Acute limb ischemia in COVID-19 patients despite therapeutic anticoagulation: Experience from Africa.

Background: Hypercoagulability is a common complication seen in COVID-19 infection. However, arterial thrombosis such as acute limb ischemia (ALI) is far less common. Data on the incidence and nature of arterial thromboembolic complications in patients with COVID-19 is limited, originating from a few case reports and case series. Data in the African continent are very scarce. Method: This is a case series of 10 patients with COVID-19 who developed ALI while on treatment at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. All patients with ALI and COVID-19 admitted between February 1, 2021, and December 31, 2021, were retrospectively identified and reviewed. COVID-19 was confirmed by RT-PCR and ALI was confirmed by Doppler ultrasound and/or computed tomography angiography in the presence of clinical suspicion. Results: A total of 3098 patients were hospitalized with confirmed COVID-19 during the study period. In a series of 10 patients, 8 (80%) males with a median age of 53.5 years were included. All except one (10%) had one or more risk factors for ALI and one had a 'possible' case of vaccine-induced thrombotic thrombocytopenia (VITT) associated with ALI. All were admitted with severe COVID-19 and most (80%) developed ALI during hospitalization (median of seven days from admission). The median duration between COVID-19 and ALI symptom onset was 14.5 days (IQR, 11-15). The majority (60%) were taking therapeutic anticoagulation at the time of ALI onset which is the standard of care for patients with severe disease. Five (50%) were successfully revascularized (median time of 3.5 days) and the rest underwent amputation. All survived and were discharged improved. Conclusion: ALI can occur in the context of COVID-19 even while a patient is on therapeutic dose anticoagulation and in the absence of traditional risk factors. It is wise to be vigilant of this complication for timely intervention and better treatment outcomes.

Imaging Findings of Concomitant Pulmonary and Central Nervous System Sarcoidosis: A Case Report.

Background: Sarcoidosis is a multisystem idiopathic granulomatous disorder characterized by the development of noncaseating infiltrative granulomas in various body organs. The central nervous system (CNS) is one of the sites to be affected by sarcoidosis. We present a case of sarcoidosis with concomitant involvement of lung and CNS with emphasis on neuroimaging findings. Case: A 45-year-old Ethiopian male patient was sent to our radiology department at Tikur Anbessa Specialized Hospital for chest computed tomography (CT) and brain Magnetic resonance imaging (MRI) evaluation for an indication of panhypopituitarism, nasal congestion, and decreased vision. The chest CT reveals the perilymphatic distribution of multiple soft tissue attenuating pulmonary nodules which is a pattern seen in sarcoidosis. The brain MRI also revealed thickening and gadolinium enhancement of hypothalamus/optic chiasm which is also a common site of involvement in neurosarcoidosis. The nasal biopsy finding of granulomatous inflammation with the above imaging findings supports the diagnosis of sarcoidosis. Conclusion: As sarcoidosis is a systemic disease that can affect any organ in the body, multimodality imaging is important in the diagnosis of sarcoidosis. Brain MRI with gadolinium contrast is a preferred imaging modality that can assess different patterns and areas of CNS involvement in sarcoidosis.

Intrathoracic giant solitary fibrous tumor of the pleura: Case report.

INTRODUCTION: Solitary Fibrous Tumor of the Pleura(SFTP) is exceedingly rare mesenchymal tumor commonly arising from the visceral pleura and accounts for <5% of all pleural tumors. Although it commonly has benign histologic characteristics, the tumor behavior is often unpredictable and less understood due to limited number of cases. CASE PRESENTATION: We present a rare case of Intrathoracic Giant SFTP in a 65 years old female who presented with a progressive worsening of shortness of breath of 1 year duration associated with intermittent dry cough, low grade fever, easy fatigability and loss of appetite. Complete enbloc resection was done and she was discharged improved. DISCUSSION: Most patients with SFTP are asymptomatic and definitive diagnosis is often made after surgical exploration and histopathologic study. Although 80% of SFTP arise from visceral pleura, the origin in our case was from the parietal pleura which is rare. CONCLUSION: SFTP should be considered as differential diagnosis in patients with atypical or recurrent respiratory symptoms despite adequate medical treatment. Complete surgical excision is the main stay of treatment and meticulous post-operative follow up is mandatory as the risk of recurrence is higher and the tumor behavior is still less understood.