Rare case of coexisting hepatic, splenic, and vertebral hemangiomas - A case report.

Synchronous existence of hepatic, splenic, and skeletal hemangiomas has not been reported previously in the English literature to our knowledge. In this case report, we present a case of coexistence of hepatic, splenic, and skeletal hemangiomas in a 30-year-old woman with on and off bilateral lumbar region pain and no significant past medical history. Radiological investigations, including ultrasound and computed tomography and magnetic resonance imaging helped identify the synchronous existence of hepatic, splenic, and skeletal hemangiomas. The patient improved with conservative management and was kept on follow-ups. Although there have been reports of coexistence of splenic and hepatic hemangiomas in the literature, to our knowledge, this is the first report of synchronous existence of hepatic, splenic, and skeletal hemangiomas.

Neglected case of recurrent abdominal pain due to a chronically retained and broken double J (DJ) stent following percutaneous nephrolithotomy (PCNL): A case report.

Double J (DJ stent) is commonly used in urology practices. Short- and long-term complications of indwelling catheters are increasingly noted resulting in significant morbidity and at times mortality. Retained and broken DJ stent is however rare complication with few cases reported in the literature. We present a case of neglected retained and broken DJ stent in a 55-year-old male who had undergone percutaneous lithotripsy (PCNL) 4 years back presenting with recurrent abdominal pain and was misdiagnosed as peptic ulcer disease at various centers. Radiological investigations including ultrasound, radiographs, and computer tomography helped in identifying the retained and broken DJ stent. Patient improved with conservative management and left against medical advice for definite treatment. Patient education and ensuring proper follow-up can reduce the likelihood of complications associated with DJ stents.

Spontaneous extradural hematoma in a Sickle cell Beta Thalassemia patient-A rare complication.

Spontaneous extradural hematoma in Sickle cell disease is rare neurological complication with few cases reported in the English literature. We report a case of a 16-year-old male patient who was previously diagnosed with Sickle Cell Beta Thalassemia and presented with severe headache and vomiting for 3 days. An emergency CT scan of the head demonstrated right-sided acute parietal extradural hematoma with mass effect. Patient underwent emergent craniotomy with evacuation of the hematoma. Patient recovered completely. Although calvarial infarction has been associated with extradural hematoma, an absence of it makes our case distinct. A high index of suspicion should be made in SCD patients for possibility of EDH in progressive headache.

An Unusual Case of Tetanus Masquerading as an Acute Abdomen: A Case Report.

INTRODUCTION: Tetanus is an acute onset neurological disease that is often lethal. It has a high disease burden in low and middle-income countries. Tetanus is caused by a toxin made by spores of the bacterium Clostridium tetani, which are found in soil, dust, and animal feces. The toxin impairs the motor neurons leading to muscle stiffness. However, with the development of a toxoid vaccine, the incidence has sharply declined and is now categorized as a vaccine-preventable disease. The treatment of tetanus is primarily supportive and focuses on managing the complications until the effects of toxins resolve. CASE REPORT: We report the case of a 67-year-old farmer who previously sustained a laceration injury approximately 45 days prior to presenting to the emergency department with abdominal pain and rigidity. After a comprehensive evaluation to rule out other items in the differential diagnoses, he was diagnosed with tetanus based on clinical symptoms and ultimately required mechanical ventilation. The patient was then managed in the intensive care unit and later made an uneventful recovery. CONCLUSION: This case illustrates an uncommon presentation of tetanus and the latency of the infectious process. Often when patients present with atypical symptoms, it poses a diagnostic dilemma to the clinicians. Thus, it is very important to carefully elicit a history of contaminated injury. This case also highlights the importance of prophylactic vaccine in low and middle-income countries, which can reduce disease-related mortality and morbidity.

Gallbladder schistosomiasis - a rare presentation as gallbladder polyp: a case report.

Background: Schistosomiasis is a neglected tropical disease second to malaria in prevalence with significant morbidity and mortality. Although, Schistosomiasis can affect multiple organs, gallbladder involvement is very rarely reported. We present a case of isolated gallbladder schistosomiasis in a 20-year-old female presenting as gallbladder polyp radiologically and also correlated the histopathological findings which to our knowledge has never been reported in the English literature. A high index of suspicion should be made for considering Schistosomiasis when an individual hailing from endemic region presents with gallbladder pathologies.

Genital filariasis presenting as a vaginal wall cystic lesion.

Vaginal cystic lesions are rare incidental findings detected during physical examination and imaging. To our knowledge, filariasis as a cause of vaginal cystic lesions has not been previously reported in the English literature. We present vaginal cystic lesion which posed diagnostic dilemma and was confirmed on cytology to being filarial in etiology. The patient was treated with single-dose of oral diethylcarbamazine and the lesion subsided on follow up scans at three months thus avoiding inadvertent surgeries. Vaginal cystic lesions are rare entities and have multiple etiologies. A high degree of suspicion for filariasis as cause of vaginal cystic lesions should be made in individuals hailing from or have history of travel to endemic regions of filariasis.

A case report of visceral leishmaniasis and malaria co-infection with pancytopenia and splenomegaly - a diagnostic challenge.

BACKGROUND: Leishmaniasis and malaria are tropical diseases with more than half of the world population at risk of infection resulting in significant morbidity and mortality. Co-infection of Leishmaniasis and malaria pose a great challenge in the diagnosis as well as overall management. CASE PRESENTATION: In this case report, we present a rare case of a 5 years old child hailing from non-endemic region of Nepal with history of fever for a period of 3 months who was diagnosed as co-infection of malaria due to Plasmodium vivax and visceral Leishmaniasis with pancytopenia that subsequently improved after a course of treatment. CONCLUSIONS: A high index of suspicion for a possibility of co-infection with Leishmaniasis and malaria should be borne in mind when an individual hailing from or having history of travel to endemic countries presents with prolonged fever.

Spectrum of Typical and Atypical Clinico-Histopathological and Radiological Presentation of Soft Tissue and Muscular Cysticercosis in Mid-Western and Far-Western Region of Nepal.

INTRODUCTION: Soft tissue and muscular involvement in cysticercosis is a relatively rarer presentation. MATERIALS AND METHODS: Twenty seven histopathologically confirmed cases of soft tissue and muscular cysticercosis were collected and the clinical, radiological data was reviewed. RESULTS: There was female predominance for the lesions (19 cases among 27 cases). The most common location for the lesion was in the arm (9 cases), thigh (4 cases), forearm (7 cases), abdominal wall (4 cases) followed by nape of the neck (2 cases). Lesion ranged from 8 mm to 5 cm in size. Ultrasound was diagnostic in 24 cases and inconclusive in three cases. Histopathologically, intact cyst wall was noted in 12 cases, scolex in 5 cases. Seven cases showed degenerating cyst wall surrounded by inflammatory cells, granulation tissue and fibrosis. CONCLUSION: Fine needle aspiration cytology and histopathological assessment is prudent in the diagnosis of soft tissue and muscular cysticercosis in cases posing clinical diagnostic dilemma.

Improved sensitivity of 3.0 Tesla susceptibility-weighted imaging in detecting traumatic bleeds and its use in predicting outcomes in patients with mild traumatic brain injury.

BACKGROUND: The efficacy of susceptibility-weighted imaging (SWI) for detecting intracranial bleeds (ICBs) in patients with mild traumatic brain injury (MTBI) has not been directly compared to that of T2*-weighted gradient-recalled-echo imaging (T2*WI). Further, its prognostic value for MTBI patients remains unproven. PURPOSE: To compare the sensitivity of ICB identification between SWI and T2*WI and examine the prognostic value of SWI for MTBI patients. MATERIAL AND METHODS: T2*WI, SWI, and clinical information of 63 MTBI patients were collected. Sensitivity was compared between T2*WI and SWI for ICB identification, and statistical analysis was conducted to understand the correlations between SWI and clinical characteristics. RESULTS: ICBs were detected in more patients (47 vs. 35, P < 0.001) and more ICBs were detected (276 vs. 147, P < 0.001) on SWI than T2*WI. On SWI, patients with conscious disturbance showed higher ICBs prevalence (84.6% vs. 58.3%, P = 0.020), and more patients from the post-concussive syndrome (PCS)(+) group than the PCS(-)group were ICBs positive (86.1% vs. 59.3%, P = 0.015). The numbers of ICBs were significantly higher in the PCS(+) group than the PCS(-) group (P < 0.001). Significant correlation was found between PCS and ICBs number (r = 0.510, P < 0.001). Multiple logistic regression analysis showed that ICB number was an independent variable predicting occurrence of PCS. CONCLUSION: SWI is more sensitive than T2*WI in detecting hemorrhagic foci in MTBI patients and may offer valuable prognostic information regarding these patients, for example, information on PCS. Further, cerebral parenchymal hemorrhage may affect long-term outcomes in MTBI patients.

Magnetic resonance imaging characteristics of primary intraspinal peripheral primitive neuroectodermal tumour.

PURPOSE: The purpose of our study was to describe the salient magnetic resonance imaging (MRI) findings in primary intraspinal peripheral primitive neuroectodermal tumour (PNET). METHODS: A retrospective review of the clinical and MRI images of 7 pathologically proven cases of intraspinal peripheral PNETs was performed. The various parameters, such as vertebral level of involvement; tumour location, size, focality, and margin; signal intensity of the lesion; the presence of hemorrhage or calcification; any signal voids; assessment of the adjacent cord for cord compression; cord dilatation; the presence of paraspinal tissue mass; or vertebral or other bony changes, were analysed. RESULTS: All 7 patients had lesions in the thoracolumbar region. Three patients had extradural lesions, 4 had intradural extramedullary lesions, and none had intramedullary lesions. Six lesions were well circumscribed. Only 1 patient had multifocal involvement. All lesions were of hypointense or isointense signal on T1-weighted imaging, whereas all but one were hyperintense on T2-weighted imaging. Lesions enhanced heterogeneously except 1 intradural extramedullary lesion, which enhanced homogeneously. A paraspinal mass was noticed in 2 patients. Vertebral collapse was present in 1 patients. CONCLUSION: Intraspinal peripheral PNETs are rare spinal tumours. Although imaging characteristics are not specific, a focal circumscribed lesion in a young individual at the intramedullary, extramedullary intradural, or extradural spinal location that shows hypointense and hyperintense signal on T1- and T2-weighted images, respectively, requires PNET to be considered in the differentials.

Primary spinal chondrosarcoma: radiological manifestations with histopathological correlation in eight patients and literature review.

PURPOSE: The aim of this study was to delineate radiological-pathological correlation in primary vertebral chondrosarcoma. METHODS: Eight histopathologically confirmed cases were analyzed for pathological and radiological characteristics. RESULTS: Magnetic resonance images of three conventional and one clear cell cases showed lobulated or irregular masses with line or septa enhancement. Two conventional lesions showed signal intensity of high water content on T2-weighted images, in which aneurismal bone cysts were confirmed. The myxoid lesion showed a relatively diffuse signal and enhancement. Marked masses were found in the two mesenchymal patients, either dumbbell-like or round-like. CONCLUSION: Primary spinal chondrosarcomas have certain radiological findings that may correlate to the pathological subtypes.

Primary pulmonary cryptococcosis: evaluation of CT characteristics in 26 immunocompetent Chinese patients.

BACKGROUND: Discrepancies still exist in the diagnosis of primary pulmonary cryptococcosis in immunocompetent patients. PURPOSE: To describe and evaluate radiological manifestations of pulmonary cryptococcosis in immunocompetent patients. MATERIAL AND METHODS: Twenty-six histopathologically confirmed cases of pulmonary cryptococcosis were analyzed for clinical, pathological, and CT characteristics. Necessary statistical tests for differences in CT presentations and correlation analysis between clinical and CT characteristics were performed. RESULTS: The patients' ages ranged from 24 to 79 years, with 20 men and six women. Eighteen patients were symptomatic, with cough as the most common symptom (n = 14, 53.8%). Nodules (n = 21, 80.8%) were the most common CT findings. Eight cases presented with solitary and nine with multiple nodules, while 13 cases presented with irregular and 19 with ill-defined nodules. The halo sign was demonstrated, encompassing nodules in 14 of the 21 patients. Lesions were mainly localized in the lower lobes of the lungs (n = 15, 57.7%) with peripheral distribution (n = 18, 69.2%). Ground-glass opacities (GGOs) were more easily detected in older patients (66.7%, P <0.01). No significant differences in CT abnormalities were found between male and female patients. CONCLUSION: Primary pulmonary cryptococcosis in immunocompetent patients exhibits certain CT characteristics. The typical presentation includes multiple nodules with the halo sign scattered in the peripheral field in the lower lobes of the bilateral lungs. This could contribute to diagnosis of the disease entity. However, vigilance should be exercised when facing GGOs, with or without nodules, in older patients.

CT features of peripheral T-cell lymphoma in the gastrointestinal tract in Chinese population and literature review.

INTRODUCTION: The aim of the study was to retrospectively investigate the CT features in peripheral T-cell lymphoma (PTCL) of the gastrointestinal tract in the Chinese population. METHODS: Computed tomography scans of 15 histopathologically proven cases of PTCL involving the gastrointestinal tract were retrospectively reviewed for characteristics such as sites, multiplicity, morphological features, the pattern and degree of contrast enhancement, lymphadenopathy, involvement of other organs and complications such as perforation, intussusceptions, ascites and so on. By reviewing the literature, CT findings of PTCL involving the gastrointestinal tract were compared with that involved by B-cell lymphoma. RESULTS: PTCLs involved the stomach and intestine in six and nine patients, respectively. Multiplicity was seen in seven patients, and solitary involvement was seen in eight. At CT, wall thickening was the predominant finding in all cases with an exception of one intestinal PTCL case presented as polypoid mass. Among the 14 patients, the gastric or bowel wall thickening was mild (<10 mm) in three, moderate (10-20 mm) in 10 and severe (>20 mm) in one. Nine cases demonstrated mild homogeneous enhancement, whereas six showed mild heterogeneous enhancement. Lymphadenopathy was present in eight patients, five of which were non-bulky (diameter <5 cm) and diffuse type and the rest (three) were non-bulky and localised type. Other organs were involved in four patients. Perforation as complication was evident in one gastric and five intestinal lymphomas (55.6%). Among the nine intestinal PTCLs, seven of the patients were male (77.9%) and the rest (two) were female with a median age of 37.1 years old. Intestinal PTCLs predominantly involved colon (n = 5). Other sites of involvement were ileum (n = 1), ileocaecum (n = 1), ileum and ileocaecum (n = 1) and entire bowel segment from distal ileum to transverse colon (n = 1). CONCLUSION: PTCLs have some distinguishing radiological features from B-cell type gastrointestinal lymphomas as mild or moderate gastric or bowel wall thickening and higher incidence of perforation with multiplicity. In China, intestinal PTCLs are not usually associated with coeliac disease and commonly present in a young male population with colon being the most frequent site of involvement.

(1)H magnetic resonance spectroscopy and diffusion weighted imaging findings of medulloblastoma in 3.0T MRI: A retrospective analysis of 17 cases.

(1)H magnetic resonance spectroscopy and diffusion weighted imaging features of the cerebellar vermis in 17 medulloblastoma patients were retrospectively analyzed, and 17 healthy volunteers were selected as controls. (1)H magnetic resonance spectroscopy showed that in all 17 medulloblastoma patients, N-acetyl aspartate and creatine peaks were significantly decreased, the choline peak was significantly increased, and there was evidence of a myo-inositol peak. Further, 11 patients showed a low taurine peak at 3.4 ppm, five patients showed a lipid peak at 0.9-1.3 ppm, and three patients showed a negative lactic acid peak at 1.33 ppm. Compared with the control group, the ratios of N-acetyl aspartate/choline and N-acetyl aspartate/creatine were significantly decreased, and the ratio of choline/creatine was increased, in medulloblastoma patients. Diffusion weighted imaging displayed hyperintensity and decreased apparent diffusion coefficient in medulloblastoma patients. These findings indicate that (1)H magnetic resonance spectroscopy and diffusion weighted imaging are useful for qualitative diagnosis of medulloblastoma.

Primary gastrointestinal lymphoma.

Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.

Primary retroperitoneal malignant melanoma: A case report.

Primary malignant melanoma occurring at an extra cutaneous site is rare. A case of primary malignant melanoma located in the retroperitoneum of an 18-year-old female is presented in this study. Histopathological examination of the tissue biopsies at laparotomy with immunohistochemical stains confirmed a diagnosis of malignant melanoma. Further extensive clinical and radiological investigations proved the retroperitoneum to be the primary site.

Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review.

Primary lymphoma that involves the esophagus is very rare, with fewer than 30 cases reported in the English-language literature. Non-Hodgkin lymphoma accounts for most of the cases. Esophageal lymphomas have varied radiological appearances, which poses diagnostic difficulty. We report two cases of histopathologically confirmed primary diffuse large B-cell esophageal lymphoma and describe their radiological features, and briefly review the literature.

Perfusion computed tomography in colorectal cancer: protocols, clinical applications and emerging trends.

Perfusion computed tomography (CT) has emerged as a novel functional imaging technique with gradually increasing importance in the management of colorectal cancer (CRC). By providing the functional tumor microvasculature, it also helps the assessment of therapeutic response of anti-angiogenic drugs as it may reflect tumor angiogenesis. Perfusion CT has been applied in clinical practice to delineate inflammatory or neoplastic lymph nodes irrespective of their size, identify micro-metastases and to predict metastases in advance of their development. It is of increasing significance for preoperative adjuvant therapies and avoidance of unnecessary interventions. Despite controversies regarding the techniques employed, its validity and reproducibility, it can be advantageous in the management of CRCs in which the prognosis is dependent on preoperative staging. With recent advances in the perfusion CT techniques, and incorporation to other modalities like positron emission tomography, perfusion CT will be a novel tool in the overall management of CRCs. This article aims at reviewing the existing clinical applications and recent advances of perfusion CT with a reference to future development in the management of CRCs.