Paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features of multiple myeloma.

Black brown hyperpigmentation of the mucosae, sunexposed skin, palmar creases and frictional sites (Addisonian pigmentation) is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation. We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up.

Primary synovial osteochondromatosis of the surapatellar pouch of knee. Correlation of imaging features with surgical findings.

A 31 years old female presented with swelling and pain above the right knee for three years. On examination, there was a tender swelling over the right knee more pronounced over the suprapatellar region. Plain X-ray, US, CT scan and MRI of the knee were suggestive of Primary synovial osteochondromatosis (PSC) of the suprapatellar pouch. Patient underwent total synovectomy and the diagnosis of synovial osteochondromatosis was confirmed histopathologically. Recognizing the imaging appearances of PSC is important to improve patient management.

Transverse testicular ectopia.

A case of transverse testicular ectopia of the left testis is hereby reported. A 5-year-old boy presented in surgical outpatient department with right inguinal hernia and impalpable testis in left scrotum and inguinal canal. Right herniotomy was performed. Left testis was found in right superficial inguinal pouch and brought to the left scrotum through transceptal window.

Pictorial review: Imaging features of unusual patterns and complications of hydatid disease.

Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. We demonstrate rare locations and unusual complications of this entity during past 6 years. Rare locations during our observation included lumbar spine, sacral spine, spleen, ovary, abdominal wall, diaphragm, pelvis and right kidney. Unusual complications included formation of bronchopulmonary fistula, complete collapse of left lung secondary to hilar location of Hydatid cyst and hydatiduria.

Imaging features of renal hydatid cyst presenting with hydatiduria.

We report a case of renal hydatid cyst in a 25-year-old male who presented with hydatiduria. Intravenous pyelography revealed presence of a space-occupying lesion in the lower pole of right kidney with curvilinear calcifications. Ultrasound, computed tomography and MRI were suggestive of hydatid cyst in the right kidney. Patient underwent right-sided nephrectomy. Passage of hydatid cysts in urine is an exceedingly rare occurrence. Urinary tract involvement develops in 2-4% of all cases of hydatid cyst. Hydatiduria is an extremely rare manifestation of renal hydatid cyst. We report such a case with emphasis on IVU, sonographic, CT and MRI findings.

Hydatid cysts in abdominal wall and ovary in a case of diffuse abdominal hydatidosis: Imaging and pathological correlation.

We report a case of diffuse abdominal hydatidosis with correlation of imaging findings with gross pathology. The patient had involvement of liver, diaphragm, pelvic cavity, ovary and abdominal wall. Hydatid cysts were morphologically different from each other including calcified, uniloculated and multiloculated cystic lesions. Our case is rare as ovary and abdominal wall involvement is described in less than 1 % cases of hydatid disease.

Multiple bronchoceles in a non-asthmatic patient with allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction due to a fungus, Aspergillus fumigatus. It is typically seen in patients with long-standing asthma. Our patient was a non-asthmatic 18 years old male who presented with chronic cough for 2 years. Peripheral blood eosinophilia and elevated scrum IgE were observed. His x-ray chest revealed v-shaped opacity in the left upper lobe close to the hilum. High resolution computed tomographic scan of the chest revealed multiple dilated bronchi filled with mucous (bronchoceles) and central bronchiectasis (CB) involving main segmental bronchi. Central bronchiectasis (CB) was typical of ABPA but bronchocele formation was a rare manifestation of the disease. The patient was managed with oral prednisolone and was relieved of his symptoms. Occurrence of ABPA in non-asthmatics is very rare and deserves reporting.

Inverted Meckel's diverticulum causing intussusception in an adult.

Adult intussusception is rare, making-up only about 1% of the causes of bowel obstruction intussusception, secondary to an inverted Meckel's diverticulum, is also a rare occurrence. Chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms may lead to an unnecessary delay in diagnosis. This case report describes a rare cause of adult intestinal intussusception due to inverted Meckel's diverticulum. Intussusception was diagnosed on emergency ultrasound of the patient, who was successfully managed with surgery.

Multifocal osseous tuberculosis involving hand and feet.

A rare case of multifocal cystic tuberculosis of hands and feet is presented in an adolescent female. The presence of multiple lytic areas mimicked secondary metastases and biopsy remained the mainstay for final diagnosis.

Brodie's abscess--an uncommon cause of leg pain.

A rare case of Brodie's abscess of distal left tibia is presented in a child which was initially missed on clinical grounds alone. Differentiation from different bone neoplasms was done on radiological grounds. The patient was managed surgically with high dose intravenous antibiotics. Brodie's abscess is very rarely encountered in our reporting of X-rays.

Granular cell tumour of the common bile duct.

Granular cell tumors (GCTs) are rare soft tissue neoplasms and occur in different parts of the body. We report a case of granular cell tumour of common bile duct (CBD) in a 39 years old lady, presenting with obstructive jaundice. Magnetic resonance cholangiopancreatography (MRCP) showed it as a benign looking mass in CBD. Complete surgical excision of the tumour was done. Histopathology was confirmatory. No histological evidence of malignancy was found.

Transdiaphragmatic rupture of huge hepatic hydatid cyst with formation of bronchopleural fistula.

A case of right sided transdiaphragmatic rupture of hepatic hydatid cyst into the right hemithorax is presented. Computed Tomography (CT) scan showed a large hydatid cyst replacing the right lobe of liver and causing complete collapse of right lung secondary to the transdiaphragmatic rupture. Per-operatively, a bronchopleural fistula was also identified and repaired.

Isolated malignant peripheral nerve sheath tumor of retroperitoneum.

A case of an isolated Malignant Peripheral Nerve Sheath Tumor (MPNST) of the retroperitoneum without neurofibromatosis is presented. The tumor was located deep in the retroperitoneum with metastasis to the ribs. It was surgically removed. Patient was further managed with radiotherapy and chemotherapy. MPNST in such a location is very unusual.

Mucocoele formation due to congenital bronchial atresia--a rare cause of solitary pulmonary nodule.

We present a case of congenital bronchial atresia with unique features in a twenty eight years old asymptomatic, non-smoker male who presented to our department for X -ray chest as a part of routine annual medical check up. It revealed an incidental, well defined, branching opacity in the left upper lobe close to the hilum. A differential diagnosis of vascular malformation and bronchocoele was given with advice to the patient to follow up after five months. A repeat x ray chest 5 months later revealed same branching character of the opacity. The CT scan of chest showed the detailed characteristics of the opacity. The lesion was located in the apico-posterior segment of the left upper lobe. It was non-enhancing and had a typical branching character with paucity of vessels in the surrounding lung. Lack of symptoms and CT features of the opacity were sufficient to label this patient as a case of congenital bronchial atresia with mucocoele formation . No frank emphysematous change had yet developed around the atretic bronchial segment.

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly.

Mayer Rokitansky Kuster Hauser (MRKH) syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier.

Pulmonary edema and lung injury after severe laryngospasm.

A young male with no pre-operative medical illness underwent corrective surgery for a deviated nasal septum under general anesthesia. At the end of surgery, patient was extubated but went into severe laryngospasm that did not improve with gentle Intermittent Positive Pressure Ventilation (IPPV) and small dose of Suxamethonium. As the situation worsened and patient developed severe bradycardia and de-saturation, re-intubation was done that revealed pink froth in the endotracheal tube. His portable chest X-ray was suggestive of non-cardiogenic pulmonary edema. With an overnight supportive treatment, using mechanical ventilation with Positive End-Expiratory Pressure (PEEP), morphine infusion and frusemide, patient improved and was subsequently weaned off from ventilator.

An unusual presentation of testicular tumor.

A case of testicular choriocarcinoma is reported in which blood mixed stools and haemoptysis were the presenting manifestations as the patient never told about the testicular swelling to his parents. Orchidectomy was performed but the patient presented again with massive hematemesis due to gastric perforation secondary to gastric metastasis. The size of the testis at diagnosis was approximately 12 x 7 cm. This was also unusual as testicular choriocarcinoma presents as a small mass. The patient eventually died of the complications within one month of diagnosis.