rare case of deep hemangioma presenting as a periorbital swelling and its excellent response to intralesional steroids

A hemangioma is a benign and usually self-involuting tumor of the endothelial cells of blood vessels, and is characterized by an increased number of normal or abnormal vessels. It usually appears in the first few weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas involute by age five, 70% by age seven, and most of the remainder by age twelve. In more severe cases hemangiomas may leave residual tissue damage. The dermatologic indications for intervention in a case of hemangioma include maceration and erosion of the epidermis, infection, and cosmetic disfigurement. The treatment options include corticosteroids [oral], interferon, vincristine, propranolol, pulsed dye laser and surgery. The intralesional steroids are usually not recommended in the periocular region because of side effects like eyelid necrosis and central retinal vein occlusion. Here we report the case of a deep hemangioma in periorbital region with no overlying skin changes and its excellent response to intralesional steroids with no side effects.

Involvement of the cervical cord and medulla in posterior reversible encephalopathy syndrome

The posterior reversible encephalopathy syndrome [PRES] is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord [apart from the typical parieto-occipital lesions]-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome

Congenital lobar emphysema associated with polysplenia syndrome

Polysplenia, or left isomerism, is a rare heterotaxy syndrome characterized by bilateral bi-lobed lungs, bilateral pulmonary atria, a symmetrical midline liver, and multiple aberrant splenic nodules. We report a case of polysplenia associated with congenital lobar emphysema apart from other typical anomalies. Such an association has not been previously reported. The patient was a young male with progressive exertional breathlessness referred for high resolution CT of the lungs. CT, MRI and echocardiography revealed [in addition to congenital lobar emphysema of right lung] a hemiazygos continuation of the inferior vena cava, a persistent left superior vena cava, multiple splenunculi in the right hypochondrium, midline liver, bilateral bilobed lungs, a large pulmonary artery [suggestive of severe pulmonary artery hypertension] and a large VSD- a typical constellation of findings described in polysplenia syndrome

Dental erosion: a salient manifestation of gastroesophageal reflux disease [GERD]

Gastro esophageal reflux disease [GERD] is a chronic disease which is usually ignored by the individual until the appearance of its complication. Aim and objective of the study was to find GERD prevalance,its correlation with dental erosion in the Pakistani community and its awareness among the diseased patients. This study was carried out at 3 different tertiary care centers of Lahore namely Punjab Dental Hospital, gastroenterology department of Shaikh Zayed Hospital and Mayo Hospital, 150 patients were seen at Punjab Dental Hospital for non carious dental lesion. Thirty patients were seen at Shaikh Zayed Hospital and 60 patients at Mayo Hospital gastroenterology department. Dental erosin grading was done according to Eceles and Jenkeis Erosin scale and recorded on a specifically designed close ended questionnaire SPSS version 11 was used to analyze results. Patients with dental erosion were pre-dominantly related to GERD both symptomatic and asymptomatic and erosion manifested as a common sign for GERD. General dental practitioners should identify for this specific sign and refer the patient for complete medical evaluation to assist in early diagnoses of the disease and aid in reducing its frequency and progress