Presacral space is a potential space between the rectum anteriorly and lumbosacral spine posteriorly containing derivatives from various primitive germ cell types which serve as origin to a myriad of tumors. Imaging plays a vital role in diagnosis, characterization, assessing extent and evaluation of spread. We present a series of six cases of pediatric presacral tumors with intraspinal extension. The series comprises of an immature sacrococcygeal teratoma (Altman type II), a malignant sacrococcygeal teratoma (Altman type IV), a neuroblastoma, a rhabdomyosarcoma, a clear cell sarcoma and an Ewing’s sarcoma of the ilium which can be broadly categorized as tumors of germ cell, neuroblastic, mesenchymal, osteogenic origin. In spite of overlapping imaging features, careful retrospective observation revealed few distinctive features that would aid in optimal characterization of tumors with a fair degree of certainty.In summary, the salient imaging features that aid in differentiation are the epicentre of the tumor, pattern and degree of bone involvement, status of sacral foramina and neural elements and internal characteristics such as presence of fat, calcification, hemorrhage, necrosis, etc.
Cutaneous leucocytoclastic vasculitis (CLV) is a type of small vessel vasculitis, predominantly presenting with palpable purpuras and sometimes with systemic manifestations. The following report describes the case of a woman, who presented with fever, anorexia and maculopapular lesions over both lower limbs. Skin biopsy revealed CLV. CT scan demonstrated bilateral pulmonary nodules, ileocecal wall thickening and generalised lymphadenopathy. Colonoscopy guided biopsy obtained from ileocecal valve ulcer showed epitheloid cell granuloma with Langhans-type giant cells and caseous necrosis. Rapid clinical improvement was seen with anti-tubercular therapy. Among infectious causes, although rare and an uncommon presentation,Mycobacterium tuberculosisshould be considered as an important cause of CLV.
COVID-19 is a viral respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Majority of the cases present with upper or lower respiratory tract disease. Common complications of the disease include cytokine storm and acute respiratory distress syndrome. The disease is also found to be associated with an increased incidence of thromboembolism. However, data and literature regarding this dreadful complication are limited. Here, we present a case report of arterial thrombosis in COVID-19 which led to ischemia and gangrene of the fingers.
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