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1.
Eur J Radiol ; 152: 110341, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1821220

ABSTRACT

In the wake of the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, a new epidemic of COVID associated mucormycosis (CAM) emerged in India. Early diagnosis and prompt treatment of this deadly disease are of paramount importance in improving patient survival. MRI is the cornerstone of diagnosis of early extrasinus disease, particularly intracranial complications which have traditionally been associated with a high mortality rate. In this review, we depict the sinonasal, perisinus, orbital and intracranial involvement in CAM. Special emphasis is laid on intracranial disease which is categorized into vascular, parenchymal, meningeal, bony involvement and perineural spread. Vascular complications are the most common form of intracranial involvement. Some unusual yet interesting imaging findings such as nerve abscesses involving the optic, trigeminal and mandibular nerves and long segment vasculitis of the internal carotid artery extending till its cervical segment are also illustrated. In our experience, patient outcome in CAM (survival rate of 88.5%) was better compared to the pre-pandemic era. Presence of intracranial disease also did not affect prognosis as poorly as traditionally expected (survival rate of 82.8%). Involvement of brain parenchyma was the only subset of intracranial involvement that was associated with higher mortality (p value 0.016). The aim of this review is to familiarise the reader with the MR imaging spectrum of CAM with special focus on intracranial complications and a brief account of their impact on patient prognosis in our experience.


Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Magnetic Resonance Imaging , Mucormycosis/complications , Mucormycosis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Prognosis , SARS-CoV-2
2.
Curr Probl Diagn Radiol ; 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1671743

ABSTRACT

OBJECTIVE: Recent pandemic of COVID19 infection has witnessed a re-emergence of invasive fungal sinusitis especially of the Mucor species, which has been a rare entity in the pre covid era. Covid associated mucormycosis (CAM) is one of the dreaded and fatal complications which has surfaced up and early diagnosis is critical for management and survival .It is identified to affect both subset of patients, those with active COVID-19 infection and those who have recovered from the disease in the last 4-6 weeks. Imaging features suggestive of early invasion with supportive imaging examples and relevance of these findings in clinical decision making is presented. METHODS: This paper reviews the various imaging signs of early invasion in CAM A comprehensive checklist for clinically relevant and quick reporting is also presented. RESULTS: Emphysematous or ulcerative mucosal changes in the nasal cavity is an early imaging feature of CAM. Periantral soft tissue and soft tissue within the pterygopalatine fossa are important imaging signs to indicate extrasinus invasion. Disease within pterygopalatine fossa may lead to multidirectional spread and is an important check site. These findings are seen even in absence of bony erosions owing to the neurovascular spread of disease. Intra orbital and intracranial extensions were found to be fairly common and must be sought for. CONCLUSION: The knowledge of early subtle signs of CAM on imaging can aid in prompt diagnosis of this fatal entity in the pertinent clinical setting. Imaging signs of spread of disease and delineation of its extent as inferred from CT imaging aids in prognosis and appropriate surgical management.

3.
Ophthalmic Plast Reconstr Surg ; 38(3): 242-249, 2022.
Article in English | MEDLINE | ID: covidwho-1593635

ABSTRACT

PURPOSE: To correlate the clinical, radiological, and histopathological features in Covid-associated Rhino-orbito-cerebral mucormycosis cases presenting with acute visual loss. DESIGN: Cross-sectional study. METHODS: Covid-associated Rhino-orbito-cerebral mucormycosis cases with unilateral visual loss, planned for exenteration, underwent orbital and ophthalmological ocular examination. The available radiological sequences, doppler ultrasonography and histopathology findings were correlated with clinical manifestations. RESULTS: The median age was 51 years and the male: female ratio was 3:1. All except one presented with unilateral ophthalmoplegia. The ocular media were hazy in 2 eyes. In 8 eyes, retinal changes were suggestive of occlusion of CRA (6), combined occlusion of CRA and central retinal vein (1), and myopic degeneration with hypertensive retinopathy (1). The contralateral eye showed retinal ischemic changes in one patient. Radiological imaging showed orbital apex involvement in the 10 affected eyes and one contralateral eye. Ipsilateral cavernous sinus thrombosis, diffusion restriction on MRI of optic nerve, internal carotid artery narrowing/thrombosis, and cortical watershed infarcts were seen in 8, 4, 4, and 2 cases, respectively. The blood flow in CRA and ophthalmic artery was absent or reduced in all the 10 affected eyes and in 1 contralateral eye. On histopathology, orbital fat necrosis, fungal hyphae, acute inflammation, granuloma formation, ischemic thrombosis of ophthalmic artery was observed in 10 specimens. CRA was patent in 9 and thrombosed in 1 eye. Optic nerve was ischemic in 8 and viable in 2 eyes. CONCLUSION: Acute visual loss in ROCM cases is associated with orbital apex involvement and thrombotic ischemia of ophthalmic artery. Cessation of flow in CRA possibly occurs secondary to ophthalmic artery thrombosis.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , COVID-19/complications , Cross-Sectional Studies , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Female , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/microbiology , Orbital Diseases/etiology , Orbital Diseases/microbiology , Vision Disorders/diagnosis , Vision Disorders/etiology
4.
Journal of Evolution of Medical and Dental Sciences ; 10(33):2761-2764, 2021.
Article in English | CAB s | ID: covidwho-1547817

ABSTRACT

BACKGROUND: Since the outbreak of coronavirus disease (Covid-19) many patients have presented with a variety of other symptoms along with primary respiratory symptoms. The increased reporting of these extra-pulmonary symptoms has made it necessary for the clinicians to establish a proper cause and relation between coronavirus disease 2019 (Covid-19) and extra-pulmonary symptoms. This study was undertaken to assess if the cause of elevated lipase levels in Covid-19 patients was due to acute pancreatitis. METHODS: A retrospective observational study was performed at a local critical care ICU facility in Bathinda, India (MediWin Hospital, Bathinda, Punjab). RT - PCR, Rapid antigen test, CT scans were done to establish the Covid-19 status. Clinical signs and symptoms, CT scans were used to confirm the diagnosis of acute pancreatitis. MRI was preferred in patients with deranged renal function test. RESULTS: Lipase test was done in 62 patients and the levels were found elevated in 52 patients. 40 patients were found to have symptoms of the spectrum of acute pancreatitis. 10 patients had symptoms along with signs of severe inflammatory response syndrome. Imaging was advised in these 10 patients with moderate to severe presentation of acute pancreatitis. 9 patients were advised CT scans which had no significant findings. 1 patient with deranged renal function test was advised MRI scan which showed mildly diffusely bulky pancreas. Mild peripancreatic fat stranding and fluid collection, suggestive of acute interstitial pancreatitis. It was associated with poor outcomes and lead to the patient's death eventually. CONCLUSIONS: Hyperlipasemia led to acute pancreatitis in 1 (1.6%) patient. It was associated with poor outcome and caused eventual death of the patient. The prospects of a Covid-19 patient developing Hyperlipasemia due to acute pancreatitis were found to be statistically insignificant.

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