Two Cases of Interrupted Inferior Vena Cava with Azygos / Hemiazygos Continuation.

Interrupted inferior vena cava (IVC) is a rare disease, occurring either in isolation or in association with asplenia or polysplenia syndromes. Infrahepatic part of the IVC is absent representing the failure of fusion of the vitelline and subcardinal embryological portions of the IVC. It is replaced by an enlarged azygos or hemiazygos vein continuing into the thorax, either into the superior vena cava or into the brachiocephalic veins. We present two cases of interrupted IVC, one occurring in isolation with hemiazygos continuation and discovered incidentally, and the second one is a child with azygos continuation, associated with polysplenia syndrome. Key Words: Inferior vena cava, Polysplenia, Azygous vein, Hemiazygos vein.

Spontaneous Pneumomediastinum in COVID-19 Pneumonia: A Rare Occurence.

Spontaneous pneumomediastinum with COVID pneumonia is a rare occurrence with or without accompanying subcutaneous emphysema or pneumothorax. The aim of this study was to establish relation of this complication to severity of lung disease and its clinical outcome. The study was conducted for a period of seven months from April to October 2020 in the CT Department of Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, Pakistan. All COVID positive patients having spontaneous pneumomediastinum on high resolution CT (HRCT) chest were included (n=14). These patients were assessed for severity of lung disease as per CT severity score (CTSS), and were followed up for their clinical outcome. All patients with spontaneous pneumomediastinum had moderate to severe degree of COVID pneumonia; mortality in patients with pneumomediastinum was 50%; and was seen in those patients who had greater severity of lung disease as per the CTSS. Key Words: Spontaneous, Pneumomediastinum, COVID, Pneumothorax, Subcutaneous, Emphysema.

Ancillary findings on high resolution CT chest associated with typical features of COVID-19 pneumonia (Observational descriptive study at a tertiary care hospital).

OBJECTIVE: To determine the frequency of ancillary pulmonary signs and their relation to the severity of disease seen on high-resolution computed tomography of chest in patients of coronavirus disease-2019 pneumonia. METHODS: The observational descriptive study was conducted at the Armed Forces Institute of Radiology and Imaging, Rawalpindi, Pakistan, from March to July 2020, and included in place of comprised all coronavirus disease-2019 patients who were found positive on reverse transcription-polymerase chain reaction-and were referred to have high-resolution computed tomography of chest. Ancillary pulmonary findings in addition to typical features of coronavirus disease-2019 pneumonia were recorded. These included vacuole sign, halo sign, reverse halo sign, subpleural white line, subpleural translucent line, microvascular dilatation, fibrotic streaks and bronchiectasis. Relative frequency of these signs were determined for mild versus and severe disease, as determined by the computed tomography severity score. Data was analysed using SPSS 26. RESULTS: Of the 1645 patients, 1286(78.2%) were males and 359(21.8%) were females. The overall mean age was 47.5±15.7 years (range: 1-92). High-resolution computed tomography was normal in 418(25.4%) patients, typical findings for coronavirus disease-2019 were seen in 1110(67.5%), indeterminate in 113(16.9%) and atypical in 4(0.2%). Vacuole sign, subpleural white line, subpleural translucent sign, microvascular dilatation and fibrotic streaks were more commonly seen in severe disease (p<0.001), while discrete pulmonary nodule was identified more in the milder form (p<0.05). Halo and reverse halo signs as well as bronchiectatic changes demonstrated no significant propensity to the degree of disease severity (p>0.05). CONCLUSIONS: Coronavirus disease-2019 pneumonia demonstrated various ancillary pulmonary features on high resolution computed tomography of the chest in addition to typical findings more commonly described; radiologists should be aware of these signs and their relation to disease severity.

Factors Affecting the Participants' Skills Test Performance in a Basic Life Support Course.

OBJECTIVE: To determine the effect of age, gender, varying specialties and year of residency on the practical skills of cardiopulmonary resuscitation in participants of basic life support (BLS) courses run at College of Physicians and Surgeons Pakistan (CPSP), Islamabad - Regional Centre of American Heart Association (AHA). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: College of Physicians and Surgeons of Pakistan (CPSP), Islamabad - Regional Centre of American Heart Association (AHA), from February 2013 to November 2016. METHODOLOGY: A total of 269 candidates participating in BLS courses were included in the study. Their age, gender, specialty, year of training and status (trainee or supervisor) were recorded. Results of practical skills were collected and data were compiled using Statistical Package for the Social Sciences (SPSS) version 17, to determine the factors affecting the outcome of BLS skills test. RESULTS: Junior residents performed better than the senior residents in their practical skills, while other factors including age, gender and specialty did not significantly alter the outcome of BLS skills performance. CONCLUSION: Better performance of junior residents compared to their senior counterparts implies that BLS training should be introduced at the beginning of the resident programme when residents are fresh into their training followed by refresher courses. Age, gender or specialty does not affect the performance of doctors' practical skills of BLS.

Delta-Beta Thalassaemia in a Pathan Family.

Delta-beta-thalassaemia (δß-thalassaemia) is a rare type of thalassaemia which mostly results from deletion of δ and ß genes with preservation of γ genes. δß-thalassaemia is classified into (δß)+ and (δß)0 types. The (δß)0-thalassemia is further divided into GγAγ(δß)0-thalassaemia and Gγ(Aγδß)0-thalassaemia. In heterozygous state, (δß)0mutations give rise to phenotype resembling ß-thalassaemia trait but with raised Hb-F, ranging from 5 to 20%, without a rise in Hb-A2. In homozygotes, the clinical picture is usually that of thalassaemia intermedia and the patients have 100% Hb-F. Workup of a 1-year child suffering from pallor, chronic ill health, and splenomegaly referred to our laboratory with the suspicion of ß-thalassaemia, ultimately resulted in a diagnosis on polymerase chain reaction as having homozygous inversion/deletion Gγ(Aγδß)0-thalassaemia. Her family members were also investigated.

A case of systemic lupus erythematosus with aplastic anaemia.

Systemic lupus erythematosus is an autoimmune disorder, which has a rare association with aplastic anaemia. A young 26 years old lady who presented with a history of intermittent fever, microcytic anaemia, joint pains and mild degree of splenomegaly was investigated. Bone marrow examination showed aplasia. Serological tests revealed positive antinuclear antibody and anti double-stranded DNA tests. Patient was diagnosed as having aplastic anaemia with Systemic lupus erythematosus, managed with steroids and being followed up for monitoring the response.

Vein of Galen aneurysmal malformation masquerading as carotid cavernous fistula in a child with proptosis.

PURPOSE: An infant with proptosis and dilated episcleral vessels was diagnosed with vein of Galen malformation, which is a rare condition presenting initially to an ophthalmologist. METHODS: An 8-month-old child presented with slowly progressive proptosis of the left eye of 5 months' duration. The proptosis was axial, nonpulsatile, with no associated bruit. Dilated corkscrew episcleral vessels were observed. The patient was referred to our center with diagnosis of carotid cavernous fistula. The child had a history of episodes of seizures. RESULTS: Contrast-enhanced computed tomographic scan of the patient showed dilated vessels, hydrocephalus, and dilated vein of Galen. Vein of Galen aneurysmal malformation was confirmed on magnetic resonance venography. CONCLUSIONS: Occasionally patients with Vein of Galen aneurysmal malformation may first present to the ophthalmologist. Ophthalmologists should therefore be aware of this rare but potentially treatable condition.