Tubercular Mycotic Aortic Aneurysm: Complication of Tubercular Spondylodiscitis due to Treatment Default

We have reported rare case of tubercular aortic aneurysm which has developed as complication of spinal tuberculosis. Imaging of patient is available prior to starting of antitubercular treatment which showed vertebral tuberculosis with absence of aortic aneurysm. However, patient defaulted on treatment after taking antitubercular chemotherapy only for 2 months. Patient again reported after 14 months with chest pain. At this stage, imaging showed progression of spinal tuberculosis with development of pseudoaneurysm in adjacent descending thoracic aorta. This contiguous spread of tuberculosis from spine to aorta may have been prevented if patient had completed complete course of antitubercular therapy with regular follow-ups. Patient of spinal tuberculosis need to be counselled and informed regarding its various complications, so that they remain adhered to antitubercular chemotherapy and timely follow-ups to prevent complications.

Streptococcus intermedius: unusual presentation and complication of lung abscess

We report a case of a 54-year-old immunocompetent male who had lung abscess secondary to Streptococcus intermedius that led to discitis by contiguous spread of infection. He initially presented with constant chest pain for 6 weeks that radiated to lower back, with no fever, chills or weight loss. He denied smoking cigarettes, alcohol use or any illicit drug. On investigation, a mass was identified on the posterior medial aspect of the right lower lobe with direct infiltration into right side of the T5–T6 vertebral bodies. Histopathology identified organising pneumonia with abscess. Tissue cultures showed S. intermedius, and were negative for other microorganisms. This case highlights a rare presentation of S. intermedius discitis by contiguous spread of infection from posterior right lower lobe lung abscess. S. intermedius usually occurs in older patients with pulmonary infections complicated with pleural effusion or lung abscess, but can present in young patients with no clear symptoms of lung infection, like our patient.

Evaluation of Focal Breast Lesions Using Ultrasound Elastography with FNAC and / or Histopathological Correlation - A Prospective Observational Study in the Region of Katihar, Bihar

BACKGROUND We wanted to evaluate the sensitivity and specificity of ultrasound elastography in the detection and characterization of various breast masses and study its role in differentiating benign vs malignant breast masses with fine needle aspirarion cytology (FNAC) and/or histopathological correlation of its findings. METHODS A total of 120 patients with breast lesions were prospectively evaluated using ultrasonography (USG) in the Department of Radiodiagnosis at Katihar Medical College, Katihar, Bihar. After procuring consent from the patients, B-mode and elastography examination of all the patients was carried out simultaneously, using the Philips EPIQ 5G ultrasound machine. The findings were noted in a proforma for observation and further comparisons. The usefulness of elastography, regarding prediction of the nature of the mass (benign/malignant), delineation of its exact extent, and correlation with clinical/cytological diagnosis was studied. RESULTS A sensitivity of 97.0% and specificity of 86.7% was observed when a cut off value of 3 was used for elasticity score. A specificity of 95.5% and a sensitivity of 93.3% was observed when a cut off of 3.8 was used for strain ratio (SR). In all cases, the extent of the pathology, the local or contiguous spread and vascular involvement, predicted by ultrasound elastography examination corroborated well with the cytological findings. The results of this study are in concordance with results of studies that have been conducted previously. CONCLUSIONS Ultrasound elastography is a simple and rapid method that can improve the sensitivity and specificity of ultrasonography of focal breast lesions and can decrease the rate of unnecessary biopsies. The diagnostic accuracy of combined ultrasound and elastography is quite high and thus improves the diagnostic confidence of the cases under evaluation. KEYWORDS Elastography, Ultrasound, Focal Breast Lesions

Intracranial suppurations surgically managed at Jos, North Central Nigeria: a nine-years retrospective review

Background: Intracranial suppurations are rare but can be fatal entities consisting of pus collection within the intracranial cavity. The aim of the study was to document the clinical and radiological findings in our patients and the outcome of treatment.Methods: A retrospective analysis of all consecutive patients presenting to the Jos University Teaching Hospital from January 2012 to December 2019. Data of interest were retrieved from their folders and entered into SPSS version 22 and descriptive statistics run on the variables.Results: There were 33 patients within this period, but only 21 had complete records and thus used for the analysis. The median age was 18 years (IQR=29), males accounted for 81% of the patients. The median time to presentation was 14 days (IQR=23). The most common cause of abscess in our series was trauma (surgical and non-surgical) in 38.1%, followed by contiguous spread from the ear or paranasal sinuses (23.8%). The most common symptom was fever occurring in 61.9%, followed by headache 42.8%. In two thirds of the patients, the abscess was intra-axial (the frontal lobe being the most common site). Patients were managed surgically with either a craniotomy (28.6%) or a burr whole (71.4%). A positive culture was obtained in 33.3% of cases.Conclusions: Intracranial suppurations are uncommon, but can occur in the setting of predisposing factors. A high index of suspicion is required to clinch the diagnosis.

A Non-Sinus Forming Mandibular Actinomycotic Osteomyelitis with a Submandibular Gland Swelling - A Case Mimicking a Periapical Infection

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic & granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) & ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible & submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.

Screening in cryptogenic brain abscess: Do not forget pulmonary arteriovenous malformations

Background: Brain abscess usually occurs secondary to trauma, through contiguous spread (e.g.; dental infections, [paranasal] sinusitis, otitis, and mastoiditis), after intracranial neurosurgical procedures, or through hematogenous spread in case of an arteriovenous (AV) shunt, for example; atrial septum defect. Although uncommon, another possible cause of AV shunt which can facilitate brain abscess is a pulmonary arteriovenous malformation (PAVM). We report a case of brain abscess secondary to a solitary PAVM and review the literature. Case Description: A 74-year-old male patient presented with headaches, fatigue, low-grade fever, and homonymous hemianopsia. He was diagnosed with a brain abscess in the left occipital lobe. A chest computed tomography (CT) with intravenous (IV) contrast was performed because of fever and respiratory insufficiency in a period where screening for COVID-19 in suspected patients was important. A solitary PAVM of the left lung was diagnosed. Initial stereotactic burr hole drainage of the abscess was insufficient and resection of the abscess was deemed necessary. Routine workup did not reveal any additional pathology apart from the PAVM. After treatment of the cerebral abscess, the PAVM was treated with embolization using an endovascular plug. Conclusion: It is recommended to screen for PAVM by chest CT with IV contrast in patients with brain abscess when no obvious source of infection can be identified.

Metastatic anorectal malignant melanoma causing ileocaecal junction obstruction due to contiguous spread

Malignant melanoma of the anal canal is a rare and aggressive tumour associated with significant mortality. Early diagnosis and early curative surgical resection have shown to offer a survival advantage. We present a case of 53-year-old woman, who was accidentally diagnosed to have a localised lesion of malignant melanoma of the anal canal on histopathology report of the specimen of haemorrhoidectomy done for thrombosed external haemorrhoids. She refused any form of treatment and did not return for follow-up. Two years after the initial diagnosis, she presented with intestinal obstruction. The malignant melanoma had become advanced with multiple metastases to the lungs, the liver, the peritoneum and the spine. The patient underwent a diverting loop ileostomy. At the time of surgery, it was found that the primary malignant melanoma of anal canal had contiguously involved the entire large intestine up to the ileocaecal junction and hence transverse colostomy could not be done.

Intracranial brain parenchymal spread of mucormycosis through olfactory tract: a diffusion-weighted imaging-based concept

Mucormycosis is an opportunistic fungal infection involving among others the paranasal sinuses, nasal fossa and brain parenchyma. Mucor can invade the brain parenchyma by either contiguous spread from the paranasal sinuses or through vascular invasion. We report a case of fatal rhino-cerebral mucormycosis in whom cytotoxic edema at magnetic resonance diffusion-weighted imaging was symmetrically restricted to both neocortical and paleocortical primary areas of olfactory projection at earliest phase of the disease process. Shortly later tissue damage extended into the whole brain. This undescribed observation raised the hypothesis of preferential way of brain invasion by Mucor through the olfactory tract.

Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases

Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions. This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials. First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient’s history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals. Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2–3 weeks. Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.

Occuloplastic intervention in mycosis

<p class="abstract">Mycosis of the paranasal sinuses with an indolent course is usually noted in the immunocompetent and the likely species is usually aspergillosis. The fungus is predominantly seen in the maxillary sinus. It encroaches into its vicinity either by contiguous spread or as a skip lesion, with a normal tissue in between. Imaging studies, CT or MRI clinches the diagnosis. Laterally the infratemporal fossa and superiorly the orbit are the regions of concern. Progressive cheek paresthesia and restricted eye moments and field of vision are the clinical presentations in such a scenario. Oral antifungals “the imidazoles” though are quite effective but often a surgical intervention is called for, other than for the purpose of a biopsy. Oculoplastic intervention was undertaken in one patient.</p>