Background Spontaneous pneumomediastinum, pneumothorax and spontaneous subcutaneous emphysema are rare entities. A rising trend in the setting of COVID-19 even in patients who are not put on invasive ventilation can suggest an alternative aetiology. Case presentation We describe four cases which presented with suspected symptoms of COVID-19 and were diagnosed with pneumomediastinum, pneumothorax, and subcutaneous emphysema which would have been missed if not for computed tomography scan performed at the time of admission. Three of these cases had no prior history of any iatrogenic intervention, and the fourth person developing pneumothorax and subcutaneous emphysema after intubation. Conclusions Pneumomediastinum, pneumothorax and subcutaneous emphysema can be noted as a complication of COVID-19 itself as well as the complication of management of COVID-19.
Introduction Emphysematous epididymo-orchitis in the young to middle age groups without any comorbidity like diabetes or metabolic disorders is an uncommon entity. Case report We present a case of a nondiabetic young patient, diagnosed with emphysematous epididymo-orchitis as a sequela to urinary tract infection. Discussion Clinically differentiating diagnoses of the acute scrotum may be difficult and ultrasound can be used reliably as the initial modality showing the presence of air for early diagnosis. Conclusion Nondiabetic young patients without any metabolic disorder should also be suspected for emphysematous epididymo-orchitis in the setting of the acute scrotum. An ultrasound examination can predict its presence with confidence.
Background: The objectives were to perform an analysis of lung ultrasonography (LUS) findings in severely ill patients with novel coronavirus disease-2019 (COVID-19) and to compare the accuracy with high-resolution computed tomography (HRCT) of the thorax. Methods: Sixty-two intensive care unit (ICU) patients with COVID-19 were evaluated during their hospital stay. LUS was performed with convex and linear transducers using a designated ultrasonography machine placed in the COVID-19 ICU. The thorax was scanned in 12 areas. Initial LUS was performed on admission and follow-up LUS was done in 7 (mean) days. At the time of the initial LUS, HRCT was performed in 28/62 patients and a chest radiography in 19/62 patients. Results: On admission, LUS detected pleural line thickening (>6 lung areas) in 49/62, confluent B-lines in 38/62, and separate B-lines in 34/62, consolidation in 12/62, C prime profile in 19/62, and pleural and cardiac effusions in 4/62 and 1/62, respectively. The single beam “torchlight” artifact was seen in 16/62, which may possibly be a variation of the B-line which has not been described earlier. Follow-up LUS detected significantly lower rates ( P < 0.05) of abnormalities. Conclusion: Ultrasound demonstrated B-lines, variable consolidations, and pleural line irregularities. This study also sheds light on the appearance of the C prime pattern and “torchlight” B-lines which were not described in COVID-19 earlier. LUS findings were significantly reduced by the time of the follow-up scan, insinuating at a rather slow but consistent reduction in some COVID-19 lung lesions. However, the lung ultrasound poorly correlated with HRCT as a diagnostic modality in COVID-19 patients.
Introduction: Novel Coronavirus-2019 (nCoV-2019) is capable of human-to-human transmission and can lead to acute respiratory distress syndrome similar to Middle East Respiratory Syndrome (MERS) due to lung parenchyma destruction. Some patients with COVID-19 consistently demonstrated no hypoxaemia, however, some patients develop sense of difficulty in breathing due to increased airway resistance. Aim: To assess the potential of High Resolution Computed Tomography (HRCT) thorax as an early predictor of hypoxaemia in COVID-19 patients. Materials and Methods: A prospective longitudinal cohort study of 1000 Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 and HRCT thorax positive patients, who were monitored simultaneously for SpO2 levels, were undertaken. HRCT findings were graded into Computerised Tomography Severity Index (CTSI) and correlated with patient’s SpO2 levels, at the time of scan on admission. Patients, who had normal SpO2 levels (≥95%) at the time of initial scan, were monitored upto five days. Pearson’s correlation test was used to find correlation between CTSI and SpO2 levels. Results: In present study group there was male predominance (4:1). Fever was the most common clinical presentation followed by cough. HRCT thorax features were categorised as Typical 769 (76.9%), Indeterminate 176 (17.6%) and atypical 55 (5.5%). 371 (82.8%) patients with SpO2 >95% were having CTSI between 0-7, similarly 189 (54.4%) patients with SpO290-94% were having CTSI between 8-15 and 133 (64.8%) patients with SpO2 <90% were having CTSI between 16-25. So, the present study categorised the patients into three groups- Category 1 (CTSI 0-7), Category 2 (CTSI 8-15) and Category 3 (CTSI 16-25) for better and prompt identification of clinical severity and their management. Majority of patients in CTSI category 1, 2 and 3 were having SpO2 levels ≥95%, 90-94% and <90%, respectively. Statistical correlation between CTSI and SpO2 levels at the time of initial scan was significant (Pearson’s correlation coefficient (r)=-0.261 and p-value <0.01). Number of patients who developed hypoxaemia (SpO2 <95%) on follow-up in CTSI Category 1, 2 and 3 were 42 (11.32%), 10 15.87%) and 2 (14.28%), respectively. The association between CTSI and development of hypoxaemia based on follow-up SpO2 levels was statistically found to be insignificant (chi-square value=1.21, degree of freedom (d.f.) 2 and p-value=0.570). Conclusion: In present study group, a negative correlation was established between CTSI and SpO2 levels. The association between CTSI and development of hypoxaemia on follow-up SpO2 monitoring was found to be non-significant statistically. So, HRCT thorax cannot be relied upon as an early predictor of hypoxaemia in COVID-19 patients.
Objectives: We present a case report and review the literature on Hajdu Cheney syndrome (HCS), an extremely rare connective tissue disorder with <100 cases reported in the last 72 years. We have emphasized on the patterns of acro-osteolysis (acrosteolysis) in the literature review to conclude if the syndrome follows any particular pattern like in our case. Material and Methods: All major databases were searched for all cases of HCS. One hundred and eighty-eight hand radiographs were analyzed and detailed analysis of all digits was carried out with emphasis on the pattern of acrosteolysis. Results: Acrosteolysis may not be a mandatory association in HCS as 18.8% did not have acrosteolysis at all. The first finger to be involved in 90/96 (93.7%) of the cases was the index finger, followed by the middle finger and then the thumb. The 4th digit (ring finger) was involved in only 11/96 (11.4%) of the cases, of which 9/11 (81.8%) were above the age of 25. Incidence of acrosteolysis of the 4th digit when in comparison to all other finger has a P < 0.05 and a P < 0.001 with the index finger. Newborn with HCS evaluated for acrosteolysis at birth was negative. Conclusion: There was statistical evidence to conclude that in a majority of the cases the 4th digit was involved the least. A rough timeline of the onset and progression of acrosteolysis was made. An attempt was made to shed light on the possible lesser-known manifestations of the syndrome such as retroflexed odontoid, Arnold Chiari I, middle phalanx osteolysis, and first carpometacarpal joint osteolysis. As very little is known about the disease and awareness about it is pertinent for early management and to differentiate it from other less-lethal causes of acrosteolysis.
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