Tuberculous pancreatic abscess: an unusual manifestation of HIV infection.

Pancreatic tuberculosis is unusual occurring in only 2.7% of autopsy studies of persons with miliary disease. Reports of focal pancreatic tuberculosis are rare, even in patients with the acquired immunodeficiency syndrome (AIDS) in whom abdominal tuberculosis is a frequent feature. We describe two patients infected with the human immunodeficiency virus (HIV) who developed tuberculous pancreatic abscesses. In both this was their AIDS-defining illness.

A sonographic-pathological correlation of liver biopsies in patients with the acquired immune deficiency syndrome (AIDS).

The liver is commonly involved in patients with AIDS and a first line investigation for hepatic dysfunction is liver ultrasound (US) which is often abnormal. It is unclear how these US abnormalities correlate with the underlying pathological processes. A retrospective study was performed in 48 patients with HIV disease who had undergone both liver biopsy and hepatic (US), correlating the findings. Only 25% of patients had an entirely normal liver (US) examination and only 10% patients had a normal liver biopsy. The commonest sonographic abnormalities was a diffusely hyperechoic liver seen in 46% of patients and this correlated with steatosis. Forty-four percent of biopsies contained more than one histological abnormality including granulomas, inflammation, steatosis or siderosis. In addition clinically unsuspected pathology was revealed in five of the cases of mycobacterial infection and in three cases of lymphoma. The combination of multiple histological abnormalities, unsuspected pathology, and the altered immune response in this group makes the US findings even less specific than in non-AIDS patients. We recommend that liver biopsy should remain an essential and early part of the management of AIDS patients.

Thrombosis within an external jugular venous aneurysm.

Jugular plebectasia is rare, and most patients present in childhood. We describe a thrombotic episode within an external jugular venous aneurysm in an adult. This has not previously been described in the medical literature.

Case report: torsion of the gall-bladder on ultrasound--differentiation from acalculous cholecystitis.

Acalculous cholecystitis is usually seen in critically-ill patients while torsion of the gall-bladder tends to arise de novo, pre-disposed to by an absent mesentery. There are ultrasonic features in common but the most useful distinguishing finding is the sign of the 'floating gall-bladder'. A case is reported and the ultrasound literature reviewed.