DIGGING DEEPER

2015 ◽  
Vol 86 (11) ◽  
pp. e4.187-e4
Author(s):  
Jonathan Witherick ◽  
Begoña Bovill ◽  
Anni Dong ◽  
Mahableshwar Albur ◽  
Rose Bosnell
Keyword(s):  
Chromosomal Translocation ◽  
Immunocompromised Host ◽  
Bronchial Biopsy ◽  
Csf Analysis ◽  
Contrast Enhanced ◽  
History Of ◽  
Initial Improvement ◽  
Recent Diagnosis ◽  
Active Inflammation ◽  
Multiple Ring

BackgroundMultiple ring-enhancing brain lesions have a wide differential. We report a case with a rare cause that was successfully treated.Case reportAn 18 year old presented with a short history of headache, dry cough and fevers. His past medical history included Aspergers, childhood epilepsy and bilateral hearing loss (with identified chromosomal translocation) and a recent diagnosis of trans-bronchial biopsy-positive sarcoidosis for which he was taking prednisolone. Radiology showed left upper zone consolidation; despite initial improvement with piperacillin-tazobactam, his headaches intensified and contrast-enhanced brain imaging demonstrated multiple ring-enhancing lesions; lesions were also identified in the liver and spleen. CSF analysis confirmed active inflammation but cultures (including liver biopsy) were negative. Subsequently liver tissue 16S rDNA rtPCR analysis identified rDNA of the pseudomonas genus with a 99% sequence homology for P.luteola and P.zeshuii. These soil-dwelling organisms may have been acquired by the patient whilst working on his grandfather's allotment. The patient was successfully treated with Meropenem.ConclusionThis case involved input from multiple clinical specialties and highlights the collaboration needed to diagnose and manage such a rare organism. The case highlights unusual pathogens that may cause opportunistic infection in the immunocompromised host and the importance of a thorough occupational history.

scholarly journals The value of contrast-enhanced FLAIR magnetic resonance imaging in detecting meningeal abnormalities in suspected cases of meningitis compared to conventional contrast-enhanced T1WI sequences

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Wael Hamza Kamr ◽  
Mohamed Gaber Eissawy ◽  
Amr Saadawy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Early Diagnosis ◽  
Diagnosis And Treatment ◽  
Effective Management ◽  
Resonance Imaging ◽  
Flair Sequence ◽  
Csf Analysis ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri

Abstract Background Early diagnosis of meningitis with magnetic resonance imaging (MRI) would be useful for appropriate and effective management, decrease morbidity and mortality, and provide better diagnosis and treatment. The objective of the current study is to compare the accuracy of contrast-enhanced FLAIR (CE-FLAIR) and contrast-enhanced T1WI (CE-T1WI) in the detection of meningeal abnormalities in suspected cases of meningitis. Results Out of 45 patients, 37 patients were confirmed to have meningitis on CSF analysis. Out of the 37 patients, 34 patients were positive on CE-FLAIR sequence and 27 were positive on CE-T1WI. The sensitivity of CE-FLAIR sequence was 91.9% and specificity 100%, while the sensitivity of CE-T1WI sequence was 73% and specificity 100%. Conclusion CE-FLAIR is more sensitive than CE-T1WI in diagnosis of meningitis. It is recommended to be used in any cases with clinically suspected meningitis.

Rare cause of chronic abdominal pain: left paraduodenal hernia and its surgical management

2021 ◽  
Vol 14 (12) ◽  
pp. e245024
Author(s):  
Ajay Chikara ◽  
Sasidhar Reddy Karnati ◽  
Kailash Chand Kurdia ◽  
Yashwant Sakaray
Keyword(s):  
Abdominal Pain ◽  
Stable Condition ◽  
Paraduodenal Hernia ◽  
Inferior Mesenteric Vein ◽  
Anterior Border ◽  
Initial Reduction ◽  
Contrast Enhanced ◽  
History Of ◽  
Enhanced Computed Tomography

A 30-year-old man presented with colicky abdominal pain for 2 months, associated with occasional episodes of bilious vomiting. He had a history of similar complaints at the age of 16 and 26 years. Contrast-enhanced computed tomography abdomen was consistent with a diagnosis of left paraduodenal hernia. On laparoscopy a 3 × 3 cm hernial defect was identified in the left paraduodenal fossa (fossa of Landzert). Contents were jejunal, and proximal ileal loops which were dilated and edematous. Anterior border of the sac was formed by the inferior mesenteric vein and left branch of the left colic artery. Initial reduction of contents was easy. However, complete reduction proved to be difficult due to adhesions with the sac opening, the hernial sac instead laid open by dividing the Inferior Mesentric Vein (IMV) (anterior border of defect) using a vascular stapler. The patient was discharged on postoperative day 3 in a stable condition. On follow-up the patient is doing well.

Intraductal Papillary Mucinous Neoplasm of the Pancreas

2021 ◽  
Vol 8 (28) ◽  
pp. 2562-2566
Author(s):  
Jayalatha Nethagani ◽  
Priyanka Govula ◽  
Revathi Chandu ◽  
Pravin Raj T
Keyword(s):  
Epigastric Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
Cystic Lesions ◽  
Chronic Alcoholic ◽  
Contrast Enhanced ◽  
History Of ◽  
Head Of The Pancreas ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 36-year-old non-smoker, chronic alcoholic female presented with recurrent episodes of epigastric pain and vomiting in the last 10 days. H/o similar episodes of pain 3 times, with last episode was noted 2 months back. She also had history of vomiting (3 episodes). Jaundice/melena/steatorrheas was not observed. Subsequently, contrast-enhanced computed tomography (CECT) of the patient was done and it showed well defined multiple cystic lesions with peripheral wall enhancement involving head and body of pancreas, largest measuring 24 X 22 X 22 mm in the head of the pancreas, the lesion was seen abutting antro-pyloric region anteriorly. Main pancreatic is mildly dilated measuring 4 mm in diameter. A well-defined heterogeneously hypodense (necrotic) para duodenal lesion, was noted inferior to uncinate process, m/s 22 X 20 X 20 mm, which is indicative of lymph nodal deposit. On magnetic resonance cholangiopancreatography (MRCP): few cystic lesions were seen scattered in the pancreatic parenchyma, with one of the cysts showing communication with main pancreatic duct (MPD) ab.

scholarly journals Congenital Toxoplasmosis presenting as multiple ring enhancing lesions in brain on neuroimaging

2018 ◽  
Vol 5 (5) ◽  
pp. 2020
Author(s):  
Pareshkumar A. Thakkar ◽  
Aakashi Shah ◽  
Bakul B. Javadekar ◽  
Saurabh Modasia
Keyword(s):  
Ct Scan ◽  
Past History ◽  
Stable Condition ◽  
Congenital Toxoplasmosis ◽  
Cellular Reaction ◽  
Protein Levels ◽  
Elevated Protein ◽  
Intravenous Antibiotics ◽  
History Of ◽  
Multiple Ring

We report a case of congenital toxoplasmosis in a male child who presented at 1 month 21 days of life. He had a past history of meningitis on third day of life which resolved with intravenous antibiotics. This time, the child presented with progressive enlargement of head and CSF (Cerebrospinal fluid) showed elevated protein levels with cellular reaction and CT scan showed dilated ventricular system with aqueductal obstruction and multiple ring-enhancing lesions in bifrontal and bioccipital regions with a right porencephalic cyst. Repeat CSF after 14 days of intravenous antibiotics showed elevated protein with no cellular reaction. Fundus examination was normal. Toxoplasma blood serology (IgG and IgM) in baby and mother were positive. The child received treatment with Pyrimethamine, Clindamycin, Folinic acid and Prednisolone. CSF parameters got normalized and multiple ring-enhancing lesions disappeared on repeat CT scan. He underwent a Ventriculo-Peritoneal shunt surgery for the hydrocephalus and was discharged in a stable condition.

Rapidly progressive vision loss due to fulminant idiopathic intracranial hypertension: a diagnostic and management dilemma

2020 ◽  
Vol 13 (11) ◽  
pp. e236188
Author(s):  
Jagadeesh Sutraye ◽  
Mohan Kannam ◽  
Rajat Kapoor ◽  
Virender Sachdeva
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Obese Woman ◽  
Visual Fields ◽  
Csf Analysis ◽  
Contrast Enhanced ◽  
Grade Ii ◽  
The Right ◽  
The Brain

A 44-year-old obese woman presented with decrease in vision in the right eye (RE) for 3 days. She reported a simultaneous onset of holocranial headache that worsened on bending forward. She denied eye pain, pain on eye movements, and other ocular or neurological complaints. On examination, her distance best-corrected visual acuity was counting fingers at 1 m in the RE and 20/20 in the left eye (LE). Colour vision was subnormal in both eyes (BE). There was grade II relative afferent pupillary defect in the RE. Fundus examination showed disc oedema in BE . Visual fields in the LE showed central scotoma extending nasally. A provisional diagnosis of papillitis was considered. However, contrast-enhanced MRI of the brain and orbits showed evidence of elevated intracranial pressure. Cerebrospinal fluid (CSF) opening pressure was 42 cm H2O while rest of the CSF analysis was normal. Diagnosis was revised to fulminant idiopathic intracranial hypertension. Management with medical therapy and urgent thecoperiteoneal shunt improved visual function in BE.

Lung Cancer Single Intramedullary Metastasis Vs Delayed Radionecrosis

2009 ◽  
Vol 22 (4) ◽  
pp. 458-463
Author(s):  
R. Conforti ◽  
G. Tagliatatela ◽  
M. De Cristoforo ◽  
A. Di Costanzo ◽  
A. Scuotto ◽  
...  
Keyword(s):  
Patient Management ◽  
Spinal Metastases ◽  
Lesion Size ◽  
Radiation Myelopathy ◽  
Intramedullary Metastasis ◽  
Metastatic Lesions ◽  
Contrast Enhanced ◽  
Highly Sensitive ◽  
History Of ◽  
Spinal Mri

Intramedullary metastases are rare, accounting for 0.9–5% of spinal metastases. Radiation myelopathy is considered one of the most distressing complications of radiotherapy. In both cases symptoms are aspecific, and there are no characteristic neuroradiologic findings. We describe a case of single intramedullary metastasis from lung microcytoma in a 55-year-old man with a history of malignancy, treated by radiotherapy five years previously. The patient returned to our observation complaining of pain and paraesthesia in the left C7 area. Spinal MRI and rachicentesis findings were aspecific. Ten days later a new MRI showed that the lesion size had increased, and neoplastic cells were found in CSF. Intramedullary metastases are extremely rare, accounting for 0.1–0.4% of all CNS tumors. The risk of developing delayed radionecrosis varies with the total dose administered. In both cases diagnosis is histological, while contrast-enhanced MRI is highly sensitive and specific in identifying and characterizing the lesion. In case of metastatic lesions the prognosis is unfavorable. Differential diagnosis is important because it has a strong effect on patient management.

scholarly journals Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

2012 ◽  
Vol 70 (8) ◽  
pp. 578-582 ◽  
Author(s):  
Laura Nicoleti Zamproni ◽  
Viviane Flumignan Zétola ◽  
Marcos Christiano Lange
Keyword(s):  
Antiphospholipid Syndrome ◽  
Transcranial Doppler ◽  
High Intensity ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Stroke Group ◽  
History Of

OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

scholarly journals Disseminated Saksenaea infection in an immunocompromised host associated with a good clinical outcome: a case report and review of the literature

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
N. Davidson ◽  
K. Campbell ◽  
F. Foroughi ◽  
V. Tayal ◽  
S. Lynar ◽  
...  
Keyword(s):  
Dual Therapy ◽  
Immunocompromised Host ◽  
Laboratory Diagnosis ◽  
Favourable Outcome ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Emerging Pathogens ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Treatment Regimens ◽  
History Of

Abstract Background Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown. Case presentation A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived. Conclusions We describe an unusual case of disseminated infection with a favourable outcome to date.

scholarly journals Mediastinal Pseudocyst and Cardiac Tamponade Due to Massive Pericardial Effusion in Pediatric Chronic Calcific Pancreatitis

2016 ◽  
Vol 06 (03) ◽  
pp. 194-198 ◽  
Author(s):  
Suprit Basu ◽  
Mala Bhatacharya ◽  
Bidyut Debnath ◽  
Sandip Sen ◽  
Anish Chatterjee ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pancreatic Enzyme ◽  
Recurrent Abdominal Pain ◽  
Chronic Calcific Pancreatitis ◽  
Contrast Enhanced ◽  
History Of ◽  
Posterior Mediastinal ◽  
Enhanced Computed Tomography

AbstractA 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

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