Clostridium perfringens Empyema: Anaerobic Invasion in an Uncommon Location.

Clostridium perfringens bacteremia arises due to skin inoculation from the external environment or translocation from the gastrointestinal tract. In the event of bacteremia, it tends to colonize in anaerobic environments due to its obligatory anaerobic nature. Its inoculation in the lung, albeit rare, can occur if an anaerobic nidus is created. In the presented case, the patient developed C. perfringens bacteremia andempyema in the area of lung necrosis caused by acute pulmonary embolism. He did not have any history of chest trauma, and the source of bacteremia was deemed to be via gut translocation. The patient was noted to have multiple gastric ulcers on endoscopy and jejunal wall thickening, which likely led to the bacterial translocation into the bloodstream. He underwent video-assisted thoracoscopic surgery-assisted decortication and intravenous antibiotics, eventually leading to clinical improvement. To identify the source of Clostridium in the absence of penetrating trauma, a thorough gastrointestinal evaluation, including a colonoscopy, is warranted to identify the pathology leading to the gastrointestinal translocation.

Recurrent Spontaneous Coronary Artery Dissection: A Case of Triple Trouble.

SCAD (Spontaneous Coronary Artery Dissection) is a rare disorder which rarely recurs. It is increasingly diagnosed as a cause for acute coronary syndrome (ACS) with limited insight into its pathophysiology and treatment. Lack of randomized trials and consensus guidelines make this a unique and challenging disease to manage. We describe a complex case of recurrent idiopathic SCAD with prior history of NSTE-ACS (Non-ST elevation Acute Coronary Syndrome) and discuss its management based on current clinical practices.

Ipsilateral Displaced Physeal Fractures of the Proximal and Distal Humerus with Subperiosteal Extrusion in a 6-Year-Old Child: A Case Report.

CASE: We present a case of a 6-year-old male child with ipsilateral proximal and distal physeal separation of humerus with subperiosteal extrusion after manipulation by a bonesetter. Treatment included open reduction and internal fixation with Kirschner wire proximally and distally. At 1.5-year follow-up, the child had a shortening of 0.5 cm, no pain, and/or no instability. CONCLUSION: Manipulation by bonesetters, a commonplace in developing countries, can produce unpredictable complications and compromise outcomes. Although accepted in certain settings, the regional orthopaedic surgeons should be mindful of the unique clinical challenges imposed by such a practice.

COVID-19 and the Radiology Department: What We Know So Far.

COVID-19 is a global healthcare pandemic that is now growing through nations across the world. The role of radiology is crucial, and a variety of guidelines have been published regarding the role of imaging. These aim to protect healthcare workers (HCWs) and the general public from exposure, while preserving critical radiology operations and conserving personal protective equipment (PPE) and other critical care resources during the COVID-19 pandemic. Fleischner Society published guidelines on indications of imaging various settings. These guidelines take into account resource availability, pre-test probability, degree of symptoms and risk factors, which is crucial for decision-making regarding need and indications of imaging. Mitigating steps and alternative approaches should be considered to provide the best care for patients while protecting all HCWs. Owing to overlap of COVID-19 imaging findings with other pathologies, standardized reporting acquires importance for risk assessment and effective communication of suspicious findings. RSNA followed by Dutch Radiological Society (NVvR) have published guidelines on standardized CT reporting for COVID-19, which show excellent inter-observer variability. Standardized reporting can provide guidance and confidence to radiologists as well as increased clarity to physicians through reduced reporting variability. The article discusses the published recommendations and aims to make radiologists aware of the protocols and guidelines that need to be followed in this ongoing public health crisis for effective patient care while protecting HCWs and conserving resources.