Rahat Brar

Ruptured pulmonary artery aneurysm: a surgical emergency

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Multifocal lateral and fourth ventricular B-cell primary CNS lymphoma

We present the case of a 65-year-old woman presenting with 2 eeks history of intractable vomiting and headaches. CT followed y MRI of the brain showed two homogenously enhancing intraentricular masses, one each in the lateral and fourth ventricles. urgical exploration and biopsy performed from the lateral venricular mass demonstrated a high-grade B-cell lymphoma. Such ultifocal presentation of intraventricular lymphoma has not been eported so far. Although there is an increase in the number of ases of primary CNS lymphomas in the recent past, this case is elieved to be the tenth case report of an intraventricular primary NS lymphoma and the first ever case report that describes the imultaneous involvement of both the lateral and fourth ventricles. e suggest that primary B-cell lymphoma should always be conidered in the differential diagnosis of enhancing intraventricular esions, even in immunocompetent individuals.

Anticoagulant-induced intramural hematoma of the jejunum

BackgroundSpontaneous intramural intestinal hematoma in patients on oral anticoagulation therapy is rare.Materials and methodsCase report.ResultsWe report a spontaneous intramural jejunal hematoma presenting with small bowel obstruction in a patient who was on oral anticoagulation therapy with acitrom following aortic valve replacement. Contrast-enhanced computed tomography of the abdomen showed findings of intramural hematoma. The patient was successfully managed conservatively.ConclusionAbdominal pain and abnormal coagulation profile in patients on oral anticoagulants should alert the clinician to consider intramural hematoma. Early diagnosis is essential, as patients are successfully managed conservatively with good outcome.

Glioblastoma of the optic pathways: An Atypical case

We present a case of glioblastoma multiforme of the optic pathways in a 68 year old lady. Glioblastomas of the optic pathways are rare tumors; the predominant non enhancing component and the vast extent of involvement makes this a unique case. This case report further increases the database of knowledge available on the MRI characteristics of malignant optic glioma of adulthood.

Post-traumatic occipito-cervical pseudomeningocele without any bony injury

Pseudomeningoceles are collections of the cerebrospinal fluid CSF) in the extradural space due to a defect in the dura-arachnoid ayer of the meninges. These defects may be congenital, postraumatic or post-operative. The true incidence of post-traumatic ervical pseudo-meningoceles is not known, as there are few cases eported in literature. They are either related to brachial plexus njury or to bony injury. Pseudo-meningoceles without nerve root njury or bony injury are even rarer. We present a 9-year-old boy ho presented with a large pseudomeningocele in the occipito ervical region without any bony injury.

Primary extradural hydatid cyst associated with nephrotic syndrome in a pediatric patient

BackgroundPrimary intracranial extradural hydatid cyst is a very rare entity. Overlying bony erosion and extension of an extradural hydatid cyst into the scalp has never been described in literature. Association of nephrotic syndrome is described in pulmonary and hepatic hydatid cysts, but never reported in intracranial hydatidosis.Case reportWe report a 6-year-old girl with primary extradural hydatid cyst having unusual radiological features. The child initially presented with features of nephrotic syndrome. Steroid therapy failed to achieve complete remission of the nephrotic syndrome, which was later abolished by cyst removal and albendazole therapy.ConclusionBecause of the very slow increase in the volume of the extradural hydatid cyst, intensification of symptoms may also be very slow. Sometimes, the cyst may already be very large at the time of the diagnosis. The hydatid disease should be considered in the etiology of nephrotic syndrome especially in the endemic zones.

MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs

Magnetic resonance imaging (MRI) has been found to be an excellent imaging tool for meniscal injuries. Various MRI signs have been described to detect displaced meniscal injuries, specifically the bucket-handle tears. Although these signs are quite helpful in diagnosing meniscal tears, various pitfalls have also been reported for these signs. Double anterior cruciate ligament (ACL) sign refers to presence of a linear hypointense soft tissue anterior to the ACL, which represented the flipped bucket-handle tear of the meniscus. Disproportional posterior horn and flipped meniscus signs represent asymmetrically thickened horns of the menisci due to overlying displaced meniscal fragments. We report a case wherein MRI of the knee showed tear and displacement of the medial patellofemoral ligament (MPFL) and vastus medialis complex, medial collateral ligament (MCL), and posterior cruciate ligament (PCL) mimicking these signs. To our knowledge, internally displaced MPFL and MCLs have not been described as mimics for displaced meniscal fragments.

Pancreatic choledochal fistula complicating acute pancreatitis

Summary Background: Biliary tract involvement in acute necrotizing pancreatitis is rare. Case Report: We report a case of a 53-year-old man who had a pancreatic choledochal fistula complicating acute necrotizing pancreatitis. The fistula was suspected at computed tomography and confirmed at surgery. The patient underwent necrosectomy, cholecystectomy and proximal biliary diversion. He is well at 1-year follow-up. Conclusions: Simultaneous presence of air in the biliary tree and pancreatic collection is highly suggestive of a pancreaticobiliary fistula. Pancreatic necrosectomy and proximal biliary diversion resulted in closure of the fistula.

Caught in the act: migrating intraventricular neurocysticercosis causing intermittent unilateral hydrocephalus due to foramen of Monro obstruction

A 53-year-old male with known neurocysticercosis (NCC) diagnosed radiologically, presented with sudden onset of severe headache and vomiting. Patient was on antihelminthic treatment at the time of admission. Previous MRI (done around 4 months earlier) had shown an intraventricular cyst in the posterior body of the left lateral ventricle (Fig. 1a). In addition, there were multiple cysticercus cysts in different stages, in subarachnoid and parenchymal locations, involving supra and infra tentorial compartment. MRI on admission showed that the intraventricular cysticercus cyst had migrated and was obstructing the left foramen of Monro causing dilatation of the left lateral ventricle with surrounding periventricular interstitial edema (Fig. 1b). The patient was advised urgent ventricular drainage but was not keen on undergoing a surgery; so reluctantly antihelminthics were continued and close follow-up was suggested. The follow-up MRI after 10 weeks showed that the cyst had dislodged from the left foramen of Monro and was now seen to lie in the mid body of the left lateral ventricle. The left ventricular dilatation along with periventricular edema had resolved. The cyst was also smaller in size (Fig. 1c). The three-dimensional constructive interference in the steady state (3D-CISS) sequence distinctively demonstrated the cyst to be obstructing the left foramen of Monro (Fig. 2a).

An unusual case of sphenoid wing meningioma and adenocarcinoma of the caecum

Background: Sphenoid wing meningiomas are common in females and association with colon cancer in females is known. An unusual case of meningioma with co-existant caecal cancer is being reported in a male patient. Case description: A 76-year-old male patient diagnosed with left lateral sphenoid wing meningioma underwent total excision of the tumour. Post-operatively he developed intestinal obstruction due to perforation of colonic growth. Histopathology confirmed the lesion as adenocarcinoma. The patient succumbed to septic shock. Conclusion: The uniqueness of male presentation and a perforated colonic cancer manifesting post-operatively has not been reported in the past. The possibility of syndromic presentation should always be kept in mind.