Specific Radiological Findings Research Articles

Meta-Analysis of Interobserver Agreement in Assessment of Interstitial Lung Disease Using High-Resolution CT.

Background High-resolution CT (HRCT) is central to the assessment of interstitial lung disease (ILD), and accurate classification of disease has important implications for patients. Evaluation of imaging features can be challenging, even for experienced thoracic radiologists. Previous work has provided equivocal evidence on the interpretation of HRCT features at ILD-related imaging. Purpose To perform a meta-analysis to assess the level of agreement among expert thoracic radiologists in interpreting ILD-related imaging. Materials and Methods A systematic literature search from January 2000 to October 2023 of the Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases was performed for articles reporting assessments of interobserver agreement between thoracic radiologists for evaluation of ILD findings, such as severity and progression of disease, presence of features such as honeycombing and ground-glass opacification, and classification based on the 2011 and 2018 American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana del Tórax (ATS/ERS/JRS/ALAT) guidelines for idiopathic pulmonary fibrosis (IPF). Meta-analysis was performed using a random-effects model to obtain pooled κ or intraclass correlation coefficient (ICC) values as measures of interobserver agreement. Results The final analysis included 13 studies consisting of 6943 images and 146 radiologists. In 10 studies assessing agreement of specific radiologic findings in ILD, the pooled κ value was 0.56 (95% CI: 0.43, 0.70). In eight studies, the assessed interobserver agreement of the ATS/ERS/JRS/ALAT diagnostic guidelines for IPF based on usual interstitial pneumonia (UIP) patterns, the pooled κ value was 0.61 (95% CI: 0.48, 0.74). One study reported a κ value of 0.87 for ILD progression. Seven studies assessing ILD severity could not be pooled; the individual κ values for ILD severity ranged from 0.64 to 0.90, and ICC values ranged from 0.63 to 0.96. Conclusion There was moderate agreement between thoracic radiologists when assessing ILD features and UIP pattern diagnosis but little evidence on agreement of disease severity, extent, or progression. Meta-analysis registry no. PROSPERO CRD42022361803 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Humbert in this issue.

Computed Tomography Analysis of the Nasal Septal Deviation and Related Paranasal Sinus Pathologies

Purpose: Nasal Septum Deviation (NSD), which is defined as a dislocated septum, is a prevalent condition that is mostly asymptomatic; however, it can cause difficulties such as nasal obstruction and rhinosinusitis symptoms. Other Paranasal Sinuses (PNS) disorders, e.g., Osteo Meatal Complex (OMC) obstruction, have been assumed to be correlated with NSD. This study investigates the possible correlation of specific radiological findings of PNS pathologies in patients with or without the existence and direction of NSD. We also discussed the different types of NSD and their incidence among different groups stored by age, gender, etc. Materials and Methods: This is a cross-sectional study conducted at multiple imaging centers in Iran between July 2019 and February 2020 to estimate the prevalence of deviated nasal septum and correlate between NSD and other findings using paranasal sinus scans. All the individuals who met the inclusion and exclusion criteria were included in the study. NSD types have been classified based on Mladina's method. Results: We prospectively reviewed PNS Computed Tomography (CT) scans obtained from 254 cases (82 men and 172 women), aged 18 to 81 years (mean: 35.53), evaluated over seven months. Out of 254 cases, 135 (53 %) patients had NSD, without any direction predominance (right-sided vs. left-sided), and equally distributed between genders. The most common NSD types were type V with a frequency of 42.22% and type III with a frequency of 24.44%. Other PNS CT findings were also investigated in our patients, like OMC obstruction, pansinusitis, mucocele, air-fluid level, mucosal thickening, and concha bullosa. There was no statistically significant correlation between any of these pathologies and NSD (P-value > 0.05). Conclusion: Although NSD was observed in more than half of our cases' PNS CTs, there was no significant correlation between NSD and other findings in most subjects. This reveals that the effectiveness of septal repair surgeries in relieving patients' symptoms might not be as high as expected.

Cognitive performance in patients with neuromyelitis optica: clinical and imaging characteristics

This study aimed to identify the prevalence, clinical and radiographic characteristics, and risk factors for cognitive dysfunction in patients with Neuromyelitis optica spectrum disorder (NMOSD). Eighty-three participants who were diagnosed with NMOSD were recruited. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Frontal Assessment Battery (FAB). The mean age of the patients was 47.78 ± 13.14 years, with an average of 12.05 ± 4.62 years of formal education. The majority (54%) exhibited cognitive impairment, defined by a MoCA score < 25 (mean: 22.96 ± 3.82). Disease severity (evaluated by the Expanded Disability Status Scale) and lower formal education levels were associated with cognitive impairment (p = 0.011 and < 0.001, respectively). The annualized relapse rate, disease duration, and AQP4 antibody status were not associated with cognitive impairment. Interestingly, informant-reported cognitive decline was associated with poorer cognitive performance (p = 0.027). Radiographic findings of lesion location and severity were associated with MoCA-assessed cognitive performance, particularly for lesions in the right parietal lobes (p = 0.023). Hippocampal atrophy was negatively correlated with FAB scores. In conclusion, approximately half of the Thai patients with NMOSD exhibited cognitive impairment, which was associated with age, formal education level, disease severity, relative perception, and specific radiological findings. Further studies incorporating comprehensive neuropsychological tests and subjective cognitive complaints are warranted.

Invasive mould infection in immunocompromised children: Pulmonary computed tomography findings from two multicentre paediatric cohorts

BackgroundInvasive fungal disease (IFD) can cause significant morbidity in immunocompromised children. The lung is the most common site for IFD caused by moulds. Timely diagnosis is key to facilitate initiation of appropriate treatment. As clinical manifestations are non-specific, initial diagnosis relies on computed tomography (CT) imaging, yet there are limited recent data documenting imaging changes in paediatric pulmonary IFD. In this study, CT images of children with proven/probable pulmonary IFD from two multi-centre cohorts were assessed to document typical changes, including a comparison between causative pathogens, and to measure reliability of radiological reporting in this context. MethodsPulmonary IFD cases diagnosed between 2003–2013 and 2017–2020 were identified from two respective Australian multi-centre cohort studies of immunocompromised children. Proven/probable IFD was defined according to the EORTC/MSG definitions. Initial CT images at the time of IFD diagnosis were independently reviewed by two board-certified paediatric radiologists. Presence of EORTC/MSG-defined and other changes was documented. Inter-rater reliability was assessed. Impact of specific imaging features on outcome at 6 months was assessed using multivariate regression. ResultsA total of 99 cases were included (65 aspergillosis, 19 non-aspergillus moulds (NAM) and 15 histopathological-mould cases). Median age was 9.6 years (IQR 5.1–13.6); 89.9 % had an underlying haematological malignancy. Nodules (85.4 %), the halo sign (49.5 %) and wedge shaped/segmental consolidation (35.9 %) were the most frequent EORTC/MSG-defined features. Cavitation and air-crescent sign were uncommon. Agreement between radiologists was fair to moderate for most common imaging features. No specific radiological finding differentiated aspergillosis from NAM infection. The presence of mass on initial CT and NAM infection were independently associated with poor outcome. ConclusionsIn proven/probable pulmonary IFD in immunocompromised children, nodules with or without halo sign are the most frequent finding. Agreement between radiologists was variable for common imaging features, and specific findings did not correlate with the causative pathogen. Microbiological confirmation remains vital in children with suspected pulmonary IFD.

Acute Necrotizing Encephalopathy in Children: A Case Report in Barranquilla-Colombia

Acute necrotizing encephalopathy is a rapidly progressive disease of the central nervous system that is generally described in texts as a pathology of pediatric patients, but even in people of this age range, it is rare to find a case of this disease, which presents with a fulminant tissue necrosis and can be secondary to infections, mainly of viral origin. Due to presenting very non-specific clinical manifestations, this diagnosis often goes unnoticed or is made late. ANE survivors go through three phases during the clinical course that include the prodromal stage, the period of acute encephalopathy, and the recovery stage. It is through specific radiological findings observed on computed tomography affecting the bilateral thalamus and possibly the cerebral white matter, brainstem, or cerebellum that the diagnosis can be confirmed. This report discusses the case of an 8-year-old schoolboy who begins with acute gastroenteritis, which progresses with seizures and neurological deterioration. A skull CT scan is performed with imaging findings suggestive of acute necrotizing encephalopathy. Management is established with adequate clinical response and favorable recovery of neurological symptoms. The clinical characteristics and radiological findings are the key to facilitating an early diagnosis, reducing sequelae and improving the prognosis, which provides a chance of life to people who suffer from this condition.

A rare case of retroperitoneal teratoma with evidence of papillary thyroid carcinoma: a case report

BackgroundTeratomas are germ cell tumors composed of somatic tissues from up to three germ layers. Primary retroperitoneal teratomas usually develop during childhood and are uncommon in adults and in the retroperitoneal space. While there are only a few cases of retroperitoneal thyroid tissue, we report a unique case of a retroperitoneal papillary thyroid carcinoma.Case presentationA 41-year-old woman presented in our institution due to intermitted unspecific abdominal pain. Magnetic resonance imaging detected a multi-cystic solid retroperitoneal mass ventral to the psoas muscle and the left iliac artery. After surgical removal of the retroperitoneal mass, histology sections of the specimen indicated evidence of papillary thyroid carcinoma cells. A staging computed tomography scan of the body showed no further manifestations. To reduce the risk of recurrence, total thyroidectomy was performed followed by radioiodine therapy with lifelong hormone substitution.ConclusionsPrimary retroperitoneal teratoma with evidence of papillary thyroid carcinoma is a rare condition. Preoperative diagnosis is difficult due to its non-specific clinical manifestation and lack of specific radiologic findings. Histopathology analysis is necessary for diagnosis. Although surgery is considered the first line treatment, there is still discussion about the extent of resection and the need for total thyroidectomy with adjuvant radioiodine therapy.

Prevalence of priformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis.

The traditional approach for diagnosing piriformis syndrome (PS) is to rule out other causes of sciatica. This approach may lead to unnecessary radiological examinations and a waste of time. In contrast to the traditional approach, we aimed to first exclude PS and determine its prevalence by injecting patients with priformis tenderness. This observational cross-sectional study included patients diagnosed with PS who had sciatica and tenderness on palpation of the priformis muscle and whose pain was reduced by at least 50% with local injection. Age, sex, pain duration, presence of tenderness in the piriformis muscle, Freiberg test, PACE sign, FADIR, Visual Analog Scale (VAS) score, Douleur Neuropathique 4 Questions (DN4) score, and radiological findings were compared between patients who responded and those who did not respond to the priformis injection. A total of 110 patients with sciatica were evaluated, of whom 66 with tenderness on palpation of the primiformis muscle underwent local injection. In 27 of the 66 patients (40.9%), a decrease in the NRS score of >50% was observed after injection, and PS was diagnosed. There were no statistically significant differences in age, sex, pain duration, Pace, FADIR test positivity, radiological findings, NRS, and DN4 scores, but Freiberg test positivity was statistically higher in patients diagnosed with PS. PS is more common than is thought to be a cause of sciatica. A positive Freiberg test is predictive for the diagnosis of PS, but it should be confirmed by tenderness of the priformis muscle and local injection. Many pathologies can be detected incidentally radiographically in PS; however, they are not predictive of the diagnosis.

Radiological findings in blunt abdominal trauma: bowel and mesenteric injuries

Mesenteric and intestinal injuries resulting from blunt abdominal trauma are relatively uncommon, but can be life-threatening. In this case, we present the story of a 46-year-old man who experienced blunt abdominal trauma due to a traffic accident. We will examine the specific and non-specific radiological findings that should alert us to the possibility of mesenteric or intestinal injury in such cases.

Systemic lupus erythematosus in a 15-year-old female with multiple splenic nodules: A case report

BACKGROUND Systemic lupus erythematosus (SLE) is a chronic inflammatory disease primarily affecting young females. SLE can invade any organ, and various forms of splenic invasion have been reported. Manifestations include splenomegaly and splenic infarction, rupture, and calcification. The study encountered a rare case of splenic involvement, with nodules of various sizes without calcifications or ruptures. CASE SUMMARY A 15-year-old girl presented with arthralgia, weight loss, fever, increased levels of inflammatory markers, and positive antinuclear antibody test results. The patient was diagnosed with SLE. She was asymptomatic while taking steroids and hydroxychloroquine. Ten months after discharge, the patient developed a fever and abdominal pain. Lupus enteritis was suspected, and abdominopelvic computed tomography (AP-CT) was performed. There were no specific findings in the gastrointestinal tract, but multiple splenic nodules were observed. Infection or hemangioma was considered; however, no specific radiological findings were observed. A biopsy of the spleen was performed to determine the possibility of malignancy. The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris. Based on the biopsy results, the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants. CONCLUSION As disease activity increased, multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed. Spleen invasion by SLE can appear in multiple nodular forms and patterns. Therefore, physicians should consider these findings when differentiating these nodules from infections and malignancies.

Primary pancreatic lymphoma: Histopathological pattern of 8 cases.

To report the histopathological pattern of primary pancreatic lymphoma (PPL) in 2 tertiary hospitals. The pathology slides and reports of all the cases diagnosed in pathology departments in 2 referral hospitals were reviewed. An additional immunohistochemistry study was done to reclassify lymphomas according to the current system. Eight patients with PPL have been identified. The ages ranged from 36 to 71 years. Clinical presentation includes abdominal pain, weight loss, jaundice, abdominal mass, nausea, and vomiting. Pathological evaluation revealed 5 diffuse large B-cell lymphomas, one high-grade B-cell lymphoma, one MALT lymphoma, and one follicular lymphoma. Primary pancreatic lymphoma is a very rare tumor without specific clinical, laboratory tests, or radiological findings. Abdominal pain is the most common clinical presentation. Diffuse large b-cell lymphoma is the most common pathological subtype. Primary pancreatic lymphoma should be taken into consideration when evaluating pancreatic mass to avoid unnecessary surgical resection.

The Use of Low-Dose Chest Computed Tomography for the Diagnosis and Monitoring of Pulmonary Infections in Patients with Hematologic Malignancies.

The study aimed to assess the image quality and diagnostic performance of low-dose Chest Computed Tomography (LDCCT) in detecting pulmonary infections in patients with hematologic malignancies. A total of 164 neutropenic patients underwent 256 consecutive CT examinations, comparing 149 LDCCT and 107 Standard-Dose Chest CT (SDCCT) between May 2015 and June 2019. LDCCT demonstrated a 47% reduction in radiation dose while maintaining acceptable image noise and quality compared to SDCCT. However, LDCCT exhibited lower sensitivity in detecting consolidation (27.5%) and ground glass opacity (64.4%) compared to SDCCT (45.8% and 82.2%, respectively) with all the respective p-values from unadjusted and adjusted for sex, age, and BMI analyses being lower than 0.006 and the corresponding Odds Ratios of detection ranging from 0.30 to 0.34. Similar trends were observed for nodules ≥3 mm and ground glass halo in nodules but were not affected by sex, age and BMI. No significant differences were found for cavitation in nodules, diffuse interlobular septal thickening, pleural effusion, pericardial effusion, and lymphadenopathy. In conclusion, LDCCT achieved substantial dose reduction with satisfactory image quality but showed limitations in detecting specific radiologic findings associated with pulmonary infections in neutropenic patients compared to SDCCT.

Commonly misdiagnosed round pneumonia in a child: a case report

Round pneumonia, a specific radiological finding in children, is often caused by Streptococcus pneumoniae; but it is easily misdiagnosed with some other diseases, causing many difficulties for clinicians. We described a case report of round pneumonia in a 9-year-old boy, with chest pain, following fever, productive cough, left-sided pulmonary consolidation syndrome, tachypnea, no chest indrawing, and a round homogenous lesion about 4 cm in diameter with a clear border in the left upper lobe position on chest X-ray. He was initially misdiagnosed as a lung tumor. He was correctly diagnosed with round pneumonia prior to pneumonectomy and was successfully treated with antibiotics. Therefore, it is important to carefully analyze round pneumonia cases that are often misdiagnosed, resulting in poor therapy.

Analysis of post-COVID symptoms and predisposing factors for chronic post-COVID syndrome.

While there is sufficient information about acute COVID-19, which can cause a multisystemic and fatal disease, post-COVID syndrome and risk factors for this condition remain poorly known. We aimed to identify postCOVID symptoms and risk factors for chronic post-COVID syndrome through this study. This prospective cross-sectional study was conducted on 254 out of 384 COVID-19 patients admitted to our COVID-19 polyclinic between February and April 2021. The patients were questioned with a list of 37 symptoms at the fifth and twelfth weeks after disease onset via phone review, and their acute post-COVID (APC) and chronic post-COVID (CPC) symptoms were recorded. Data on risk factors were collected from the hospital's medical records system. Associations between symptom count in the CPC phase and age, sex, hospitalization, RT-PCR result, specific radiological findings, comorbidities, and long-term medications were evaluated. Two hundred twenty-one patients had APC symptoms, and 138 patients had CPC symptoms. While the most common symptom was fatigue at week five, it was hair loss at week 12. Symptoms were observed significantly less in the CPC phase than in the APC phase (Z= -12.301, p= 0.00). Female sex and the presence of specific radiological findings were significantly associated with the occurrence of CPC symptoms (p= 0.03, p= 0.00, respectively). Long-term use of angiotensin-2 receptor blockers (ARBs) was correlated with a low symptom count in the CPC phase (p= 0.00). Female sex and the presence of specific radiological findings were risk factors for developing CPC. Long-term use of ARBs was associated with a low chronic post-COVID symptom burden. A substantial cluster of multisystemic symptoms was observed in both phases, and this condition highlights the requirement for customized outpatient management that includes long-term follow-up and treatment of COVID-19 patients. Identifying the high-risk patients that will develop persistent symptoms can guide this management.

Sclerosing Angiomatoid Nodular Transformation of The Spleen: A report of a rare entity

Abstract Introduction/Objective Sclerosing angiomatoid nodular transformation (SANT) is a benign vascular lesion of spleen with uncertain etiology. It predominately affects women between 30 to 60 years of age. Clinically, it is asymptomatic or can cause abdominal pain, but usually discovered incidentally on imaging, which can identify a mass but may not provide a definitive diagnosis. In uncertain vascular lesions, there is always a risk of spontaneous rupture of large vessels and potential for spreading malignancy. Hence, the final diagnosis is rendered on microscopy after splenectomy Methods/Case Report A middle age female came to clinic complaining of abdominal pain. Radiology showed solid splenic mass and the patient underwent splenectomy. Gross examination showed a 3 cm white firm mass with focal hemorrhage. Microscopy revealed multiple nodules of variable sizes surrounded by fibrosclerotic stroma. The nodules showed round to slit-like vascular spaces with numerous red blood cells. The internodular stroma consisted of dense fibrous tissue with scattered plump myofibroblasts and lymphoplasmacytic cells. These distinctive features lead to the diagnosis of SANT Results (if a Case Study enter NA) SANT possessed characteristic histologic features with distinctive immunohistochemistry (IHC). IHC reveals three different types of vessels within the nodules: 1. Small veins (CD34- CD31+ CD8-); 2. Sinusoids (CD34- CD31+ CD8+); and 3. Capillaries (CD34+ CD31+ CD8-). All 3 vessels are negative for CD21/CD35 and CD68. Hemangioma and littoral cell angioma are two frequent vascular tumors in the spleen that should be differentiated. Both lesions lack microscopic features of SANT and have only a single type of vessels. The vessels in hemangioma are (CD31+ CD34+ CD8-); while in littoral cell angioma they are (CD31+ CD34- CD8- CD21+ CD68+) Conclusion There are no specific clinical or radiologic findings for SANT. It is important to recognize these characteristic features and to differentiate it from other benign and malignant lesions, such as angiosarcoma. A thorough histopathologic examination and IHC are helpful to make the correct diagnosis

Neuroendocrine Carcinoma of the Breast: Report of A Case

Objective: Breast cancer is the most prevalent malignant disease among women and ranks among the top three most common cancers globally, alongside lung and colon cancer. Various subtypes of breast cancer have been identified. Primary neuroendocrine breast cancer, a rare and distinct type of breast carcinoma, lacks specific radiological findings. The definitive diagnosis is achieved through the expression of Synaptophysin and Chromogranin A on tumor biopsy, and it necessitates the absence of tumor detection in other regions. Staging and treatment are recommended to follow a similar approach as that of conventional breast cancer. It is believed that the prognosis of neuroendocrine breast tumors is generally poorer compared to invasive cancers.

Abstract #1411935: A Radiographic Diagnosis: IgG4-Related Hypophysitis Presenting with Hypopituitarism and Central Diabetes Insipidus

Hypophysitis is defined as inflammation of the pituitary gland. IgG4-related hypophysitis is a rare form and isolated IgG4-related hypophysitis is even more rare. Here, we discuss an interesting patient who presented with symptoms of diabetes insipidus and was found to have panhypopituitarism with suspicious MRI findings of a suprasellar mass and a thickened pituitary stalk, suggestive of IgG4-related hypophysitis. A 69-year-old male with past medical history of lung adenocarcinoma status-post right pneumonectomy, chronic obstructive pulmonary disease, orthostatic hypotension, and poor oral intake due to esophageal compression presented with acute encephalopathy and sepsis secondary to pneumonia. CT head scan done for encephalopathy showed a 1.2 cm suprasellar mass. On consultation, the patient was found to be hypernatremic. Upon further questioning, the patient reported experiencing polydipsia, nocturia, chronic cold intolerance, fatigue, and impotence for several weeks to months. He denied any vision changes, breast tenderness, or galactorrhea. Laboratory testing revealed a sodium level of 157 mmol/L (n.135-145 mmol/L) with plasma osmolality elevated at 332 mOsm/kg (n.275-295 mosm/kg). Urine sodium was low at < 20 mmol/L. Desmopressin (DDAVP) 0.1mg nightly was started given concern for diabetes insipidus. Peak cortisol after performed Cosyntropin stimulation test resulted at 13.5mcg/dL with an ACTH 6 pg/mL (n.6-50 pg/mL). TSH was < 0.01 mU/L, free T4 1.79 ng/dL, and free T3 4.9 nmol/L. The elevated free T3 was felt to be from heparin displacement. Total testosterone was 84 ng/dL with suppressed FSH and LH. Elevated prolactin of 39 ng/mL was thought to be from stalk-effect. MRI of the pituitary gland revealed a 1.3cm enhancing suprasellar mass in the region of the optic chiasm and a smaller 9mm intra-sellar mass, with a thickened pituitary stalk. Given these radiologic findings and the patient's age and gender, the possibility of IgG4 hypophysitis was suspected. CT chest, abdomen, and pelvis were unremarkable. In addition to the DDAVP, he was started on high-dose hydrocortisone, thyroxine replacement, and testosterone replacement. Serum IgG4 level was 23.6 mg/dL (n. 4-86 mg/dL). A six week repeat pituitary MRI is pending; however, the patient is clinically improving and doing well. Specific radiologic findings, such as thickened pituitary stalk and pituitary enlargement with suprasellar mass, led us to strongly consider IgG4-related hypophysitis in our differential for this patient. Clinical presentation of panhypopituitarism, along with patient age and gender, also supported the diagnosis of IgG4-related hypophysitis. Although this patient does not meet all Leporati diagnostic criteria for IgG4-related hypophysitis, the high degree of suspicion led to prompt treatment with high dose steroids. High dose steroids have been shown to revert symptoms and prevent irreversible fibrosis. This case highlights the need for radiologists and endocrinologists to work together in the early recognition of the diagnosis and treatment of IgG4-related hypophysitis.

Can radiological findings detect neuropathic pain in patients with osteoarthritis of the knee undergoing surgery?

The mechanism underlying neuropathic pain (NP) in osteoarthritis (OA) of the knee is not completely understood. This study aimed to investigate whether possible NP in patients with knee OA undergoing knee surgery is associated with specific radiological findings. This study included 197 patients who underwent knee surgery for symptomatic knee OA. Clinical evaluation was performed using the Central Sensitization Inventory (CSI), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and PainDETECT questionnaire. Radiological evaluation was performed using the hip-knee-ankle (HKA) angle, posterior tibial slope (PTS), varus and valgus laxities, and magnetic resonance imaging OA Knee Score (MOAKS). Radiological findings were compared between patients with possible and unlikely NP. Logistic regression analysis was performed to identify the predictive factors for NP. There were 163 and 34 patients with unlikely NP and with possible NP, respectively. The percentage of patients with CSI score ≥ 40 was significantly higher in the possible NP group than in the unlikely NP group (17.6% vs. 6.1%). Patients with possible NP had worse WOMAC scores than patients with unlikely NP. There were no significant positive associations between the possible NP and radiological findings in knee OA. Regression analysis showed no predictive factors for possible NP. Possible NP is not associated with specific radiological findings in knee OA. Patients with possible NP may mediate CS and experience more severe symptoms, including decreased knee function and lower quality of life, than patients with unlikely NP.

Ileoileal intussusception due to Meckel's diverticulum in a pre-term neonate

Presented is a case of ileoileal intussusception in a pre-term male born at 24 weeks gestation caused by a Meckel's diverticulum, which likely occurred in utero. Neonatal intussusception accounts for less than 1.3% of all intussusception cases and is exceedingly rare in premature infants [2]. Around 90% of pediatric intussusceptions involve the ileum telescoping into the cecum or ascending colon (ileocolic), however, ileoileal intussusception due to Meckel's diverticulum is less common [6]. The diagnosis of intussusception in the neonatal period requires a high index of suspicion and does not have any specific radiological findings or signs, in contrast to older children. Misdiagnosis leads to delay in treatment, which leads to intestinal perforation and necrosis [3]. Radiologic studies to help differentiate intussusception from other disease entities, including necrotizing enterocolitis (NEC). These studies include ultrasound, plain abdominal films, and air or contrast enema. Treatment of neonatal intussusception is primarily operative versus necrotizing enterocolitis(NEC) in which medical treatment can be considered initially. This case presentation reports an exceedingly rare cause of intestinal obstruction in a neonate and reminds clinicians to expand the differential diagnosis when consulted by the NICU.

Surgical Intervention for Endobronchial Tuberculosis with Total Bronchial Occlusion: A Case Report

Introduction. Endobronchial Tuberculosis (EBTB) is a specific TB form affecting the tracheobronchial tree with microbial and histopathological evidence. Early diagnosis is essential to provide timely treatment and prevent complications but also proves difficult due to the low positive rate of acid–fast bacilli (AFB) staining of sputum smears and non–specific clinical and radiological findings. Case Illustration. We reported a 19–year–old man with a productive cough suspected of pulmonary tuberculosis, with a positive GeneXpert test and negative AFB smear. He received anti–tuberculosis drugs for six months. Although the symptoms initially seemed to improve, the patient complained of dyspnea during moderate activities in the sixth month. Chest x–ray showed complete atelectasis of the left lung. Further investigation with thorax computed tomography and confirmation with bronchoscopy revealed total occlusion of the left main bronchus. Left pneumonectomy was successfully conducted. Conclusion. Endobronchial tuberculosis may progress to an advanced stage despite adequate anti–tuberculosis drugs. Therefore, early diagnostic strategies are required to prevent the progression of the disease, particularly due to the insidious nature of its pathophysiological process

Fibrous hamartoma of infancy. Radiologic-pathologic study of 21 cases: 8 with predominant pseudoangiomatous pattern

Fibrous hamartoma of infancy (FHI) is a very rare benign soft tissue lesion that principally affects the axilla, trunk, and upper extremities of children younger than 2 years. It is usually cured by local excision. Histologically, these lesions have a triphasic morphology in an organoid pattern: mature adipose tissue, fibroblastic/myofibroblastic trabeculae, and small round cell nests in a myxoid matrix. However, morphologic variants have recently been described. Focal areas with a pseudoangiomatous pattern have been found in some FHI, but few cases with predominant pseudoangiomatous areas have been previously described in the medical literature. We report 21 new cases of FHI, 8 of them with a predominant pseudoangiomatous pattern. Our cases with a predominant pseudoangiomatous pattern did not present specific radiological findings.