Nem todo abscesso em pequenos ruminantes é causado por Corynebacterium pseudotuberculosis / Not all abscesses in small ruminants are caused by Corynebacterium pseudotuberculosis

O presente estudo objetivou determinar a prevalência e distribuição de lesões abscedativas, identificação do agente etiológico e avaliação das lesões histológicas em caprinos e ovinos abatidos em um matadouro-frigorífico com Serviço de Inspeção Federal do estado da Bahia. Foram coletadas 153 amostras de vísceras e linfonodos com abscessos de 1.148 animais abatidos. A maior prevalência na espécie ovina foi em macho, com faixa etária de 12 meses, sendo os principais órgãos acometidos fígado (21,2%) e linfonodo pré-escapular (20,3%). Na espécie caprina, a prevalência maior foi em macho, com faixa etária de 30 meses, sendo os linfonodos retro faríngeo (25%) e pré-escapular os mais acometidos (25%). Isolou-se os seguintes micro-organismos das amostras: Corynebacterium pseudotuberculosis em 33,33%, Escherichia coli (19,61%), Proteus mirabilis (9,80%), Pseudomonas aeruginosa (7,19%), Trueperella pyogenes (5,22%), Streptococcusspp. (5,22%) e Staphylococcus aureus (4,57%). As lesões macroscópicas e histológicas dos abscessos coletados não apresentaram diferenças entre micro-organismos isolados.(AU)

The study aimed to determine the prevalence and distribution of abscessed lesions, etiologic agent identification and assessment of histological lesions in sheep and goats slaughtered in a slaughter plant refrigerator with Federal Inspection Service in the State of Bahia. The amount of 153 samples of viscera and lymph nodes with abscesses of 1.148 slaughtered animals were collected. The highest prevalence in sheep was in males, aged 12 months, as in liver (21.2%) and prescapular lymph nodes (20.3%) the main affected organs. The prevalence in goats in male, aged 30 months and in retropharyngeal (25%) and prescapular lymph nodes (25%). The following microorganisms were isolated from the samples: Corynebacterium pseudotuberculosis 33.33%, Escherichia coli 19.61%, Proteus mirabilis 9.80%, Pseudomonas aeruginosa 7.19%, Trueperella pyogenes 5.22%, Streptococcus spp. 5.22% and Staphylococcus aureus 4.57%. The macroscopic and histological lesions of abscesses collected presented no difference between isolated microorganisms.(AU)

Odontogenic abscess with severe and fast evolution in a young and healthy patient

Deep cervical abscesses are infections of the different spaces on the the neck that may have a mild or severe outcome and requires fast and assertive approach. The most usual cases of severe infections are associates with comorbidities and older patients, but sometimes, in rare cases, it may affect the younger and healthier. Aim: The purpose of this is to communicate shortly a case of a severe cervical abscess with fast evolution in a 28 years old patient, to highlight the possibility of this outcome even in unexpected cases

Absceso perirrenal recidivante con atrofia renal izquierda: reporte de un caso / Recurrence perrinephric abscess with left kidney atrophy: case report

El absceso perirrenal es una entidad infrecuente donde la presentación insidiosa y variable favorece el retraso del diagnóstico reportándose una mortalidad de 39-50 por ciento. Nuestro objetivo es presentar y analizar una paciente con absceso perirrenal que recidivó, con énfasis en el tratamiento y diagnóstico. PRESENTACIÓN DEL CASO: Mujer de 56 años consulta en Hospital Regional de Antofagasta por síntomas urinarios de un mes de evolución, reciente aparición de dolor en zona lumbar y fiebre. Se realiza tomografía computarizada: hipodensidad en espacio perirrenal e hiperdensidad en pelvis renal diagnosticándose cálculo coleriforme en pelvis renal y absceso perirrenal. Paciente evoluciona hipotensa: 72/40 mm Hg, posteriormente se realiza lumbotomía exploradora, drenaje e inicio de terapia antibiótica evolucionando favorablemente. Diez días después, vuelve a consultar por sensación febril, eritema y aumento de temperatura local en cicatriz operatoria. Se realiza drenaje percutáneo y tratamiento antibiótico no focalizado debido a urocultivos negativos. Paciente progresa asintomática, con clara reducción deabsceso. La función renal es evaluada con cintigrama informando exclusión funcional renal izquierda, indicándose nefrectomía izquierda. Paciente responde de forma adecuada a antibióticos y procedimientos quirúrgicos dándose de alta. DISCUSIÓN: El absceso perirrenal es una entidad poco sospechada, infrecuente y de difícil manejo donde el diagnóstico precoz adquiere vital importancia. A pesar de lo que recomienda la literatura en casos de abscesos de gran tamaño, el drenaje percutáneo fue efectivo sin recidiva. Como en nuestro caso, la recidiva de esta patología suele ser frecuente por tanto recomendamos evaluar con precisión el tratamiento y el alta del paciente...

The peritoneal abscess is an infrequent entity, the insidious and variant presentation favors delay on the reporting diagnosis with a mortality rate of 39-50 percent. CASE REPORT: A 56 years-old woman with a history of recurrent urinary tract infections asks for help due to urinary-related symptoms, fever and lower back pains. A computed tomography(CT) is performed: hypodensity in the perirenal space and hyperdensity in the renal pelvis. A coral shaped calculus in the renal pelvis along with perirenal abscess is diagnosed. The Patient evolves on a hypotensive way, this is followed the realization of a lumbotomy incision, drainage and antibiotic therapy. Evolving favorably, she is discharged. Ten days later, she consulted again due to a feverish sensation, erythema and increased local temperature on the operation scar. A percutaneous drainage is performed along with the initiation on a non-focal antibiotic treatment due to negative urine culture. The patient progressed asymptomatically with a clear reduction of the abscess. Renal function was evaluated with a reported scintigram process of the left kidney. Left nephrectomy is pointed out. The patient responds appropriately to the antibiotic therapy and surgical procedures. she was discharged being summoned to the urology clinic. DISCUSSION: The perirenal abscess is a rare and unwieldy entity, where an early diagnosis is imperative. Despite what the literature recommends in cases of large abscesses, percutaneous drainage was effective without recurrence. As in our case, the recurrence of this condition is usually prevalent therefore recommend to accurately assess treatment and patient discharge...

Ressecção de cisto e abscesso renais por laparoscopia em um cão / Resection of renal cyst and abscess by laparoscopy in a dog

Cistos renais podem formar-se em qualquer parte do néfron e dos ductos coletores. Alguns são hereditários, originando-se durante a organogênese, e outros se desenvolvem no tecido renal normal, depois que os rins estão completamente formados. No presente relato, descreve-se a ressecção de cisto e abscesso renais, por cirurgia laparoscópica em um cão. Para o acesso, foram utilizados três portais, dois de 10mm de diâmetro e um de 5mm, dispostos na parede abdominal lateral direita e, num segundo momento, na parede abdominal lateral esquerda. Conclui-se, portanto, que a técnica laparoscópica com três portais permite a realização de ressecção de cisto e abscesso renais em cães, sem a ocorrência de recidivas em curto prazo.

Renal cysts can be formed anywhere in the nephron and collecting duct system. Some are hereditary, originated during organogenesis, and others could have origin in the normal kidney tissue, after the kidney's development. This report describes the resection of renal cysts and abscesses by laparoscopic surgery in a dog. In order to access the cavity, three portals were used; two with 10mm and another with 5mm diameter, in the right lateral abdominal wall, and in another moment, in the left lateral abdominal wall. It is concluded that the laparoscopic technique with three portals allows the resection of renal cysts and abscesses in dogs, without the occurrence of relapses in the short postoperative time.

Angina de Ludwig: experiencia en 29 pacientes / Ludwig’s angina: experience in 29 patients

Introducción: La angina de Ludwig es una celulitis severa del cuello, con afectación rápida del espacio submandibular. Tiene suma importancia por el potencial riesgo de muerte. Objetivo: del presente estudio fue conocer las características clínicas y terapéuticas de esta patología. Diseño: estudio analítico, retrospectivo Materiales y métodos: se incluyeron 29 pacientes atendidos en el Hospital Carlos Andrade Marín, de Quito, Ecuador, entre enero del 2005 y enero del 2013. Se analizaron datos demográficos, clínicos, bacteriológicos, de manejo de la vía aérea, de abordaje quirúrgico y de morbi-mortalidad. Resultados: El sexo masculino fue predominante. En el 79% el foco etiológico fue odontogénico. La tomografía axial computarizada (TAC) se realizó en el 85% de los casos, y mostró áreas abscedadas en un 68%. Se practicó cervicotomía en 24 pacientes, en 12 de los cuales fue unilateral, sin que se aumentara la morbilidad, y se disminuyó la estancia hospitalaria. La bacteria aislada más frecuente fue el estreptococo milleri, y en el 58% se encontró gas en la cavidad quirúrgica. En el 24% de los casos se efectuó traqueotomía. El antibiótico más usado fue un betalactámico + inhibidor de β-lactamasa. La estancia hospitalaria media fue de diez días. Un 66% de pacientes presentaron complicaciones, pero no mortalidad. Conclusión: La antibioticoterapia de amplio espectro y la descompresión quirúrgica fueron eficaces en el manejo de la angina de Ludwig de nuestros pacientes…

Introduction: Ludwig's Angina is a severe cellulitis with rapid spread to the submandibular space and of vital importance for the potential risk of death. Our goal was to determine the clinical and treatment. Design: analytical study, retrospective Materials and methods: 29 patients treated at the Hospital Carlos Andrade Marín of Quito, Ecuador, between January 2005 and January 2013 were included. Demographic data, clinical, bacteriological, management of the airway, surgical approach and morbidity and mortality were analyzed. Results: Males were predominant. In 79% the focus was odontogenic etiology. Computed tomography (CT) was performed in 83% of cases, showing abscess by 68%. Cervicotomy was performed in 24 patients, in 12 of which was unilateral, without there having increased morbidity and decreased hospital stay. The most frequently isolated bacteria were Streptococcus milleri and 58% gas was found in the surgical cavity. In 29% of patients under went tracheotomy. The most commonly used antibiotic was a betalactam + β-lactamase inhibitor. Mean hospital stay was10 days. 66% of patients had complications but not mortality. Conclusion: The broad-spectrum antibiotic therapy and early surgical decompression were effective in the management of angina Ludwig of our patients…

Traqueostomía de emergencia en posición sentado por obstrucción respiratoria en angina de Ludwig: reporte de un caso / Emergency Tracheostomy Seated in Respiratory Obstruction by Ludwig's Angina: case report

La angina de Ludwig es una infección severa y rápidamente progresiva, que afecta el piso de la boca y se extiende por los espacios submaxilar, sublingual y submentoniano. Se presenta un caso clínico que demuestra la historia natural de esta patología, la cual resulta en obstrucción de la vía aérea superior, donde la única opción salvadora fue la realización de una traqueostomía con el paciente en posición sentado. Esperamos, con este artículo, mostrar nuestra humilde experiencia en un caso reto como lo es el descrito...

Ludwig’s angina is a severe and rapidly progressive infection that affects the floor of the mouth and extends to submandibular, sublingual and submental space. We present a case that demonstrates the natural history of this disease, resulting in upper airway obstruction, where the only option was the realization an Emergency tracheostomy with the patient in sitting position. We hope with this article show our humble experience in a case challenging as it is described...

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Epidemiologia das infecções maxilofaciaistratadas num hospital público da cidadede São Paulo / Epidemiology of maxillofacial infections treated in a public hospital in the city of Sao Paulo

As infecções maxilofaciais são condições clínicas graves, de ocorrência relativamente comum,caracterizadas pela rápida disseminação do processo infeccioso aos tecidos adjacentes eespaços faciais da região de cabeça e pescoço. Sua causa é geralmente odontogênica. O objetivodeste estudo foi avaliar dados referentes às causas, características clínicas, manifestaçõesclínicas e eficácia do tratamento realizado em 42 pacientes admitidos com infecção maxilofacialno Departamento de Cirurgia Bucomaxilofacial do Hospital Tatuapé, São Paulo, no períodode março de 2005 a fevereiro de 2006. As infecções odontogênicas (83,30/0). com predomíniodas infecções periapicais, foram as principais causas das infecções maxilofaciais. As manifestaçõesclínicas mais comuns encontradas nos registros foram o edema acentuado (97,60f0), trismo(52,40f0) e prostração (47,60f0). Os pacientes diabéticos não compensados apresentaram tempode internação maior quando comparados ao dos pacientes não diabéticos (P = 0,001). Em 76,2%dos casos, o tratamento instituído foi a drenagem cirúrgica complementada por antibioticoterapiaendovenosa e remoção da causa. De acordo com o estudo realizado, pudemos concluirque houve predomínio de infecções maxilofaciais em adultos jovens, sendo as infecções odontogênicasas principais causas. O tratamento empregado foi efetivo na grande maioria dos casos.

Maxillofacial infections are severe clinical processes of relative occurrence characterizedbya rapid spreading of the infection into the neighboring tissues and to the fascial spaces ofthe head and neck region. Its cause is predominantly odontogenic. This study aimed to assess,retrospectively, data concern to the causes, clinical characteristics, clinical manifestations andtreatment efficacy in 42 in-patients with maxillofacial infection at the Department of Oraland Maxillofacial Surgery of Hospital Tatuapé, São Paulo, from March 2005 to February 2006.The odontogenic infections (mainly the periapical infections) accounted for 83.30f0 of the maxillofacialinfections. The most common clinical manifestations were exuberant edema (97.6%),trismus (52.40f0) and prostration (47.60f0). Uncontrolled diabetic patients showed a lonqer-recoveringperiod at the hospital when compared with that of nondiabetic patients (P = 0.001). In76.20f0 of the cases, the treatment proceeding was surgical drainage coupled with antibiotic intravenoustherapy and cause resolution. Summarizing the main findings, this study showed thatmaxillofacial infections occurred mostly in young-adults, with the odontogenic infections beingtheir principal cause. The providing treatment was effective in the great majority of the cases.

Klebsiella pneumonia as a rare cause of parapharyngeal abscess

The incidence of parapharyngeal abscess has reduced dramatically, with the evolution of antibiotics. In a high risk patient for example diabetics, the condition do occur and the abscess is usually well formed and frank abscess will be drained. We report a case of diabetic lady who presented with left neck mass. Imaging showed collection of pus with trapped air under the fascia. Culture from drainage obtained revealed Klebsiella pneumonia, which is a rare organism in the region

Infantile Vulvar Abscess with a Normal Anus: A Suspicious Sign of Rectovestibular Fistula

PURPOSE: We investigated whether infantile vulvar abscesses are predictable features of rectovestibular fistula with a normal anus. MATERIALS AND METHODS: A retrospective analysis of five infants with vulvar abscesses and rectovestibular fistulae with normal anuses was performed. RESULTS: Four cases had a left vulvar abscess, and in one case the vulvar abscess was on the right side. All caregivers reported passage of stool from the vagina. The fistulae were almost uniformly located from the vestibule to the rectum above the anal dentate line, observable by visual inspection and probing under anesthesia. The first two cases were treated with division and closure of the fistulae after a diverting loop colostomy, and the remaining three cases with fistulotomy and curettage. There was no recurrence during the median follow-up period of 38 months. CONCLUSION: This unique rectovestibular fistula should be suspected in female infants with vulvar abscesses, especially when parents report passage of stool from the vagina. Fistulotomy and curettage may be an initial treatment and effective as a temporary diverting colostomy and delayed repair of the fistula.

Tumor de Pott / Pott´s Puffy tumor

Tumor de Pott (Pott‘s Puffy tumor) é uma comorbidade caracterizada por um ou mais abscessos sub-periosteais do osso frontal associados a osteomielite subjacente. As etiologias incluem trauma e sinusite, entre outras. Relatamos o caso de uma paciente de 17 anos que se apresentou com abaulameto doloroso, calor local e flutuação na região frontal à direita há um mês, bem como cefaléia holocraniana e hipertermia. O diagnóstico de Tumor de Pott como uma complicação de uma sinusite frontal foi estabelecido pela clínica e confirmado por tomografia computadorizada de crânio. Foi tratada com sucesso com esquema inicial de amoxicilina mais clavulanato, o qual foi substituído por ciprofloxacina, associados à craniotomia, com craniectomia do osso acometido. Esta é uma doença que por ser infreqüente muitas vezes não é diagnosticada. Deste modo enfatizamos o diagnóstico e tratamento precoces como forma de evitar seqüelas neurológicas.

Pott‘s Puffy Tumor is a comorbidity characterized by one or multiple subperiosteal abscesses of the frontal bone associated with underlying osteomyelitis. Etiologies include trauma and sinusitis among others. Here we report the case of a 17-year-old female patient with painful bulging, local heat, and fluctuation in the frontal region on the right for a month, as well as holocranial headache and hyperthermia. The diagnosis of Pott‘s Puffy Tumor as a complication of frontal sinusitis was clinically established and confirmed by computerized tomography of the skull. It was successfully initially treated with amoxicilin + clavunate, followed by ciprofloxacin, combined with craniotomy and craniectomy of the affected bone. Because of its rarity, this disorder often goes underdiagnosed. Thus we emphasize an early diagnosis and treatment so as to avoid neurological sequels.

MRI imaging of ulnar leprosy abscess.

Leprosy is a chronic granulomatous infection, caused by mycobacterium leprae, primarily affecting the peripheral nerve trunks and cutaneous nerves. It classically presents with neural or dermal signs and symptoms. The indolent course of leprosy may manifest as erythema nodosum (appearance of tender inflamed subcutaneous nodule) and reversal reaction (inflammation in the previous skin lesion, appearance of new skin lesions, neuritis and abscess). Ulnar nerve is most commonly involved. This report illustrates the MR imaging appearance of ulnar nerve abscess. ©

Floor of the nose mucosa lysis and labial abscess caused by a bee sting

Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.

A ordem das himenópteras inclui abelhas, que possuem um ferrão na cauda capaz de de injetar veneno nos tecidos afetados. Fasciite necrosante, infecção fatal e assimetria hemifacial são algumas das reações incomuns relatadas após picada de himenópteras. Este estudo relata um caso de picada de abelha no assoalho da narina direita que simulou uma infecção odontogênica atingindo o lábio superior, o espaço canino e a cavidade nasal, como observado nos casos de infecção secundária após patologia pulpar ou periodontal dos dentes anteriores. Após completo exame clínico e radiográfico, foi descartada a hipótese de infecção odontogênica e foi estabelecido o diagnóstico de lise da mucosa do assoalho da narina e abscesso do lábio, após picada de abelha. Este caso foi tratado com sucesso com adequada incisão, drenagem e administração de antibióticos, sem outras complicações. Há vários relatos de reações incomuns resultantes de picada de himenópteras, porém poucos são relativos a infecções locais e nenhum se refere à localização anatômica afetada no paciente do caso aqui relatado. Diagnóstico e tratamento precoces preveniram a disseminação da infecção e a possibilidade de necrose tecidual, como já relatado em casos de fasciite necrosante.

Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

OBJECTIVE: We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). MATERIALS AND METHODS: The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. RESULTS: The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2-weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2-weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. CONCLUSION: MR imaging is helpful for differentiating between NF and PM.

Changing profile of prostatic abscess

PURPOSE: To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism. MATERIALS AND METHODS: We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome. RESULTS: The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 ± 11.02 yrs and 49.14 ± 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II. CONCLUSION: The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.

Tubercular splenic abscess.

Splenic abscess is a rare clinical condition and yet rarer is a tubercular splenic abscess. Here we report a case of tubercular splenic abscess. A forty years old male patient was admitted in Medicine unit of Mymensingh Medical College Hospital (MMCH) on 09-08-2006 with the complaints of Left upper quadrant abdominal pain and fever for 15 days and Respiratory difficulty for 2 days. Two days after admission he developed generalized abdominal pain and distension. Pain was not associated with vomiting. Patient was transferred to surgical unit for features of peritonitis. Ultrasonogram of whole abdomen revealed moderately enlarged spleen showing 8.8 x 9.7 cm semicystic mass, which may represent an abscess. There was mild free fluid collection in the lower abdomen. X-ray chest P/A view showed bilateral pleural effusion. On laparotomy huge amount of free pus was found in the peritoneal cavity and the spleen was hugely enlarged with a burst abscess cavity in it. Splenectomy and thorough peritoneal toileting was done. Postoperative recovery was uneventful except few stitch infections. Pus culture revealed no growth but histopathology of spleen confirmed Tubercular Splenic Abscess. Patient was given an antitubercular regimen with Rifampicin, Isoniazid, Ethambutol and Pyrazinamide for initial two month which to be followed by Rifampicin and Isoniazid for another ten months.

Expansile lake of translucency in pericardial effusion. A manifestation of left ventricle to pericardial fistula from rupture of tuberculosis myocardial abscess

A 12 year old boy was admitted to a District hospital with history of abdominal pain, and persistent vomiting of several days duration. Exploratory laparotomy was done and terminal small intestine appearances were suggestive of ileocaecal tuberculosis. During post operative course he was found to have large bilateral pleural effusions on chest x-ray. Subsequently his general condition deteriorated and he was then shifted to tertiary care hospital where chest intubation was done. Echocardiography revealed large pericardial effusion with tamponade which was drained with a pigtail catheter, kept in situ for intermittent drainage. Clinical workup and investigations were consistent with disseminated tuberculosis for which anti-tuberculosis treatment was started. A month later, echocardiography was repeated for removal of pigtail catheter which revealed lake of translucency within the small residual pericardial fluid which was expansile with cardiac cycle. This was further evaluated with colour and colour M-mode. [Panel A,B,C,D]. Findings were suggestive of fistulous communication between left ventricular cavity and pericardial space secondary to tuberculous myocardial abscess rupture confirmed on histopathology post-operatively. What lends novelty to this case is that this serious but apparently innocuous looking finding could easily have been overlooked in a casual examination