Systemic phaeohyphomycosis in pregnancy and the puerperium

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.(Au)

Tuberculous encephalopathy. A rare complication of pulmonary tuberculosis

A case of tuberculous encephalopathy, a rare form of neurotuberculosis, is reported in a 16-year-old girl who had pulmonary tuberculosis and extensive cerebral demyelination. The clinical, laboratory and pathological features of this entity are highlighted and the pathogenesis discussed.(Au)

Malignant meningioma with extension into the neck

One per cent of all brain tumours and twenty per cent of meningiomas eventually develop an extracranial extension. The least common site is the neck. We report a case of malignant meningioma with extension into the neck of a 39-year-old male.(Au)

Solid and Papillary epithelial neoplasm. Ultrasound and CT features of an unusual pancreatic tumour

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.(Au)

CT appearance of the rapunzel syndrome: an unusual form of bezoar and gastrointestinal obstruction

The CT appearance oa an unusual type of trichobezoar which cause the Rapunzel syndrome are described. This syndrome is characterized by intestinal obstruction secondary to a bezoar possessing a tail which extends to or beyond the ileocecal valve. Most cases of bezoar are diagnosed with plain films or barium meal, but CT may be requested in patients who present with abdominal masses. The Rapunzel syndrome may be diagnosed with a combination of the CT findings and the history.(AU)

Chronic relapsing pancreatitis from a scorpion sting in Trinidad

Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. Thorough clinical evaluation, including CT scanning, disclosed unabated pancreatitis, particularly in children, a scorpion sting should be considered an aetiologically possibility(AU)

Computed tomography of the calves: a screening procedure in the diagnosis of unilateral thrombosis of the deep veins of the lower limbs

A prospective study of twelve patients, referred to the Department of Radiology of the University Hospital of the West Indies between March, 1990 and November, 1991 with a clinical diagnosis of deep vein thrombosis, was undertaken. All patients had computed tomography of the calves, as well as venography of the affected limb. Six patients (50 percent) had positive venographs. Of these, five had a difference of greater than 10 percent between the areas of the muscular compartments of the two limbs. Six patients had negative venograms but only three demonstrated a defference of a similar magnitude. The ratios of the area of the muscular compartment to the total limb area were also compared. Two of the six patients with negative venograms showed a greater ratio in the affected limb. In this study, 83.3 percent of patients who did not have thrombosis of the deep veins of the calves had a ratio of muscular area to total limb area that was less than or equal to that of the unaffected side. This latter finding provides a potentially useful means of screening patients referred for venograms (AU)

Aorta-oesophageal fistula: a rare cause of gastrointestinal haemorrhage

Primary aorto-oesophageal fistula is a rare cause of massive and usually fatal gastrointestinal haemorrhage. We herein present a case of a 62-year-old chronic alcohol abuser who had a small haematemesis after a week of persistent vomiting. He succumbed to an exsanguinating bleed 36 hours after admission. An aorto-oesophageal fistula was found at autopsy. We emphasize the need for a high index of suspicion and recognition of premonitory signs for accurate diagnosis and management of this condition. (AU)

Computerised tomography of the head and neck - abstract

The main advantage of computerised tomography (CT) over conventional radiography is the supreme ability to distinguish radiologically between different soft tissue densities, while simultaneously producing images with extremely sharp bony detail. With each succeeding generation of scanners have come faster scanning times, increased capability in software and the ability to RECONSTRUCT images on different planes from data stored in the computer. It is now possible to visualise and magnify minute, complex anatomical areas such as the middle ear - areas not previously clearly visible by conventional radiography. Close co-operation between the otolaryngologist and the radiologist is mandatory - the one to define the problem, the other to apply the most relevant technology to visualise it. With such co-peration, the otolaryngologist is better able to define submucosal spread of inflammatory or malignant disease in the head, sinuses and neck, and/or the extent of lymph node metastasis in the neck. Fractures involving the skull, facial skeleton and orbit, or the cartilaginous framework of the larynx in acutely traumatised patients, may now be easily visualised by CT scanning and the extent of displacement accurately assessed. This is a distinct advantage in planning and executing treatment. Patients with vertigo or migraine headaches, common symptoms in ENT practice, can now be safely evaluated with the aid of CT scan (AU)

Epilepsy: disappearing lesions appearing in the United Kingdom

Objective: - Investigation of spontaneously resolving lesions associated with epilepsy. Design:- Observational study during one year. Setting:- One neurology department. Patients:- 4 cases in patients (one of Indian parents, one African, one white English, and one Afro-Caribbean) resident in the United Kingdom, who presented with transient epilepsy. Main outcome measures:- Findings on computed tomography and on screening for infections. Results:- In all four cases a small mass lesion in one cerebral hemisphere was observed on computed tomography, which resolved after 9, 4, 3 and 1.5 months respectively without surgery. Conclusions:- The number of cases seen in one year suggests that the lesions may be more common in the United Kingdom than previously recognised and that research into their cause is warranted. (AU)

Cranial computerized axial tomography (CAT scanning) in Trinidad - abstract

Cranial computerized axial tomography (CAT Scanning) in Trinidad was studied retrospectively to determine the impact of computerized tomography (CT) in neurodiagnosis and patient care. Using a EMI 5005 modified scanner, 213 scans were done - 206 from Trinidad, 2 from Tobago and 5 from other West Indian territories. One hundred and thirty-six scans were normal and 77 were abnormal. The commonest CT diagnoses were cerebral infarctions (21), cerebral atrophy (12), hydrocephalus (8) and 17 primary and 5 metastatic brain tumours. Also seen were cerebral abscesses (2), subdural haematomata (2), arteriovenous malformations (2), cerebral oedema (1) and empty sella turcica (1). The commonest symptoms investigated were headaches, seizures and hemiparesis. Headache scans yielded only 6 abnormal scans out of 58, but the yield was high in seizures (12 of 41) and hemiparesis (11 of 21). Sixty-four doctors comprising 4 neurosurgeons, 2 physicians doing predominantly neurology, 31 specialists and 25 general practitioners referred patients. Montly referral rates gradually increased, and 5 new doctors used the scan each month. Neurosurgeons and physicians doing neurology had 45 abnormal scans out of 110 ordered, while specialist physicians had 27 out of 70 and general practitioners 5 out of 33. When compared to the previous six months (without CT), there was a dramatic reduction in invasive neuroradiological procedures - angiograms from 64 to 22, pneumoencephalograms from 52 to 24 ventriculograms from 12 to 3, indicating reduction by 66 percent, 54 percent and 75 percent respectively (AU)

Extrapelvic enodometriosis presenting as unusual swellings of the buttock and thigh

We present the first case of extrapelvic endometriosis (EPE) presenting as combined swellings of the thigh and buttock in 28-year-old nulliparous woman. The diagnosis was aided by the history of cyclical symptoms, needle aspirate, ultrasonography and computed tomography scan and was confirmed by histological analysis of the exercised specimens. Of note, laparoscopy showed the pelvis to be free of gross disease. Surgical excision combined with hormonal suppression therapy proved adequate treatment in preventing recurrence as well as the complications of wound implantation. (AU)