SUMMARYWe present a case report of splenic abscess causing pneumoperitoneum in a case of uncontrolled diabetes. The patient presented with chronic pain abdomen and fever which later evolved to acute abdomen during the course of hospital stay. An X-ray showed pneumoperitoneum and exploratory laparotomy was performed under a strong clinical suspicion of hollow viscus perforation. The patient was treated with antibiotics and had an uneventful recovery. BACKGROUND
Primary intracranial leiomyoma is a rare tumour of mesenchymal origin, with less than 30 cases reported in literature including two cases from the Indian subcontinent. In this article, we describe a case of primary intracranial leiomyoma in an immunocompromised patient with a brief review of literature.
Introduction: Breast Imaging, Reporting and Data System (BI-RADS) is an effective tool for management of patients with breast pathologies. While the BI-RADS 1 (negative) and BI- RADS 2 (benign) categories patients are advised for routine mammography screening. BI-RADS 4 (suspicious abnormality) and BI-RADS 5 (highly suggestive of malignancy) categories patients are recommended for tissue diagnosis, BI-RADS 3 category patients are managed with follow-up examinations. But upto 2% of BI-RADS 3 lesions are proved to be malignant on follow-up examinations and tissue diagnosis. Aim: To evaluate the efficacy of spectral Doppler indices in predicting malignancy in BI-RADS 3 category breast lesions. Materials and Methods: A prospective cohort study was conducted in the Department of Radiology, Katuri Medical College, Guntur, Andra Pradesh, India from July 2019 to February 2021. Study was conducted on 292 BI-RADS 3 lesions from 257 patients to evaluate the efficacy of spectral Doppler indices in differentiating malignant BI-RADS 3 lesions from benign ones. All the breast masses were evaluated with spectral doppler and the resistive and pulsatility indices were compared with histopathology findings of the suspicious lesions detected in follow-up examinations. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 2017 version 25, and the quantitative data was expressed in mean and standard deviation. Results: The patients recruited in the study were in age range of 27-80 years, and the mean age of the patients was 46±15 years (mean±SD). Follow-up examinations and tissue diagnosis of suspicious lesions revealed 8 out of 292 BI-RADS breast masses to be malignant. On spectral Doppler analysis, high resistivity and pulsatility indices are predictive of malignancy. A resistive index of more than 0.6 as a sign of malignancy proved to have a sensitivity of 87.5% and specificity of 85.5% and more than 0.8 as a sign of malignancy has a sensitivity of 25% and specificity of 95%. A pulsatility index of more than 0.9 as a sign of malignancy has a sensitivity of 87.5% and specificity of 87% and more than 1.6 as a sign of malignancy has a sensitivity of 37.5% and specificity of 96%. Conclusion: Spectral doppler is reliable in the prediction of malignancy of BI-RADS 3 breast masses.
Introduction: The aetiology of ascites can be established in a majority of patients with routine clinical examination and conventional laboratory and imaging investigations; but in a minority, the cause may remain undetected even after these examinations. This ascites is termed as ascites of unknown origin. The Contrast Enhanced Computed Tomography (CECT) abdomen of these patients sometimes shows peritoneal nodules which can be useful to establish diagnosis. Aim: To evaluate the diagnostic value of peritoneal nodules detected on CECT abdomen in the management of ascites of unknown origin. Materials and Methods: This retrospective study was conducted in Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India on the data retrieved from the medical records of the patients between January 2019 to January 2021. These patients had already been vainly investigated with basic clinical, laboratory and diagnostic ultrasound examinations for the aetiology of ascites. All the patients who were diagnosed to have peritoneal nodules on CECT abdomen and later underwent laparoscopic tissue diagnosis of these peritoneal nodules were included in the study. The sizes of the peritoneal nodules and the distribution of the pathology were collected from CECT abdomen reports and compared them with the histopathology findings. Statistical analysis and plotting of the Receiver Operating Characteristic (ROC) curve were done using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Fifty-two patients of ascites of unknown origin with peritoneal nodules were included in the study. Of the total, 36 (69.2%) patients were males and 16 (30.8%) were females. Mean age of the patients was 48 years (22 to 74 years). Tissue diagnosis of the peritoneal nodules revealed that majority of the patients had carcinomatosis peritonei (88.5%) while a minority had tuberculosis (11.5%). A nodule size of more than 5 mm as a sign of malignancy on CECT abdomen had a sensitivity of 93% and a specificity of 83%. Based on the tissue diagnosis of the peritoneal nodules these patients were treated with antituberculosis drugs for tuberculous abdomen and chemotherapy for carcinomatosis peritonei. Conclusion: Detection of peritoneal nodules on CECT abdomen can be helpful in guiding the clinician for further management of ascites of unknown origin.
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