COVID-19-Associated Rhino-Orbito-Cerebral Mucormycosis: A Single Tertiary Care Center Experience of Imaging Findings With a Special Focus on Intracranial Manifestations and Pathways of Intracranial Spread.

Background and objective The COVID-19 pandemic and mucormycosis epidemic in India made research on the radiological findings of COVID-19-associated mucormycosis imperative. This study aims to describe the imaging findings in COVID-19-associated mucormycosis, with a special focus on the intracranial manifestations.  Methodology Magnetic resonance imaging (MRI) scans of all patients with laboratory-proven mucormycosis and post-COVID-19 status, for two months, at an Indian Tertiary Care Referral Centre, were retrospectively reviewed, and descriptive statistical analysis was carried out. Results A total of 58 patients (47 men, 81%, and 11 women, 19%) were evaluated. Deranged blood glucose levels were observed in 47 (81%) cases. The intracranial invasion was detected in 31 (53.4%) patients. The most common finding in cases with intracranial invasion was pachymeningeal enhancement (28/31, 90.3%). This was followed by infarcts (17/31, 55%), cavernous sinus thrombosis (11/58, 18.9%), fungal abscesses (11/31, 35.4%), and intracranial hemorrhage (5/31, 16.1% cases). The perineural spread was observed in 21.6% (11/51) cases. Orbital findings included extraconal fat and muscle involvement, intraconal involvement, orbital apicitis, optic neuritis, panophthalmitis, and orbital abscess formation in decreasing order of frequency. Cohen's kappa coefficient of interrater reliability for optic nerve involvement and cavernous sinus thrombosis was 0.7. Cohen's coefficient for all other findings was 0.8-0.9. Conclusions COVID-19-associated rhino-orbito-cerebral mucormycosis has a plethora of orbital and intracranial manifestations. MRI, with its superior soft-tissue resolution and high interrater reliability, as elucidated in this study, is the imaging modality of choice for expediting the initial diagnosis, accurately mapping out disease extent, and promptly identifying and scrupulously managing its complications.

Lung Manifestations of COVID-19 on Chest Radiographs-Indian Experience in a High-Volume Dedicated COVID center.

Chest imaging, which includes X-ray imaging and CT scan, is the main modality for assessing lung involvement in patients affected with the COVID-19 virus. Although CT is more sensitive, due to ease and affordability issues, X-rays are the preferred first-line study. The aim of this article is to familiarize the treating physician with the imaging spectrum of the coronavirus lung infection on X-ray and to discuss the frequency of these findings. A total of 593 radiographs of admitted COVID-19 patients (RT-PCR proven) were retrospectively assessed in the study. Demographics of admitted patients and COVID manifestations on chest radiographs were assessed. Male to female ratio of patients in our study was 2.1:1. The largest number of patients was in the 50 to 60-year age bracket (29%). Forty percent of the X-rays in our study were negative. No X-ray showed findings exclusively in the upper zones, and 88% showed findings in the mid-lower zones. Ground glass opacification was the commonest finding (75% of cases) in abnormal X-rays. The next most common findings were peripheral lung opacities and confluent consolidation. Confluent consolidation, which indicates more severe disease, was observed in 15% of the abnormal X-rays. The proportion of patients showing confluent consolidation was seen more in the older age groups (> 50 years old) with a peak in the 60-70-year age bracket. Small reticular opacities, pneumothorax, pneumomediastinum, and pleural effusions were uncommon findings in our study.

Primary Breast Liposarcoma.

Liposarcoma of breast is a rare breast malignancy. It accounts for 0.3% of the breast sarcomas. Subtypes of breast sarcomas are angiosarcoma (most common), liposarcoma, malignant fibrous histiocytoma, leiomyosarcoma and fibrosarcoma. We hereby report a case of liposarcoma in a 55 year old female emphasizing the imaging features that can aid in differentiating it from carcinomas, other sarcomas and benign fat containing masses. This is important as treatment of these varying conditions differ widely. Histologically, liposarcoma may be well differentiated, mixed or dedifferentiated (high grade). Risk of metastasis and recurrence increase with higher grade. Determination of the degree of differentiation is important for surgical planning and prognosis.

Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies.

PURPOSE: Nerve disorders are commonly encountered in clinical practice. Ultrasonography (USG) is a useful modality in the evaluation of most of the peripheral and superficial pathologies amenable to penetration by ultrasound. The primary objective is to study the USG findings of various peripheral nerve pathologies and to correlate them with electrophysiological (EMG-NCV) findings. METHOD: 42 patients referred with suspicion of peripheral nervous system affection were evaluated with USG along with EMG-NCV. After reviewing detailed anatomy of the region, the affected nerve was visualized along the major neurovascular bundle or at a known anatomical landmark with a high-frequency (9-20 MHz) linear/hockey stick transducer. RESULTS: The USG parameters, namely loss of fibrillary pattern, hypoechogenicity and nerve thickening, showed significant p value (p < 0.05) on the tests of significance, suggesting these parameters are significant predictors of nerve affection/pathology on USG. Each ultrasound parameter was correlated individually with SNAP and CMAP. The results revealed positive correlation of echogenicity (r = 0.210, p = 0.05), fibrillary pattern (r = 0.209, p = 0.05) and thickening (r = 0.387, p < 0.05) with sensory nerve action potential (SNAP) and compound muscle action potential (CMAP). CONCLUSION: USG can be used as corroborative investigation to strengthen the findings of EMG-NCV. This combination represents a powerful tool in enabling appropriate planning for treatment, preventing unnecessary intervention and thus improving overall outcomes in patients with peripheral neuropathy.