Evaluation of Sequential Head Computed Tomography in Traumatic Brain Injuries.

BACKGROUND: The grading of the severity of head trauma plays a vital role in acute patient management and planning a case-appropriate follow-up protocol. Few studies have been published regarding the Rotterdam scoring. In this study, we have established a correlation between the Rotterdam scores, need for sequential CTs, and the cumulative radiation dose. This correlation has helped develop a preliminary protocol that can be followed for patients hence bringing about better planned and efficient patient care. MATERIALS AND METHODS:  From August 2014 to December 2020, 88 cases of traumatic head injury on whom a minimum of one sequential CT was performed, with no surgical intervention, were included and studied. Sequential head CTs of each patient were evaluated by skilled radiologists with a minimum experience of five years, all of whom were blinded to the findings of the initial and previous head CT findings. The serial head CTs were evaluated for the Rotterdam CT score (RCTS).  Results: Among the patients with extradural hemorrhage (EDH), only 28.6% (8) progressed over successive CTs and 75.5% (34) of patients with subdural hemorrhage (SDH) showed significant progression over sequential CTs. Maximum number of serial CTs were obtained for cases presenting with a score of 3 (34 cases) with about three of them requiring up to a total of three CTs. However, no significant change in findings was noted on serial CTs. On the contrary, significant disease progression was noted in patients with baseline scores of 4 (76.9%) and 5 (100%), with statistical significance obtained on further analysis (P = 0.001). CONCLUSIONS: We are of the opinion that there is no additional role of sequential CT for the cases with Rotterdam score of 1 or 2 in the initial CT unless there is clinical evidence of deterioration. Rotterdam score 3 needs sequential CT after 24 hours and Rotterdam scores 4 and 5 need sequential CT after 12 hours if surgical intervention is delayed. The Rotterdam score may help predict any further need for a second CT, hence decreasing the unwanted radiation exposure.

Multiple intracranial cryptococcomas in an immunocompetent patient with pulmonary involvement.

Opportunistic infections affecting central nervous system (CNS) have high prevalence in developing countries and cryptococcosis is one of them. It is associated with myriad of signs symptoms and clinical behavior. Though commonly associated with AIDS/HIV infection, it has been reported to be pathogenic in immunocompetent patients. Leptomeningitis is most common presentation in CNS, but unusual tumor like mass lesions have been reported. Lungs are primary site of infection, but it can affect different organs with varied clinical presentations. Therefore, correct diagnosis and proper management is essential in such cases excluding the differentials as fatality rate can be quite high. We report such an unusual case of multiple cryptococcal mass lesions in brain in a healthy immune competent individual with bilateral pulmonary involvement.

Pancreatico-pleural and bronchial fistulae and associated pseudocysts: case series.

CONTEXT: Pancreatico-pleural fistula is rare complication of chronic or acute pancreatitis. Previous studies have reported imaging features and various management options of this condition including conservative/medical management, endoscopic treatments and surgery.This article reviews the myriad of imaging appearances of this condition in multimodality imaging and different strategies for the successful management in a short case series. METHODS: After obtaining the institutional ethics committee approval, retrospective review of the medical records of five patients of pancreatico-pleural fistulae who were diagnosed and successfully managed in our hospital in 2012 and 2013 was done. Follow up with out patient records of these patients was also included.Findings were compared with the current available literature on this entity. RESULTS AND DISCUSSION: Pancreatico-pleural fistulae presents with massive pleural effusion.A high index of suspicion is essential for accurate diagnosis. Demonstration of the fistulous tracts requires cross sectional imaging with contrast enhanced CT being most commonly used and affords accurate diagnosis. MRI demonstrates the tracts and ductal disruptions with greater detail and are helpful in confirming the CT findings. Endoscopic ultrasound and ERCP also offer potential of diagnosis, although being technically demanding and invasive is reserved for interventions. Management of these conditions should be initially conservative with endoscopic stenting being offered in selected cases with favourable anatomy and not responding to conservative management. Surgery is reserved for cases not responding to conservative and endoscopic management. CONCLUSION: In conclusion this case series highlights the clinical and imaging spectrum of pancreatico-pleural fistulae and provides insight into the different management strategies that can be adopted for this condition.