Atypical Presentation of Hepatocellular Carcinoma in a Chronic Alcoholic: Diagnostic Challenges and Therapeutic Approach.

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver, often arising in the context of chronic liver disease and cirrhosis. This case report describes the clinical presentation, diagnostic evaluation, and therapeutic intervention of a 72-year-old male with a long-standing history of alcohol use who presented with right hypochondrial pain. A 72-year-old male with a 20-year history of alcohol consumption presented with a one-month history of dull, aching pain in the right hypochondrium. Diagnostic imaging, including abdominal ultrasound and contrast-enhanced computed tomography (CECT), revealed significant hepatomegaly with nodular and irregular liver margins, free fluid in the abdomen and pelvis, and multiple hypodense nodules in both liver lobes. One nodule in the right lobe exhibited characteristic imaging features of hepatocellular carcinoma, including peripheral enhancement on the arterial phase and washout on the delayed phase. Histopathological analysis of a biopsy from the suspicious nodule confirmed the diagnosis of hepatocellular carcinoma. The patient was diagnosed with hepatocellular carcinoma based on clinical, radiological, and histopathological findings. He was subsequently scheduled for radiofrequency tumor ablation. This case underscores the importance of comprehensive diagnostic imaging and histopathological evaluation in patients with liver cirrhosis and suspected HCC, particularly in those with a history of chronic alcohol use.

A Study of High-Resolution Ultrasound and Magnetic Resonance Imaging Findings in Shoulder Joint Pain at a Tertiary Care Hospital in Central India.

Objective This study aims to investigate the diagnostic efficacy of high-resolution ultrasound (USG) and magnetic resonance imaging (MRI) in patients with shoulder joint pain at a tertiary care hospital in Central India. Methods This cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital from 2021 to 2024. The study population consisted of patients with shoulder pain, without fractures, who were evaluated using USG and MRI. Participants with infective arthritis, rheumatoid arthritis, previous shoulder surgery, or contraindications for MRI were excluded. Data were recorded and analyzed using Microsoft Excel (Microsoft Corporation, Redmond, Washington) and R 4.2.0 software (The R Foundation, Vienna, Austria). Sensitivity, specificity, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of USG and MRI. Results A total of 80 patients were included, with 49 (61%) males and 31 (39%) females. The MRI findings showed supraspinatus partial tears in 44 (55%) cases, complete tears in 10 (12.5%), and various other shoulder pathologies. USG detected supraspinatus partial tears in 16 (19.5%) and complete tears in seven (8.8%). Kappa statistics indicated moderate to high agreement between USG and MRI for several pathologies, with near-perfect agreement for complete tears. Conclusion High-resolution USG is a valuable tool for the initial assessment of shoulder joint pain, providing reliable diagnostic information with high agreement levels with MRI for complete tears and certain shoulder conditions. MRI remains indispensable for comprehensive evaluation, particularly for partial tears and complex pathologies.

A Rare Co-occurrence of Lumbo-Costo-Vertebral Syndrome With Congenital Lumbar Hernia in a Six-Year-Old Child.

Lumbo-costo-vertebral syndrome (LCVS) is a very rare congenital disorder seen in children. It is characterized by a congenital absence of ribs, vertebral anomalies, scoliosis, meningocele, and hypoplastic abdominal wall muscles presenting as abdominal wall hernia. We present a case of a six-year-old Indian female who came with complaints of swelling in the left lumbar region since birth, which was evident in coughing and scoliosis. On auscultation, bowel sounds were heard over the swelling. Physical examination revealed a left lumbar hernia and scoliosis. Abdominal X-rays revealed the absence of the 12th rib on the left side and vertebral anomalies with kyphoscoliosis. Abdominal ultrasonography (USG) showed a left lumbar hernia with bowel loops as its content. Computed tomography (CT) was done, which confirmed the X-ray and USG findings. Based on clinical and radiological findings, a diagnosis of LCVS associated with congenital lumbar hernia (CLH) was made. The patient was then referred to the surgery department for further management. This case illustrates a unique link between two extremely rare conditions and emphasizes the necessity of thorough clinical and radiological evaluation in suspected patients for early diagnosis and treatment.

Decoding Femoral Vein Leiomyosarcoma: A Rare Vascular Malignancy Revealed Through Imaging.

Lumps are commonly found in the femoral triangle. Femoral hernias and lymphadenopathy are included in the differential diagnosis. One of the rare possibilities of femoral triangle swellings is leiomyosarcoma. Leiomyosarcoma originating from the walls of blood vessels is very rare, and only a few cases are reported. We present a case of a 50-year-old male patient complaining of swelling over the left thigh. Ultrasonography showed a highly vascular soft tissue tumour in the anteromedial compartment of the thigh. Magnetic resonance imaging (MRI) was done later. It showed a well-defined, heterogeneously enhancing solid cystic lesion along the femoral vein with intravenous extension, and the femoral artery was seen encasing along its length. A surgical exploration of the lesion suggested a mass originating from the femoral vein, obstructing the vein itself. The mass was excised, and the defect in the vein was repaired. Histopathological examination revealed the mass to be leiomyosarcoma of vascular origin.

A Rare Case of Pyometra in a 65-Year-Old Post-menopausal Woman.

Pyometra is a gynecological condition characterized by pus accumulation in the endometrial cavity. It is a rare condition, and it should be included in the differential diagnosis of abdominal pain in postmenopausal women. We present a case of a 65-year-old postmenopausal woman with complaints of foul-smelling white discharge, itching in the perineal region, lower abdominal pain, and postmenopausal bleeding for two to three months. USG of the pelvis was done outside, which revealed heterogeneous ill-defined cervical growth with endometrial fluid collection and multiple uterine fibroids. CT and MRI of the pelvis were done in our hospital, which revealed an ill-defined heterogeneously enhancing growth in the cervix with multiple uterine fibroids and heterogeneous endometrial collection showing restricted diffusion in MRI suggestive of pyometra. Cervical biopsy revealed features suggestive of moderately differentiated squamous cell carcinoma.

Bladder Carcinoma With Solitary Skull Metastasis: A Rare Presentation in a Middle-Aged Female.

Bladder carcinoma is a common malignant tumor of the urinary system, with the leading cause of death being the metastasis of cancer. It, however, is a rare malignancy in the Indian population with the incidence being higher in males compared to females. The most common sites of metastasis for bladder carcinoma are the peritoneum, liver, lung, pleura, lymph nodes, adrenals, intestine, and kidney. Metastasis to the heart and brain are rare. Only a few cases of bladder cancer metastasizing to the skull have been reported to date. Here in this article, we describe a female patient who presented with metastasis to the calvarium from bladder cancer before the identification of the original tumor.

A Rare Case of Fibrous Dysplasia Presenting With Facial Swelling and Craniofacial Deformity in a 13-Year-Old Girl.

Fibrous dysplasia (FD) is a rare benign skeletal disorder that replaces normal bone with fibrous tissue and immature woven bone. We present a case of a 13-year-old girl with right-sided facial swelling and craniofacial deformity since birth, accompanied by nasal obstruction and difficulty in breathing and swallowing. Computed tomography (CT) imaging revealed an expansile bony lesion with a ground-glass matrix involving multiple craniofacial bones. Histopathological examination confirmed the diagnosis of FD. Management involved regular monitoring and conservative measures, with surgical intervention reserved for symptomatic progression or cosmetic concerns. This case underscores the importance of considering FD in the differential diagnosis of craniofacial asymmetry and highlights the collaborative approach to patient care. Further research is needed to optimize management strategies and outcomes for pediatric patients with FD.

Unveiling the Intricacies: A Comprehensive Review of Magnetic Resonance Imaging (MRI) Assessment of T2-Weighted Hyperintensities in the Neuroimaging Landscape.

T2-weighted hyperintensities in neuroimaging represent areas of heightened signal intensity on magnetic resonance imaging (MRI) scans, holding crucial importance in neuroimaging. This comprehensive review explores the T2-weighted hyperintensities, providing insights into their definition, characteristics, clinical relevance, and underlying causes. It highlights the significance of these hyperintensities as sensitive markers for neurological disorders, including multiple sclerosis, vascular dementia, and brain tumors. The review also delves into advanced neuroimaging techniques, such as susceptibility-weighted and diffusion tensor imaging, and the application of artificial intelligence and machine learning in hyperintensities analysis. Furthermore, it outlines the challenges and pitfalls associated with their assessment and emphasizes the importance of standardized protocols and a multidisciplinary approach. The review discusses future directions for research and clinical practice, including the development of biomarkers, personalized medicine, and enhanced imaging techniques. Ultimately, the review underscores the profound impact of T2-weighted hyperintensities in shaping the landscape of neurological diagnosis, prognosis, and treatment, contributing to a deeper understanding of complex neurological conditions and guiding more informed and effective patient care.