Reddy Ravikanth

Management of acquired bronchopleural fistula due to chemical pneumonia

Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from a necrotizing pneumonia/empyema (anaerobic, pyogenic, tuberculous, or fungal), lung neoplasms, and blunt and penetrating lung injuries or may occur as a complication of procedures such as lung biopsy, chest tube drainage, thoracocentesis, or radiation therapy. The diagnosis and management of BPF remain a major therapeutic challenge for clinicians, and the lesion is associated with significant morbidity and mortality. Here, we present a 70-year-old male with acquired BPF due to chemical pneumonitis caused by aspiration of kerosene who presented with the symptoms of fever, cough with expectoration, breathlessness and signs of tachycardia, tachypnea, diminished breath sounds, and crepitations. After a 3-week course of culture-sensitive antibiotics with β-lactam and β-lactamase inhibitors, open drainage of the empyema was done following which the patient showed symptomatic improvement and was discharged.

Mediastinal pseudocyst clinically presenting as mechanical dysphagia and dyspnea in a case of acute-on-chronic pancreatitis

Pseudocyst is a common complication of acute pancreatitis. However, its extension into the mediastinum is a rare entity. Contrast-enhanced computed tomography has a very high sensitivity in providing the location and anatomical relation of the pseudocyst to the surrounding structures. Here, we present a rare case of pancreatic pseudocyst in the mediastinum presenting clinically with dysphagia and dyspnea.

Extracranial meningioma presenting as infratemporal fossa mass

A 38‐year‐old woman presented with left‐sided headache, facial pain, and left‐sided cheek swelling for 2 years. The headaches were recurrent and associated with blurring of vision and were worsened with chewing and cold exposure. The cheek swelling had an insidious and progressive onset. Associated left eye ptosis with exophthalmos was present. Microsurgical tumor excision was done using left transzygomatic and temporal approach. Histopathology of the infratemporal fossa mass lesion revealed meningioma (WHO Grade I) [Figure 1a‐c].

Klatskin tumor (hilar cholangiocarcinoma)

Klatskin tumor is a term that was given to a hilar cholangiocarcinoma, occurring at the bifurcation of the common hepatic duct. Typically, these tumors are small, poorly differentiated, exhibit aggressive biologic behavior, and tend to obstruct the intrahepatic bile ducts. Here, we present the multidetector computed tomography findings in a case of hilar cholangiocarcinoma.

Effective radiological imaging for the good of patients: Weighing benefits and risks

85 Effective and balanced communication of radiation risks requires sufficient background, education and resources to support the risk – benefit dialogue, particularly in pediatric patients. For example, it is important to communicate that risks can be controlled and benefits maximized by selecting an appropriate procedure and using methods to reduce patient exposure without reducing clinical effectiveness. While the fundamentals of risk communication and risk–benefit dialogue are common to all health‐care settings, the implementation of an effective communication strategy in nuclear imaging, emergency, oncology, and pediatric imaging often requires unique considerations.

Musculoskeletal manifestations in sickle cell anemia

Sickle cell anemia is an inherited hemoglobin disorder characterized by substitution of glutamic acid by valine at the sixth position of the beta globin chain. The sequence of events leads to pain crisis. Ischemia of the tissues resulting from decreased blood flow is believed to occur in pain crisis. Repeated or prolonged sickling causes red cell death in the form of hemolytic anemia. The majority of hospital admissions are due to painful crisis. These patients are at increased risk for both osteomyelitis and infarction of the long bones. Magnetic resonance imaging has been shown to be helpful in the diagnosis of early osteomyelitis and its differentiation from infarction in sickle cell disease patients with acute bone crisis. Others findings include dactylitis, medullary infarcts, diploic space widening, fish mouth vertebrae, and avascular necrosis. We present a case series on the various musculoskeletal manifestations of sickle cell disease.

Advanced magnetic resonance imaging of glioblastoma multiforme

A 68-year-old male presented to the emergency department with a headache. He had no known comorbidities. His general physical and neurological examination was normal. He underwent an emergency magnetic resonance (MR) screening which showed a T1 heterogeneously hypointense, T2 heterogeneously hyperintense [Figure 1] lesion involving the subcortical and deep white matter of the right parietooccipital region. The lesion was noted to infiltrate across the midline through the splenium of corpus callosum. Perilesional edema was noted causing regional sulcal effacement. A focal area of diffusion restriction was noted in the inferomedial aspect of the lesion suggestive of high cellularity zone [Figure 2]. Tiny intralesional foci of blooming were noted suggestive of microbleeds [Figure 3]. Postcontrast T1-weighted fat saturated images showed evidence of peripheral heterogeneous enhancement [Figure 4]. Single-voxel MR spectroscopy (MRS) showed elevated choline, lactate, lipid peaks, and decreased N-acetylaspartate (NAA) peak in the intralesional [Figure 5] and perilesional [Figure 6] regions of the tumor. In addition, choline: NAA ratio was 1.7, choline: Creatinine ratio was 2.4, and NAA: Creatinine ratio was 1.41 in the intralesional voxel and choline:NAA ratio was 2.29, choline:Creatinine ratio was 1.36, and NAA:Creatinine ratio was 1.68 in the perilesional voxel. In assumption of a malignant tumor, we performed a stereotactic-guided right parietooccipital craniotomy with radical subtotal resection of the lesion, and the histopathological examination confirmed the presence of glioblastoma multiforme (GBM). The patient underwent additional radiotherapy and chemotherapy with concomitant temozolomide. Temozolomide dosed at 75 mg/m /day, started the night before the first radiation treatment and given for 42 consecutive days. Dexamethasone with a dosage of 16 mg daily, administered in 2 Advanced Magnetic Resonance Imaging of Glioblastoma Multiforme https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488569/?report=printable

Get the GIST: A Case Series on Gastrointestinal Stromal Tumors

This case series illustrates CT appearances of gastrointestinal stromal tumors (GIST) involving the stomach, small intestine, mesentery, peritoneum and posterior mediastinum. GIST of the stomach is the commonest with majority having an exophytic growth, but it can also have an intra-luminal growth. Necrosis is a common feature of GIST irrespective of the location resulting in heterogenous enhancement on CT.

Hepatic pseudolesion in SVC obstruction - 99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

An area of increased activity in segment IV of liver (quadrate lobe) on 99mTc-sulfur colloid (TSC) scans has been well documented in patients with superior vena cava obstruction. Similarly intense enhancement of the quadrate lobe in the arterial phase may be seen on computed tomography in patients of superior vena cava syndrome. We present this imaging finding in a case of malignant thymoma causing superior vena cava syndrome and discuss the physiological cause and importance of this sign.

Acute yellow phosphorus poisoning causing fulminant hepatic failure with parenchymal hemorrhages and contained duodenal perforation

White phosphorus is well known as a potent hepatotoxin and a severe local and systemic toxin causing damage to gastrointestinal, hepatic, cardiovascular, and renal systems. It is used in the manufacture of matches, fireworks, rodenticide, and fertilizers. Death results due to acute liver failure. Management of yellow phosphorus (YP) poisoning is supportive with no antidote available. Here, we present a case of acute YP poisoning in a 25-year-old female presenting with fulminant hepatic failure and duodenal perforation.