Radiographic Manifestations Research Articles

P269 Is there a correlation between ethnicity and severity of axial spondyloarthropathy?

Abstract Background/Aims Axial spondyloarthropathy (axSpA) is more prevalent in the Caucasian population. This is in part due to genetics; HLA-B27, the main contributing gene, is more prevalent in the Caucasian population, with up to 90% of patients being positive. Incidence is much lower in the Asian and Black population. There are few studies which have compared the relationship between ethnicity and severity of axSpA. Existing studies show that, despite lower incidence of HLA-B27, Black patients actually suffer more severe disease. However, there are few studies investigating the relationship in the Asian population. With Leicester, UK being such a diverse area, we took this opportunity to investigate the correlation between ethnicity and severity of axSpA, including radiographic and extra-articular manifestations. Methods Data was collected by retrospective analysis of axSpA patients attending University of Leicester (UHL) axSpA services. Inclusion criteria entailed a diagnosis of axSpA with a documented BASDAI within a year of MRI spine and sacroiliac joints, prior to starting any biological treatment. Exclusion criteria included active infection and/or malignancy, or BASDAI not documented prior to starting biological therapy or within a year of MRI. Data on demographic characteristics, extra-articular manifestations (uveitis, inflammatory back pain, enthesitis, peripheral arthritis, dactylitis, psoriasis, and inflammatory bowel disease), family history, response to NSAIDs, and HLA-B27 status were collected from 149 patients. Relationship with ethnicity was assessed using Pearson’s chi-squared, which we conducted via Statistical Package for the Social Sciences (SPSS) software. Results Of the 149 patients, 68% were White Caucasian, 30% Asian and 1% Black. The average age was 43, with 66% male and 34% female. There was no significant relationship between ethnicity and active sacroiliitis (p = 0.926), chronic sacroiliitis (p = 0.218) or axial disease (p = 0.307). 64 Caucasian patients were HLA-B27 positive compared to 27 Asian patients, and no Black patients were positive. Despite this, there was no statistical correlation between ethnicity and HLA-B27 (p = 0.383). Overall, Caucasians consistently had a greater incidence of extra-articular manifestations compared with non-Caucasians. However, no significant p values were observed here or with response to NSAIDs, family history or familial HLA-B27 and BASDAI scores. Conclusion From this study, demographics show a larger proportion of Caucasians affected with axSpA compared to other ethnicities, as well as a higher proportion of HLA-B27 positivity, which is in keeping with population studies. It would seem there is a higher incidence of extra-articular manifestations in the White population - however, no statistical significance can be observed. This study was useful to gain further insights into the Asian population but has demonstrated that it is difficult to predict how an axSpA patient will behave based on ethnicity alone. Larger population studies will be needed to further evaluate the relationship between axSpA and ethnicity. Disclosure S. Byravan: None. A. Moorthy: None.

Spinal Brucellosis Masquerading as Pyogenic Spondylodiscitis: A Rare Case

Brucellosis is a zoonotic infection secondary to Brucella spp. Musculoskeletal system is the most affinity site to been affected by this disease and lumbar vertebrae the most favourite site of involvement. The disease can manifest as focal or diffuse. The dietary history is a main and good clinical clue towards the definite diagnosis. Plain radiograph may benefit in terms of focal disease, however MRI is the most sensitive and appropriate imaging to look for extension of the disease and spinal complications. We are reporting a case of spinal Brucellosis in a lady who was initially diagnosed as pyogenic and tuberculous spondylodiscitis. Patient’s initial presentation as well as the radiological investigation led towards the diagnosis of pyogenic spondylodiscitis, however the blood culture revealed Brucella melitensis. We would like to highlight the importance of clinical history and challenges in diagnosing spinal Brucellosis as radiographic manifestation is non-specific and the organism are almost forgotten nowadays.

Study of vital inflamed pulp therapy in immature permanent teeth with irreversible pulpitis and apical periodontitis

To assess the treatment effectiveness of vital inflamed pulp therapy (VIPT) in immature permanent teeth with irreversible pulpitis and apical periodontitis. The faculty members in the Department of Pediatric Dentistry, the Ninth People's Hospital were invited to submit consecutive VIPT cases from June 2015 to June 2016 (follow-up periods>12 months). The cases were retrospectively reviewed, clinical symptoms and radiographic changes in periapical radiolucency were evaluated, meanwhile, the data of radiographic changes such as apical diameter and root length were calculated and analyzed with ANOVA. Totally thirteen submitted patients/cases were included (6 males and 7 females) in the present study,. The average age of patients was (9.9±1.4) years old. The average follow-up time was (26.5±6.8) months (17-37 months). At the 12-month visit, all 13 treated teeth survived, 9 out of 11 teeth with apical periodontitis showed normal radiographic manifestation. At the 3, 6 and 12 months visits, the within-case percentage changes in apical diameter were (8.0±5.1)%, (24.1±9.1)% and (70.3±10.7)%, respectively, while the within-case percentage changes in root length were (11.4±9.8)%, (14.5±9.8)% and (27.4±14.2)%, respectively. There were statistically significant differences in the changes of apical diameter (F=18.80, P<0.001) and root length (F=4.64, P=0.047) from the preoperative time to the postoperative follow-ups. VIPT might improve clinical outcomes, even achieve continued root development. VIPT can be an option in treating immature teeth with irreversible pulpitis and apical periodontitis.

THE EFFECT OF DIFFERENT TREATMENT REGIMENS AMONG PATIENTS WITH INTERSTITIAL LUNG DISEASES OF UNKNOWN ETIOLOGY

Interstitial Lung Diseases (ILD) are a collection of parenchymal lung disorders classified together for its similar clinical, radiographic and pathological manifestations. It is characterized by scarring and fibrosis of the lung interstitium. Several biomarkers including clinical and radiological biomarkers have been proposed to predict the stage and progress of the disease. In Saudi Arabia, there are no studies yet that has discussed the best treatment approach to those patients. For that, our research had focused about gathering informationabout the use of steroids, and whereas it had an effect on the disease progression.Furthermore, this study measured the outcome of the use of an immunosuppressive medications to control the disease. The study is a retrospective cohort study that was done in National Guard Hospital in Jeddah during the period from 2017 to 2019 for patients admitted with ILDs of unknown etiology during the period 2012 to 2016 who are Adults ( 18 years or older ) excluding those who have other chronic lung disease, heart failure, or known triggers to the disease. The data of the patients was collected by looking at their medical records (hardcopy). A data extraction sheet was used that included baseline demographics and disease characteristics, used medications, outcome parameters ( PFT, CT Chest, Subjective Clinical Improvements ) for data interpretation. And Data was analyzed using the software STATA. Results show the use of systemic steroids alone showed clinical improvement in 17% of steroid users and 8% improvement in chest CT. And the addition of immunosuppressive medications showed 33% clinical improvement and 17% chest CT improvement in comparison to those who were not treated with immunosuppressive medications. Concluding that the results were non significant with poor outcome and little improvement.

Immunoglobulin G4-related disease: A narrative review

Immunoglobulin G4-related disease (IgG4-RD) is a rare and new but increasingly recognized immune-mediated fibroinflammatory condition known to affect multiple organs. The diagnostic approach is challenging, as there is no single investigation to confirm the diagnosis, which requires the integration of clinical, biochemical, and radiographic manifestations with classic histopathologic features to establish the diagnosis. The histology of IgG4-RD is determined by a dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of an increased level of IgG4 in most patients. The first line of treatment is systemic glucocorticoids, but adverse effects of the drug, suboptimal response, and disease recurrences on reduction or termination of therapy highlight the need for an alternative therapy such as rituximab, which appears to be a promising alternate agent in the treatment of IgG4-RD; however, its efficacy needs to be evaluated in large clinically controlled trials.

The Association between the Level of Plasma D-dimer and Disease Severity and Prognosis of Mycoplasma pneumoniae Pneumonia in Children

To explore the association between the levels of plasma D-dimer and the disease severity and prognosis of Mycoplasma pneumoniae pneumonia (MPP) in children. We retrospectively analyzed the clinical data of pediatric MPP patients who were admitted in our hospital between January 1, 2016 and December 31, 2018. According to the peak value of D-dimer, patients were divided into the normal group (D-dimer<0.55 mg/L) and the elevated group (D-dimer≥0.55 mg/L). Information regarding the demographics, clinical manifestations, auxiliary examinations and treatments of patients in the two groups was compared. Of the 231 MPP patients included in the study, 70 were in the normal group and 161 were in the elevated group. The age of patients in the D-dimer elevated group was significantly higher than that of the normal group ( P<0.01). Compared with the normal group, the elevated group had longer lengths of fever, hospital stay and antibiotic therapy, and more severe radiographic manifestations (all P<0.01). In addition, the incidence of extrapulmonary complications, refractory MPP and severe MPP in the elevated group were significantly higher than those in the normal group ( P<0.01). As for the laboratory data, we found that neutrophils, C-reactive protein, lactate dehydrogenase, interleukin-6, interleukin-10 and interferon-γ were significantly higher in the elevated group than those in the normal group ( P<0.05). After treatments, all patients showed improvement and were discharged, but the proportions of patients requiring glucocorticoids, bronchoscopy, thoracentesis were significantly higher in the elevated group than those in the normal group ( P<0.05). Follow-up findings showed that the absorption rate of lung lesions 4 weeks after admission was significantly higher, the time needed for lung lesions absorption was significantly shorter, and the incidence of pulmonary sequelae was significantly lower in the normal group than those in the elevated group (all P<0.05). Correlation analysis showed that D-dimer level was positively correlated with the severity of pneumonia ( r=0.272, P=0.000) and the incidence of pulmonary sequelae ( r=0.235, P=0.000). Pediatric patients of MPP who had elevated plasma D-dimer had clinical manifestations that were more severe, required longer duration of treatment and longer recovery time for lung lesions, and were more likely to have pulmonary sequelae.

Osteoarticular disorders in sickle cell disease

Different organs can be affected secondary to sickle cell disease, including the central nervous system, kidneys, gastrointestinal tract, respiratory system, cardiovascular system, bone, and joints. This can lead to increased morbidity and mortality events among the affected patients. Osteoarticular complications represent a severe set of events for patients with sickle cell disease. These complications might include gouty, septic, juvenile, and erosive arthritis, dactylitis, bone infarction, and osteomyelitis. These are the most common complications reported in the literature, and some case reports even reported other types of complications that develop secondary to the previously mentioned ones. Adequate diagnosis might be challenging in some cases. Therefore, clinicians must be crucial in determining the appropriate clinical and radiographic manifestations. Treating these cases is also challenging. Consequently, clinicians should be aware of these complications to enhance the prognosis of the affected patients. Further research is needed for the standardization of the diagnostic and management approaches in these events.

Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis.

Roughly 37% of Americans 60 years of age and older experience chronic pain due to osteoarthritis (OA) of the knee. After conservative treatment (pharmacologic, physical therapy, and joint injections) fails, patients often require total knee arthroplasty to alleviate pain and regain knee function. Given the high economic burden of surgery paired with its invasive nature, many patients with this degenerative joint disease seek alternative treatment. Moreover, many patients with severe knee OA who also have comorbidities that preclude surgery-most often morbid obesity-are left without options. Geniculate artery embolization (GAE) is a minimally invasive intra-arterial intervention that was originally developed for the treatment of knee hemarthrosis that has recently been adapted for symptomatic knee OA. Through selective embolization of geniculate branches corresponding to the site of knee pain, GAE inhibits the neovascularity that contributes to the catabolic and inflammatory drive of OA. Preliminary trials over the past decade have demonstrated promising clinical results, including decreased pain and improved function and quality of life after treatment. Given such success, GAE provides another minimally invasive treatment option for knee OA to patients who feel reluctant to undergo or are ineligible for surgery. The authors review the radiographic manifestations and current standard of treatment of OA and hemarthrosis of the knee. Procedural technique, embolic selection, and clinical evidence for GAE in the treatment of OA and hemarthrosis of the knee are also explored. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2021.

A RARE RADIOGRAPHIC MANIFESTATION OF A CHRONIC COUGH

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by small vessel necrotizing vasculitis. AAV, including microscopic polyangiitis (MPA), is uncommonly association with interstitial lung disease (ILD). We present a pulmonary presentation of MPA with unique radiographic manifestations. CASE PRESENTATION: A 68-year-old woman with history of hypertension, hyperlipidemia, chronic lymphocytic thyroiditis and obesity presented with 8 weeks of dry hacking cough, associated with dyspnea on exertion and a 20lb weight loss. She was without sinusitis, visual changes, hemoptysis, abdominal symptoms, paresthesia, skin changes, or arthritis. Her initial prescriptions of loratadine and 10-days of doxycycline, then 10-days of prednisone had no effect. She was transitioned off Lisinopril to only mild improvement in her cough.The ILD CHEST questionnaire was completed without obvious toxic insult noted [1]. Her initial workup revealed mild leukocytosis (13), urinalysis with 1+ occult blood, normal Creatine Kinase, Aldolase, Thyroid studies, Liver function tests, electrolytes, and creatinine. Infectious workup was negative for HIV and COVID-19. High-resolution chest imaging demonstrated bilateral central bronchial wall thickening and inflammation and no pleural reticulation, honeycombing, nor adenopathy.Bronchoscopy with transbronchial and endobronchial biopsies revealed intra-alveolar hemorrhage and hemosiderin-laden macrophages but without definitive vasculitis. Infectious workup was unremarkable. Antinuclear and glomerular basement membrane antibody testing was negative. Serologic testing was notable for perinuclear anti-neutrophil cytoplasmic antibody titer of 1:640 (<1:20) and positive myeloperoxidase antibodies. Nephrology evaluation showed evidence of glomerulonephritis with dysmorphic hematuria and proteinuria, and Rheumatological evaluation revealed elevated sedimentation rate 120 mm/H (<20) and C-reactive protein 61mg/L (<10). DISCUSSION: Given concern for pulmonary and renal end-organ involvement, prednisone 60mg daily with Bactrim for Pneumocystis Jirovecii prophylaxis was started. Her cough markedly improved. Her case was discussed internally at our Multidisciplinary ILD board and she was transitioned to Rituximab induction for MPA/AAV treatment. Her cough has resolved with no functional dyspnea while on therapy. CONCLUSIONS: ILD is an uncommon associated finding in MPA. When present, more common radiographic manifestations include ground glace opacities, reticulations, interlobular septal thickening and even honeycombing (2). Our case was notable for radiographic central bronchial wall thickening and inflammation alone, a rare manifestation [2,3]. When present, bronchial wall thickening is typically seen in association with usual interstitial pneumonia or diffuse alveolar hemorrhage [2]. The latter of which was identified during our patient's bronchoscopy. REFERENCE #1: www.chestnet.org. [last accessed 2021 April 20]. REFERENCE #2: Suzuki A, Sakamoto S, Kurosaki A, Kurihara Y, Satoh K, Usui Y, Nanki T, Arimura Y, Makino H, Okada Y, Harigai M, Yamagata K, Sugiyama H, Dobashi H, Ishizu A, Tsuboi N, Usui J, Sada KE, Homma S; for Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable Vasculitis and Research Committee of Intractable Renal Disease of the Ministry of Health, Labour, and Welfare of Japan. Chest High-Resolution CT Findings of Microscopic Polyangiitis: A Japanese First Nationwide Prospective Cohort Study. AJR Am J Roentgenol. 2019 Jul;213(1):104-114. doi: 10.2214/AJR.18.20967. Epub 2019 Apr 11. PMID: 30973774. REFERENCE #3: Ando Y, Okada F, Matsumoto S, Mori H. Thoracic manifestation of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-related disease. CT findings in 51 patients. J Comput Assist Tomogr. 2004 Sep-Oct;28(5):710-6. doi: 10.1097/01.rct.0000135280.79012.c7. PMID: 15480049. DISCLOSURES: No relevant relationships by Kyle Halligan, source=Web Response No relevant relationships by Jennifer Kodela, source=Web Response

Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis

Abstract. Introduction Re-infection rates remain high after revision for periprosthtic joint infection (PJI). We conducted a complex diagnostic study of hip PJI and studied bone tissue involvement into the infectious process. Material and methods Twenty-nine patients treated for PJI were examined. Ten patients had acute, seven had late and 12 hematogenous infection (Tsukayama, 1996). Clinical, laboratory, microbiological, radiographic and histological methods were used for PJI detection. Results ESR exceeded the threshold in 16 and CRP in 23 cases. Pathogenic microorganisms were confirmed in 23 cases. Radiographic manifestations of periprosthetic bone destruction were seen in 14 patients with late and hematogenous infection. The histological study showed signs of osteomyelitis in 19 patients, including five cases with acute PJI. Histological study of periprosthetic and pseudosynovial membranes revealed PJI in 20 patients. The histological and microbiological tests together confirmed PJI in 27 cases (92 %). ROC analysis showed that the accuracy of CRP in the diagnosis of osteomyelitis exceeded that of ESR due to its higher sensitivity. Microbiological tests showed satisfactory sensitivity but low specificity. The radiographic study had an extremely low sensitivity and low specificity. Histology of membranes was quite sensitive and specific for the diagnosis of osteomyelitis but did not reach the level of bone histology. Conclusions Our complex diagnostic study has enabled to accurately characterize the septic process in revision arthroplasty. The histological findings show that osteomyelitis of different severity might develop in each PJI type. This fact may be a key factor for a surgeon in choosing a more reliable treatment option.

Mucormycosis in Indian COVID-19 Patients: Insight into Its Patho-Genesis, Clinical Manifestation, and Management Strategies.

Mucormycosis in patients who have COVID-19 or who are otherwise immunocompromised has become a global problem, causing significant morbidity and mortality. Infection is debilitating and fatal, leading to loss of organs and emotional trauma. Radiographic manifestations are not specific, but diagnosis can be made through microscopic examination of materials collected from necrotic lesions. Treatment requires multidisciplinary expertise, as the fungus enters through the eyes and nose and may even reach the brain. Use of the many antifungal drugs available is limited by considerations of resistance and toxicity, but nanoparticles can overcome such limitations by reducing toxicity and increasing bioavailability. The lipid formulation of amphotericin-B (liposomal Am-B) is the first-line treatment for mucormycosis in COVID-19 patients, but its high cost and low availability have prompted a shift toward surgery, so that surgical debridement to remove all necrotic lesions remains the hallmark of effective treatment of mucormycosis in COVID-19. This review highlights the pathogenesis, clinical manifestation, and management of mucormycosis in patients who have COVID-19.

Cemental tear: Literature review, proposed classification and recommendations for treatment.

Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

Propensity-matched Comparison of VATS Left Upper Trisegmentectomy and Lobectomy

BackgroundThis study aimed to investigate the oncologic outcomes of video-assisted thoracoscopic (VATS) left upper trisegmentectomy (LTS) vs left upper lobectomy (LUL) for patients presenting with stage I non-small cell lung cancer (NSCLC). MethodsA retrospective analysis identified 1543 consecutive patients presenting to Shanghai Pulmonary Hospital (Shanghai, China) with NSCLC for VATS LTS or LUL from 2013 to 2017. After propensity-score matching for patient demographics and tumor characteristics, 273 pairs were identified. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test. ResultsThe median follow-up time was 51.5 months. There were no significant differences in operative duration (2.11 ± 0.64 hours vs 2.49 ± 5.96 hours; P = .30), total blood loss (106.19 ± 170.83 mL vs 97.07 ± 149.34 mL; P = .51), and operative complications (10% vs 8%; P = .37) between the LUL and LTS groups. Patients undergoing LUL had longer postoperative hospital stays (5.55 ± 3.00 days vs 4.87 ± 2.33 days; P = .003), greater tumor margin distance (3.3 ± 1.2 cm vs 3.1 ± 0.9 cm; P < .001), and greater number of lymph nodes harvested (8.0 ± 3.2 vs 6.8 ± 3.3; P < .001) than patients undergoing LTS, but the margin-to-tumor ratio was not statistically different (2.5 ± 1.6 vs 2.3 ± 1.1; P = 0.11). Median DFS (49.5 months vs 54.3 months; P = .77) and OS (49.5 months vs 55.0 months; P = .88) were not significantly different between patients undergoing LTS and those undergoing LUL, and similar outcomes were noted across subgroups of patients stratified by tumor stage, pathologic type, and radiographic manifestations. ConclusionsVATS LTS and LUL had comparable oncologic outcomes for stage I NSCLC, regardless of tumor pathologic types and radiologic findings, as long as negative margins were confirmed.

The Level of D-Dimer Is Positively Correlated With the Severity of Mycoplasma pneumoniae Pneumonia in Children.

Objective Mycoplasma pneumoniae pneumonia (MPP) is an important disease in children. Studies have demonstrated that the levels of D-dimer are elevated in some children with MPP, especially those with thrombotic complications. However, the potential association between MPP and D-dimer remains unclear. In our study, we sought to explore the relationship between the levels of plasma D-dimer and clinical characteristics of MPP patients.MethodsRetrospective analysis was conducted on 356 patients who were hospitalized in our hospital for MPP between January 1, 2017, and December 31, 2019. According to the peak value of D-dimer, patients were divided into three groups: the normal group (D-dimer<0.55 mg/L), the mild-moderately elevated group (D-dimer 0.55–5.5 mg/L) and the severely elevated group (D-dimer >5.5 mg/L). The demographic and clinical information, radiological findings, laboratory data, and treatments of patients were compared among different groups.Results106 patients were in the normal group, 204 patients were in the mild-moderately elevated group, and 46 patients were in the severely elevated group. More severe clinical and radiographic manifestations, longer length of fever, hospital stay and antibiotic therapy duration, higher incidences of extra-pulmonary complications, refractory MPP (RMPP), severe MPP (SMPP) were found in the elevated group, when compared with the normal group (P<0.01). Meanwhile, we found that the percentage of neutrophil (N%) and CD8 + lymphocyte (CD8 +%), C-reactive protein (CRP), lactate dehydrogenase (LDH), interleukin (IL)-6, IL-10, and interferon-gamma (IFN-γ) trended higher with increasing D-dimer, whereas the percentage of lymphocyte (L%) and prealbumin (PAB) trended lower (P<0.01). In addition, the proportions of patients requiring oxygen therapy, glucocorticoid, bronchoscopy, immunoglobulin use, thoracentesis, or ICU admission were significantly higher in the severely elevated group than those in the other two groups (P<0.01). Correlation analysis showed that N%, L%, CRP, LDH, IL-10, length of fever, length of stay, and length of antibiotic therapy had strong correlations with the level of D-dimer.ConclusionsMPP patients with higher levels of D-dimer had more severe clinical manifestations and needed longer duration of treatment, which might be closely related to the severity of lung inflammation after MP infection.

Plasmacytoma and plasma cell myeloma affecting the jaws: A multi-institutional collaborative study.

Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma). Paraffin-embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed and follow-up status were retrieved from the pathology reports. Fifty-two cases were retrieved (mean age: 59.4years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumours usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5years of follow-up was 26.6%. Plasma cell neoplasms are aggressive tumours with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.

Pediatric Orbital Entrapment: Radiographic Findings and Their Predictive Values.

Although orbital fractures are less common in children than adults, the literature suggests that orbital entrapment occurs more frequently in the pediatric population. Orbital entrapment is an emergency, and early diagnosis and prompt management are critical. Specific radiographic manifestations such as herniation of extraocular muscles (EOMs) through orbital fractures have led to increased suspicion and overdiagnosis of orbital entrapment. This study evaluated the value of specific radiographic findings in predicting clinical findings after pediatric orbital floor fractures. A retrospective review at a pediatric level 1 trauma center was performed. ICD-9 and ICD-10, codes identified patients with orbital fractures. Computed tomography (CT) reports were queried for the following terms: "herniation," "herniated," "entrapped," and "entrapment." Patients 16 years and older were excluded, as were all patients who were unable to undergo EOM evaluation on presentation. Electronic medical records were reviewed for fracture type, mechanism of injury, clinical and radiographic findings, surgical interventions, and demographic information. Medical diagnosis tests, including positive and negative predictive values, sensitivity, as well as specificity, were calculated to identify the relationship between radiographic findings and specific symptomology. One hundred fifty-three patients with 265 orbital fractures were included. "Entrapment" was mentioned in 34.6% of CT reports, whereas the incidence of clinical entrapment was 12.4% (19/153). Radiographic fat herniation, EOM herniation, and EOM irregularity had positive predictive values of 25%, 31%, and 10%, respectively, for clinical entrapment diagnosis at the initial examination. Overall, 32.7% (50/153) of patients with orbital fractures required surgery. Although the radiographic description of soft tissue herniation has become interchangeable with entrapment, these CT findings alone are poorly predictive. Orbital entrapment should be diagnosed preoperatively by physical examination, with radiographs as an adjunct only. Radiographic statements without clinical correlation may lead to the improper management of pediatric facial trauma patients.

Diagnosis, treatment, and misdiagnosis analysis of 28 cases of central nervous system echinococcosis

BackgroundTo explore central nervous system (CNS) involvement in this disease, from the perspectives of diagnosis, treatment, and misdiagnosisMethodsTwenty-eight patients with CNS echinococcosis were included in this retrospective study, including 18 males (64.3%) and 10 (35.7%) females. The average age of all the patients were 23.5 years (ranged 4–60 years). Twenty-three (23) patients (82.1%) received the first surgical resection in our hospital. Five (5) patients (17.9%) gave up surgical treatment for multiple-organ hydatidosis and previous surgery history at other hospitals, and albendazole was applied for a long-term (3–6 months) adjunct therapy for the 5 patients. The average follow-up time was 8 years.ResultsFor the 28 patients, 23 cases received surgical treatments, and the diagnosis was confirmed by pathological examinations. The diagnosis of 4 cases of brain echinococcosis and 2 cases of spinal cord echinococcosis could not be confirmed, resulting in a misdiagnosis rate of 21.4% (6/28). For the pathological examination, a total of 17 cases were infected with Echinococcus granulosus (including 2 cases of spinal cord echinococcosis), and 6 cases were infected with Echinococcus alveolaris.ConclusionThe diagnosis should be specifically considered in endemic regions. The clinical features of CNS hydatidosis were intracranial space-occupying lesions. For the treatment, the surgical removal of cysts should be necessary. In addition, the adjuvant therapy with drug and intraoperative prophylaxis is also suggested. The misdiagnosis may have resulted from atypical clinical features and radiographic manifestations, as well as the accuracy of hydatid immunologic test.

Reappraisal of Pediatric Normal-Pressure Hydrocephalus.

While normal-pressure hydrocephalus (NPH) is most commonly diagnosed in older adulthood, a significant body of literature has accumulated over half a century documenting the clinical phenomenon of an NPH-like syndrome in pediatric patients. As in adult NPH, it is likely that pediatric NPH occurs due to a heterogeneous array of developmental, structural, and neurodegenerative pathologies, ultimately resulting in aberrant cerebrospinal fluid (CSF) flow and distribution within and around the brain. In this review, we aimed to systematically survey the existing clinical evidence supporting the existence of a pediatric form of NPH, dating back to the original recognition of NPH as a clinically significant subtype of communicating hydrocephalus. Leveraging emergent trends from the old and more recent published literature, we then present a modern characterization of pediatric NPH as a disorder firmly within the same disease spectrum as adult NPH, likely with overlapping etiology and pathophysiological mechanisms. Exemplary cases consistent with the diagnosis of pediatric NPH selected from the senior author’s neurosurgical practice are then presented alongside the systematic review to aid in discussion of the typical clinical and radiographic manifestations of pediatric NPH. Common co-morbidities and modern surgical treatment options are also described.

Autotransplantation of a completely developed impacted maxillary canine: A 7-year follow-up case report

BackgroundImpacted maxillary canines are likely to be extracted in adult patients once orthodontic treatment is ruled out. The missing teeth are generally replaced with dental implants. Case DescriptionThe authors report the clinical case of a 45-year-old man who was missing the maxillary left canine for 30 years. Radiographic examination revealed that the maxillary permanent left canine was palatally impacted. The tooth was transplanted into the prepared socket on the missing tooth site and secured in the desired position with a flexible wire splint. During the 7-year follow-up, the tooth remained clinically sound with no radiographic manifestation of inflammatory or root resorption. Practical ImplicationsThe prognosis for the transplanted tooth was favorable after long-term follow-up observation. This result suggests that autotransplantation of impacted maxillary canines can be a viable treatment option for some adult patients who expect to retain their natural teeth.

Improvement in Pulmonary Function Following Discontinuation of Vaping or E-Cigarette Use in Adolescents with EVALI.

Introduction: In 2019, an alarming number of cases coined as e-cigarette, or vaping, product use-associated lung injury (EVALI) were described in adolescents ranging from mild respiratory distress to fulminant respiratory failure. Limited data have been published on outcomes at short-term follow-up. We aimed to describe pulmonary manifestations, function, and radiologic findings after corticosteroid therapy in a cohort of adolescent patients. Methods: A retrospective chart analysis of all patients presenting to our institution between July 2019 and December 2019 with EVALI was conducted. Patients who had pulmonary follow-up were included. Spirometry was performed before discharge from the hospital and during outpatient follow-up. A paired t-test was used to compare serial spirometry data between visits. Results: Eight patients (6 males) were included. Two patients required intubation with mechanical ventilation, 2 required bilevel positive airway pressure, and 3 required oxygen supplementation. All patients received glucocorticoids (3 receiving pulse dosing). Initial spirometry revealed decreased forced expiratory volume in one second and forced vital capacity with clinically and statistically significant improvement at follow-up (mean follow-up was 46.5 days). Radiographic manifestations also improved after vaping was discontinued. Conclusion: In our cohort of patients with EVALI, at short-term follow-up, all normalized their spirometry parameters and showed clinical resolution of symptoms.