Cerebro vascular accident in sickle cell disease

An 11-year-old Saudi female reported in pediatric outpatient department with complaint of weakness of left side of the body for last two days. The child was a known case of sickle cell disease and was diagnosed at an age of 6 months. Two other siblings were also sicklers. She had an episode of left sided hemiparesis 2 years back and on CT scan, diagnosis of cerebral infarct was made [Figure 1]. Exchange transfusion was done at that time. Patient recovered completely. She was receiving blood transfusion every 6-8 weeks. During summer vacations, she went to her native town and did not receive blood transfusion for about 13 weeks. She developed weakness on left side of the body. On examination, she was fully conscious and well oriented in time, place and person. She was pale and her vital signs were stable. On central nervous system examination, her speech was normal. No cranial nerve deficit was noted. Power in left upper limb was grade IV/V with normal reflexes. Power in left lower limb around hip and knee was grade IV/V and power around left ankle was grade II. Plantar extensor and plantar clonus was present in the left side. No signs of cerebeller lesion or meningial irritation were noted. Rest of the systemic examination did not reveal any abnormality. Her blood counts revealed hemoglobin 7.2 g/dl, platelets 203 x 109/l and total leukocyte count 13.5 x 109/l with differential showing neutrophils 51%, lymphocytes 45%, monocytes 2% and eosinophils 2%. Reticulocyte counts were 13%. Biochemistry profile revealed glucose, urea, creatinine, electrolytes, calcium, aspartate transaminase and alanin transaminase within normal range. Total bilirubin was 46.7 umol/l [normal range 0.0-24 umol/l]; out of this unconjugated bilirubin was 41 umol/l. Lactate dehydrogenase [LDH] levels were 1543 U/l [normal value 297-537 U/l]. CT scan of the brain revealed right temporo-parietal infarct. Her hemoglobin S was 83% on hemoglobin electrophoresis. Exchange transfusion was done as per protocol of this hospital and child was maintained on adequate hydration. Child was discharged from hospital after two weeks. She was advised physiotherapy for weakness of left lower limb and hyper-transfusion protocol in outpatient department regularly

Hydatid cyst in soft tissues of the calf

A rare case of primary intramuscular hydatid cyst is reported here because of its unusual presentation. A young man presented clinically as having a soft tissue nodular mass in right calf. Histopathological examination revealed characteristic findings, which were consistent with hydatid cyst. A high level of awareness concerning the occurrence of these cysts is important, especially in regions where echinococcus is endemic. Radiological investigations can be helpful in non-invasive diagnosis of the condition. Surgical treatment follows the principles of malignant tumors, namely, wide surgical resection. A 40 years old man of rural origin had six months history of painless lump in right calf region, which gradually started increasing in size. There was no history of trauma, fever or weight loss. Local examination revealed a walnut sized, ovoid, non-tender mass in the posteromedial aspect of right calf in its middle third. The mass was found to be attached to the deep muscles. The clinical picture was suggestive of soft tissue tumor. General physical examination revealed no abnormality. Systemic examination was also normal. No evidence of visceromegaly was noted. Chest was clear. Plain radiograph of the right leg revealed an ovoid, partly calcified 4x3 cm mass in soft tissues on posteromedial aspect of mid-calf, with intact bones. Total leukocyte count [TLC] was 6,700 micro L with eosinophils upto 8%. Ultrasonography of the lesion, using 7.5 MHz transducer, was performed, which showed a well-defined 4x3 cm septated, cystic mass with multiple daughter cysts. Fluid level was also noted in one of the cysts. The findings were suggestive of hydatid cyst. Chest radiograph and abdominal ultrasonography were performed, which were normal. The patient underwent surgery. On exploration, a hydatid cyst attached to fascia covering tibialis posterior was found. This was excised and soft tissue washed with 0.5% silver nitrate solution. Histopathology confirmed echinococcus cyst. The patient was put on medical treatment and discharged in a satisfactory condition

Radiologic evaluation of ileo-ceacal tuberculosis

The radiologic findings in 22 patients with ileo-caecal tuberculosis were studied to determine its role in diagnostic evaluation. On barium contrast studies 20 patients showed characteristic radiographic appearances: conical, shrunken, retracted caecum associated with a narrow, ulcerated terminal ileum. Two cases presented with nonspecific intestinal obstruction. In conjunction with clinical correlation, barium studies are helpful in the evaluation of ileo-caecal tuberculosis showing the location and extent of intestinal involvement in most cases. Typical radiographic findings are seen when the inflammatory process is severe

Radiological evaluation of obstructive jaundice

A study involving 125 patients of obstructive jaundice was conducted in Combined Military Hospital and Military Hospital Rawalpindi. The study group predominantly consisted of female patients between 40 and 60 years. Ultrasonography and endoscopic retrograde cholangiopancreatography [ERCP] were the commonest radiological investigations used. Ultrasonography [USG] was performed in 100% patients. It successfully differentiated obstructive from non-obstructive jaundice. ERCP was perfomed in 100 patients [80%]- It was helpful in permitting direct, non-surgical imaging of pancreatic and bilary ducts. It proved to be useful diagnostic tool as it provided gastroduodenoscopy, cholangiography and pancreatography with a single examination. Percutaneous transhepatic cholangiography [PTC] was helpful in assessing the presence, site and cause of obstruction