ABSTRACT
Background:There is a sudden rise of fungal infection with coronavirus disease. This is attributed to the immunomodulation by the disease and the drugs used, diabetes mellitus, steroid use, oxygen inhalation using dirty water, use of zinc and iron supplements, etc. Early diagnosis and prompt medical and surgical intervention is the mainstay of treatment. This can greatly reduce the high morbidity and mortality associated with this disease. The objective of the retrospective study is to describe the imaging findings of acute invasive rhino-orbito-cerebral mucormycosis (ROCM) in 58 patients with severe acute respiratory syndrome coronavirus 2, from SVP hospital with proven mucormycosis. Special emphasis is placed on the signal patterns of sinonasal mucosa, the earliest and most common findings.Material And Methods:We report the sinonasal, orbital and neuroimaging findings in patients of suspected acute invasive ROCM. A total of 58 patient’s scans were analyzed. The study comprises cases performed at two different imaging modalities and a tertiary care hospital from March 23,2021 to September 1, 2021. All the patients had positive reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and were hospitalized with clinically severe disease as per the guideline s laid down during the second wave in India. They were on intravenous steroids and oxygen. Thirty patients (52%) had diabetes mellitus. All of them presented with headache, facialand/or orbital pain,periorbital puffiness with decreased vision, during the course of treatment. CT or MRI examination of the paranasal sinuses, orbits and brain was done, with intravenous contrast wherever possible. The presence of mucormycosis was confirmed by histological diagnosis in all of them following clinico-radiological diagnosis of acute invasive ROCM. Result:Computed tomography (CT) and magnetic resonance imaging (MRI) of 58 patients showed most commonly involved sinuse s as maxillary and ethmoid sinuses together. Sino-nasal mucosal thickening was the most common finding. Periantral infiltration preceded orbital, cerebral complications, with grossly intact bones. Sinus wall erosions were seen in only patients and maxillary alveolar arch erosionwere frequent findings. CT showed hypodense soft tissue thickening or fat stranding as the predominant finding in involved areas, while MRI showed T2 iso-to hyperintense mucosal thickening with T2 hypointense component as the main finding. Conclusion:MRI is better at demonstrating early mucosal abnormalities, turbinate necrosis, devitalized tissues, orbital apex involvement and intra-cerebral extension. Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses in premaxillary, retroantral fat, facial muscles, pterygopalatine fossa, temporal, infratemporal fossa and extraconal orbital-fat along with typical patterns of sinonasal mucosal thickening should raise the suspicion of acute invasive fungal etiology given the short duration of history and immunocompromised status. High incidence of periantral and orbital extension of the disease is suggestive of acute invasive form of fungal infection. Also the rapidly progressive inflammatory changes without much bone involvement should suggest the suspicion of ROCM. Bony, cerebral and vascular involvements are relatively late complications.
ABSTRACT
Retroperitoneal mature cystic teratomas are exceedingly uncommon in young male. They are more common in infants and in young females. We report an unusual case of 27 year old male presented with abdominal distension, abdominal fullness and vomiting. Patient underwent ultrasonography and contrast enhanced computed tomography (CT) scan of abdomen which were suggestive of large mature cystic lesion. Patient was planned for surgery and laprotomy was done. A huge retroperitoneal mass was observed and was totally excised. Onhisto-pathological examination (HPE) stratified squamous epithelium with keratin flakes, underlying fibromuscular tissue reveal hair shaft & sebaceous glands and mature cystic teratomawas diagnosed. Retroperitoneal mature cystic teratoma in an older maleis extremely rare. Primary gonadal teratoma with retroperitoneal metastasis should be excluded first. Evaluation of age and location of tumor are critical for its prognosis.