Retrograde Transvenous Thoracic Duct Embolization for Tubercular Chylothorax.

This case study documents the clinical profile of a 27-year-old male patient who visited the medical facility two months ago with complaints of dry cough, fatigue, weight loss, and occasional fever. He had been treated for ascites and pleural effusion in the hospital before presentation and returned with an intercostal drain in place. A detailed examination revealed symptoms of respiratory disorders, including fluid in both lungs, fever, and dyspnea. His fluid levels showed multiple deviations from the normal range, according to the report's findings and lab test results. It was determined that the patient had chylothorax, which resulted from hemophagocytic lymphohistiocytosis (HLH) and abdominal tubercular lymphadenopathy. His anti-tubercular treatment (AKT4) was initiated, along with octreotide for his management. Initial management included non-invasive ventilator (NIV) support, intravenous antibiotics, nebulization, and an intercostal chest drain (ICD). Later, the patient underwent retrograde transvenous thoracic duct embolization (TDE) using N-butyl cyanoacrylate (NBCA) glue. The removal of the drainage tube and the patient's stable discharge were made possible through regular monitoring and collaboration between specialists.

Current Advances in Diagnostic and Treatment Approaches for Subclavian Steal Syndrome: A Case Report and Review of the Literature.

With newly created therapy devices and cutting-edge diagnostic techniques, we successfully diagnosed and treated subclavian steal syndrome in this case report. This case report is complemented by a literature review that examines the current state of knowledge about diagnostic and treatment options. The patient reported pain and numbness in his left upper arm when raising his arm above his head. On clinical examination, he had good left radial and ulnar pulses while in a sitting position; however, he had absent left ulnar pulses when he raised his hand above his head. Angiography revealed retrograde perfusion of the left vertebral artery and nearly complete occlusion of the ostium of the left subclavian artery. The patient underwent angioplasty and stenting. Immediately after the procedure, the patient reported a reduction in the pain and numbness in his left upper limb by 50%, which completely disappeared at his routine follow-up after one month. The patient was completely asymptomatic during follow-up and had no signs of neurological deficit.

The Diagnostic Value of CT Scan in Identifying Adenoid Hypertrophy in Adults: A Case Report.

The utility of computed tomography (CT) scan in diagnosing adenoid hyperplasia in adults. A 22-year-old woman presented with persistent bilateral nasal obstruction, anterior nasal discharge, mouth breathing, and snoring over the past three months. Despite attempts with both local and systemic decongestants, there was no improvement, and flexible nasopharyngoscopy could not be conducted. CT scans revealed a heterogeneously enhancing space-occupying mass in the nasopharynx, and a rare diagnosis of adult adenoid hypertrophy was reported. The patient responded to a combination of painkillers, antibiotics, and nasal decongestants. Adenoid hyperplasia in adults is quite rare and inadequate examination by indirect posterior rhinoscopy may lead to misdiagnosis and mismanagement. A CT scan not only provides a clearer view of the nasopharyngeal space and adenoids but also reveals details about the nature of lesions, including their extension and potential bone destruction, suggesting the presence of a malignant tumor. Additionally, a CT scan proves valuable in diagnosing chronic sinusitis.

A Case Report on Vaginal Melanoma That Metastasized Distantly.

A case report of a 55-year-old woman who had just gone through menopause complained for a month about objects coming out of her vagina with a foul-smelling vaginal discharge. A 3-4 cm tumor growing from the vagina was discovered on a vaginal examination. The growth bled on contact and was friable. The patient also complained of multiple lumps on the body and difficulty in breathing. The patient underwent pelvic magnetic resonance imaging (MRI) and computed tomography (CT) of the chest and was diagnosed with vaginal melanoma with distant metastasis. Following radiotherapy, a sizeable local excision of the vaginal masse was done as a palliative measure, along with the dissection of both inguinal lymph nodes. After experiencing abrupt dyspnea six months prior, the patient's CT scan of her chest showed the growth of metastatic lesions in her lungs, and she eventually passed away from her illness.

Radiological Diagnosis of Crouzon Syndrome: A Case Study.

Crouzon syndrome, distinguished by a classic trio of an atypical skull structure, distinctive facial features, and protruding eyes, ranks among the most prevalent types of craniofacial dysostosis. Therefore, patients presenting with dental abnormalities are under-reported in medical literature despite the developmental neurological defects. We report a rare case of Crouzon syndrome in a four-year-old girl who had forward displacement of the lower jaw, bulging eyes, undeveloped upper jaw, and dental abnormalities. She was evaluated with cranial computed tomography with three-dimensional reconstruction; genetic studies confirmed the findings.

Surviving a Rare Case: Successful Endovascular Treatment for Multiple Dural Venous Sinus Thrombosis With Dural Arteriovenous Fistula.

Vascular anomalies known as dural arteriovenous fistulas (DAVFs) occur when arteries that emerge from carotid or vertebral artery branches empty straight into the dural venous sinuses. A 16-year-old male patient at the center of this case study initially arrived at the hospital with symptoms of generalized tonic-clonic seizures and headaches accompanied by vomiting, followed by right-sided hemiparesis and subsequently left-sided hemiparesis. An MRI brain with MR angiography was performed, revealing an abnormal fistulous connection between the sigmoid and transverse sinus and the branches of the bilateral external carotid and right internal carotid artery. Embolization was performed using a mixture of glue and lipoid to address the issue.

Hidden Depths: Unveiling Endometriosis in the Canal of Nuck.

Endometriosis located within the canal of Nuck represents a highly uncommon occurrence, often posing a diagnostic challenge due to its atypical site and varied clinical presentations. The case of a 31-year-old female who presented with groin swelling and subsequent suprapubic pain for a duration of two years is described in this study. Utilizing magnetic resonance imaging (MRI), a cystic lesion was detected within the canal of Nuck, raising suspicion of endometriosis. Surgical exploration confirmed the presence of endometrial implants, supporting the initial radiological findings. This particular case emphasizes the significance of imaging techniques in diagnosing endometriosis in unusual sites, thereby enabling timely interventions and enhancing patient outcomes. Furthermore, it underscores the necessity of a multidisciplinary approach involving radiologists, gynecologists, and surgeons in ensuring comprehensive care for such patients. In the subsequent sections, we endeavor to present a unique instance of endometriosis within the canal of Nuck, a condition scarcely documented in the existing global literature. Our objective is to heighten awareness and encourage the consideration of endometriosis as a potential differential diagnosis in females presenting with inguinal masses and pelvic discomfort.

A Case Report: Giant Liver Hemangioma Treated with Transcatheter Embolization.

When treating patients with a massive cavernous hemangioma of the liver that requires nonsurgical therapy, transcatheter arterial embolization has proven to be an effective technique. Significant advantages include the ability to obliterate the vascular supply of these lesions and the minimally invasive nature compared to surgery. A 65-year-old woman arrived at our hospital complaining primarily of stomach pain that had been there for six months. The patient had a hard lump in the right hypochondrium on clinical examination. Ultrasound showed a large, well-defined, heterogeneous lesion with central necrotic areas, with the rest of the liver parenchyma having normal echotexture and flow in the portal vein. The 65-year-old woman's primary complaint upon arrival at our hospital was a stomach ache that had been there for six months. The results of the liver function test were normal. Upon presumptive identification of a significant hepatic hemangioma, the patient was brought to the angio-suite for angiography and proper hepatic artery embolization. Considering the patient's age, the severity of the lesion, and its highly vascular character, endovascular embolization of the proper hepatic artery using lipidol and bleomycin was performed. The patient was discharged after two days in the hospital, administered antibiotics, and advised to follow up after 15 days. Liver function after embolization was within normal limits. The patient had no symptoms after a follow-up at three months. Therefore, endovascular embolization with lipidol and bleomycin is a safe and effective method to obliterate the vascular supply to the lesion, prevent catastrophic bleeding, and provide symptomatic relief to the patient.

Splenic Artery Pseudoaneurysm Management With Cyanoacrylate Glue: A Case Report.

We present the case of a 40-year-old female who presented with abdominal pain, hematochezia, and melena for the past week and was diagnosed with a pseudoaneurysm emanating from the mid-splenic artery. The patient was managed with endovascular cyanoacrylate glue embolization, resulting in the complete resolution of an impending catastrophic hemorrhagic shock.

Atypical Presentation of Wilson Disease: Unravelling a Clinical and Radiological Complexity in a Rare Case.

Wilson disease (WD) is an autosomal recessive disorder marked by aberrations in copper metabolism, leading to its accumulation in vital organs such as the liver, brain, cornea, kidneys, and heart. While WD typically presents with hepatic symptoms in early childhood, neuropsychiatric manifestations are more prevalent during adolescence. This case report highlights an extraordinary instance of WD in an eight-year-old girl, characterized by intricate clinical and radiological features. The patient exhibited atypical symptoms, emphasizing the importance of recognizing diverse presentations of WD. Delayed diagnosis and treatment initiation can prove fatal in WD cases, underscoring the significance of awareness regarding these unusual clinical and radiological features to facilitate prompt intervention and prevent adverse outcomes.

Malignant hemangioendothelioma of occipital bone.

Epithelioidhemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioidhemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.

Repeat Uterine Artery Embolization for Obstetric Hemorrhages: A Rare Event in a Single Patient.

This is a case report of a single patient who had two episodes of obstetric hemorrhages, first in the puerperium and second one post medical termination of pregnancy for which the patient had to be managed by uterine artery embolization (UAE). This is a rare case in which this interventional radiological procedure proved life-saving twice in her obstetric history. A 29-year-old woman with an obstetric history of para two and living two (P2L2), presented with a complaint of per-vaginum (p/v) spotting with a history of recent intake of pills for medical termination of pregnancy (MTP). Retained products of conception (RPOC) were ruled out radiologically and she was managed conservatively. She subsequently presented with acute uterine bleed with severe anemia and lethargy. After initial resuscitation and failing of conservative therapy, she was promptly taken up for bilateral UAE. She had also undergone UAE 5 years ago during her puerperal period. Uterine artery embolization is a safe and effective life-saving procedure to control torrential uterine bleed and should be considered when the conservative approach has failed.

Utility of digital volume tomography in maxillofacial trauma.

PURPOSE: To assess the diagnostic quality of images generated using the newly developed digital volume tomography (DVT) system and comparing them with conventional images from patients with maxillofacial trauma. MATERIALS AND METHODS: The study population included 22 male patients aged 18 to 60 years with a history of maxillofacial trauma. Each patient had undergone conventional radiographic and DVT examinations to analyze the number of fracture lines in the jaws and to compare the images for their diagnostic quality by an oral radiologist and a general radiologist using the χ(2) test. RESULTS: A statistically significant difference was found between the number of fracture lines evaluated on the conventional radiographs and on DVT, especially for condylar head (7) and the midface (4.41 to 4.57), zygomaticomaxillary complex and Le Fort fractures, respectively. CONCLUSIONS: The detection of fracture lines and visualization within the mandibular-maxillary area using DVT was superior to using conventional radiographs.

Spontaneous Twin Ectopic Pregnancy Managed Successfully With Methotrexate-Mediated Ultrasound-Guided Fetal Reduction: A Fertility-Preserving Approach.

Ectopic pregnancy has emerged as an alarming problem for obstetricians worldwide. Live twin ectopic conception is rare to occur, and spontaneously conceived twin ectopic pregnancy is even more infrequent. A 32-years-old gravida 3, para 1, live 1, abortion 2, presented with a confirmation of pregnancy on a urinary pregnancy test kit along with pain in the right iliac fossa. Blood investigations revealed raised serum beta-human chorionic gonadotropin hormone. Transvaginal ultrasonography revealed twin ectopic conception in the right fallopian tube with both the embryos showing cardiac activity and no evidence of intrauterine gestational sac. The patient was managed with methotrexate-mediated ultrasound-guided fetal reduction and is doing well on follow-up presently. Hence, our case report highlights the importance of prompt diagnosis and management of twin ectopic pregnancies with the help of newly evolving interventional radiology procedures.

Surgical reconstruction of interdental papilla using subepithelial connective tissue graft (SCTG) with a coronally advanced flap: a clinical evaluation of five cases.

AIM: The aim of these case reports was to evaluate the effectiveness of a subepithelial connective tissue graft with a coronally advanced flap to reconstruct an interdental papilla. BACKGROUND: In the last decade, esthetics has become a major concern in periodontal therapy. One of the most difficult and elusive goals for the periodontist in the esthetic aspect of periodontal therapy is the reconstruction of the interdental papilla. Consequently, the absence or loss of the interdental papilla for a variety of reasons may create significant esthetic, functional, and phonetic challenges for the patient. CASE DESCRIPTION: Five systemically healthy patients between the ages of 23 and 52 years with absence of the periodontal pocket were selected. Loss of interdental papillary height was classified using the Nordland and Tarnow classification system as class 1 to 4. All five patients received a subepithelial connective tissue graft (SCTG) with a coronally advanced flap (CAF). Four parameters were measured at baseline and at six months post-surgery: (1) vertical distance from contact point to gingival margin, (2) soft tissue (papilla) height in the interdental area, (3) horizontal distance at the gingival margin, and (4) width of keratinized gingiva. The changes noted at six months post-surgery were (1) the vertical distance decreased from 3.2±0.44 mm to 0.4±0.54 mm, (2) the mean gain in soft tissue (papilla) height increased from 3.2±0.44 mm to 5.8±0.44 mm, (3) the horizontal distance at the gingival margin was reduced from 2.6±0.54 mm to 0.4±0.54 mm and the width of the keratinized gingiva increased 1.4±0.89 mm. CONCLUSION: The periodontal surgical technique used for the five reported cases successfully reconstructed the interdental papilla in just one type of papilla loss, the class I situation. Therefore, it should not be concluded that the technique shown would be equally as successful for every type of papilla loss. Furthermore, the postoperative time interval was short, at only six months. CLINICAL SIGNIFICANCE: A subepithelial connective tissue graft supported by a coronally advanced flap should be considered to surgically correct the loss of an interdental papilla in class I cases.

Acute Myocardial Infarction with Left Ventricular Failure as an Initial Presentation of Takayasu's Arteritis.

Takayasu's Arteritis (TA) is an uncommon chronic inflammatory and stenotic disease of medium and large-sized arteries characterized by a strong predilection for the aortic arch and its major branches. We report a rare manifestation of TA in a 16-year-old female with no previous history of heart disease who presented with heart failure. She was found to have hypertension and discrepancies of pulses in upper and lower limbs. She developed ST elevated anterior wall myocardial infarction (MI) during hospitalization. Her aortography revealed narrowing of descending thoracic, upper abdominal and infrarenal aorta with significant stenosis of both renal arteries. She was diagnosed as a case of TA on the basis of her clinical profile and arteriography. Her coronary angiography did not reveal any stenosis or occlusion or aneurysm in coronary arteries or at coronary ostia which is in contrast to patients of TA with MI reported in the literature who had focal or diffuse stenosis or aneurysm in the coronaries.

Angiolymphoid hyperplasia with arterial ectasia and arteriovenous malformation: Response to intra-arterial embolization.

Angiolymphoid hyperplasia with eosinophilia is a rare disease characterized by vascular proliferation of unknown origin. The lesions are mostly seen in the head and neck region and are characterized by papules or nodules. A 20-year-old man presented with a 1 year history of reddish papulo-nodular lesions overlying a pulsatile swelling on the left auricular area. Histopathology was suggestive of angiolymphoid hyperplasia with eosinophilia. B-mode ultrasonography, color Doppler and angiography revealed arterial ectasia and arteriovenous malformation of the left auricular artery. Such malformations have been reported previously, in association with angiolymphoid hyperplasia with eosinophilia. The cutaneous lesions responded well to transarterial embolization of the nidus.

Giant cavernous hemangiomas of the brain.

Cavernous angiomas or hemangiomas or cavernomas are benign, vascular malformations of the central nervous system and classified as occult vascular brain lesions, usually present in adulthood. With the advent of computed tomography and magnetic resonance imaging, these lesions are increasingly recognized in children. We report two cases of pediatric brain cavernomas where the children presented with recurrent seizures. Imaging findings were suggestive of giant cavernous hemangioma. The lesions were excised completely and the patients recovered well without deficits with good control of seizures.

Spinal hydatid with meralgia paresthetica in a female: A rare case report.

Meralgia paresthetica presents as tingling sensation in the antero-lateral aspect of thigh. It occurs due to compression of the lateral cutaneous nerve of thigh. Proximal spinal lesions may present as meralgia paresthetica due to radiculopathy. We present a rare case of spinal hydatid with meralgia paresthetica.