Malakoplakia presenting as Pleuropulmonary masses: A rare clinical, radiological and histopathological diagnosis.

Pleuropulmonary malakoplakia is a rare granulomatous inflammatory condition characterized by the accumulation of histiocytes that contain basophilic inclusions called Michaelis-Gutmann bodies . It is usually reported in patients with acquired immunodeficiency syndrome. We present clinical, radiological, pathological features and management of a rare case of pulmonary malakoplakia in an immunocompetent male patient with a past history of empyema treated with surgical decortication. Clinically, the patient presented with shortness of breath, productive cough and lethargy. On imaging, Computed Tomography of Thorax showed multiple nodular lung masses and nodular pleural thickening with marked Fluorodeoxyglucose Positron Emission Tomography avidity raising suspicion of advanced pulmonary malignancy. Characteristic Michaelis-Gutmann bodies were identified on histopathology, confirming the diagnosis of malakoplakia. The patient was medically managed with a long course of antibiotics. On follow-up, there was a significant clinical and radiological improvement. Pulmonary malakoplakia is a rare entity, with very few cases reported worldwide, and even fewer in immunocompetent individuals.

Chest x-ray scoring as a predictor of COVID-19 disease; correlation with comorbidities and in-hospital mortality.

OBJECTIVES: To devise a novel, simple chest x-ray (CXR) scoring system which would help in prognosticating the disease severity and ability to predict comorbidities and in-hospital mortality. METHODS: We included a total of 343 consecutive hospitalised patients with COVID-19 in this study. The chest x-rays of these patients were scored retrospectively by three radiologists independently. We divided CXR in to six zones (right upper, mid & lower and left, upper mid & lower zones). We scored each zone as- 0, 1 or 2 as follows- if that zone was clear (0) Ground glass opacity (1) or Consolidation (2). A total of score from 0 to 12 could be obtained. RESULTS: A CXR score cut off ≥3 independently predicted mortality. Along with a relatively higher NPV ≥80%, it reinforced the importance of CXR score is a screening tool to triage patients according to risk of mortality. CONCLUSIONS: We propose that Pennine score is a simple tool which can be adapted by various countries, experiencing a large surge in number of patients, to decide which patient would need a tertiary Hospital referral/admission as opposed to patients that can be managed locally or at basic/primary care hospitals.

Misplacement of temporary pacing wire into the left ventricle via an anomalous vein.

We report on a case where a temporary pacing wire that was inserted through the left internal jugular vein was subsequently noted to follow an unusual course on the chest radiograph. A 12-lead electrocardiogram showed right bundle branch block pattern during pacing, suggesting that the lead was pacing the left ventricle. Computed tomography of the chest demonstrated that the likely path of the pacing wire was through an anomalous vein that originated from the left subclavian vein and drained into the left atrium. The importance of paying careful attention to the chest radiograph and electrocardiogram after transvenous pacing are discussed.