Pranav Sharma

Ocular chemical injuries and their management

Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment. The majority of victims are young and exposure occurs at home, work place and in association with criminal assaults. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Emergency management if appropriate may be single most important factor in determining visual outcome. This article reviews the emergency management and newer techniques to improve the prognosis of patients with chemical injuries.

Transarterial Therapies for Hepatocellular Carcinoma: a Comprehensive Review with Current Updates and Future Directions.

Hepatocellular cancer is a very common cause of cancer related deaths worldwide. Only 30-40% of patients present with early-stage disease open to curative treatments, such as resection or transplantation, while others can only undergo local therapies or palliative care. Various trans-arterial approaches have been used for treatment of hepatocellular carcinoma in patients who need a down-staging to liver transplantation, and who are not candidates for transplantation or radiofrequency ablation. Transarterial chemoembolization (TACE), transarterial embolization (TAE), drug-eluting beads, and radioembolization have been used for locoregional control, and have been shown to prolong the overall survival when compared with supportive care. In this review, we discuss patient selection, pre- and post-procedure imaging, techniques, safety, and clinical outcomes related to these therapies. Newer advances with future directions in various fields related to trans-arterial therapies are also discussed.

Pott Puffy Tumor

Pott puffy tumor is osteomyelitis of the frontal bone with associated subperiosteal abscess causing swelling and edema over the forehead and scalp. It is a complication of frontal sinusitis or trauma. We present the case of an 8-year-old girl with frontal swelling. Imaging evaluation showed frontal osteomyelitis as a complication of frontal sinusitis with associated epidural and subperiosteal abscess. The patient was treated surgically and recovered well. This case highlights the need for high clinical suspicion and early diagnosis and management to prevent life-threatening complications. Unfortunately, in our case the patient had to undergo surgery for this complication, which could have been prevented by earlier diagnosis.

Different Sonographic Faces of Ectopic Pregnancy

Vaginal bleeding in the first trimester has wide differential diagnoses, the most common being a normal early intrauterine pregnancy, with other potential causes including spontaneous abortion and ectopic pregnancy. The incidence of ectopic pregnancy is approximately 2% of all reported pregnancies and is one of the leading causes of maternal mortality worldwide. Clinical signs and symptoms of ectopic pregnancy are often nonspecific. History of pelvic pain with bleeding and positive β-human chorionic gonadotropin should raise the possibility of ectopic pregnancy. Knowledge of the different locations of ectopic pregnancy is of utmost importance, in which ultrasound imaging plays a crucial role. This pictorial essay depicts sonographic findings and essential pitfalls in diagnosing ectopic pregnancy.

Isolated medial longitudinal fasciculus syndrome: Review of imaging, anatomy, pathophysiology and differential diagnosis:

Isolated medial longitudinal fasciculus (MLF) syndrome due to infarction limited only to the midbrain is a rare occurrence. The MLF are a group of fiber tracts located in the paramedian area of the midbrain and pons. They control horizontal eye movements by interconnecting oculomotor and abducens nuclei in the brain stem. Such small infarcts can easily be overlooked by young neuroradiologists and trainees. In this review, we discuss the clinical and imaging characteristics, comprehensive review of the anatomy, pathophysiology, and differential diagnosis.

Prostatosymphyseal fistula after transurethral resection of the prostate (TURP), a rare and difficult to recognize complication

a Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA b St. Georges School of Medicine, 3500 Sunrise Highway, Building 300, Great River, NY, 11739, USA c Department of Interventional Radiology, University of Miami Miller School of Medicine, 1611 Northwest 12th Avenue 2nd Floor West WingRoom W203, Miami, FL, 33136, USA d Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, USA

Bilateral emphysematous pyelonephritis

Emphysematous Pyelonephritis (EPN) is a rare necrotizing infection defined by gas production in the renal system. Bilateral disease has only been reported to occur in 10% of cases.1 This condition is considered a urologic emergency as mortality and morbidity rates are exceedingly high. The most common predisposing factor to developing EPN, is long-term poorly controlled Diabetes Mellitus (DM), particularly in females.2 Early intervention is crucial in decreasing mortality rates, though there is still discussion of the appropriate management. This report presents the unsuccessful conservative management of a critically ill patient with bilateral disease.

Recurrent diabetic myonecrosis –an under-diagnosed cause of acute painful swollen limb in long standing diabetics

Diabetic myonecrosis (DMN) is an under-diagnosed complication of long-standing poorly controlled diabetes mellitus. It presents as abrupt pain and swelling of the extremity, mostly lower limbs. Diagnosis is often delayed as it mimics a number of clinical entities such as deep vein thrombosis (DVT), cellulitis, necrotizing fasciitis and malignancy. Failure to properly identify this condition can result in increased morbidity through exposure to unnecessary tests and biopsy. A 56-year-old male with a history of complicated type 2 diabetes mellitus, hypertension presented to emergency with gradually worsening left calf pain for last 2 weeks. A lower-extremity venous Doppler was negative for DVT. Magnetic resonance imaging (MRI) was suggestive of muscle edema likely of inflammatory etiology. Muscle biopsy revealed myonecrosis with ischemic myopathy and was negative for vasculitis or inflammatory myopathy. He was managed conservatively and his symptoms resolved in 4 weeks. After 6 months he had recurrence in right thigh which was managed conservatively too. Given these findings, a diagnosis of recurrent diabetic myonecrosis was made. Myonecrosis is a less known microvascular complications of diabetes and should always be keep in mind when evaluating a diabetic patient with muscle pain. Diagnosis can be made on MRI in appropriate clinical settings. The clinical course is usually self-limiting and patients respond well to supportive medical therapy that involves bed rest, strict glycemic control along with analgesic.

Paraneoplastic limbic encephalitis in a patient with rectal adenocarcinoma: A rare entity

Introduction: Paraneoplastic neurological syndromes are defined as remote effects of cancer, not caused by the tumor and its metastasis, or by metabolic disruptions or ischemia. Paraneoplastic limbic encephalitis (PLE) is one of them, and commonly have been described in patients with lung or breast cancer. Colon and rectal cancers have also been shown to be associated with PLE as in our case. Case Report: We report a case of 56-year-old male who had been diagnosed with adenocarcinoma of the rectum one year ago. He initially responded well to systemic chemotherapy, resulting in symptomatic relief related to the primary disease. However, one year after the initial diagnosis, the patient presented with recurrent seizures and disorientation for few days. Magnetic resonance imaging (MRI) scan of the brain was performed which demonstrated findings of PLE. Serum analysis revealed a high titer of anti-Ri, an antibody shown to be associated with paraneoplastic Kusum Hooda1, Nishant Gupta2, Charu Chanana3, Pranav Sharma1, Salil Sharma1, Joshua Sapire4 Affiliations: 1Resident, Diagnostic Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, CT, USA; 2Resident, Diagnostic Radiology, St. Vincent Medical Center, Bridgeport, CT, USA, Bridgeport, CT, USA; 3Attending Obstetrician and Gynecologist, Bassett Healthcare Network, Cooperstown, NY USA; 4Clinical Assistant Instructor in Diagnostic Radiology, Yale New Haven Health System at Bridgeport Hospital. Corresponding Author: Kusum Hooda, 267 Grant Street, Deptt of Diagnostic Radiology, Bridgeport, CT, USA 06610; E-mail: kusumhooda78@gmail.com Received: 02 October 2016 Accepted: 24 November 2016 Published: 17 January 2017 PEER REVIEWED | OPEN A CE S neurologic syndromes. The patient’s symptoms improved markedly after treatment with antiepileptic therapy (phenobarbital) and methylprednisolone. After two months followup MRI scan showed complete resolution of the abnormalities. Conclusion: Paraneoplastic limbic encephalitis can complicate the patient’s clinical course, response to treatment and affect the prognosis. In a patient with non-neurological malignancy presenting with new neurologic problems PLE should always be kept in the differential diagnosis. The characteristic MRI findings of these syndromes are very helpful in early diagnosis and excluding other causes.

Burkitt lymphoma as a lead point for jejunojejunal intussusception in a human immunodeficiency virus patient

Intussusception is commonly seen in children but is rare in adults and represents only 5% of all intussusceptions causing 1% of intestinal obstructions. More than 50% of these intussusceptions in adults are due to intestinal neoplasms, including malignant lymphoma, e.g., Burkitt lymphoma. These lymphomas are more common in human immunodeficiency virus (HIV)-positive patients than in the general population. We present a case of a young male who was diagnosed with HIV when he developed intestinal obstruction and intussusception secondary to Burkitt lymphoma. He was managed with surgical resection followed by chemotherapy and antiretroviral treatment. HIV patients presenting with acute abdomen pose a diagnostic challenge to clinicians due to a wide range of differential diagnoses including inflammatory, infectious and neoplastic conditions. In a young HIV patient presenting with acute abdomen, intussusception caused by Burkitt lymphoma should be considered in the differential.