scholarly journals A Rare Case of Fungal Necrotising Otitis Externa Centred on the Left Temporomandibular Joint

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
A. Khan ◽  
E. Omakobia ◽  
S. Hasnie ◽  
R. Barton ◽  
P. Gopalan ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Antifungal Therapy ◽  
Otitis Externa ◽  
Pcr Analysis ◽  
Causative Organism ◽  
Cross Sectional ◽  
Chronic Renal Impairment ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction. Necrotising otitis externa (NOE) is a rare life-threatening complication of simple otitis externa which can be difficult to diagnose and manage. It is very rarely centred on the temporomandibular joint (TMJ). Fungi cause NOE in approximately 5–20% of patients, and a high index of suspicion is required for diagnosis, particularly when there is no improvement with prolonged topical and intravenous antibiotic therapy. Objective. To report a novel case of fungal NOE centred on the left TMJ in an immunocompromised adult male with a focus on investigations and optimal management. Case Report. A 67-year-old male with comorbid chronic renal impairment presented to our otolaryngology department with prolonged left otalgia and otorrhoea. Subsequent cross-sectional imaging demonstrated left NOE centred on the TMJ. Poor resolution with prolonged courses of systemic and topical anti-pseudomonal antibiotics prompted maxillofacial surgical input for left TMJ exploration, washout, and biopsy from the joint capsule. The causative organism was identified as Aspergillus flavus on PCR analysis. The patient was successfully treated with oral posaconazole and repeated topical insertions of amphotericin B-soaked ribbon gauze to the left ear. Discussion. A combination of various imaging modalities including CT, MRI, Tc-99, and gallium-67 are utilised in clinical practice both to diagnose NOE and subsequently monitor disease progression or resolution. Immunocompromised patients with confirmed fungal NOE may require a combination of treatments including surgical debridement and prolonged antifungal therapy for a number of months, if not lifelong, treatment. Initiating empirical antifungal therapy may be justified in some patients. However, this should be judged on a case-by-case basis and guided by discussion with the local microbiology and infectious diseases departments. However, there is no national guideline or consensus regarding treatment of these patients, especially in cases of fungal NOE.

Cross-Sectional Imaging of Nontraumatic Peritoneal and Mesenteric Emergencies

2013 ◽  
Vol 64 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Michael N. Patlas ◽  
Abdullah Alabousi ◽  
Mariano Scaglione ◽  
Luigia Romano ◽  
Jorge A. Soto
Keyword(s):  
Emergency Department ◽  
Correct Diagnosis ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Emergency Radiologist ◽  
Mesenteric Adenitis ◽  
Sectional Imaging ◽  
High Index Of Suspicion

Multiple nontraumatic peritoneal and mesenteric emergencies are encountered at imaging of patients in the emergency department. Peritoneal and mesenteric emergencies are usually detected in patients in the emergency department during evaluation of nonspecific abdominal pain. A high index of suspicion is required for the establishment of early diagnosis and aversion of life-threatening complications in cases of peritoneal carcinomatosis, nontraumatic hemoperitoneum, and peritonitis. A correct diagnosis of omental infarction, mesenteric adenitis, and mesenteric panniculitis helps patients primarily by avoiding unnecessary surgery. In this review article, we illustrate the cross-sectional imaging appearance of various nontraumatic peritoneal and mesenteric emergencies by emphasizing the role of the emergency radiologist in detecting and managing these entities.

scholarly journals Pulmonary Arterial Dilatation: Imaging Evaluation Using Multidetector Computed Tomography

2021 ◽  
Author(s):  
Sreenivasa Narayana Raju ◽  
Niraj Nirmal Pandey ◽  
Arun Sharma ◽  
Amarinder Singh Malhi ◽  
Siddharthan Deepti ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Bronchial Tree ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography ◽  
Imaging Evaluation ◽  
Cross Sectional ◽  
Clinical Background ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Pulmonary Arterial

AbstractPulmonary artery dilatation comprises a heterogeneous group of disorders. Early diagnosis is important as the presentation may be incidental, chronic, or acute and life threatening depending upon the etiology. Cross-sectional imaging plays an important role, with CT pulmonary angiography being regarded as the first line investigation in the evaluation of pulmonary artery pathologies. Moreover, effects of pulmonary artery lesions on proximal and distal circulation can also be ascertained with the detection of associated conditions. Special attention should also be given to the left main coronary artery and the trachea-bronchial tree as they may be extrinsically compressed by the dilated pulmonary artery. In context of an appropriate clinical background, CT pulmonary angiography also helps in treatment planning, prognostication, and follow-up of these patients. This review mainly deals with imaging evaluation of the pulmonary arterial dilatations on CT with emphasis on the gamut of etiologies in the adult as well as pediatric populations.

scholarly journals A Rare Case of Life-Threatening Bleeding Caused by a Jejunal GIST

2019 ◽  
pp. 1-2
Author(s):  
Aloka Liyanage ◽  
Aloka Liyanage ◽  
R Kalaiselvan ◽  
R Rajaganeshan ◽  
S P B Thalgaspitiya
Keyword(s):  
Rare Case ◽  
Haemorrhagic Shock ◽  
Gi Tract ◽  
Gastrointestinal Stromal Tumours ◽  
Cross Sectional ◽  
Male Preponderance ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Intermittent Bleeding ◽  
Mesenchymal Tumours

Gastrointestinal Stromal Tumours (GISTs) are rare mesenchymal tumours that are specific to GI tract. GISTs usually associated with advanced age and have a slight male preponderance. GISTs are commonly found in stomach. Jujunal GISTs are the rarest and account for about 0.1-3% of all GI tumours [1]. The most common clinical manifestation of symptomatic GISTs includes intermittent bleeding due to mucosal ulceration. Massive, life threatening gastrointestinal (GI) bleeding is a rare occurrence. We report a rare case of bleeding Jejunal GIST in a 32-year-old female who presented with haemorrhagic shock that required resuscitative laparotomy. Histopathology and immunohistochemistry confirmed the tumour to have features of GIST with clear margins and post-operative cross-sectional imaging excluded any metastatic deposits.

scholarly journals P-EGS03 Curious Case of Life Threatening Gastrointestinal Bleed

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
VIBHA SINGH
Keyword(s):  
Arteriovenous Malformation ◽  
Gastrointestinal Stromal Tumors ◽  
Severe Anaemia ◽  
Intestinal Bleeding ◽  
Cross Sectional ◽  
Stromal Tumors ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Cells Of Cajal ◽  
Resection And Anastomosis

Abstract Background Gastrointestinal stromal tumors are mesenchymal in origin, being derived from the interstitial cells of Cajal. These can be found anywhere in the gastrointestinal tract and are commonly found in the stomach followed by the small bowel. Gastrointestinal stromal tumors are usually asymptomatic and are often found incidentally. Chronic bleeding is one of the most common presentation. Gastrointestinal stromal tumors presenting with massive gastro intestinal haemorrhage and mimicking arteriovenous malformation on radiology are rare with only few cases reported. Methods Herein we present such a case of a 45-year-old gentleman with massive gastro intestinal bleeding. At presentation, patient was in congestive heart failure due to severe anaemia with a hemoglobin of 2.9g/dL. CECT Angiography localised the bleed to be from a jejunal mass lesion with radiological features consistent with those of arteriovenous malformation. Patient underwent laparoscopy assisted resection and anastomosis. Results Histopathology examination revealed a low risk jejunal gastrointestinal stromal tumor with no evidence of arteriovenous malformation. The mass was removed completely and the patient was discharged on 5th post-operative day. Patient was followed up in the out-patient department and was found to be doing well. Conclusions Gastrointestinal stromal tumors though relatively uncommon should be kept as important differentials for acute torrential gastrointestinal bleeding. It is highlighted that a presentation of gastrointestinal stromal tumors similar to that of arteriovenous malformations on cross sectional imaging should be kept in mind. The present case is reported in hope of expanding the knowledge of a rare occurrence, its aetiology, clinical impact and treatment.

The first case of fungal endogenous endophthalmitis caused by Aspergillus nidulans: Diagnostic and therapeutic challenge

2020 ◽  
pp. 112067212093208
Author(s):  
Lucia Mata-Moret ◽  
Clara Monferrer-Adsuara ◽  
Laura Hernández-Bel ◽  
Marisa Hernández-Garfella ◽  
Miriam Torrecillas-Muelas ◽  
...  
Keyword(s):  
Vision Loss ◽  
Visual Outcome ◽  
Endogenous Endophthalmitis ◽  
Pcr Analysis ◽  
Causative Organism ◽  
Systemic Corticosteroids ◽  
First Case ◽  
Dismal Prognosis ◽  
History Of ◽  
High Index Of Suspicion

Significance: Fungal endogenous endophthalmitis is an uncommon and potentially blinding infection. Aspergillus is a causative organism in immunocompromized although is virulent enough to afflict immunocompetents. Their propensity to affect macula usually results in a dismal prognosis; thus, improving visual outcome has always been challenging to clinicians. A. nidulans has only rarely been implicated in exogenous endophthalmitis. Purpose: To report the first case of A. nidulans endogenous endophthalmitis. Case report: An asthmatic 42-year-old female presented with sudden unilateral vision loss due to a submacular abscess that progressively worsened in a matter of days. Vitreous PCR analysis after an urgent vitrectomy was positive for A. nidulans with no active systemic foci found. Oral and intravitreal Voriconazole was prescribed but multiple reactivations led to three vitrectomies in total alongside with subretinal Voriconazole, abscess aspiration, and endolaser. There was complete resolution of the infection and, although visual acuity was poor due to macular scar, enucleation was avoided. Conclusion: Although uncommon, we must consider Aspergillus as the causative organism in apparently immunocompetent patients with history of recent systemic corticosteroids treatment, especially if they suffer a broncopulmonary disorder. Aspergillus is an aggressive organism so a high index of suspicion along with early diagnosis and prompt treatment is the key for better outcomes. We highlight A. nidulans as the causative agent as there are no other reported cases.

scholarly journals FRI0432 INTEREST OF IMAGING IN THE DIAGNOSIS OF INFECTIOUS SPONDYLODISCITIS (ABOUT 113 CASES)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 814.1-814
Author(s):  
L. Ben Ammar ◽  
A. Ben Tekaya ◽  
M. Ben Hammamia ◽  
O. Saidane ◽  
S. Bouden ◽  
...  
Keyword(s):  
Neurological Complications ◽  
Causative Organism ◽  
Disc Space Narrowing ◽  
Disc Space ◽  
Cross Sectional ◽  
Multi Stage ◽  
Cross Sectional Imaging ◽  
Infectious Spondylodiscitis ◽  
Magnetic Resonance Imaging Mri ◽  
Standard Radiographs

Background:Infectious spondylodiscitis is a diagnosis and therapeutic emergency. Its clinical presentation can be insidious and standard radiographs can be falsely reassuring. This explains the interest of cross-sectional imaging and more particularly magnetic resonance imaging (MRI).Objectives:To analyse the contribution of imaging in the diagnosis of infectious spondylodiscitis.Methods:These are 113 cases of spondylodiscitis collected in a rheumatology department over a period of 20 years [1998-2018]. The diagnosis is made on the basis of clinical, biological, radiological and bacteriological data.Results:Our population was divided into 62 men (54.9%) and 51 women (45.1%) (p = 0.8) with an average age of 55 years [16–86]. Predisposing factors were found in 52.2% of cases: diabetes (23%), neoplasia (2.7%), hepathopathy (5.3%), long-term corticosteroid therapy (1.8), recent surgery (3.5%), history of tuberculosis (2.7%) and consumption of unpasteurized dairy products (28.3%).The approximate time between onset of symptoms and diagnosis ranged from 0.23 to 24 months (median 3 months). Impaired general condition was observed in 81% of the cases and fever in 34.5% of the cases. Radiculalgia was found in 46% of the cases and a neurological deficit was noted in 16% of the cases. Biological inflammatory syndrome was found in 91.2% of the cases.Standard radiographs of the spine were abnormal in 85% of cases, showing disc space narrowing (72%), irregularity of the vertebral plates (35.5%), erosions (13.1%) and para-vertebral spindle (4.7%). CT and spinal MRI were performed respectively in 57.5% and 70.8% of cases and revealed: erosions (46.2%), mirrored geodes (16.9%), para-vertebral abscess (57.5%), epiduritis (71.3%) and spinal compression (26.3%). The lumbar spine was the most affected (55.8%), followed by the dorsal spine (30.1%) and the cervical spine (8.8%). The Infectious spondylodiscitis was multifocal in 24.8% and multi-stage in 12.4% of cases.A disco-vertebral biopsy was performed in 70% of cases and was contributory in 44.3% of cases. The causative organism was tuberculosis in 55.8% of cases, brucellosis in 21.2% of cases and pyogenic germs in 23% of cases.Conclusion:Imaging plays an important role in the diagnosis of spondylodiscitis. MRI is considered the key examination, capable of mapping injuries and detecting potentially serious neurological complications. The importance of imaging the entire spine to detect multifocal forms should also be emphasized.Disclosure of Interests:None declared

scholarly journals Etiology of ambiguous genitalia in newborns with XX karyotype: A cross-sectional observational study.

2021 ◽  
Vol 28 (06) ◽  
pp. 799-803
Author(s):  
Waqas Imran Khan ◽  
Abdur Rehman ◽  
Erum Afzal ◽  
Asim Khurshid ◽  
Sidra Anjum ◽  
...  
Keyword(s):  
Observational Study ◽  
Congenital Adrenal Hyperplasia ◽  
Gestational Age ◽  
Ambiguous Genitalia ◽  
P Value ◽  
Adrenal Hyperplasia ◽  
Cross Sectional ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Local Defects

Objective: To determine the etiology of ambiguous genitalia in newborn females with XX karyotype. Study Design: Cross Sectional Observational study. Setting: Children Hospital and Institute of Child Health Multan (CH& ICH). Period: July 2018 to December 2019. Material & Methods: Fifty two patients were enrolled after taking informed consent from parents/guardians. Various causes of ambiguous genitalia like CAH, maternal intake of virilizing drugs during pregnancy and isolated local genital defect were noted. Results: Out of 52 patients, mean gestational age was 38.23 ± 2.36 weeks and 10 (20.2 %) had gestational age up to 36 weeks while 42 (80.8%) had gestational age more than 36 weeks. Mean age was 12.37 ± 4.21 days. Mean weight was 2965.43 ± 412.23 grams while 24 (46.1%) had weight up to 2500 grams and 28 (53.9%) had weight more than 2500 grams. Congenital adrenal hyperplasia in our study cases was noted in 45 (86.5%). Congenital local genital defects in our study cases were noted in 6 (11.5%) while maternal ingestion of virilizing drugs during pregnancy was noted in 1 (2%). CAH was not associated with gestational age or weight of newborn with p value 0.680 and 0.595 respectively. Conclusion: Congenital adrenal hyperplasia in our study cases was the commonest reason of ambiguous genitalia in newborn females with XX karyotype followed by congenital local defects and maternal use of virilizing drugs. High index of suspicion is required for the diagnosis of potential life threatening disorder like CAH.

scholarly journals Abdominal malrotation overlooked at extensive cross-sectional imaging and leading to life-threatening gastrointestinal bleeding

Endoscopy ◽  
2015 ◽  
Vol 47 (S 01) ◽  
pp. E639-E640
Author(s):  
Alexander Arlt ◽  
Dörthe Schuldt ◽  
Susanna Nikolaus ◽  
Clemens Schafmayer ◽  
Witig von Schoenfels ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Sectional Imaging

scholarly journals Acute Renal Infection in Adult, Part 1: An Overview of What the Radiologist Needs to Know

2019 ◽  
Vol 03 (02) ◽  
pp. 126-136
Author(s):  
Suman Hazarika ◽  
Rochita Venkataramanan ◽  
Tonmoy Das ◽  
Sukanya Deuri ◽  
Shalini Lohchab ◽  
...  
Keyword(s):  
Medical Condition ◽  
Therapeutic Interventions ◽  
Emphysematous Pyelonephritis ◽  
Cross Sectional ◽  
Perinephric Abscess ◽  
Risk Of Progression ◽  
Progression Of Disease ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Renal Infection

AbstractAcute renal infection or acute pyelonephritis (AP) denotes the process of inflammation of the renal parenchyma and its collecting system and the urothelium following infection. Uncomplicated AP commonly affects otherwise healthy, young women without structural or functional urinary tract abnormalities and without relevant comorbidities. More severe and complicated AP occurs in patients with a structurally or functionally abnormal genitourinary tract, or in persons with a predisposing medical condition like immune compromised state and diabetes. Complicated AP is characterized by a broader spectrum of clinical presentations, a wider variety of infecting organisms, and a greater risk of progression to a complication, such as intrarenal or perinephric abscess or emphysematous pyelonephritis and has the capacity to damage the organ and at times maybe life threatening. Role of imaging in renal infection is secondary, and in most situations, imaging is done to confirm the clinical diagnosis, map progression of disease in immune-compromised group of patients, or to evaluate for potential complications and therapeutic interventions. This article attempts to discuss the pathophysiology of AP from the standpoint of medical imaging and also brings out illustrative examples of various manifestations of AP and its complications. It provides imaging insight into various stages of inflammation, development of complication, and a roadmap for understanding AP through cross-sectional imaging.

scholarly journals 302 Migratory Foreign Body in The Neck- How A Fishbone Morphed into A Piece of Glass In 18 Months

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Horlick ◽  
S Sehgal ◽  
B Al-Dulaimy ◽  
R Anmolsingh ◽  
J Goswamy
Keyword(s):  
Foreign Body ◽  
Vascular Complications ◽  
Neck Exploration ◽  
Cross Sectional ◽  
Persistent Symptoms ◽  
Soft Diet ◽  
Cross Sectional Imaging ◽  
Life Threatening ◽  
Fish Ingestion ◽  
The Right

Abstract Background Foreign body (FB) ingestion is a common presentation to ear, nose, and throat (ENT) surgeons. Usual culprits include fish or chicken bones, steak, or non-organic items. FBs can be categorised into batteries, hard objects, and soft boluses. Hard objects that have not passed beyond the post-cricoid region require removal to minimise perforation risk. In rare cases FBs are reported to migrate extra-luminally into surrounding tissues of the neck necessitating cross-sectional imaging ahead of neck exploration. Case Report A 70-year-old lady presented to A&E with a sensation of FBs in her throat. She was aphagic without dyspnoea. Home-cooked fish ingestion was the precursor. Panendoscopy was clear. The patient was discharged once tolerating fluids and soft diet. She presented 14 months later to the ENT clinic with a persistent FB sensation in her throat. A computed-tomography scan of neck showed a right sided, radio-opaque, 3 cm foreign body sitting just anterior to the carotid sheath, behind the right superior thyroid lobe. An elective external neck exploration revealed a 3 cm shard of glass which was successfully removed without complications. Conclusions Extra-luminal migration of FBs is extremely rare. They may present with life-threatening suppurative or vascular complications. A literature review revealed that migratory FBs tend to be sharp and long such as needles, wires, or fishbones. To allow prompt diagnosis and management, we propose a low threshold for CT imaging in instances with a clear history and persistent symptoms even when panendoscopy is negative.

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