Hemoptysis after COVID: Pulmonary artery pseudoaneurysm treated with endovascular coiling.

Pulmonary artery pseudoaneurysms are a rare but life-threatening cause of hemoptysis. These are saccular dilatations of the pulmonary artery which do not involve all the three layers of the vessel and are prone to rupture. PAPAs are most commonly associated with infections but may also be caused by vasculitis, lung fibrosis, pulmonary hypertension and a multitude of other causes. CT pulmonary angiography is the diagnostic modality of choice allowing delineation of the PAPA, underlying cause and allowing planning of further management. Although treating the underlying cause is an important part of management, endovascular intervention is required in cases with hemoptysis. Long COVID is an entity that is still under evaluation. It has multisystem involvement. We describe the case of a 30-year-old teacher with hemoptysis after COVID who was diagnosed with a PAPA of segmental branch of left upper lobar pulmonary artery and treated with endovascular embolization with coils and glue. His hemoptysis has stopped since then. He also had pulmonary fibrosis and growth of multidrug resistant Klebsiella pneumoniae in sputum. These were treated medically and he has resumed his work as a teacher.

Endovascular repositioning and resizing of the distal catheter of a ventriculoatrial shunt.

Ventriculoatrial (VA) shunts are an effective alternative to ventriculoperitoneal shunts for diversion of cerebrospinal fluid in patients with hydrocephalus. Accurate placement of the distal end of a VA shunt in the right atrium is imperative for appropriate drainage and can be technically challenging. Misplaced or dislodged shunt catheter needs urgent repositioning, which can be performed by endovascular techniques. We present a case of VA shunt placement related complication, in which the dislodged distal fragment was retrieved by endovascular techniques. The remaining distal catheter, found to be in the internal jugular vein, was not only repositioned, but also resized for accurate placement in the right atrium.

Fibrous Dysplasia of Radius Bone-excision and Fibula Graft: A Case Report.

Introduction: Fibrous dysplasia (FD) is a congenital disorder in which the bone is distorted and replaced by poorly organized and structurally unsound fibrous tissue. The disorder can be localized to a single bone or affects multiple bones. Although any bone can be affected, the bones of the upper extremity are less commonly involved by the disease. The disease process results in deformity of the bones and is often complicated by pathological fractures. Case Report: A 14-year-old girl presented with gradually progressive deformity of the right forearm for the past 1 year associated with mild pain. Skeletal radiographs of the right forearm revealed an expansile lytic lesion with ground glass appearance involving the proximal meta-diaphysis of the right radius, with its resultant bowing. The zone of transition was narrow and there was no evidence of matrix calcification. The lesion was causing thinning of the bony cortex. With this radiographic appearance in mind, a diagnosis of FD of the radius was put forth. The lesion was managed surgically. The proximal three-fourth of the radius bone was exposed and the lesion was excised along with 1 cm of normal bone on the distal side. Proximally, a thin shell of the cortex was preserved after curettage of the proximal end of the radius. Fibular cortical strut graft was harvested from the leg of same side. Graft length was kept 2 cm more than the excised bone to avoid shortening of the forearm. The graft was beveled on the distal end and jammed into the shaft of the distal radius such that 1 cm of graft was inside the original bone. A long arm or above elbow splint was applied keeping the elbow at 90 degrees of flexion and the forearm in supination for a total of 6 months. The patient was being followed up regularly. Follow-up radiographs obtained at 7 months revealed complete incorporation of the cortical bone graft with reformation of the intramedullary bone canal and restoration of hand and elbow function. Conclusion: Non-vascularized fibular cortical strut grafting is an effective treatment modality for FD of radius bone. External or internal fixation is not necessary if a tightly fitting cortical graft is jammed into the defect caused by lesion excision.

Obstructive Jaundice as the Initial Manifestation of Gastric Adenocarcinoma.

A 52-year-old female presented with epigastric pain, yellowing of the sclera, and vomiting for three weeks. Laboratory investigations revealed markedly elevated serum bilirubin and alkaline phosphatase levels, accompanied by a modest rise in transaminases. A clinical diagnosis of obstructive jaundice was established. Ultrasound of the abdomen depicted a mass in the region of the head of the pancreas. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an infiltrative gastric mass spreading across the gastroduodenal junction and involving the ampulla of Vater. Owing to comorbid conditions and widespread lymphadenopathy, a palliative gastrojejunostomy with excision biopsy was performed. Histopathology confirmed an undifferentiated gastric adenocarcinoma.

Imaging of coronavirus disease (COVID-19): a pictorial review.

Coronavirus disease (COVID-19), caused by a highly contagious novel coronavirus, has seen a rapid surge of cases over the past 6 months spreading to more than 215 countries and posing a global threat to mankind. Reverse transcriptase-polymerase chain reaction (RT-PCR) from pharyngeal swabs is considered the gold standard for diagnosis of this disease. Portable chest radiography (CXR), point of care ultrasound, and computed tomography (CT) are crucial modalities in diagnosis and follow-up. Portable CXR can help in patients who are clinically unstable, and also to prevent the cumbersome process of steriliastion after every CT scan. However, chest CT is useful as a problem-solving tool, to look for progression and complications associated with the disease. In a few cases, in our experience (as has also been documented by others), RT-PCR was negative in early disease, and CT chest was able to detect the radiologi-cal findings raising suspicion of COVID-19. With this pictorial review, we aim to describe and illustrate the typical, and a few atypical, radiological findings of this disease.

Oesophageal lung: a rare cause of complete hemithorax opacification.

Congenital bronchopulmonary foregut anomalies are uncommon group of disorders that reflect upon the embryological development of the foregut. These conditions represent the intimate embryological proximity of the foregut and tracheobronchial tree. The radiological findings are typically of segmental or lobar consolidation with abnormal vascular supply or foregut communication. We report a case of a breathless neonate with oesophageal origin of the right main bronchus. This communication was well demonstrated with the help of an oesophagogram. The radiologist plays an important role by identifying this communication on a CT done for non-resolving lung collapse. Contrast-enhanced CT of the chest is also useful in evaluating the vascular supply of the lung that helps in diagnosis and also directs treatment.