Imaging findings in a patient with suspected vaccine induced immune thrombotic thrombocytopenia.

Covid-19 vaccine was developed in response to the SARS Cov2 pandemic. Despite the effectiveness of the vaccine, various complications have been reported after vaccination. We present the case of a 55-year-old patient with post-vaccination complication. The patient was vaccinated with ChAdOx1 nCov-19 Vaccine and 2 weeks later presented with headache, confusion and abdominal pain for 1 week duration. Clinical examination demonstrated reduced Glasgow Coma Scale (GCS), reduced muscle power bilaterally and dysphasia. Blood test showed thrombocytopenia, high titres of D-Dimer and mildly raised INR. The CT scan of the head showed a fairly large left temporoparietal intracranial hemorrhage with midline shift and subsequent CT venogram demonstratedthrombosis of the left transverse and sigmoid dural venous sinuses. CT scan of the abdomen and pelvis showed thrombosis of the portal and hepatic veins and multiple infarcts of the liver, left kidney and lingular segment of the partially imaged lungs (Figure 2). Patient tested positive for antibodies directed against platelet factor-4 and was treated for vaccine induced thrombotic thrombocytopenia. Treatment included Intravenous immunoglobulin, Fresh Frozen Plasma, non-heparin based anticoagulant and required care in tertiary center. Incidence of vaccine-induced immune thrombotic thrombocytopenia is unknown and strongly mimics autoimmune heparin-induced thrombocytopenia with typical clinical features of thrombocytopenia and thrombosis. Of the reported cases, the common imaging finding is thrombosis in various sites such as cerebral venous thrombosis, portal vein thrombosis, pulmonary embolism and ischemic stroke.

A Pictorial Review on Reversible Splenial Lesions.

Splenium of corpus callosum can be involved in a variety of pathologies causing reversible or irreversible damage. Magnetic resonance imaging (MRI) is a useful investigation to evaluate the same. In spite of the differing etiologies implicated, MRI findings can be quite common. We review the reversible causes of diffusion restriction involving the splenium of corpus callosum and highlight the etiopathologic mechanisms implicated in these pathologies. We further discuss these pathologies in entirety with relevant clinical and laboratory findings helping make definitive diagnosis and guiding appropriate management.

Morphometric differences in normal bony nasolacrimal anatomy: comparison between four ethnic groups.

PURPOSE: To compare bony nasolacrimal duct anatomy between ethnic groups. METHODS: A retrospective observational study of patients of four ethnic groups who had high-resolution CTs between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS: More females (n = 114) than males (n = 40) were included. South Asian (Indian subcontinent), Afro-Caribbean and European groups were equivocal demographically (n = 25-29, mean age 40-45); however, the Oriental group was fewer in number (n = 13) and slightly older (mean age 51). South Asian and European ducts had no significant differences. Afro-Caribbean ducts were wider and shorter than European. Afro-Caribbean faces are wider and their noses flatter and wider than European. Oriental ducts were wider and longer than European, but Europeans have taller noses. CONCLUSION: The results from our Oriental group fits with the published data in Orientals. The bony nasolacrimal duct is greater in calibre (inner diameter) if the patient is of Afro-Caribbean or Oriental origin compared to European or South Asian. Acquired nasolacrimal duct obstruction in Afro-Caribbean or Oriental patients may be more likely due to secondary causes.

High-resolution computed tomography assessment of bony nasolacrimal parameters: variations due to age, sex, and facial features.

PURPOSE: To compare nasolacrimal duct anatomy between gender, age, and facial features, and explore correlations between bony parameters. METHODS: A retrospective case series of patients of four races who had high-resolution computed tomography (CT) between 2004 and 2019 covering the full length of their nasolacrimal ducts in two hospitals in Essex, England. Only normal ducts were included; patients with tearing or radiological abnormalities were excluded. Measurements were taken of the nasolacrimal duct and surrounding anatomy based on measurements found in the existing literature. RESULTS: More females (n = 114) than males (n = 40) were included. Mean age was slightly older for females (45.7 years) compared to males (42.5). Males have taller noses and wider faces. Nasolacrimal duct calibre correlated positively with age, male gender, and facial width, and negatively with nasal height. There was a tendency for nasolacrimal ducts to be longer in males. CONCLUSION: The bony nasolacrimal duct is smaller in younger female patients. Having a taller nose and narrower upper face is also correlated with a smaller calibre duct. Acquired nasolacrimal duct obstruction in patients without these demographics or facial features may be more likely due to secondary causes.

A rare case of chemotherapy induced reversible cerebral vasoconstriction syndrome in a patient of acute lymphocytic leukemia.

Neurotoxic reactions of chemotherapy occur frequently and are often dose limiting side effects of chemotherapy. It is important to differentiate these various nonneoplastic effects from metastases, or sometimes even from each other, since the therapeutic approach differs accordingly. To arrive at a definitive and comprehensive diagnosis, the radiologist should integrate imaging findings, clinical signs, and laboratory results together. Here we present a unique case of chemotherapy induced reversible cerebral vasoconstriction syndrome in a 13-year-old patient of acute lymphoblastic leukemia.

A rare case of malignant chondroid syringoma of scalp.

Chondroid syringoma represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands, therefore it is also termed "mixed tumour of the skin." It is generally accepted that there are both eccrine and apocrine variants of mixed tumors of skin. Malignant chondroid syringoma is a malignant eccrine neoplasm that is very rarely encountered in radio-pathological and clinical practice. Unlike the benign variety which occurs most often on the head and neck, malignant chondroid syringomas are most often found on the trunk and extremities. The usual presentation is that of an asymptomatic slow-growing mass in the region of head or neck. We present here a case report of histopathologically proven malignant chondroid syringoma of scalp in occipital region, with dural invasion. Malignant chondroid syringomas clinically appear as very large nodules and they metastasize at a very high rate. The treatment of these malignancies is surgical excision.

Anorectal mucinous adenocarcinoma in child: a case report.

Colorectal cancer is extremely rare in children with incidence of one child per one million. We report an 11-year-old boy who presented with a 3-month history of anorexia, weight loss, vomiting with constipation and occasionally blood in stools. Imaging study revealed an eccentric growth in the anorectum. The patient underwent incision surgical biopsy, and subsequent histopathologic analysis revealed a mucinous adenocarcinoma of the colon. No patient follow-up was possible after the child left our department as he was very poor and could not afford the expenses of surgery or chemoradiotherapy.