SummaryPancreaticopleural fistula is an extremely rare complication of chronic pancreatitis with characteristic feature that it may appear in the absence of changes of acute pancreatitis. We present a case of a 32-year-old man whose CT scan showed multiple pseudocysts along the body and tail of the pancreas, left crus of diaphragm and in the posterior mediastinum with associated splenoportal thrombosis. MR cholangiopancreatography imaging diagnosed the case as a pancreatico-pleural fistula, with the fistulous tract connecting distal body and tail of the pancreas to the posterior mediastinum through a diaphragmatic hiatus with right-sided mild-to-moderate pleural effusion. Meanwhile the patient was treated conservatively for his acute symptoms that included pleural tap also. Finally, endoscopic retrograde cholangiopancreatography was done and minor papilla papillotomy was performed and a stent was placed. Knowledge about such cases would help one to be aware of such a rare but dangerous complication, so that timely and correct diagnosis and management can be undertaken. BACKGROUND
Castleman's disease (CD) is a rare lymphoproliferative disease of uncertain etiology that affects lymph nodes. CD can be classified as a) unicentric vs. multicentric, based on clinical and radiological findings, b) hyaline vascular (80-90%) vs. plasmacytic (10-20%) vs. mixed cellularity variety based on histopathology. Unicentric disease is more common in the 3rd and 4th decade, whereas the multicentric form is more common in the 5th and 6th decade with no sex predilection. HIV seropositive individuals appear to be at an increased risk for multicentric castleman's disease (MCD) at a younger age due to the increased incidence of HHV- 8 infection. Diagnosis is usually based on histopathology features as imaging features show considerable overlap, thus posing diagnostic difficulties. Overall prognosis is good, particularly in the unicentric variety of disease. We have presented a case of the unicentric CD in a 40 year old male patient having abdominal pain and hematuria as chief complaints.
SummaryMalrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes results in delayed diagnosis and treatment. We present the case of a 28-year-old woman who presented with vomiting and mild acute pain in the abdomen. CT scan showed abnormal location of the midgut and abnormal relation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) and duodenal jejunal flexure, confirming midgut malrotation. Peroperative findings showed the duodenum, small bowel loops located on the right side of the abdomen. The caecum and appendix were located at the midline in the epigastrium with the presence of Ladd's bands. SMA right and anterior to SMV whirled around SMA. Incidentally, the intraoperatively dilated left renal vein was compressed between the SMA and the aorta, which was confirmed retrospectively on CT scan with no symptoms related to the condition. BACKGROUND
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