Bhattarai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Upper gastrointestinal bleeding is a rare presentation of the aortoesophageal fistula (AEF) and is usually caused by thoracic aortic aneurysms. We present the case of a 61-year-old male who presented with chest pain and hematemesis. A chest X-ray showed a widened mediastinum. The patient underwent computed tomography angiography (CTA), which showed the presence of a large aneurysm in the aorta, which caused compression of the trachea, esophagus, and left pulmonary artery. Additionally, there was evidence of an AEF. It was decided to perform an emergency surgical intervention on the patient. However, the patient had multiple episodes of hematemesis and expired.

Spontaneous pneumomediastinum (SPM) refers to the presence of air in the mediastinum without any obvious cause. It is an uncommon condition occurring due to alveolar rupture as a result of increased intrathoracic pressure. It is commonly seen in young males, patients with known asthmatic disorders and pulmonary diseases. We report a rare case of SPM in a young healthy male without any significant past history. The patient was managed conservatively and discharged.

Subcutaneous emphysema refers to the presence of air in the subcutaneous planes of the body. It may result from a benign cause like trauma, accidental injection, or entry of air through a negative pressure gradient, or it could be a part of the life-threatening ailment in the form of necrotizing fasciitis with gas gangrene. We report a 31-year-old male who sustained trauma to the hand followed by pressurized air injection into the wound resulting in the subcutaneous emphysema of the left upper limb. Imaging studies confirmed the presence of subcutaneous emphysema. The patient was managed conservatively with limb immobilization. Being rarely reported in the medical literature, we aim to improve the awareness of such a condition and beware of impending complications.

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Breast lump in perimenopausal women is considered a primary malignancy unless proved otherwise. Metastasis to the breast from extramammary sites is rare. Malignant melanoma (MM) is known for its ability to spread to distant sites, which can be both hematogenous and lymphatic. The common sites are skin, lung, liver, brain, etc. However, reports of melanoma metastasizing to the breast are rare. We present a case of 50-year-old female patient, who underwent wide local excision and split skin grafting for MM right leg. She did not undergo any adjuvant therapy and one year later presented to us with a solitary lump occupying the upper inner quadrant of the right breast. The breast lump turned out to be metastatic deposit from MM based on the presence of melanin in cells on fine needle aspiration cytology (FNAC). Therefore, breast lump in perimenopausal is not always a primary malignancy, and differential diagnosis should also include metastatic tumors.

Background Use of B-mode ultrasound (US) may not obviate the need for diagnosis by histopathology, which is an invasive technique and remains the gold standard. These limitations are being overcome with the advent of shear wave elastography (SWE). Objectives To assess the diagnostic role of SWE parameters and combined SWE and B-mode US in diagnosing malignant breast lesions. Method This cross-sectional study included all patients with a breast mass on clinical examination. A B-mode US with a Breast Imaging Reporting and Data System (BI-RADS) assessment and SWE evaluation (distance ratio [DR], area ratio [AR] and shear wave velocity [SWV]) in the lesion and healthy breast tissue of all recruited patients was performed. Cut-offs for SWE parameters were derived by receiver operating characteristic (ROC) analysis. The diagnostic performance of the B-mode US, the SWE parameters and the combined imaging in diagnosing malignancy was assessed. Results This study included a total of 175 breast masses. The median values of the SWE parameters were significantly higher ( p < 0.001) in the malignant breast masses (DR, 1.29 vs. 1.03; AR, 1.69 vs. 1.06; and SWV, 9.1 metre per second [m/s] vs. 2.1 m/s). The ROC cut-off for malignancy was derived at 1.135 m/s, 1.18 m/s and 3.18 m/s, respectively, for DR, AR and SWV. The area under the ROC curve was highest for the DR (0.930), whilst this value was 0.914 and 0.901 for the SWV and AR, respectively. Amongst the respective sensitivities and specificities of the B-mode US (90.6% and 90%), SWE (97.6% and 61.1%), SWE (excluding AR) (96.5% and 77.8%) and combined imaging (100% and 72.2%), the highest sensitivity was noted for the combined method. Conclusion All the SWE parameters were significantly higher in the malignant breast masses, compared to the benign lesions. On combining SWE and B-mode US, there was a significant increase in sensitivity but a decrease in specificity.

Splenic abscess is a relatively uncommon condition, posing a diagnostic and therapeutic challenge for the treating physician. It occurs due to haematogenous spread from endocarditis or other septic foci, especially in immune-compromised individuals and diabetics. We describe an elderly male who presented with splenomegaly and low-grade fever with no predisposing factors. Examination revealed a tender splenomegaly. Ultrasonography (US) showed a hypoechoic area within the spleen from which guided aspiration of pus grew Staphylococcus aureus and Klebsiella pneumoniae. Percutaneous drainage and culture-based antibiotics failed to resolve the abscess, obligating surgical drainage. Intraoperative biopsy from the abscess wall was reported as splenic marginal lymphoma. This unusual presentation of lymphoma needs to be considered in splenic abscess without known risk factors.