Uncontrolled bleeding during tooth extraction from an undiagnosed arteriovenous malformation.

Arteriovenous malformations (AVMs) are rare congenital disorders of vascular morphogenesis. These lesions are characterised by high vascular flow with risk of severe bleeding from accidental trauma or surgical manipulation. Although infrequent, potentially life-threatening and fatal oral bleeding has been reported during extraction of tooth associated with AVM. This paper presents a case of uncontrolled bleeding in an adult female patient undergoing mandibular anterior tooth extraction. The bleeding was related to undiagnosed soft tissue AVM in gingivobuccal space. Management of the case with review of previously reported similar cases is presented.

Retrospective analysis of chest HRCT findings in coronavirus disease pandemic (COVID-19)- An early experience.

CONTEXT: Corona virus disease (COVID-19) has spread in a rampant manner all over the World causing severe acute respiratory illness. Prompt recognition of disease is invaluable to ensure timely treatment, and rapid patient isolation is crucial for containment of this communicable disease. AIMS: To evaluate the performance of high resolution CT (HRCT) in the diagnosis of COVID-19. To establish the role of HRCT in prognosis of affected patients and to assess severity of disease based on HRCT findings. SETTINGS AND DESIGN: This retrospective study included 216 patients admitted to our institute with a diagnosis of COVID-19 infection confirmed by nucleic acid RT-PCR testing. SUBJECTS AND METHODS: Patients underwent non contrast HRCT chest examination and images were reconstructed in thin 1.25 mm lung window. Images were evaluated for presence of lung lesions & CT severity score was assigned to each patient based on number of lung lobes involved. RESULTS: Ground-glass opacities (GGOs) with or without consolidation, interlobular septal thickening, the "reversed halo" sign (Atoll sign) and GGO's with rounded nodular pattern are common CT features of COVID-19. CONCLUSIONS: Typical peripheral subpleural distributions of GGO's with bilateral asymmetrical lung involvement are characteristic features of COVID19 pneumonia. Chest HRCT can be a very useful and standard imaging method to assess the severity and progression of the disease and thereby optimizing the management of patients. With increasing case load all over the world HRCT can be used as a one stop radiological investigation for the diagnosis and prognosis of corona virus disease.

Large Gastric Perforation Sealed by Splenic Lysis: Emphasis on Indirect Signs - A Rare Case Report.

BACKGROUND: Gastric perforation is a life-threatening condition, requiring early and reliable discovery. The delay before surgical treatment is a strong determinant of poor outcome, associated complications and hospitalization costs. By using ultrasound and multi-detector computed tomography (MDCT) we can further evaluate undiagnosed cases of silent gastric perforations presenting with non-specific acute abdomen. Here we bring forth the role of a radiologist in cases of perforation which present with indirect signs involving the organs forming the stomach bed, like the spleen, pancreas and kidney. CASE REPORT: A 25-year-old male patient presented with an acute onset of severe upper abdominal pain radiating to the back and vomiting. MDCT of the abdomen was done which revealed atrophic pancreas with organized collection in the sub-capsular location indenting the superior pole of the left kidney. Spleen was not visualized. The most striking imaging finding in that case was destruction of the splenic parenchyma with protrusion of the remaining tissue into the stomach lumen. The hypothesis behind this was a cascade of events which started with gastric perforation, spillage of highly destructive gastric juice over the stomach bed and finally becoming silent with rapid sealing of the defect by the omentum and the spleen. CONCLUSIONS: Acute abdomen is a diagnostic challenge to a clinician and radiologist with gastric perforation being a great mimicker of other urgent abdominal pathologies. To avoid a delayed diagnosis or a misdiagnosis, familiarity with typical and atypical imaging features is essential as in our case of splenic lysis. It acted as the 2(nd) policeman and provided a great clue to solve the diagnostic dilemma.