Differential Radiographic Chest Findings in COVID-19 Positive Patients with and Without Comorbidities.

Background: The pandemic of Covid-19 resulted in significant morbidity and mortality, especially in those with pre-existing diseases like diabetes mellitus, cardiovascular diseases, etc., primarily due to extensive pulmonary involvement. The chest radiograph is the first imaging tool used in all Covid-19 patients. Hence, in this study, we attempt to understand and evaluate the role of the chest radiograph in Covid-19 patients with and without coexisting diseases. Materials and Methods: Our study included RTPCR-positive Covid-19 patients with comorbidities (560 cases) and without comorbidities (145 controls), viz. diabetes mellitus, hypertension, coronary artery disease, or thyroid disease. All controls and cases had chest radiographs with simple fractional zonal scores in a predesigned proforma. Statistical evaluation of chest radiograph scores was compared with and within groups. Results: Among the controls, approximately 63.5% revealed pulmonary findings on chest radiographs contrary to 77% among cases. No statistical differences were noted among controls and cases based on age and gender. The presence of pleural effusion was noted as a significant factor affecting the score and hence the prognosis in both controls and cases. Statistically significant differences were noted in SFZ scores between controls and various case groups. Conclusion: Chest radiograph scores in Covid-19 disease are higher in patients with comorbidities at the time of presentation, most marked in those with both hypertension and thyroid disease followed by those with hypertension and coronary artery disease. Lower zone predominance is seen in all patients including those with and without comorbidities. The chest radiograph scores become statistically significant with more than one existing comorbidity.

Mucocele Arising from the Submandibular Gland Presenting as Neck Swelling: A Rare Case Report.

Mucoceles rarely involve major salivary glands. Very few cases involving the submandibular gland have been reported to date. A young male child presented with diffuse, soft, and painless swelling of the left submandibular region. Investigations suggested mucocele of the submandibular salivary gland. The mucocele was excised along with the left submandibular gland. Recovery was uneventful.

Wolffian system agenesis with contralateral ejaculatory duct stenosis: First case in the literature.

Congenital agenesis of seminal vesicles and vas deferens is rare and its co-existence with structural abnormality on the contralateral side is even rarer. We report a case of an adult male presenting with infertility due to obstructive azoospermia, in which transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) revealed the agenesis of Wolffian derivatives on the left side with stenosis of the ejaculatory duct on the contralateral side. This dual combination of uncommon anomalies is the rarest phenomenon and poses as a diagnostic dilemma for the radiologist. Emphasis is given to MRI as a one-stop shop modality in the evaluation of complete genitourinary system; as well as on the importance of TRUS as a screening tool in patients with infertility due to obstructive azoospermia.

Pictorial essay: Salivary gland imaging.

Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.

Neurological deficit as the first manifestation of vesical transitional cell carcinoma.

Transitional cell carcinoma of urinary bladder (TCCUB) usually presents with hematuria. Cerebral and leptomeningeal metastases as a first manifestation of TCCUB have been occasionally reported in the medical literature. Hence, we report a case of an elderly man who presented with localizing neurological signs and whose magnetic resonance imaging brain showed multifocal cerebral and leptomeningeal lesions suspected to be metastatic deposits. Thorough search for the primary tumor revealed TCCUB.

Esophagobronchial fistula - A rare complication of aluminum phosphide poisoning.

Aluminum phosphide is a systemic lethal poison. Fistulous communication between esophagus and airway tract (esophagorespiratory fistula) has rarely been reported in the survivors of aluminum phosphide poisoning. We report a case of benign esophagobronchial fistula secondary to aluminum phosphide poisoning, which to best of our knowledge has not been reported in the medical literature.

Ultrasonography with color Doppler and power Doppler in the diagnosis of periapical lesions.

AIM: To evaluate the efficacy of ultrasonography (USG) with color Doppler and power Doppler applications over conventional radiography in the diagnosis of periapical lesions. MATERIALS AND METHODS: Thirty patients having inflammatory periapical lesions of the maxillary or mandibular anterior teeth and requiring endodontic surgery were selected for inclusion in this study. All patients consented to participate in the study. We used conventional periapical radiographs as well as USG with color Doppler and power Doppler for the diagnosis of these lesions. Their diagnostic performances were compared against histopathologic examination. All data were compared and statistically analyzed. RESULTS: USG examination with color Doppler and power Doppler identified 29 (19 cysts and 10 granulomas) of 30 periapical lesions accurately, with a sensitivity of 100% for cysts and 90.91% for granulomas and a specificity of 90.91% for cysts and 100% for granulomas. In comparison, conventional intraoral radiography identified only 21 lesions (sensitivity of 78.9% for cysts and 45.4% for granulomas and specificity of 45.4% for cysts and 78.9% for granulomas). There was definite correlation between the echotexture of the lesions and the histopathological features except in one case. CONCLUSIONS: USG imaging with color Doppler and power Doppler is superior to conventional intraoral radiographic methods for diagnosing the nature of periapical lesions in the anterior jaws. This study reveals the potential of USG examination in the study of other jaw lesions.

Role of imaging in female infertility [Dr. K.M. Rai Memorial Oration Award].

Infertility in females is multifactorial in origin. Though hysterolaparoscopy is the gold-standard investigation, USG is usually the first-line investigation. MRI has expanded the usefulness of imaging in female infertility. This pictorial essay reviews the role of imaging in the evaluation of female infertility.

Cystic lymphangioma scroti: a common tumor at a rare location.

Cystic lymphangioma is a common benign tumor caused by lymphatic malformation. The scrotum is a very rare site for this tumor and only few cases have been reported in the literature. We herewith present a rare case of cystic lymphangioma of the scrotum in an ado-lescent who presented with an incidental scrotal swelling with no other abnormality, where the diagnosis was suspected on scrotal ultrasonography.

Liposarcoma scroti: A rare tumor.

Malignant extratesticular tumors (EXTT) are rare. Majority of EXTT are benign; lipoma being the commonest. Most of the malignant tumors are solid and have nonspecific features on ultrasonography (US). Computed tomography (CT) and magnetic resonance imaging (MRI) are more helpful. The authors report a rare case of liposarcoma of scrotum that was suspected on ultrasonography and computed tomography and confirmed on histopathology.

Renal lymphangiectasia associated with chronic myeloid leukemia.

Renal lymphangiectasia is a rare disorder characterized by dilatation of peripelvic, renal and perirenal lymphatic ducts. The exact etiology is not known. Congenital forms and ac-quired forms have been described. The latter has been attributed to obstruction of draining retro-peritoneal lymphatic ducts caused by either infection, inflammation or any other cause. We des-cribe the rare association of renal lymphangiectasia with chronic myeloid leukemia, which is probably not yet reported in the medical literature.

Ultrasonographic diagnosis of an unusual vesical hemangioma presenting as hydroureteronephrosis.

Vesical hemangiomas are rare and benign tumors of mesenchymal origin. They usually present with multiple episodes of hematuria and the diagnosis is usually achieved patho-logically. We present a rare case of vesical hemangioma at vesicoureteric junction that presented with abdominal pain secondary to hydroureteronephrosis and the diagnosis was suspected on ultrasonography and confirmed later by pathology.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy: A rare clinicoradiologic case.

Pachydermoperiostosis (PDP) or primary hypertrophic osteoarthropathy is a rare syndrome with diverse radiological and clinical features. Though the diagnosis can be made on the basis of the classic clinical and radiological features, it is often missed due to variable presentations. A case of PDP that presented with dental complaints and had almost all the clinical and radiological features described in literature is reported. We also discuss the differential diagnosis.

Acute gastric dilatation secondary to septicaemia in newborn: a rare entity.

Acute gastric dilatation in a newborn is a rarely encountered clinical entity. Such dilatation without any obstruction is furthermore rare. The authors hereby present a rare case of acute gastric dilatation that developed in a two-days old child who was born premature and was suffering from septicaemia and respiratory distress. The causes and the differential diagnosis of the rare condition are discussed.

Gastric outlet obstruction due to neurofibromatosis: an unusual case.

Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is an autosomal dominant condition with an approximate incidence of one in 3000 births. NF-1 is known to involve multiple systems in the body. Abdominal involvement include neurofibroma and tumor growth in the liver, mesentery, and retroperitoneum in addition to gastric and bowel tumors. Gastrointestinal neoplasms occur in up to one quarter of patients. The author reports a rare case of diffuse submucosal neurofibromatosis resulting in gastric outlet obstruction.

Gall bladder carcinoma presenting as multiple cavitary pulmonary metastases - a rare event.

Carcinoma of the gall bladder is the commonest malignancy of the biliary tract. It is either detected incidentally during routine imaging or presents as lump in right hypochondrium or with signs of jaundice. Rarely, it may present with multiple cavitary metastatic lesions in the pulmonary parenchyma. The authors, report such a rare case of gall bladder carcinoma that presented with extensive, bilateral pulmonary cavitary metastases with no evidence of any nodal disease and where the diagnosis was delayed due to this rare presentation.