Santosh Rai

Seminal vesicle schwannoma presenting with left hydroureteronephrosis

We report a very rare case of seminal vesicle schwannoma in a 50-year-old male, with left hydroureteronephrosis. Only five cases of seminal vesicle schwannomas have been reported in medical literature until date.

Unusual Larva in the CSF and Unique MRI Findings in a Case of Eosinophilic Meningitis

Eosinophilic meningitis may be caused by non-infectious and infectious agents. Angiostrongylus cantonensis is the commonest causative agent of eosinophilic meningitis. Rats are the primary hosts of this parasite. Humans get infected by ingestion of raw or inadequately cooked hosts (snails or monitor lizard) or food contaminated with the infective third-stage larvae. A 16-year-old boy was admitted to our hospital with history of fever, headache, and altered sensorium. Magnetic resonance imaging of the brain showed unique findings. Cerebrospinal fluid (CSF) examination showed eosinophilia and the CSF wet mount identified a larva. Patient history revealed ingestion of monitor lizard 2 weeks prior to onset of symptoms. Hence, a diagnosis of eosinophilic meningitis caused by A. cantonensis was made. He was treated with oral albendazole and steroids, resulting in gradual improvement. A. cantonensis as a cause of eosinophilic meningitis is a possibility in patients who present with headache and vomiting after eating raw meat (monitor lizard). To the best of our knowledge, this is a very rare case being reported from India where the larva was identified during the microscopic examination of the CSF.

Recurrent metastatic mixed germ cell tumor of central nervous system with additional seminomatous component

Mixed germ cell tumors (GCTs) are aggressive tumors owing to poor response to therapy, frequent recurrence and metastasis. We present here a case of 29-year-old male with recurrent metastatic mixed GCT in the left parietal lobe, with right testicular primary. Interestingly, the recurrent tumor exhibited a seminomatous component, in addition to yolk sac tumor and embryonal carcinoma. The patient was treated with surgery, cranial radiotherapy and cisplatin-based chemotherapy. The metastatic intracranial tumor recurred twice and the patient died 18 months after the first appearance of central nervous system metastasis.

A Rare Case of Primary Calcific Pleural Tuberculosis – A Case Report

Tuberculosis is a highly prevalent disease in India. It has a myriad of presentations. Usually pleural tuberculosis occur secondary to pulmonary tuberculosis which can manifest as pleural effusion leading to pleural calcification. Primary pleural calcification due to tuberculosis is an extremely rare manifestation of active tuberculosis. We present a case of a 21-year-old female presenting with fever, cough, weight loss and loss of appetite who was diagnosed to have pleural calcification due to primary tuberculosis. We highlight the need to keep primary pleural tuberculosis in mind with above symptoms suggestive of active tuberculosis even when there is no underlying lung pathology.

Imaging findings of solid pseudopapillary neoplasms of the pancreas on multiphasic multidetector CT scan – a single institute experience from Southern India

Introduction Solid Pseudopapillary Neoplasms (SPN) are uncommon pancreatic tumours and are slow growing with uncertain malignant potential, showing female preponderance. Postoperative prognosis is good and metastasis is rare. Aim To summarise the imaging and pathological features of seven cases of SPN in three years period, from January 2013 to January 2016. Materials and Methods In this retrospective study the imaging features of seven cases on triphasic multidetector Computed Tomogram (CT), a 16-slice scanner, were reviewed along with CT-guided Fine Needle Aspiration Cytology (FNAC) and histopathological examination. Statistics were expressed in terms of percentiles. Results All cases were female patients with an age range of 13-35 years (mean: 23.3 years). On CT assessment, the size of the tumours varied from 2.5-14 cm (mean: 5.3 cm). All these tumours were well capsulated and round to oval in shape. In four out of seven cases, the tumour was located in the tail of pancreas. All the solid enhancing portions showed moderate enhancement of at least 20-30 HU compared to unenhanced scan, on the other hand the cystic parts remained unenhanced with <5 HU variation in comparison to the plain scan. Histopathological examination exhibited characteristic poorly cohesive cuboidal cells arranged in papillaroid pattern having fine nuclear chromatin with nuclear grooves. Conclusion Solid pseudopapillary neoplasm is a high diagnostic possibility in case of a young female having pancreatic mass and needs to be evaluated with triphasic contrast enhanced CT scan, followed by FNAC and or histopathological examination.

Evolution from invasive arterial puncture to a venous access for cerebral angiography: "Cath Lab to CT suite"

Background: Digital subtraction angiography (DSA) is considered as the gold standard in the evaluation of intracranial aneurysms. This study was undertaken to evaluate the effectiveness of computed tomogram angiography (CTA) in the detection and accurate characterization of intracranial aneurysms in suspected cases of nontraumatic subarachnoid hemorrhage. The importance of three‑dimensional volume rendering of the intracranial vasculature and it’s used as an aid in improving diagnostic capabilities with regards to intracranial aneurysms in multi‑detector computed tomography angiography (MDCTA), was stressed upon. This study also tried to probe whether MDCTA alone can be used in detection and treatment of intracranial aneurysms in emergency situations. Materials and Methods: Suspected cases of nontraumatic acute subarachnoid hemorrhage, over an 18 months period, underwent CTA in 16‑slice‑computed tomography suite. Fifty cases where CTA demonstrated intracranial aneurysms were studied. A set protocol of three‑dimensional reconstruction was followed. Comparison of findings of MDCTA with surgical notes was performed. DSA was done in ambiguous cases. Results: Aneurysm was confidently diagnosed by CTA in 48 cases, and further confirmed on surgery. In doubtful cases, DSA was performed and then diagnosed as aneurysm. Thus, the sensitivity of CTA is diagnosing aneurysm is 96.6%, with a specificity of 100%. Conclusions: Digital subtraction angiography is an invasive, relatively costly, procedure to be done by highly skilled personnel with serious complication rate of 1%. This can be replaced by MDCTA, which is noninvasive, cost effective and easy to perform, and DSA can be reserved for doubtful or difficult cases. Following a set protocol of three‑dimensional reconstruction helps in reducing errors.

A Case of Multifocal Eosinophilic Granuloma Involving Spine and Pelvisin a Young Adult: A Radiopathological Correlation

We present a case of multiple osteolytic lesions in a 28-year-old adult who presented with headache, back pain, and hip pain of 6 months. There was no history of localized swelling or rise of temperature, no history of weight loss or evening rise of temperature. On examination, there were no focal neurological deficits. Routine laboratory investigations, including total leukocyte counts, differential leukocyte counts, hemoglobin, and platelet counts, were within normal limits. There was a borderline elevation of erythrocyte sedimentation rate. Non enhanced computer tomography (NECT) demonstrated no abnormality in the brain or skull bones. However, incidentally, a lytic lesion involving the third cervical (C3) vertebral body and the neural arch was detected which also demonstrated a soft tissue component adjacent to the lytic lesion. These findings warranted further work up; and magnetic resonance imaging of whole spine and pelvis was performed that revealed multiple bony lesions involving the cervical vertebrae, head and neck, bilateral femur, sacrum, and iliac bones. Computed tomography-guided biopsy was performed from the C3 vertebral lytic lesion which showed features of eosinophilic granuloma on histopathological evaluation.

Ceelen-Gellerstedt syndrome in an elderly Indian man: Case report of an unusual case

Ceelen-Gellerstedt syndrome, also known as idiopathic pulmonary hemosiderosis (IPH), is a rare disease characterized by recurrent pulmonary alveolar hemorrhages associated with a classical clinical triad of hemoptysis, unexplained iron deficiency anemia, and diffuse pulmonary infiltrates on imaging. We present a case report of Ceelen-Gellerstedt syndrome in an elderly 69-year-old Indian male patient, which is an unusual case as the condition is more common in children and young adults. Diagnosis was suspected on high-resolution computed tomography (HRCT) scan, which revealed diffuse areas of consolidation, ground glass opacities, and septal thickening with perihilar and basal predominance and further workup with bronchoscopy and bronchoalveolar lavage helped to confirm the diagnosis.

Endovascular Stenting - Novel Technique in the Management of Acute Stanford Type B Aortic Dissection Involving Right-sided Aortic Arch: Is This the Way Forward? Systematic Literature Review with Case Study

The occurrence of aortic dissection involving a right-sided aortic arch (RAA) is extremely rare. Majority of the symptomatic cases have been managed with open surgical treatment. However, middle-aged and elderly patients with coexistent comorbidities have higher postoperative risks if managed by surgery. The purpose of this case study is to review the literature for occurrence and treatment modalities for RAA with dissection, to review the various literature studies which have helped establish a consensus and guidelines in the management of aortic dissections, to review previous reported cases of successful endovascular management of RAA dissections, and to report our experience of treating a case of Stanford Type B right-sided aortic dissection managed by complete endovascular approach, the first of its kind in India. Our search in the databases revealed around 32 cases of RAA with aortic dissection published in the literature, most of which have been treated with open surgical approach; however, very few cases are managed with endovascular approach only like in our case.

Neurological melioidosis presenting as intracranial abscess

Melioidosis is an emerging disease in our country caused by the bacteria Burkholderia pseudomallei. Melioidosis can virtually affect any organ. It has varying clinical presentations ranging from pneumonia to fatal sepsis. Central nervous system (CNS) involvement in melioidosis is rare. We present a case of CNS melioidosis from South India. As the incidence of diabetes is increasing in our country varying manifestations of melioidosis will be seen in routine clinical practice. Melioidosis should be considered in the differential diagnosis of intracranial abscess and meningoencephalitis, especially in diabetics.