Mohd Khalid

Xanthogranulomatous pyelonephritis: Rare presentation of a rare disease

Xanthogranulomatous pyelonephritis is a rare chronic renal infection of unknown pathogenesis characterized by replacement of renal parenchyma by lipid filled macrophages frequently associated with an enlarged, non-functioning kidney and an obstructing calculus. We report a case of a 45 year old non diabetic female who presented with gradually enlarging renal mass with extensive retroperitoneal involvement and a non-functioning kidney with no evidence of obstructing stone or fat density and simulating malignancy. She was diagnosed as stage III Xanthogranulomatous pyelonephritis and managed with radical nephrectomy with favourable outcome.

Intramedullary tubercular abscess with syrinx formation

Intramedullary spinal cord tubercular abscess with involvement of whole cord is a rare entity that too with syrinx formation following disseminated meningitis. Accurate diagnosis requires a high index of suspicion with clinical history and imaging features for a favorable outcome. Here-in we present a similar case with tubercular etiology which was also associated with syrinx formation and has not been reported previously in the literature up to the authors knowledge.

Diagnostic value of ultrasonography in evaluation and management of acute abdominal conditions in the paediatric age group.

BACKGROUND The aims of this study have been elaborated below: (1) to enumerate the common causes of acute abdominal emergencies by ultrasonography in paediatric patients; (2) to establish the diagnostic efficacy of ultrasonography in evaluation of acute abdominal conditions in children and to illustrate the associated ultrasonographic findings; (3) and, to discuss the role of ultrasonography in guiding the mode of intervention in these cases. PATIENTS AND METHODS This prospective study of ultrasonographic examination in 146 paediatric patients presenting with acute onset abdominal pain at the emergency/paediatric outpatient department section of Jawaharlal Nehru Medical College & Hospital, Aligarh, between June 2006 and December 2007, using 3.75 MHz and 8 MHz transducers of the ADARA (Siemens) machine. RESULTS Common causes of acute abdominal emergencies in pediatric patients as noted on ultrasonography included nonspecific pain (28%), abdominal abscess (21%), acute appendicitis (7%) and intussusception (7%). Ultrasonography was diagnostic in 45.2% cases and supportive in 12.3% of the cases. As for as the final outcome, ultrasonography prevented surgery in almost 20% cases and laparotomy was avoided in 7% of the patients as ultrasound guided interventions in the form of abscess aspiration were carried out. CONCLUSION Ultrasonography evaluation of children with acute abdominal pain, helps in making significant changes in the management plan of the patients, and also reveals various clinically unsuspected diseases.

Diagnostic efficacies of computed tomography and ultrasonography in pediatric blunt abdominal trauma

Background: Blunt abdominal trauma is a common cause of morbidity and mortality in children. The objectives of the study are to evaluate the specific patterns of organ injury in pediatric patients as illustrated by ultrasonography and computed tomographic (CT) scan and assess the role of nonoperative management in such cases depending upon the severity of injury and the organ injured. Materials and Methods: This prospective study was conducted on pediatric patients with blunt abdominal trauma that presented to the casualty of Jawaharlal Nehru Medical College over a period of 2 years. A total of 45 patients were examined. The ultrasonographic evaluation of the patients was performed and thereafter CT scan of the patients were performed within 24 h of hospital admission if on ultrasonography any evidence of intraperitoneal free fluid was detected with or without any detectable visceral organ injury. Results: Ultrasonography detected hemoperitoneum in 15 patients (51.72%) as compared to CT which detected it in 23 cases (79.31%). Spleen was the most common solid organ injured, encountered in 10 cases (34.48%) on ultrasonography and 15 cases (51.72%) on CT scan. Liver was the second most common injured organ which was demonstrated by ultrasonography in five cases (17.24%), while CT detected hepatic parenchymal injuries in nine cases (31.03%). CT was also significantly more sensitive than ultrasonography in the detection of renal injuries which were illustrated by ultrasound in only one case (3.44%), while CT showed renal injuries in three cases (10.34%). Pancreatic injuries were least common and were seen in two cases and were detected equally by ultrasound and CT scan. Conclusion: Ultrasonography is a very useful and sensitive investigation for the detection of hemoperitoneum and visceral injuries. However, CT better delineates the solid organs injuries and grades the injury as well, thus guiding the management protocol. Nonoperative management is the rule in hemodynamically stable patients in correlation with radiological and clinical scenario.

Kirner's Deformity Misdiagnosed as Fracture: A Case Report.

Kirner`s deformity or dystelephalangy is a rare entity which presents with painless, progressive, bilateral radiovolar curving of the terminal phalanges of the little fingers. It is a clinicoradiological diagnosis. Herein, we present a case where the patient was being treated as having a fracture of the distal phalanx because of misdiagnosis of Kirner`s deformity. Given the rarity of the deformity, we believe it useful to present our case report as a contribution to the literature.

Comparison of Magnetic Resonance Imaging Findings between Pathologically Proven Cases of Atypical Tubercular Spine and Tumour Metastasis: A Retrospective Study in 40 Patients

Study Design Retrospective study. Purpose To note the magnetic resonance imaging (MRI) differences between pathologically proven cases of atypical spinal tuberculosis and spinal metastasis in 40 cases. Overview of Literature Spinal tuberculosis, or Potts spine, constitutes less than 1% of all cases of tuberculosis and can be associated with a neurologic deficit. Breast, prostate and lung cancer are responsible for more than 80% of metastatic bone disease cases, and spine is the most common site of bone metastasis. Thus, early diagnosis and prompt management of these pathologies are essential in preventing various complications. Methods We retrospectively reviewed 40 cases of atypical tuberculosis and metastasis affecting the spine from the year 2012 to 2014, with 20 cases each that were proven by histopathological examination. MR imaging was performed on 1.5 T MR-Scanner (Magnetom Avanto, Siemens) utilizing standard surface coils of spine with contrast injection. Chi-square test was used for determining the statistical significance and p-values were calculated. Results The most common site of involvement was the thoracic spine, seen in 85% cases of metastasis and 65% cases of Potts spine (p=0.144). The mean age of patients with tubercular spine was found to be 40 years and that of metastatic spine was 56 years. The following MR imaging findings showed statistical significance (p<0.05): combined vertebral body and posterior elements involvement, skip lesions, solitary lesion, intra-spinal lesions, concentric collapse, abscess formation and syrinx formation. Conclusions Tuberculosis should be considered in the differential diagnosis of various spinal lesions including metastasis, fungal spondylodiskitis, sarcoidosis and lymphoma, particularly in endemic countries. Spinal tuberculosis is considered one of the great mimickers of disease as it could present in a variety of typical and atypical patterns, so proper imaging must be performed in order to facilitate appropriate treatment.

Multifocal giant cell reparative granuloma involving maxilla and mandible: a rare entity.

Giant cell reparative granuloma (GCRG) is a rare lesion that is a reactive process, not a true neoplasm. It was originally coined by Jaffe to describe lesions, which he believed were a response to intraosseous hemorrhage from jaw trauma. Regardless, GCRG is much more distinct from giant cell tumor (GCT) of bone, both histologically and clinically. We report a patient who presented with multiple facial swelling involving the facial skeleton that showed a multiloculated cystic appearance on CT involving the maxilla and mandible. The patient refused surgery, but after 6 months of follow up there was no progression.

Solitary parotid plexiform neurofibroma - diagnostic difficulty in a clinically unsuspected case.

373 Indian Journal of Cancer | July–September 2014 | Volume 51 | Issue 3 Solitary parotid plexiform neurofibroma ‐ diagnostic difficulty in a clinically unsuspected case Sir, A 15‐year‐old girl presented to the OPD with the complaints of a painless, progressively increasing swelling present at the angle of right jaw for the last two years. Patient did not have any cutaneous, ocular or skeletal manifestations of neurofibromatosis‐1 (NF‐1). None of the family member had any stigmata of NF‐1. Her physical examination revealed a large, lobulated, firm, non tender swelling at the angle of mandible. Examination of the oral cavity revealed vague fullness in the floor of mouth with healthy oral mucosa with House‐Brackman grade III ipsilateral facial palsy. There was no palpable cervical lymphadenopathy. Clinical impression of a benign parotid tumor was made.

Posttraumatic bifid and trifid mandibular condyle with bilateral temporomandibular joint ankylosis.

Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles.

Intrahepatic portal vein aneurysm—a rare entity

A20-year-old man was referred for abdominal ultrasound (US) examination as a part of diagnostic workup for anemia. The patient was nondiabetic and nonhypertensive and reported no history of any other chronic illness. There was no history of hemetemesis, jaundice, liver disease, trauma, or surgical intervention. Physical examination of the patient was unremarkable except for pallor. No sign of portal hypertension was found. Routine hematologic investigations were within normal limits except for anemia with a hemoglobin level of 9 g/dl. Grayscale and color Doppler US examination revealed a well-defined fusiform dilatation of the left branch of the portal vein (Figure 1), with nonpulsatile, monophasic venous flow (Figure 2). The size of the lesion was 21 3 17 3 22 mm and there was no evidence of thrombosis or calcification. CT scan was performed to rule out any other associated abnormality and confirmed the US findings with no evidence of thrombosis (Figure 3). There was no associated portal vein branching variation. As the condition was asymptomatic and discovered incidentally, routine follow-up was recommended. The lesion was stable after 6 months. As there are no standard protocols for follow-up of such lesions, we recommended continued follow-up every 6 months. The patient’s anemia was apparently unrelated and of nutritional origin, as his hemoglobin level returned to normal after 6 months of iron and folic acid administration. Intrahepatic portal venous aneurysm is an extremely uncommon entity with unknown etiology, although portal hypertension, trauma, pancreatitis, and interventional procedures have been reported as possible causative factors. Portal vein aneurysms account for 3% of all venous aneurysms with a prevalence of 0.43%. As none of the above-mentioned conditions were present in our case, this aneurysm was likely congenital. This condition has no gender predilection and is usually seen in the fifth to sixth decades of life. Aneurysms have been reported in all parts of the portal vein; however, extrahepatic aneurysms are by far more common than intrahepatic aneurysms. Grayscale and color Doppler US examination is a reliable modality to detect and monitor the growth of such aneurysms. On grayscale US, they appear as well-defined anechoic masses, usually near the porta hepatis. Color Doppler imaging can help differentiate these images from simple hepatic cysts and other FIGURE 1. Grayscale transabdominal US shows a well-defined anechoic structure near the porta hepatis, involving the left branch of the portal vein, without any visible calcifications or thrombus.