Radiological Improvement Research Articles

Atypical Pneumonia in the Elderly: A Meta-Analysis of Risk Factors, Treatment Outcomes, and Mortality

Background: Atypical pneumonia poses a significant threat to elderly individuals, often leading to severe complications and increased mortality. This meta-analysis aimed to evaluate risk factors, treatment outcomes, and mortality associated with atypical pneumonia in elderly patients. Methods: A systematic search of PubMed, Embase, and Cochrane Library databases was conducted from January 2013 to December 2024. Studies reporting on atypical pneumonia in patients aged 65 years or older were included. Data on risk factors, treatment outcomes (clinical cure rate, radiological improvement, length of hospital stay), and mortality were extracted and pooled using random-effects models. Results: Six studies involving 1,875 elderly patients with atypical pneumonia were included. Advanced age (≥80 years), comorbidities (chronic obstructive pulmonary disease, heart failure, diabetes mellitus), and delayed initiation of antibiotic therapy were identified as significant risk factors for severe disease and mortality. Treatment with macrolides was associated with a higher clinical cure rate (OR 2.15, 95% CI 1.52-3.04, p<0.001) and shorter hospital stay (mean difference -2.8 days, 95% CI -4.1 to -1.5, p<0.001) compared to fluoroquinolones. The pooled mortality rate was 12.8% (95% CI 9.5-16.1%). Conclusion: Atypical pneumonia in the elderly is associated with significant morbidity and mortality. Early recognition of risk factors and prompt initiation of appropriate antibiotic therapy, particularly with macrolides, are crucial for improving outcomes in this vulnerable population.

Recurrent Haemoptysis Revealing Hughes-Stovin Syndrome

Hughes-Stovin Syndrome (HSS) is a rare and severe disorder characterized by the combination of pulmonary artery aneurysms and deep vein thrombosis. We report the case of a 42-year-old male presenting with recurrent hemoptysis revealing HSS. Management consisted of high-dose corticosteroids and cyclophosphamide. The patient showed marked clinical and radiological improvement. HSS, as a rare form of Behçet’s disease, is associated with high morbidity and mortality due to thrombosis and potential rupture of aneurysms. Immunosuppression remains the cornerstone of management. Anticoagulation is controversial and requires careful consideration. Early diagnosis and prompt treatment are critical in managing HSS.

The Effect of Denosumab on Pain and Radiological Improvement in Giant Cell Tumours of the Spine in the Acute Setting.

Retrospective Cohort Study. The current recommended treatment for Giant Cell Tumour (GCT) of the spine is en bloc excision. Denosumab is a monoclonal antibody reducing osteoclast activity that shows promising results when used as a neo - adjuvant treatment. However, the current literature remains limited. The purpose of this study was to assess the effect of denosumab on tumour characteristics and symptom relief in the acute phase of treatment of spinal GCT. We performed a retrospective review of 16 patients treated with denosumab as neo-adjuvant and stand - alone treatment. MRI and PET tumour characteristics were taken before and after treatment and patients were interviewed for subjective pain responses. Following treatment, all patients showed improvement of pain, of which 68.7% of patients were pain free with 43.75% noting improvement within 48hours. Mean relative volumetric reduction in tumour volume was 37.3% (P < .001). Eight patients showed high grade of Bilsky classification (Epidural spinal cord compression scale - ESCC) with seven of them showing significant improvement to low grade of ESCC (P = .016). Median baseline PET Standardised Uptake Value (SUV)max was 14.57 and post treatment was 4.8 (P < .001). This study provides necessary insight to the limited literature on the use of denosumab for spinal GCT in the acute phase. The clinical and radiographic responses observed demonstrate the critical role that neo-adjuvant denosumab has by reducing the tumour burden around critical adjacent neurovascular structures before eventual resection, significant pain improvement even with presence of fractured vertebra.

Short-term outcomes of gradual ulnar lengthening in multiple hereditary osteochondromas of the forearm with monolateral external fixator.

Hereditary multiple exostoses is an autosomal dominant genetic condition primarily affecting long bones. Forearm deformities, including wrist ulnar deviation, ulnar shortening, radial or ulnar bowing, and radial head dislocation, are common manifestations. Gradual ulnar lengthening is suggested as a viable treatment option for managing these deformities. This retrospective single-center study included 15 forearms treated with gradual ulnar lengthening using a monolateral external fixator by a single surgeon. Clinical and radiological characteristics were recorded preoperatively and during follow-ups. The Wilcoxon signed-rank test compared preoperative and postoperative radiological and clinical parameters, while McNemar's test assessed changes in radial head dislocation or subluxation. Significant radiological improvements were observed post-treatment. Proportional ulnar length increased from a mean of 0.85 ± 0.10 preoperatively to 1.11 ± 0.03 at the last follow-up (P < 0.001). Ulnar variance decreased from a mean of 17.6 ± 5.58 mm preoperatively to 0.13 ± 1.81 mm at the last follow-up (P < 0.001), while radial bowing decreased from a mean of 0.06 ± 0.02 to 0.05 ± 0.01 at the last follow-up (P < 0.001). In addition, the radioarticular angle decreased significantly from a mean of 29.93 ± 7.34 to 20.20 ± 5.71° (P < 0.001). The incidence of radial head dislocation or subluxation decreased significantly, from 11 patients preoperatively to only one at the last follow-up. These findings demonstrate the effectiveness of gradual ulnar lengthening with a monolateral external fixator in correcting forearm deformities and reducing the incidence of radial head dislocation or subluxation.

Combined Treatment of Patients with Neuroendocrine Liver Metastases Accompanied by High Hormonal Activity and Uncontrolled Carcinoid Syndrome

Introduction: The percentage of cases of neuroendocrine tumors (NET) is growing every year. Moreover, the diagnosis is often made in the later stages, when the disease manifests itself with manifestations of carcinoid syndrome (CS) and its accompanying indications. Today, there is a need to systematize approaches to diagnosis and individual groups of patients with unresectable metastatic lesions of NETs.Material and methods: A retrospective assessment of the results of treatment of patients with bilobar metastatic liver disease NET on the background of uncontrolled CS was performed in the period from 2010 to 2023. The study included 10 patients with NET G1 — 4 patients, G2 — 6. The sampling structure according to the location of the primary lesion was divided into: pancreas (n = 7), small intestine (n = 3). Before the start of regional chemotherapy, the primary lesion was removed in 1 patient. The average age of the patients in the sample was 31.3 years.In order to evaluate the results, patients underwent SCT of the abdominal cavity and chest with intravenous enhancement, PET/CT of the whole body with 68Ga-DOTA TATE/NOC. All patients in the group received therapy with long-acting somatostatin analogues. Two of them additionally received everolimus 10 mg per day.The leading method of embolization is oil TACE with a suspension of doxorubicin 50–100 mg or mitomycin C 10–20 mg with superfluid lipiodol 5–8 ml, then adding a collagen sponge 0.25–0.5 cm3 into the tumor vessels until blood flow is reduced. Courses were held once every 2 months. The evaluation of the treatment was carried out according to an objective examination (ECOG 0), the nature of the complaints, and instrumental diagnostic data (CT with intravenous contrast).Results: Evaluation after regional chemotherapy: partial response in one patient; stabilization in seven; progression in two patients (according to mRECIST). The average serotonin level before CEPA was 936.5 ng/ml; after two courses there was a significant decrease to 282.1 ng/ml (p &lt; 0.05). After stabilization of the disease, the primary lesion was removed in 6 patients; patients underwent cytoreductive atypical liver resection (n = 4) and MVA (n = 1). Currently, three patients have died, the average life expectancy of the deceased is 64 months. Seven patients were alive for periods ranging from 30 to 134 (median 84) months.Conclusions : TACE in the treatment of patients with NETs that cause hyperproduction of hormones, manifested by CS and not relieved by somatostatin analogues, provides clinical and radiological improvements in 80 % of patients. Further cytoreductive interventions can extend the median overall-survival (OS) to 84 months.

Functional and Radiological Outcomes of Short-Segment Fixation With Intermediate Screws for Thoracolumbar Spine Fractures.

Introduction Thoracolumbar fractures, particularly burst fractures, represent a significant health concern due to their prevalence and functional impact. This study evaluates the efficacy of short-segment posterior fixation with intermediate screw instrumentation in treating unstable thoracolumbar fractures. Methods A prospective study was conducted from July 2022 to December 2023, including 26 patients with traumatic thoracolumbar fractures. Surgical intervention was indicated for patients with a thoracolumbar injury classification and severity (TLICS) score >4. Functional outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) grading system. Radiological outcomes, including the local kyphotic angle (LKA) and anterior vertebral body height ratio (AVBHR), were evaluated preoperatively, postoperatively, and at follow-ups. Results Significant improvements in functional and radiological parameters were observed over 24 weeks. The mean VAS score reduced from 7.50 ± 0.58 preoperatively to 1.42 ± 0.50 (p < 0.001), and the mean ODI improved from 42.23 ± 3.54 to 16.12 ± 3.09 (p < 0.001). Neurological improvements were seen in ASIA grades B-D, with no new deficits. Radiologically, the mean LKA improved from 19.73 ± 1.59° preoperatively to 8.46 ± 1.33° at 24 weeks (p < 0.001), and the AVBHR increased from 34.08 ± 2.25% to 86.64 ± 0.83% (p < 0.001). No implant failures were reported. Conclusion Short-segment fixation with intermediate screws provides effective stabilization and significant functional and radiological improvements in thoracolumbar fractures. It minimizes intraoperative morbidity and preserves motion segments, making it a viable alternative to long-segment fixation, particularly for non-complex fractures. Further randomized controlled trials are recommended to validate these findings.

Pulmonary lymphangiomatosis: insights into an ultra-rare disease

BackgroundPulmonary lymphangiomatosis (PL) is an ultrarare disease characterized by diffuse infiltration of the lung, pleura and/or mediastinum by abnormal lymphatic proliferation. Consented diagnostic or treatment approaches are not established. We therefore aimed to collect data on diagnostics and treatments in a cohort of patients with PL from a tertiary center for rare lung diseases.MethodsClinical, radiological and outcome data from PL patients were collected retrospectively.Results12 patients were diagnosed between 1996 and 2022 in our center. PL was diagnosed more commonly in female (58%), never smokers (75%) and younger patients (mean age 42 years). Main clinical symptoms comprised haem- and chyloptysis (58%) and dyspnea on exertion (83%). Pulmonary function was mostly restrictive (mean VC 59%) with impaired DLCO (mean 65%). Radiological assessment mainly showed mediastinal involvement (83%), and pleural effusion (67%), pleural thickening (67%) and bronchial wall thickening (67%) while interstitial changes were rare. Diagnosis was confirmed by surgical or transbronchial cryobiopsy. 8 patients were treated with sirolimus, 3 of these combined with a surgical intervention and in one case surgical intervention was necessary 9 months after initiation of sirolimus. Clinical and radiological improvement was demonstrated for all patients treated with sirolimus. 1 patient received a lung transplant due disease progression. Survival rates were 90% after a mean follow up of at least 3 months.ConclusionThis case series illustrates the variability of the clinical presentation of PL. Among our patients, those treated with sirolimus showed significant clinical, functional and radiological improvement. However, further investigation is needed to understand the pathogenesis of lymphangiomatosis in order to establish therapeutic approaches.

Endoscopic Septostomy for Treatment of Complex Hydrocephalus: A Single Center Retrospective Cohort

Abstract Objective The objective was to present the initial experience with endoscopic septostomy in a Brazilian public hospital. Methods A retrospective analysis was conducted on patients who underwent neuroendoscopic septostomy at the Department of Neurosurgery of Cristo Redentor Hospital in Porto Alegre from 2015 to 2021. Results In the period analyzed, 14 patients underwent endoscopic septostomy. The mean age of the patients was 41.86 years; 11 were male and 3 were female. The etiologies of hydrocephalus included ventricular inflammatory conditions, neoplasms, neurocysticercosis, and intraventricular cysts. Following septostomy, 64% of the patients exhibited clinical and radiological improvement. Complications occurred in 29% of the cases, including intraventricular hemorrhage and thalamic contusion. Four deaths were observed, all related to clinical complications or progression of the underlying disease. Conclusion Endoscopic septostomy is an effective and safe procedure for treating complex hydrocephalus of different etiologies. Surgical outcomes are related to the learning curve with neuroendoscopy, and the benefits for patients are evident, considering the possibility of safely and effectively performing simultaneous endoscopic procedures with septostomy.

Paradoxical Deterioration During Treatment of Tuberculous Meningitis Responded to Infliximab But Not to Steroids.

Patients with tuberculous meningitis may experience a paradoxical deterioration in spite of correct antituberculosis treatment.The paradoxical deterioration may have a severe clinical presentation, requiring high vigilance and consideration of treatment escalation.Here we report that off-label administration of tumour necrosis factor-alpha blocker infliximab induced a significant clinical and radiological improvement in a severe case of paradoxical deterioration in a patient with tuberculous meningitis, suggesting its potential as a treatment when standard therapies fail.

Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results. To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement. Cohort study; Level of evidence, 3. Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes. A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures. Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

RADT-33. GAMMA KNIFE RADIOSURGERY FOR ORBITAL CAVERNOUS HEMANGIOMA: A SYSTEMATIC REVIEW AND SINGLE-ARM META-ANALYSIS

Abstract Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH. Following the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH, including complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate. From 1856 search results, six studies with 100 patients were included. Only five minor complications related to GKRS were reported, including three with orbital pain and two with periorbital chemosis, resulting in a complication rate of 13% (95% CI: 7% - 25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI: 63% - 96%) and 71% (95% CI: 47% - 95%), respectively. Proptosis improved in 94% of cases (95% CI: 83% - 100%). The tumor reduction rate was 77% after GKRS (95% CI: 69% - 85%). In conclusion, GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by the absence of a control group, and additional studies are needed to evaluate the relative efficacy of GKRS compared with alternative surgical modalities for OCH.

Comparative analysis of 333 proGAV® and proGAV 2.0® adjustable valves in pediatric hydrocephalus treatment: survival and complication rate assessment

ObjectiveProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates.MethodsThis retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years.ResultsInclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, p < 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, p = 0.002), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (p = 0.041 and 0.011, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (p = 0.001 and p = 0.038). Younger children (< 2 years of age) also experienced significantly more valve adjustment difficulties (p = 0.049) and had higher rates of valve explantation (p < 0.001).ConclusionThe findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation.

A conservative management approach for spinal tuberculosis causing cauda equine syndrome in pregnancy

Background: Spinal tuberculosis in pregnancy leading to neurological sequelae is rare and a challenging condition to manage. The usual approach is to perform urgent decompression surgery, but patients with a more stable course of the disease may benefit from a conservative approach with anti-tuberculosis (ATT) therapy.Case presentation: A pregnant mother in her second trimester presented with a history of chronic backache exacerbated by right-sided foot drop, L5 root sensory loss and intermittent urinary retention. MRI revealed L5 vertebral collapse with para-vertebral collection causing cauda equine compression at the L5-S1 level. High ESR, strongly positive tuberculin test, and the clinical and radiological findings were compatible with a diagnosis of spinal tuberculosis. Based on the multi-disciplinary team’s decision, a conservative management approach with ATT and supportive therapy was initiated with close observation. The patient showed a remarkable response to ATT with clinical and radiological improvement. She underwent an elective caesarean section at 37 weeks and delivered a healthy baby. On the fourth week postpartum, she underwent decompressive surgery with complete neurological recovery,Discussion and conclusion: Spinal TB in pregnancy causing neurological impairment is usually managed with urgent surgical interventions. This is one of the few reported cases where a conservative approach was undertaken, with close observation and a positive outcome.Therefore, it is important to carefully select patients needing surgical interventions and those who would benefit better from a conservative approach. High suspicion, early diagnosis, prompt treatment initiation and close monitoring are vital components in achieving the best outcome.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Utility of very high-pressure valves in persistent symptomatic shunt overdrainage

IntroductionShunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients. MethodsRetrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data. ResultsThe median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months. ConclusionsBefore considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.

Primary division of annular pancreas: a surgical technique.

The authors presented a case of duodenal obstruction in a 61-year-old man, resulting from an annular pancreas diagnosed on imaging (computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound). The patient underwent a diagnostic laparoscopy. Intraoperatively, given a straightforward appearance and anatomy of the annular pancreas overlying the second part of the duodenum, and due to extensive adhesions in the abdomen, a primary division of the annular pancreas was performed, instead of a bypass procedure such as gastrojejunostomy. He had some residual symptoms 1 week postoperatively which was treated with duodenal dilatation endoscopically. On review and follow-up at 1 year, he has remained well with resolution of symptoms, supported by radiological improvement on a computed tomography performed at 4months post-operatively. We believe this approach has resulted in less morbidity and a shorter period of recovery as compared to a bypass procedure and represents a reasonable therapeutic option for annular pancreas.

Tubercular dactylitis/Spina ventosa-A rare skeletal form of extrapulmonary tuberculosis.

A 9-year-old girl presented with progressive, painful swelling over the left index finger, associated with local signs of inflammation and restriction of finger movements. After the swelling was punctured using a needle, chronic discharging sinus formed. Examination revealed firm swelling over the right parotid area, bilateral cervical and left axillary lymphadenopathy, and firm swelling over the left index finger with a chronic discharging sinus over the lateral aspect of proximal phalanx. Mantoux intradermal injection was reactive (22x24 mm induration). Blood and pus cultures were sterile. Hand radiograph revealed dactylitis (Figure 1A-C). Fine aspiration and cytology of the cervical lymph node showed degenerated inflammatory cells, epithelioid granuloma and acid-fast bacilli. She was initiated on 4-drug antitubercular therapy (ATT). At 2-months follow-up, she was asymptomatic and had the pain and swelling over the left finger have reduced with significant radiological improvement. Tubercular dactylitis or 'spina ventosa' (wind-filled sail) refers to cystic expansion of short, tubular bones. It is commonly seen in younger children (between 1 and 6 years of age) and adults (between 20 and 50 years of age). A common presentation in endemic areas is presence of a painless, fusiform swelling over a single digit, most commonly the proximal phalanx of index or middle finger as in the index case, or over the metacarpals of middle and ring fingers. Earliest radiological clues include periosteitis followed by gradual destruction of bone and cyst formation in the cavity giving a ballooned-out appearance.

Clinical and Radiological Features of Lung Abscesses and their Management: A Retrospective Observational Study

Introduction: A lung abscess is a localised area of destruction of lung parenchyma in which infection by pyogenic organisms results in tissue necrosis and suppuration. It is one of the common diagnosis in patients presenting to the respiratory Outpatient Department (OPD) and accounts for up to 4.0 to 5.5 per 10,000 hospital admissions each year. Aim: To study the clinical profile, predisposing factors, anatomical location and response to medical treatment in patients with lung abscesses. Materials and Methods: This was a retrospective observational study conducted on patients who had lung abscesses from the outpatient and inpatient departments of Respiratory Medicine at LG Hospital, Ahmedabad, Gujarat, India during January 2019 to December 2020. Parameters such as clinical profile, demographic profile, predisposing factors, radiological profile and response to medical treatment were assessed in all patients. All data were collected and analysed statistically using Statistical Package for Social Sciences (SPSS) Software version 21.0. Results: In the study of 50 patients, 36 (72%) were in the 41-60 years age group, with a mean age of 47.56 years; the maleto-female ratio was 3.2:1. The most common symptom in the study was cough with expectoration, which was present in all the patients. Poor oral hygiene was a predisposing factor in the majority of patients, i.e., 22 (44%). Other factors included low Body Mass Index (BMI), alcohol use, diabetes, seizures and pre-existing lung disease. Mixed organisms were found in the sputum culture reports. Upper zone distribution was the most common radiological finding, observed in 29 (58%) cases. The majority of lung abscesses were located in the upper lobes of both lungs. A total of 48 (96%) cases showed clinical improvement and 42 (84%) cases showed radiological improvement after 28 days of broad-spectrum antibiotics. Conclusion: The study found that lung abscesses are more common in males in the middle age group, particularly in individuals with addiction and co-morbidities such as diabetes, with upper lobe presentation being the most common. Most patients will improve if broad-spectrum antibiotics are started timely, at optimal doses and for the appropriate duration.

Non-Surgical Management of Methicillin-Sensitive Staphylococcus Aureus Bacteremia-Related Mediastinitis.

Acute mediastinitis is rarely caused by haematogenous spread of a remote infection. In this respect, since the only medical therapy is usually unsuccessful, treating acute mediastinitis with no source of infection detected is very challenging and management not standardized. In this case report, we describe non-surgical management experience of acute mediastinitis caused by methicillin-sensitive Staphylococcus aureus. In a 79-year-old man judged not eligible for cardiac surgery, we attempted the infection source control through vacuum-assisted closure therapy, together with antimicrobial therapy. We observed gradual clinical, laboratory and radiologic improvements: reduced swelling and normalization of the white blood cell count and C-reactive protein level were associated with reduction in size of a periaortic abscess. We managed a clinical condition with high mortality risk with chronic antimicrobial therapy alone, a strategy that is rarely considered. With this medical strategy we achieved an optimal response to a clinical picture that does not allow any other approach. Mediastinitis is a rare but severe infection with a high mortality rate.Chronic antimicrobial therapy can be an effective strategy in high surgical risk patients.The present case demonstrates good tolerability of lifelong antibiotic therapy.

Central nervous system crystal-storing histiocytosis: A case report and literature review.

Crystal-storing histiocytosis (CSH) is a rare form of histiocytosis with intralysosomal accumulations of immunoglobulins or paraproteins that aggregate as crystals. Central nervous system (CNS) involvement of CSH is uncommon but should be considered in cases of persistent parenchymal enhancement on neuroimaging. We describe one local case of CNS CSH and 10 additional cases identified by literature review. Among 11 CSH patients, lesions involved either the dura (2/11) or brain parenchyma (9/11). Two cases had leptomeningeal enhancement. One case had spinal cord involvement. Two cases were associated with marginal zone lymphoma; one case was associated with an immunoglobulin A-plasma cell dyscrasia. Eight of 11 cases had outcome data available: 7/8 cases had clinical and/or radiological improvement and 1/8 had radiological stability. Central nervous system involvement of CSH is rare. Potential cases should be comprehensively evaluated for lymphoma or myeloma with positron emission tomography/computed tomography (CT) of the body or alternatively, CT of the chest, abdomen, pelvis and nuclear bone scan, bone marrow biopsy, serum protein electrophoresis, and cerebrospinal fluid protein electrophoresis. Treatment is targeted toward the underlying malignancy.