teeth per subject). We detected calcified opacities in 1031 teeth with DPR images and in 1326 teeth with DPA images from a total of 12,407 teeth. The incidence of pulp stones was similar across genders, but different in tooth locations and dental arch sextant. Moreover, pulp stones were detected more often on maxillary molars and subjects of old ages (>40 years). Digital panoramic and periapical radiography showed significant differences in the detection of pulp stone calcifications (P < 0.05), and detected better with digital periapical radiography examination.ConclusionWe found 58.0% (n = 645) of our patients with pulp stones using digital panoramic radiography, and 74.8% using digital periapical radiography. Regarding individual teeth, only 8.5% of pulp stones were observed in digital panoramic radiography and 10.6% in digital periapical radiography. Pulp stones were more often seen in maxillary molar teeth and old patients of ages >40 years old using periapical radiography examination especially in those patients with periodontally condition. As a two-dimensional imaging system, digital periapical radiography is recommended for a definitive and routine assessment in patients suspected of hard tissue abnormality and pulp calcification formation.

Dual-Source Dual-Energy CT-Scan Confirms the Diagnosis of Ancient Hydatid Cysts Recovered from a Late Roman Burial in Amiens, France.

Background:Two calcified objects recovered from an adolescent in a burial site in Amiens, France, have been previously identified as hydatid cysts using thin-section petrography. The importance of ancient hydatidosis besides the value of these unique archeological excavated materials encouraged the authors to look at this attractive subject more interdisciplinary by implementing medical radiology.Methods:In the current experiment, which has been carried out in the Radiology Department, Tehran Heart Center (THC), Tehran, Iran, the conventional and dual-energy dual-source Tomography, X-Ray Computed-scan was used in studying the remaining structures of the two calcified masses. The imaging procedure was carried out based on X-Ray attenuation by two different tube voltages.Results:A high concentration of calcium sediment in the cyst walls was revealed in Hounsfield units, the measuring of the elements in CT. Taking advantage of implementing this imaging technique the oxalate calcium was also shown as the dominant component of the samples. The results were all in favor of diagnosing hydatid cysts.Conclusion:The achieved pictorial results in the present paper have highlighted the important role of CT scan as a noninvasive confirming technique in paleopathological investigations. Using Dual-source dual-energy CT-scan in reconfirming these previously identified hydatid cysts, is an encouraging message towards the necessity of sequential studies on invaluable biological excavated pieces.

Alveolar echinococcosis located in the liver: Report of a case

Echinococcosis is a parasitic infection caused by larval and cyst stages of Echinococcus granulosus living in dogs in humans. The definitive host of the parasite is dog, intermediate hosts are sheep, cattle and humans. The causative pathogen is mostly Echinococcus granulosus. Echinococcus multilocularis (alveolaris) and other agents are less common. Only 3% of hepatic hydatid cysts are alveolar hydatid cysts. In this study, we aimed to present a case of Alveolar echinococcosis located in the right lobe of the liver due to Ecinococcus alveolaris, together with the operation images. We evaluated the preoperative, peroperative and postoperative course of a patient who was examined with abdominal pain in our clinic and in radiological and serological examinations, we found an alveolar hydatid cyst located in the liver and underwent surgery. Our patient was a 31-year-old female. She applied for abdominal pain. Ultrasonography revealed a cystic mass of approximately 17 cm in diameter in the right lobe of the liver. In laboratory examinations, the hydatid hemagglutination test was positive at a titer of 1/2560. Hematological and biochemical parameters were normal. MRI showed a 171*125 mm sized, lobulated, locally calcified cystic mass in the right lobe of the liver. After evaluating the relationship of the lesion defined in CT angiography imaging with vascular structures, the decision to operate was made with the diagnosis of Alveolar echinococcosis.. Nonanatomical segmental right hepatectomy and total cyst excision operation was performed in our patient who was thought to have Alveolar echinococcosis based on clinical, serological and radiological findings. The patient, who had an uneventful postoperative period, was discharged on the 7th postoperative day with full recovery. In cases of echinococcosis, the treatment is determined according to the type of the agent, the stage and localization of the lesion. Medical treatment, PAIR and surgery are the treatment options that can be applied. Total excision of the mass is recommended in cases of Alveolar echinococcosis.

Fetus in fetu: A rare differential diagnosis for an antenatally identified ultrasonographic intra-abdominal mass

Background: Fetus in fetu (FIF) is a rare congenital anomaly in which a parasitic fetus is trapped inside the body of its twin. The incidence is 1 in 500,000 births. Initially, considered as a mature teratoma, it was later identified as a separate entity due to the presence of an axial skeleton and organized limbs. Clinical Description: A 48-day-old girl presented with an antenatally detected calcified intra-abdominal mass. She had a palpable retroperitoneal mass measuring 6 cm × 4 cm at the left lumbar area. Sonology showed a heteroechoic cystic mass in the left lumbar region. Serum markers were normal except for a slightly elevated serum lactate dehydrogenase. Contrast-enhanced computerized tomography of the abdomen showed a well-defined cystic lesion measuring 7.6 cm × 6.5 cm × 5.9 cm with enhancing septae, multiple calcific foci, teeth, and bones in the left suprarenal region displacing the left kidney. Management: Laparotomy showed a cystic appearing mass with solid components within. Cystic structure was the amniotic covering and solid component turned out to be the FIF with a face, limbs, and umbilical cord. No adjacent infiltration was seen. Pathology confirmed the finding of FIF with an identifiable vertebral column, umbilical cord, pelvis and lower limb bones, skin, and retinal and brain tissue. The infant has been under follow-up for a year and is thriving. Conclusion: FIF is a rare condition of infancy which can be diagnosed preoperatively by radiological examination, treated by complete excision, and confirmed by gross and histopathology. Differentiation of FIF from teratoma is mandatory as the latter can be malignant.

Serpulid reefs and their role in aquatic ecosystems: A global review.

The Serpulidae are a large family of sedentary polychaetes, characterized by a calcareous habitation tube, which they cannot leave. The calcium carbonate tube is in the form of both aragonite and calcite, in fairly constant ratio for each taxon. Tubes are cemented firmly to any hard substrate (in only few species tubes are free). Although in the majority of the species the tubes encrust the substrate for all their length, the distal part may eventually detach and grow erectly. Certain species in dense populations build tubes vertical to the substrate in clumps and cement the tubes to each other. This gives serpulids the capability of forming reef-life structures when densely settling. Despite the relative smallness of the individual tubes (rarely longer than 15cm and wider than 1cm), such reef-like structures may cover tens of m2, with a layer more than 1m thick. Serpulid reefs can be divided roughly into seven groups, according to the building modality and the type of habitat they occupy: (i) pseudocolonies; (ii) littoral belts; (iii) subtidal to deep-water reefs; (iv) reefs in coastal lakes and harbours; (v) brackish water reefs; (vi) tapestries in freshwater caves; (vii) biostalactites inside marine caves. The role of serpulid reefs in the ecosystems they inhabit is multifarious and may be distinguished in functions (biomass and production, benthic pelagic coupling, resistance and resilience, reproductive and survivorship strategies, trophodynamics, bioconstruction, living space and refuge, nursery, sediment formation and retention, food for other species, carbonate deposition and storage) and services (water clearance, reef associated fishery, cultural benefits). On the other hand, many serpulids are important constituents of biological fouling, and their calcareous masses damage submerged artefacts, causing huge economic costs. Positive and negative roles of serpulid reefs need to be compared with common metrics; the overall balance, however, is still to be assessed.

Evaluation and Correlation of Pulpal Calcification in the Patients with Cardiovascular Diseases in Vidarbha Region, India

Background: The dental pulp is soft tissue enclosed in the hard tissues of teeth. Calcification occurring in the body affects the dental pulp too. Pulp undergoes calcification as whole or in discrete masses known as denticles or pulp stones. Pulp stones are nodular, calcified masses seen more frequently in coronal pulp than radicular pulp. Pulp stones can vary from small structures embedded in pulp tissue to large masses.&#x0D; Aim: To evaluate and correlate the pulpal calcification with cardiovascular diseases in the patients using radiograph in Vidarbha region.&#x0D; Objectives:&#x0D; &#x0D; To evaluate the presence of pulpal calcification in the patients with cardiovascular disease using Ortho-pantomogram images.&#x0D; To co-relate the radiological findings with the cardiovascular disorders.&#x0D; &#x0D; Methodology: The present study comprises of 30 patients out of whom 15 patients will be in test group and 15 patients in control group. The test group will consist of patients suffering from cardiovascular diseases and control group will consist of healthy patients with no significant medical history. Ortho-pantomogram will be taken of each participant and the anterior and posterior teeth will be assessed for any pulp calcification and obliteration of pulp chamber and root canals.&#x0D; Expected Results: Positive correlation is expected between pulp calcification and cardiovascular diseases.&#x0D; Conclusion: Positive correlation can be found between the occurrence of pulpal calcifications and cardiovascular disease. Hence the occurrence of pulpal calcifications can be used to predict the future chances of cardiovascular diseases in the otherwise normal person. Early detection of pulp calcification can be used as a tool to predict the disease and will help in taking possible steps to avoid the future episodes of heart diseases.