Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients’ Care

Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis.

Management of an Alveolar paratesticular Rhabdomyosarcoma: A case report

Paratesticular Rhabdomyosarcoma is a rare mesenchymal tumor. The Alveolar variant is the one with the worse prognosis. It comprehend 20% of cases. The treatment is multimodal combining surgery, chemotherapy and radiotherapy. Depending on the extent of disease and the staging group, the approach of treatment is different. Here we report the case of an alveolar Paratesticular rhabdomyosarcoma and review the literature regarding this unusual clinical entity.

Spectrum of MR imaging findings of sinonasal mucormycosis in post COVID-19 patients

During rapid spread of coronavirus disease (COVID-19) globally, ever since WHO declared COVID-19 as pandemic, there have been various patterns of disease in terms of diagnosis, management and complications. Secondary infections are reportedly common in hospitalized and severely ill COVID-19 patients among which fungal being 10 times more common. Mucormycosis is amongst the most lethal form of Zygormycosis occurring in post COVID-19 patients. A varied patterns of disease involvement and spectrum of imaging features are observed in patients with mucormycosis in post COVID-19 patients. MRI has better efficacy than CT in detecting early invasion of mucormycosis. The goal of this review is to familiarize radiologists about the MR imaging spectrum of mucormycosis in post COVID-19 patients with potential diagnostic pitfalls in CT. Advances in knowledge: Radiological findings of mucormycosis in post COVID-19 patients show varied patterns of disease involvement and spectrum of imaging features. One should not solely rely on CT imaging to detect the extent of disease. MRI helps in early and accurate detection of invasion into adjacent structures and so helpful in early intervention.

C-reactive protein as a prognostic marker in coronavirus disease-2019

Background: Coronavirus disease-2019 (COVID-19) is a recently emerged viral disease, for which there’s currently no definitive treatment. It is, therefore, necessary to determine biomarkers to know the extent of disease severity so that timely action can be taken to reduce mortality. We aimed to determine the usefulness of C-reactive protein (CRP) levels in assessing COVID-19 disease severity and correlate them with mortality due to the same. Methods: Data for COVID-19 were retrospectively collected and analyzed from May 2020 to October 2020. The CRP value was correlated with disease severity using Karl Pearson’s correlation coefficient. A logistic regression model was adopted to analyze the association between mortality and related factors. Results: Out of 642 patients enrolled, 22 died while 620 recovered. Most of the non-survivors were male. Multivariate analysis showed that age, diabetes, hypertension, and CRP values were significantly associated with mortality. CRP showed a strong positive correlation with disease severity and, hence, mortality. Conclusion: In patients with COVID-19, CRP correlated with disease severity and tended to be a good predictor of adverse outcome.

Gynecologic tumor board: a radiologist’s guide to vulvar and vaginal malignancies

Primary vulvar and vaginal cancers are rare female genital tract malignancies which are staged using the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging. These cancers account for approximately 2,700 deaths annually in the USA. The most common histologic subtype of both vulvar and vaginal cancers is squamous cell carcinoma, with an increasing role of the human papillomavirus (HPV) in a significant number of these tumors. Lymph node involvement is the hallmark of FIGO stage 3 vulvar cancer while pelvic sidewall involvement is the hallmark of FIGO stage 3 vaginal cancer. Imaging techniques include computed tomography (CT), positron emission tomography (PET)-CT, magnetic resonance imaging (MRI), and PET-MRI. MRI is the imaging modality of choice for preoperative clinical staging of nodal and metastatic involvement while PET-CT is helpful with assessing response to neoadjuvant treatment and for guiding patient management. Determining the pretreatment extent of disease has become more important due to modern tailored operative approaches and use of neoadjuvant chemoradiation therapy to reduce surgical morbidity. Moreover, imaging is used to determine the full extent of disease for radiation planning and for evaluating treatment response. Understanding the relevant anatomy of the vulva and vaginal regions and the associated lymphatic pathways is helpful to recognize the potential routes of spread and to correctly identify the appropriate FIGO stage. The purpose of this article is to review the clinical features, pathology, and current treatment strategies for vulvar and vaginal malignancies and to identify multimodality diagnostic imaging features of these gynecologic cancers, in conjunction with its respective 2009 FIGO staging system guidelines.

Monocytes and neutrophil levels are potentially linked to progression to IPF for patients with indeterminate UIP CT pattern.

Rationale: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Identifying patients early may allow intervention which could limit progression. The indeterminate for UIP (iUIP) CT pattern, defined in the 2018 IPF guidelines, could be a precursor to IPF but there is limited data on how patients with iUIP progress over time. Objective: To evaluate the radiological progression of iUIP and explore factors linked to progression to IPF. Methods: We performed a retrospective analysis of a lung fibrosis clinic cohort (n=230) seen between 2013-2017. Cases with iUIP were identified; first ever CTs for each patient found and categorised as non-progressor or progressors (the latter defined as increase in extent of disease or to definite or probable UIP CT pattern) during their follow up. Lung function trends, haematological data and patient demographics were examined to explore disease evolution and potential contribution to progression. Results: 48 cases with iUIP CT pattern were identified. Of these, 32 had follow up CT scans, of which 23 demonstrated progression. 17 patients in this cohort were diagnosed with IPF over a mean (S.D.) period of 3.9 (1.9) years. Monocyte [HR 23, CI 1.6-340, p=0.03] and neutrophil levels [HR 1.8, CI 1.3-2.3, p<0.001] obtained around the time of initial CT, were associated with progression to IPF using Cox proportional hazard modelling. Conclusion: 53% of our evaluable iUIP patients progressed to IPF over a mean of four years. Monocyte and neutrophil levels at initial CT were significantly associated with progression in disease. These data provide a single-centre analysis of the evolution of patients with iUIP CT pattern, and first signal for potential factors associated with progression to IPF.

Comprehensive Analysis and Risk Identification of Pulmonary Cryptococcosis in Non-HIV Patients

Pulmonary cryptococcosis in the non-human immunodeficiency virus-infected population is uncommon. We aimed to explore the relevance between clinical presentations, radiological findings, and comorbidities and identify the outcome predictors. A total of 321 patients at Taichung Veterans General Hospital between 2005 and 2019 were included; of them, 204 (63.6%) had at least one comorbidity, while 67 (20.9%) had two or more. The most common comorbidities were diabetes mellitus (27.4%), malignant solid tumor (19.6%), autoimmune disease (15.6%), and chronic kidney disease (8.4%). Patients experiencing comorbidity, particularly those with multiple comorbidities, had a higher multilobar and extrapulmonary involvement, which could explain these patients being more symptomatic. In the overall population, extrapulmonary involvement independently predicted disease recurrence and death. Amongst patients with isolated pulmonary cryptococcosis, age, cryptococcal antigen (CrAg) titer in blood, and comorbidities not only predicted the extent of disease, but also its outcome. Of note, patients simultaneously with age ≥ 65 years, CrAg test ≥ 1:128, and multiple comorbidities had the lowest disease control of antifungal treatment (76.9%) and the highest rate of disease recurrence or death from any cause (40.0%). In conclusion, approximately two-thirds of patients had at least one underlying comorbidity. In addition to extrapulmonary involvement, old age, high CrAg titer in blood, and multiple comorbidities could act as risk factors for predicting the extent of disease and outcome.

Surgical intervention as a curative major for secondary hypertension

Retroperitoneal functional paraganglioma is a rare type of neuroendocrine neoplasm which secrete excess catecholamines including epinephrine, norepinephrine, dopamine and their metabolites metanephrine, normetanephrine, 3-methoxytyramine respectively. Early diagnosis of functional paraganglioma is important because its removal is often curative. The extent of disease is evaluate using 2(18F)-fluoro-2 deoxy-D-glucose positron emission tomography (FDG-PET), where increased uptake of 18-FDG observed the mass. It is one of the rare curable causes of secondary hypertension. Here, we have presented the rare case of a young female who was recently diagnosed with hypertension and pain in abdomen, was later found to have functional paraganglioma.