Radiological Presentation Research Articles

Open surgical treatment of unicameral bone cysts : Aretrospective data analysis.

Avariety of treatment options for unicameral bone cysts (UBC) exist. The controversy of open management of UBC is discussed. The aim of this study was to analyze asingle institution's experience in the open surgical treatment of UBC. By retrospective analysis of the Vienna Bone and Soft Tissue Tumor Registry, 119 patients with open surgery and histologically verified UBC with amean follow up of 4.8 years (range 1-30 years) were included. Lesion treatment failure was defined as surgically addressed UBC undergoing revision surgery due to persistence or recurrence. Local revision-free survival for lesion treatment failure was 93% after 1 year, 80% after 2 years, 60% after 5 years and 57% after 10 years. Of the patients 34 (29%) had at least 1 revision surgery due to lesion treatment failure. We found that patients with lesion treatment failure were younger (p = 0.03), had UBC with less minimal distance to the growth plate (p = 0.02) and more septation chambers in radiologic imaging (p = 0.02). Patients with open revision surgery were less likely to require a second revision due to lesion treatment failure than patients with percutaneous revision surgery (p = 0.03). Open surgery for UBC can only be recommended as reserve treatment in younger children with actively growing lesions. Open UBC surgery carries arelatively high risk of almost 30% of lesion treatment failure and therefore the indications should be limited to extensive osteolysis with high risk of pathological fractures, lesions with displaced pathological fractures, and lesions with an ambiguous radiological presentation that require tissue collection.

Primary Angiosarcoma of The Breast : A Case Report of a Rare Presentation

Primary angiosarcoma of the breast is a rare entity, accounting for less than 0.1% of breast malignancies, with potential life-threatening outcomes. Diagnosis of angiosarcoma can be difficult due to its variable and unpredictable clinical, radiological, and pathological presentation. Primary angiosarcoma occurs predominantly in younger populations with no previous risk factors; in contrast, secondary angiosarcoma occurs predominantly in the elderly with a previous of radiation exposure. We describe the case of a 50-year-old female presenting with a large, advanced breast tumour diagnosed as primary angiosarcoma.

A rare case of breast tuberculosis: case report

Abstract Breast tuberculosis is a rare form of extra-pulmonary tuberculosis. It accounts for less than 0.1% of breast conditions in developed countries but reaches about 3-4% in developing high TB endemic regions. It usually occurs in multiparous and lactating women. The clinical, radiological and pathological presentation may often mimic breast abscess, idiopathic granulomatous mastitis or carcinoma. The most common presentation is that of a lump. Constitutional symptoms are not usually present. The most common site is the right upper outer quadrant of the breast. It also occurs in association with Immunosuppression disorders such as HIV. Here we present a case of a young, multiparous non- lactating woman with tubercular mastitis, confirmed by FNAC of the mass. The Tuberculin skin test was positive and the patient improved with anti-tubercular treatment.

Clinical and radiological characteristics of pediatric COVID-19 before and after the Omicron outbreak: a multi-center study.

The emergence of the Omicron variant has seen changes in the clinical and radiological presentations of COVID-19 in pediatric patients. We sought to compare these features between patients infected in the early phase of the pandemic and those during the Omicron outbreak. A retrospective study was conducted on 68 pediatric COVID-19 patients, of which 31 were infected with the original SARS-CoV-2 strain (original group) and 37 with the Omicron variant (Omicron group). Clinical symptoms and chest CT scans were examined to assess clinical characteristics, and the extent and severity of lung involvement. Pediatric COVID-19 patients predominantly had normal or mild chest CT findings. The Omicron group demonstrated a significantly reduced CT severity score than the original group. Ground-glass opacities were the prevalent radiological findings in both sets. The Omicron group presented with fewer symptoms, had milder clinical manifestations, and recovered faster than the original group. The clinical and radiological characteristics of pediatric COVID-19 patients have evolved with the advent of the Omicron variant. For children displaying severe symptoms warranting CT examinations, it is crucial to weigh the implications of ionizing radiation and employ customized scanning protocols and protective measures. This research offers insights into the shifting disease spectrum, aiding in the effective diagnosis and treatment of pediatric COVID-19 patients.

Exploring Diverse Presentations of Cryptogenic Organizing Pneumonia: A Case Series

Cryptogenic Organizing Pneumonia (COP), the idiopathic form of Organizing Pneumonia (OP) previously known as “bronchiolitis obliterans organizing pneumonia,” is a well-documented medical condition with distinct clinicoradiological features and diagnostic criteria. COP can exhibit a diverse range of radiological presentations, including multiple patchy alveolar opacities (typical pattern), a solitary focal lesion, or diffuse bilateral infiltration. Corticosteroid therapy is typically effective in achieving rapid clinical and imaging improvement, but caution must be exercised in cases of active infections where corticosteroids are contraindicated, posing a challenge for OP diagnosis. This case series emphasizes the need for healthcare providers to be knowledgeable about the various atypical clinical manifestations of COP, recognize the diverse and uncommon radiological presentations that may mimic other pulmonary pathologies, and consider COP in the differential diagnosis to ensure appropriate management and enhance patient outcomes.

Posterior cervical congenital dermal sinus tract: case report and review of literature

Background and importanceCongenital dermal sinus tract (DST) is a rare spinal dysraphism characterized by a persistent tract lined by epithelial cells, beginning at the epidermis and terminating in deeper tissue layers. With 1% of all congenital DST cases found in the cervical region, only 4% of all cases are diagnosed after the age of 20.Clinical presentationIn this case, a 65-year-old woman with a congenital DST at the cervical level presented with symptoms of neck and some arm pain, suboccipital headaches, and unique external characteristics. Neck Disability Index and visual analog scale were used to assess the patient’s preoperative and postoperative pain, and quality of life. Patient underwent an operative intervention, where the DST was surgically removed followed by interlaminar decompression at C1–C2, excision of the epidural component, and biopsy followed by plastic surgical repair. Pathology analysis indicated a squamous epithelial-lined sinus tract interacting with the dura. Most notably, a meningothelial proliferation with associated psammomatous calcifications was identified, similar to a meningioma.ConclusionA review of literature was conducted to further discuss clinical and radiological presentation as well as to document the novel appearance of this congenital DST. As one of the oldest cases of DST, it demonstrated unusual pathological characteristics with a meningothelial proliferation, compatible with meningioma, reported at the epidural level.

Congenital mesenteric defect with distal ileal atresia and segmental volvulus in a neonate: A case report

Intestinal volvulus is a rare condition that can be life-threatening. It often occurs after birth and requires emergent surgery. Most cases of volvulus in infants and fetuses are linked to intestinal malrotation. However, Intestinal volvulus may occur even if the midgut is in normal position, due to mesenteric defects. We present the case of a A 2-day-old, female phenotype neonate who presented with recurrent episodes of bilious vomiting. Clinical and radiological presentation was consistent with distal intestinal atresia. In Surgical exploration, we found a segmental volvulus of the terminal ileum complicating a congenital mesenteric defect and associated with a distal ileal atresia. An ileo-caecal resection was performed as well as a resection of the dilated distal bowel. Then an ileo-colic end-to-end anastomosis was done followed by closure of the mesenteric defect. Postoperative course was uneventful. Mesenteric defects can lead to segmental intestinal volvulus even when the midgut is normally rotated. Treatment should be tailored according to the anatomy and bowel status of the patient.

A 16-year retrospective study of vascular anomalies in the head and neck region

SummaryDepending on the diagnostic modality, the classification of vascular anomalies varies and so does the nomenclature. The ‘International Society for the Study of Vascular Anomalies’ (ISSVA) is the most widely accepted classification in the literature and is mainly based on the radiologic and clinical presentation. The aim of this article is to review the clinical practice of diagnosis and treatment of vascular anomalies in the head and neck region in a university hospital, with special focus on the nomenclature.All patients with a vascular anomaly presenting to the department of oral and maxillofacial surgery were reviewed in a retrospective manner. Nomenclature, diagnostic process, lesion characteristics, treatment and outcome were examined. The lesions were (re)classified according to the ISSVA classification.A total of 185 patients were identified, of which 12.4% (n = 23) had a congenital anomaly. After reclassification, the most common lesions were venous malformations (n = 47, 25.4%), followed by lobular capillary hemangiomas (n = 17, 9.2%). A group of 39 anomalies could not be further specified. One hundred and one patients (54,6%) received treatment, of which 93 were treated surgically (92,1% of treated patients). Endovascular treatment was considered in 41 patients but applied in only eight. This strict selection led to a low a complication rate.We provide an overview of the clinical practice in the management of vascular anomalies in a university hospital. The histology report is a source of miscommunication because clinicians use the ISSVA classification, while pathologists use the WHO classification. Every professional involved should be aware of the differences in classification and nomenclature.

An Unusual Clinical and Radiological Presentation of Ovotesticular Disorders of Sex Development with Male and Female External Genitalia: A Case Report

Background: Ovotesticular disorders of sex development (ODSD), previously known as true hermaphroditism, is a rare disorder of sexual differentiation that causes ambiguity in external genitalia and the presence of both ovarian and testicular elements in the gonads. The condition is characterised by the existence of testicular tissue with distinctive tubules and ovarian tissue in the same gonad (ovotestis), or separately in an individual. The most common cytogenetic karyotype is 46,XX. The age and presentation of symptoms vary, but typically include hypospadias, urogenital sinus, inguinal hernia, cryptorchidism, and gynaecomastia during the peripubertal age, as well as lower abdominal mass. Case Presentation: A 15-year-old female exhibited typical male genitalia, including a normal penile shaft, scrotal sac, palpable testes, and a urethral opening, with a separate vaginal opening located between the penile shaft and scrotum. Pelvic MRI confirmed the presence of both testes within the scrotal sac and an infantile-sized uterus with a central endometrium, as well as a left-sided ovary in the pelvic region. The right ovary was not seen. Correlative ultrasound confirmed these findings and indicated that the testes had a normal echo texture and vascularity. The patient was diagnosed with ODSD, and further hormonal testing was recommended. Conclusions: ODSD is a rare cause of genital ambiguity. Typically, both paramesonephric and mesonephric duct derivatives are seen, and most of the affected individuals present as neonates or infants with ambiguous external genitalia. At peripubertal age, the symptoms typically include hypospadias, urogenital sinus, inguinal hernia, unilateral or bilateral cryptorchidism, and gynaecomastia. Fertility is not uncommon and has been reported in female-reared patients. The ovotestis is the commonest gonad in people with ODSD and are known to be predisposed to germ cell tumours. Over 500 cases of ODSD have been reported in the literature. Ultrasound is the first line of investigation used to see the pelvic organs. The non-invasive test of choice for detecting paramesonephric and mesonephric duct derivatives is an MRI pelvis. The purpose of this paper is to describe various clinical and radiological features associated with ODSD.

Fissural Pleural Effusion Presenting As ‘Pseudotumor Lung, Phantom Tumour or Round Pneumonia’ In Primary Pulmonary Tuberculosis: Bronchoscopy is Point of Care Test in Presence of Satellite Nodules in Chest Imaging!

Pulmonary Tuberculosis has diverse radiological presentations such as consolidation, cavitation, airway disease, pleural effusion and lymphadenopathy. Pneumonia-like presentation in tuberculosis is very commonly reported in Pulmonary Tuberculosis. Fissural effusion is common in cardiac failure and isolated fissural effusion is rarely described in literature with etiology as tuberculosis. Round pneumonia is commonly described in pediatric cases with community acquired pneumonia and also frequently reported in childhood pulmonary tuberculosis. Round pneumonia is very infrequently reported in adults with pneumonia and to very few published data as due to tuberculosis. In this case report, a 21-year female, presented with constitutional symptoms for 3 months duration with partial response to medical treatment received in line with pneumonia, bronchial asthma and bronchitis. Radiological investigations documented round opacity in right mid-zone with no adventitious breath sound on clinical examination. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax and documented loculated right horizontal fissural effusion with subpleural parenchymal opacity in right upper lobe posterior segment and right middle lobe lateral basal segment with peri-consolidation satellite nodules in right posterior segment. We have done bronchoscopy due to negative induced sputum microbiological workup. Bronchoscopy guided BAL microbiological workup documented MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test and negative BAL smear for AFB. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms and typical radiological features such as ‘round pneumonia or fissural effusion’ in absence of other causes for the same. Fissural effusion or round pneumonia due to tuberculosis is rare in adults but not uncommon. Bronchoscopy is a gold standard test to confirm etiological diagnosis due inadequate or poor quality of induced sputum sample in cases with round pneumonia and fissural effusion. Isolated Fissural effusion secondary to pulmonary tuberculosis is extremely rare in medical literature and this will be first case reported till date.

Outcomes by disease onset, sex, and intervention in neonates with SIP and surgical NEC.

Outcomes of infants following surgical necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) categorized by the age of onset, interventions, and sex are not well defined. Retrospective comparison of infants categorized by age of onset (NEC at <10, 10-20, and >20 days) and SIP at <7 versus ≥7 days), sex, and intervention [Penrose Drain (PD) vs. laparotomy]. A total of 114 infants had NEC and 37 had SIP. On multinomial logistic regression, infants with NEC/SIP onset >20 days had significantly lower odds of small bowel involvement (aOR = 0.07, 95% CI: 0.01-0.33, p = 0.001), higher necrosis (aOR = 3.59, 95% CI: 1.34-9.65, p = 0.012) and higher CRP (p = 0.004) than onset <10 days. Initial laparotomy was associated with more bowel loss (24.1 cm [12.3; 40.6] vs.12.1 [8.00; 23.2]; p = 0.001), small and large intestine involvement (47.1% vs 17.2%; p = 0.01), and ileocecal valve resection (42% vs. 19.4%; p = 0.036) than initial PD therapy. Females underwent fewer small bowel resections (52.3% vs 73.6%; p = 0.025) but had higher surgical morbidity (53.7% vs. 24.7%.; p = 0.001) than males. Clinical, radiological, and histopathological presentation and outcomes in preterm infants with surgical NEC/SIP are associated with age of disease onset, sex, and initial intervention. Neonates with surgical NEC onset >20 days had more severe necrosis, inflammation, kidney injury, and bowel loss than those with <10 days. Initial laparotomy was associated with later age onset, more bowel loss, and ileocecal valve resection compared to initial PD treatment, but not with differences in mortality or length of stay. Female sex was associated with lower maturity, more placental malperfusion, less often small bowel involvement, lower pre-NEC hematocrit as well as higher surgical morbidity than males. Whether the management of surgical NEC and SIP should differ by the age of onset requires further investigation.

Pachymeningeal en plaque metastasis from gastric cancer mimicking subdural hematoma: illustrative case.

Pachymeningeal metastasis associated with gastric cancer, especially in its early stages, is extremely rare. The authors describe a 77-year-old man with a past medical history of lung cancer and previously treated chronic subdural hematoma who was admitted to their hospital because of hematemesis and newly diagnosed gastric cancer. He became unconscious during the hospitalization. The preoperative brain imaging studies had the appearance of recurrent subdural hematoma and extracranial tumor with skull invasion. Craniotomy revealed pachymeningeal carcinomatosis and en plaque metastasis of tumor. The histopathology of the tumors was consistent with metastatic gastric adenocarcinoma. This is the first reported case of metastatic gastric cancer as a pachymeninges-based en plaque entity. This report highlights the rare radiological presentation and operative findings in this case. The authors also summarize those case reports associated with dural metastasis arising from gastric cancer.

Long-term efficacy of venous sinus stenting in the treatment of idiopathic intracranial hypertension.

Previous studies have suggested that cerebral dural sinus stenosis could be a possible underlying cause of idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a potential alternative for treating IIH related to dural sinus stenosis. However, most of the documented studies have been conducted in Western countries. In this study, we present the results of 16 Chinese IIH patients who underwent VSS treatment in our single center. We prospectively collected angiographic and manometric data from IIH patients who underwent angioplasty/stenting. All patients had confirmed dural sinus stenosis and had failed maximal medical therapy (MMT). Demographic, clinical, and radiological presentation, as well as long-term follow-up outcomes were collected retrospectively. A total of 16 patients who underwent VSS were enrolled in the present study. Demographic data revealed a mean age of 40 (range 20-55), with 69% (11/16) being female, and a mean body mass index (BMI) of 27.05 (range 19.18-38.04) kg/m2 . All patients presented with papilledema and visual disturbances. During a median follow-up period of 47.5 months, 93.75% (15/16) of patients reported improvement in symptoms, although only 37.5% (6/16) experienced complete resolution. Headaches, blurred vision, and amaurosis related to increased pressure improved in 100% (8/8), 81.25% (13/16), and 75% (3/4) of patients, respectively. However, one patient suffered cerebral infarction and secondary epilepsy soon after VSS, and another patient had recurrence of symptoms due to stent wall thrombosis 2 years later. The significance of venous sinus stenosis in the development of IIH may be undervalued. Our study, based on a Chinese case series, affirms the long-term safety and effectiveness of VSS in treating IIH patients with relatively lower BMI than those from Western countries.

Warthin-like papillary thyroid carcinoma: a case report and comprehensive review of the literature.

Papillary Thyroid Carcinoma (PTC) is the most frequent endocrine malignancy with a variety of histological presentations. Warthin-like Papillary Thyroid Carcinoma (WLPTC) is an uncommon neoplasm that is recognized as a distinct subtype of PTC in the WHO classification of thyroid tumors. In this report, we present a novel case of WLPTC in a female patient and provide an in-depth review of the available literature on its clinical, pathological, and therapeutic characteristics. A 27-year-old female patient was referred for neck swelling. Ultrasound showed two suspicious thyroid nodules leading to a thyroidectomy. She was diagnosed with intermediate-risk bifocal foci of classic PTC and WLPTC, arising from a background of chronic lymphocytic thyroiditis (CLT). This pT1b(m) N1b M0 malignancy was treated with adjuvant isotopic ablation and suppressive thyroxine therapy. The 1-year outcomes were favorable. It covered articles published from 1995 to 2022, by searching PubMed and Google Scholar using specific terms. Out of 148 articles reviewed by two authors, 25 relevant articles were selected, including 13 case reports and 12 case series. The study included 150 cases of WLPTC. Data related to clinical presentation, imaging, histological features, management, and outcomes, were extracted. The mean age of diagnosis was 39 years, with a female predominance. The most common clinical presentation was neck swelling. Thyroid autoimmunity was positive in 71.6% of patients. Lymph node metastases were present in 28% of cases, with no reported distant metastases. Overall, the outcomes were favorable. WLPTC shares similar clinical and radiological presentations as classic PTC. The hallmark histological features of WLPTC are papillae lined with oncocytic tumor cells with papillary nuclear changes and lymphoid stroma. WLPTC is almost constantly associated with CLT. The management of WLPTC aligns with that of classic PTC with comparable stage and risk category, often resulting in favorable outcomes.

Satellite Nodules with Pericavitary Consolidation Presenting As ‘Black Hole in the Starry Sky Pattern’ in HRCT Thorax: A Strong Predictor of Active Pulmonary Tuberculosis!

Pulmonary tuberculosis is the most common cause for cavitary lung disease in India. Radiological presentations in pulmonary tuberculosis are different and mainly depend on the immune status of hosts, durations of illness and underlying comorbidities. Consolidation, cavitation, pleural effusion, airways disease and lymphadenopathy are frequently reported in thoracic tuberculosis. In this case report, a 36-year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards pneumonia, bronchial asthma and bronchitis. Radiological investigations documented inhomogeneous nodular infiltrates in the left upper zone which was underestimated due to presence of crepitations and wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax due to nodular opacities and persistent symptoms and documented black hole in the starry sky pattern’ which is first time described in medical literature. ‘Blackhole in starry sky pattern’ is described in the present case as a giant lung cavity mimicking black hole and a satellite nodule mimicking a starry sky pattern. Satellite nodules are defined as ill-defined to well demarcated nodular opacities with or without conglomeration around tuberculous consolidation or cavity. We have done induced sputum microbiological workup and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms with Satellite nodules with pericavitary consolidation presenting as ‘black hole in the starry sky pattern’ in HRCT thorax to have successful treatment outcome.

Satellite Nodules with Pericavitary Consolidation Presenting As ‘Black Hole in the Starry Sky Pattern’ in HRCT Thorax: A Strong Predictor of Active Pulmonary Tuberculosis!

Pulmonary tuberculosis is the most common cause for cavitary lung disease in India. Radiological presentations in pulmonary tuberculosis are different and mainly depend on the immune status of hosts, durations of illness and underlying comorbidities. Consolidation, cavitation, pleural effusion, airways disease and lymphadenopathy are frequently reported in thoracic tuberculosis. In this case report, a 36-year male, presented with constitutional symptoms for 4 months duration with partial response to medical treatment received according to their knowledge and experience towards pneumonia, bronchial asthma and bronchitis. Radiological investigations documented inhomogeneous nodular infiltrates in the left upper zone which was underestimated due to presence of crepitations and wheeze. Recurrent, progressive and partially responding constitutional symptoms was the reason for referral to our center. We have further evaluated with HRCT thorax due to nodular opacities and persistent symptoms and documented black hole in the starry sky pattern’ which is first time described in medical literature. ‘Blackhole in starry sky pattern’ is described in the present case as a giant lung cavity mimicking black hole and a satellite nodule mimicking a starry sky pattern. Satellite nodules are defined as ill-defined to well demarcated nodular opacities with or without conglomeration around tuberculous consolidation or cavity. We have done induced sputum microbiological workup and documented acid-fast bacilli in sputum smear and MTB genome with rifampicin sensitivity in cartridge based nucleic acid amplification test. Treatment initiated with anti-tuberculosis (ATT) and recorded near complete radiological resolution, bacteriological cure after six months with good compliance. High index of suspicion is required while managing these cases with constitutional symptoms with Satellite nodules with pericavitary consolidation presenting as ‘black hole in the starry sky pattern’ in HRCT thorax to have successful treatment outcome.

Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases

Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality. Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient underlying condition? All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated EORTC/MSG criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally. One hundred and fourteen cases of PM were recorded, including 40% disseminated forms. Main underlying conditions were hematological malignancy (49%), allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (RHS, 26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum qPCR was positive in 42/53 patients (79%) and bronchoalveolar lavage (BAL) in 46/96 patients (50%). Transthoracic lung biopsy was diagnostic in 8/11 (73%) patients with non-contributive BAL. Overall 90-day mortality was 59%. Neutropenic patients displayed more frequently an angioinvasive presentation including RHS and disseminated disease (p<0.05). Serum qPCR was more contributive in neutropenic patients (91% vs 62%, p=0.02) and BAL in non-neutropenic patients (69% vs 41%, p=0.02). Serum qPCR was more frequently positive in patients with a >3cm main lesion (91% vs 62%, p=0.02). Overall, positive qPCR was associated with an early diagnosis (p=0.03) and treatment onset (p=0.01). Neutropenia and radiological findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in neutropenic patients and BAL examination in non-neutropenic patients. Lung biopsies are highly contributive in case of non-contributive BAL.

A case of exogenous lipoid pneumonia: Diesel aspiration pneumonitis

Exogenous lipoid pneumonia including diesel aspiration pneumonia is a challenging scenario for the physician view varied clinical presentation and no existing treatment guidelines. Clinico-radiological profiling remains the key toward early diagnosis of the condition. We present a case of a 32-year-old car mechanic presenting post accidental aspiration of diesel vehicle while siphoning air from the fuel pipe, a common practice in Indian subcontinent; highlighting the clinical and radiological presentation and therapeutic outcomes of corticosteroids in this case. The case reemphasizes the role of good clinical history, efficient physical examination, early management, and specific radiological evaluation toward management of this entity.

A COMPARATIVE STUDY OF SEVERITY OFPULMONARY TUBERCULOSIS AMONG DIBETICS AND NON DIBETICS PATIENTS IN TERTIARY CARE HOSPITAL

Aim: To assess the clinical and radiological profile of pulmonary tuberculosis patientswith and without diabetics in order to understand the various presenting modalities, etiological pattern, severity of TB and clinical-radiological connection of the study population. Design: Comparative cross-sectional study. Materials &amp; Methods:This is a hospital based cross sectional study conducted at a tertiary care hospital. We were enrolled total of 100 patients with pulmonary tuberculosis and screen them for diabetes militants. To obtain data, a predesigned and pretested questionnaire was used. A clinico-radiological profile of pulmonary tuberculosis between with and without diabetes patients were compared. Results:We recruited 100 pulmonary tuberculosis patients among them 32% werediabetes and 68% without diabetes.The most common clinical presentation among both with and without diabetes mellitus group was expectoration, it was slightly more common in non-diabetes group (84%) as compared todiabetes (79%). This followed by evening rise in fever which was slightly more common in non-diabetes group (78%) as compared diabetes group (74%).The most common radiological presentation among both with and without diabetes mellitus group was Infiltrations, however, it was more common in diabetes group (90.6%) as compared to non-diabetes group (70.6%). This followed by cavitary which was again more common in diabetesgroup (78.1%) as compared non-diabetesgroup (50%).Most of non-diabetic patients were falling into1+ and 2+ category. In both sample the severity of the disease 3+ was more in diabetes patients than non- diabetes. Conclusion:Diabetic patients were more likely to get a serious pulmonary infection. More over 40 years of age has more chance of this twin morbidity. Detection and treatment of DM among TBpatients may have a beneficial impact on TB control.

A peculiar case of pure intraventricular glioblastoma

Glioblastoma (formerly named glioblastoma multiforme) is the most common primary central nervous system tumor, representing 45% of all cases and 15% of all intracranial neoplasms [1]. Its typical radiologic findings and localization make it often a lesion easy to diagnose. In MRI it usually appears as an irregularly shaped cystic lesion with ring contrast enhancement in T1-weighted images, localized in subcortical white matter and deep gray matter nuclei of the cerebral hemispheres. It involves more frequently the frontotemporal region followed by parietal lobes [1]. Few articles in literature described cases of intraventricular glioblastomas, defining those as secondary ventricular tumors because of their probable origin primarily from cerebral tissue with consequent transependymal development [2, 3]. Atypical presentations of these tumors make it more difficult to clearly differentiate them from other lesions more commonly located in the ventricular system. We describe a case with a unique radiological presentation: an intraventricular glioblastoma lying entirely within the ventricular walls, involving all the ventricular system, without mass effect or nodular parenchymal lesions.