Hampton’s Hump: A Notable Radiographic Finding in a Patient with Infectious Endocarditis

Infectious endocarditis is a relatively uncommon entity that may present with a variety of clinical scenarios, ranging from a stable patient with nonspecific symptoms to a critically ill patient suffering from embolic disease. We report a case of an otherwise healthy 35-year-old female who presented to the Emergency Department with gradually progressive dyspnea, weight loss, and lower extremity edema. As part of her initial evaluation, a chest radiograph was performed and demonstrated Hampton’s Hump, a peripheral wedge-shaped opacity consistent with a possible pulmonary infarct. Further diagnostic investigation in the Emergency Department led to an unanticipated diagnosis of infectious endocarditis. This case serves as an important reminder that nonspecific diagnostic findings need to be appropriately considered in context and is a rare demonstration of Hampton’s Hump associated with infectious endocarditis.

Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya

OBJECTIVE Ivy sign is a radiographic finding on FLAIR MRI sequences and is associated with slow cortical blood flow in moyamoya. Limited data exist on the utility of the ivy sign as a diagnostic and prognostic tool in pediatric patients, particularly outside of Asian populations. The authors aimed to investigate a modified grading scale with which to characterize the prevalence and extent of the ivy sign in children with moyamoya and evaluate its efficacy as a biomarker in predicting postoperative outcomes, including stroke risk. METHODS Pre- and postoperative clinical and radiographic data of all pediatric patients (21 years of age or younger) who underwent surgery for moyamoya disease or moyamoya syndrome at two major tertiary referral centers in the US and Israel, between July 2009 and August 2019, were retrospectively reviewed. Ivy sign scores were correlated to Suzuki stage, Matsushima grade, and postoperative stroke rate to quantify the diagnostic and prognostic utility of ivy sign. RESULTS A total of 171 hemispheres in 107 patients were included. The median age at the time of surgery was 9 years (range 3 months–21 years). The ivy sign was most frequently encountered in association with Suzuki stage III or IV disease in all vascular territories, including the anterior cerebral artery (53.7%), middle cerebral artery (56.3%), and posterior cerebral artery (47.5%) territories. Following surgical revascularization, 85% of hemispheres with Matsushima grade A demonstrated a concomitant, statistically significant reduction in ivy sign scores (OR 5.3, 95% CI 1.4–20.0; p = 0.013). Postoperatively, revascularized hemispheres that exhibited ivy sign score decreases had significantly lower rates of postoperative stroke (3.4%) compared with hemispheres that demonstrated no reversal of the ivy sign (16.1%) (OR 5.5, 95% CI 1.5–21.0; p = 0.008). CONCLUSIONS This is the largest study to date that focuses on the role of the ivy sign in pediatric moyamoya. These data demonstrate that the ivy sign was present in approximately half the pediatric patients with moyamoya with Suzuki stage III or IV disease, when blood flow was most unstable. The authors found that reversal of the ivy sign provided both radiographic and clinical utility as a prognostic biomarker postoperatively, given the statistically significant association with both better Matsushima grades and a fivefold reduction in postoperative stroke rates. These findings can help inform clinical decision-making, and they have particular value in the pediatric population, as the ability to minimize additional radiographic evaluations and tailor radiographic surveillance is requisite.

Nasal Floor Slanting and Its Association With Nasofacial Structures

Background and Objectives Nasal floor slanting (NFS) is an incidental radiographic finding of asymmetry in the nasal floor level. Despite its frequent appearance, however, NFS has never been properly defined, neither has its correlation with the asymmetry of the adjacent nasofacial structures been investigated. We evaluated the incidence of NFS in patients with sinonasal symptoms and its correlation with the nasofacial skeletal structures.Subjects and Method We investigated patients who underwent preoperative ostiomeatal unit (OMU) CT and facial photography. We measured the incidence of NFS and its angle in the 265 patient images, and analyzed the relationships between NFS and radiologically detected asymmetries of the adjacent nasofacial skeleton and facial asymmetry visible on a photograph.Results NFS was found in 51% of the study subjects (136/265), who were defined as the slanted group. The mean NFS angle in the slanted group was 7.7° with a standard deviation (SD) of 4.4°, ranging from 2.4° to 22.4°. The slanted group showed a higher incidence of nasal septal deviation, asymmetry in the orbit and maxillary sinus, and a larger maxillary cavity (p<0.001) than the non-slanted group. Asymmetry of the face showed a higher incidence in the slanted group (p<0.01), whereas an external nasal deviation did not show an association with NFS.Conclusion NFS is evident in about 50% of patients complaining of nasal symptoms and is associated with nasofacial skeletal asymmetry as well as asymmetry in the face.

Malignant Nodular Hidradenoma of the Fingertip: A Case Report

Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant tumor derived from eccrine sweat glands. MNH usually occurs on the scalp, trunk, and proximal extremities, and rarely on the hand. A 55-year-old male patient visited clinics with a gradually enlarging painless mass at fingertip. It begins a year ago. Recently, it has grown rapidly and starts ulceration, and bleeding over the past 3 weeks. According to the biopsy report, it has focal necrosis, atypia, atypical mitoses, and nuclear pleomorphism suggested that the mass was MNH. After histological diagnosis, tiny bone erosion was observed in the re-read radiographic finding. For the oncologic evaluation, the patient was transferred to the cancer center. Radical amputation was performed to the residual tumor that might remain based on re-reading of radiographs. MNH of the finger is especially difficult to the diagnosis given its rarity and variable histology. When ulcerative skin lesion and radiographic bone erosion are observed, one should suspect malignancy and makes out a proper therapeutic plan after histologic biopsy.

Radiculopathies caused by spontaneous pneumorrachis: two case reports and review of literature

Pneumorrachis, defined as the presence of intraspinal air, is a rare radiographic finding. It is mostly caused by traumatic and iatrogenic etiologies such as pneumothoraces or pneumomediastinum. Spontaneous pneumorrachis attributable to degenerative disc disease is an exceptional condition. We report two cases of radiculopathy caused by spontaneous pneumorrachis.

Galectin-1, The New Player in Staging and Prognosis of COVID-19

Background A new virus from the group of coronaviruses was identified as the cause of atypical pneumonia and called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and disease called Corona Virus Disease (COVID-19). During the cytokine storm, the main cause of the death, proinflammatory cytokines are released which stimulate further tissue destruction. Galectin-1 is pleiotropic cytokine involved in many immune and inflammatory processes and its role in COVID-19 is still unknown. Objective The aim of this study was to determine systemic values of galectin-1 and correlations between gal-1 and proinflammatory cytokines and clinical parameters during COVID-19 progression. Design Observational and cross-sectional study. Patients 210 COVID-19 patients were included and divided into mild, severe or critical group according to COVID-19 severity. Main Measures Serum levels of IL-1β, IL-6, IL-10, IL-23, IL-33 and galectin-1 were measured using sensitive enzyme-linked immunosorbent assay (ELISA) kits. Key Results Systemic levels of IL-1β, IL-6, IL-10, IL-23, IL-33 and galectin-1 were significantly higher in stage III of COVID-19 patients compared to stage I and II. There were no significant differences in ratio between Galectin-1 and IL-10 with proinflammatory cytokines. Positive correlation was detected between Gal-1 and IL-1β, IL6, IL-10, IL-23 and IL-33. Gal-1 positively correlated with chest radiographic finding, dry cough and headache and negatively correlated with normal breathing sound. Conclusions Linear regression model and ROC curve analysis point on Gal-1 as significant predictors for COVID-19 severity. Presented results implicate on Gal-1 and IL-10 dependent immunomodulation. The precise mechanism of Gal-1 effect in COVID-19 and its potential as a stage marker of disease severity is still to be clarified.

Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment

Background. Time elapsed between trauma and treatment greatly influences the prognosis of traumatic dental injuries (TDIs). The aim of this study was to analyze clinical and radiographic findings related to complications of TDIs among patients seeking delayed treatment of such injuries. Materials and Methods. 123 permanent teeth with a history of previous TDIs were included in the study. Clinical findings analyzed were the type of fracture, type and number of injured teeth, crown discoloration, and pulpal status of the injured tooth (pulpal diagnosis). The radiographic findings analyzed included pulp canal obliteration (PCO), root resorption (RR), and periapical radiolucency (PR). Statistical analysis included descriptive analysis. Results. Tooth discoloration was the most common presenting complaint (53.65%), while fall (48.78%) was the most frequent cause of trauma. The range of time duration between trauma and presentation for treatment was 5 months to 30 years (average time 12.82 years). Pulp necrosis (PN) was the most common complication (90.24%). Almost half of the teeth with PN had fracture injury and discoloration along with a high frequency of PR (78.37%). Even teeth with a normal appearance were found to have a high incidence of PN (76.92%) and PR (53.84%). The crown discoloration was the second most frequent finding (48.78%). Many teeth (41.66%) with vital pulp were also discolored. Most of the teeth (79.31%) with yellowish discoloration and all teeth with brownish discoloration were nonvital. A high frequency of PN (90%) and PR (78.33%) was found in teeth with discoloration. PR was the most common radiographic finding (69.10%), while PCO and RR were observed in 17.88% and 21.13% of teeth, respectively. Conclusion. The findings of this study support the fact that delayed treatment of TDIs leads to increased complications. PN was the most common complication followed by tooth discoloration, RR, and PCO among patients seeking delayed treatment after TDIs.

Coronoid hypoplasia with developmental anomaly: A rare clinical-radiographic finding

A unique case of unilateral coronoid and condylar hypoplasia in 11 year old male patient who presented with progressive facial asymmetry is reported here. It is very rare developmental anomaly, usually condylar hypoplasia is found with coronoid hyperplasia. The patient reported here with complain of facial asymmetry. Clinical examination, conventional radiographs, and three dimensional computed tomography images revealed hypoplasia of both coronoid process and condyle on left side. Early diagnosis by correlating clinical and imaging features is paramount in the management of such patients.