Necrotising Sweet’s syndrome: a rare presentation of Sweet’s syndrome with unilateral painful swelling of the neck

This case describes the first documented clinical presentation of Sweet’s syndrome with unilateral swelling of the neck, severe pain and fever. The clinical and radiological manifestation resembled necrotising fasciitis and the patient underwent acute neck dissection. The patient was ultimately diagnosed with a new subtype of Sweet’s syndrome called necrotising Sweet’s syndrome, and quickly recovered after treatment with intravenous administration of prednisolone.

Severe Radiological Manifestation in Patients with Diabetes and Pulmonary Tuberculosis: A Cross-sectional Study

Purpose: Diabetes mellitus (DM) is believed to affect tuberculosis (TB) at multiple levels in disease control and treatment efficacy, but clinical and radiological presentation resulting from interaction of the two diseases is not known. We conducted a retrospective study to investigate how glycemic control impacts radiological and clinical manifestations in TB patients. Methods: A cross-sectional study was conducted on data obtained from medical records of 438 patients confirmed with TB-DM comorbidity at The Third people’s hospital of Shenzhen from April 1, 2014 to April 30, 2019. Their CT images were reviewed, and patients were divided into subgroups according to lung cavitation: with and without cavities, and number of segments showing pulmonary infiltration: <4 segment, 4-8 segment, >8 segment infiltrates. We then compared clinical parameters between these groups. Results: The median age of the patients was 50.0 years (IQR 43.3-56) and 86% (n=375) of them were male. Pulmonary cavities were found in 80.8% patients. 42.7% and 27.2% patients were seen to have infiltration involving 4-8 and >8 lung segments respectively. Patients presented with cavitation and infiltration involving a greater number of lung segments had significantly higher values of WBC, MONO%, GRA%, CRP, lower LYN% level and higher bacterial burden in sputum (P<0.001). Higher HbA1c and FBG were only observed in patients with lung cavities (P<0.001). There was no difference in positive ELISPOT.TB and PCT level between the groups regardless of presence or absence of lung cavity (P>0.9 and P=0.1 respectively). Lower HGB, ALB and higher PCT were observed in patients with infiltration involving more lung segments.Conclusion: Hyper-inflammation in peripheral blood was significantly associated with cavity and the number of lung lesions. Hyperglycemia was significantly associated with the development of lung cavity. Glycemic control and inflammation influenced radiographic manifestations in patients with TB-DM.

Peripheral Lung Squamous Carcinoma With ROS1 Rearrangement Sensitive to Crizotinib: A Case Report

ROS1 rearrangements have been identified as driver mutations, accounting for 1–2% of lung adenocarcinoma, but are extremely rare in case of lung squamous cell carcinoma. In this work, we report a lung squamous cell carcinoma in a patient with peripheral lung cancer radiological manifestation, harboring ROS1 rearrangement, with high sensitivity to crizotinib. Our findings suggest that clinicians should pay more attention toward the occurrence of ROS1 rearrangements and the application of crizotinib for lung squamous cell carcinoma treatment.

The rare anatomical variant of upper lobe

Background Primary disease in thorax associated with an azygos lobe is extremely rare. It is usually identified incidentally on chest X-ray or CT during health checkups with an incidence of up to 0.2%. This is the first study involving 46 of patients found with azygos lobe in surgery of English literature from January 1931 to July 2020. Methods PubMed, EMBASE and the Web of Science databases were searched for full-text literatures met out inclusion criteria. We summarized the clinical data, radiological manifestation, accompanying disease and treatment strategy of all patients. Results 18 eligible studies involving 46 patients were selected for this research. The mean age was 36.5 years old. There were 26 male patients and 20 female patients and the male to female ratio nearly to 1.3:1. There were many different primary diseases with azygos lobe including lung cancer (n = 8), spontaneous pneumothorax (n = 5), esophageal cancer (n = 1), pulmonary sequestration (n = 1), esophageal atresia (n = 2), hyperhidrosis (n = 29). The azygos lobe (azygos lobe in Figs. 1 and 2) is an uncommon anomaly that is found in 1% of anatomic specimens, on about 0.4% of chest radiographs and 1.2% of high resolution CT. The azygos lobe is a developmental anomaly but not a true accessory lobe. Azygos lobe of all patients was diagnosed during the operation. Conclusions Azygos lobe occurs in 0.2% of the population and can make clinical diagnosis difficult. The detection of this anomaly and clarification of its precise anatomical features are important to alert the surgeon to potential problems during surgery.

Crazy‐paving patterns as rare radiological manifestations of pulmonary cryptococcosis: a case report

Background Crazy-paving patterns are rarely reported as radiological manifestations of pulmonary cryptococcosis. Case presentation Herein, we presented a very rare case of a crazy-paving pattern as a radiological manifestation of pulmonary cryptococcosis in a patient with primary ciliary dyskinesia. The diagnosis of pulmonary cryptococcosis and primary ciliary dyskinesia was ultimately confirmed by bronchoscopic biopsy, fungus culture, whole exome sequencing of blood, etc. The patient received flucytosine (PO, 5 g per day) and amphotericin B (IV, 70 mg per day) during hospitalization and sequential therapy with voriconazole (PO, 200 mg twice a day) after discharge. He recovered during follow-up. Conclusions We concluded that pulmonary cryptococcosis should be considered a possible cause of crazy-paving patterns in chest CT scans.

Mistaking Reversed Halo Sign with Cavity in Organizing Pneumonia: A Case Report

Organizing pneumonia (OP) is a rare inflammatory lung condition affecting bronchioles and alveoli. Symptoms may include cough, fever, malaise, fatigue, and weight loss with a wide variety of radiological manifestations. Both the unspecific symptoms and the radiological manifestations wide spectrum can make the diagnosis of OP challenging in daily practice. A pathological biopsy is a gold standard for diagnosis. However, there is usually a delay in making the diagnosis as a result of the time that is taken to decide to perform the biopsy. We present a case of OP in which its radiological manifestation first was mistaken for a cavity instead of the reversed halo sign (atoll sign) due to the similarity in some radiological features.

Radiological Manifestation of Progressive Massive Fibrosis as a Complication of Silicosis-Case Report

Progressive massive fibrosis (PMF) is the outcome of complicated silicosis and falls in the category of occupational lung diseases. The underlying etiological factors responsible for this are fine particles of silica, inhaled by workers in certain specific occupation. We present a 42-year-old male patient with chief complaint of breathlessness and had occupational background in relation to sandblasting. HRCT chest had shown confluent fibrotic densities in bilateral upper lobes with loco regional bronchietatic changes and adjacent pleural thickening. The patient was diagnosed of having PMF on the history and classical HRCT findings

A Case of Abdominothoracic Cystic Lymphangiomatosis Presenting as Left-Sided Inguinal Swelling in a Young Adult: Radiological Manifestation

Lymphatic system imaging has been a challenging field in Radiology. We here describe a case of a 26-year-old male who presented with complaints of left-sided inguinoscrotal swelling and was subsequently diagnosed with abdomino-thoracic cystic lymphangiomatosis. Detailed imaging evaluation across the modalities of ultrasonography, computed tomography scan and magnetic resonance imaging evaluation revealed extensive involvement and diagnostic imaging appearance of the unique lymphatic system abnormality. Imaging findings were confirmed on histopathology.