Sporadic Spinal Lumber Epidermoid Cyst in an Obese Adolescent: A Radiological and Pathological Review.

BACKGROUND We report a case of a sporadic lumbar epidermoid cyst in a patient with no apparent risk factors for the condition. The lesion is considered an uncommon lesion that has a potentially debilitating effect on the spinal cord. CASE REPORT Our patient was a 17-year-old boy who presented to the neurosurgery clinic with lower back pain, accompanied by an electrical sensation radiating bilaterally to the buttocks, thighs, and knees. He has been increasingly reliant on a walking cane over the past few months. The patient was considered obese, with a BMI of 44. Otherwise, his physical examination was unremarkable, with no signs of dysraphism. He underwent magnetic resonance imaging (MRI) of the spine, which revealed a lumbar spine lesion, compressing the adjacent cauda equina nerve roots. MRI imaging showed the lesion was an intradural extramedullary mass showing hypointense signal on T1- and hyperintense on T2-weighted images, with diffusion restriction on diffusion-weighted imaging (DWI). The imaging findings were consistent with an epidermoid cyst. CONCLUSIONS Epidermoid cysts are benign lesions, usually found in the head and trunk. When found in the spine, they can cause a range of symptoms that can be debilitating. Patients presenting with signs and symptoms of spinal cord compression should be promptly investigated. MRI is an excellent tool for characterizing an epidermoid cyst. The lesion appears oval and hypointense on T1-weighted imaging, and characteristically shows diffusion restriction on diffusion-weighted imaging (DWI). With surgical treatment, the outcome is usually favorable.

Retraction: Pulmonary Embolism in COVID-19 Patients: A Retrospective Case-Control Study.

[This retracts the article DOI: 10.7759/cureus.18887.].

Pulmonary Embolism in COVID-19 Patients: A Retrospective Case-Control Study.

BACKGROUND: Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19. METHODS: We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021. RESULTS: The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8). CONCLUSION: The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.