months. No cause could be found despite multiple investigations. There was poor response to medication. The child was referred to dermatology for the evaluation of a rash that had developed over the past 1 month. According to her mother, the rash appeared as erythematous papules in crops and then resolved with scars. Examination revealed multiple painful erythematous papules scattered over the limbs in different stages of evolution (Figure 1). Some were raised whereas others were umblicated in the center with a necrotic base. Healed lesions appeared as whitish, porcelain-like macular scars (Figure 2). Systemic examination was normal. Her complete blood count, renal functions, liver functions, abdominal sonography and barium meal follow-through, and coagulation profile including the international normalized ratio and serum antinuclear antibody revealed no abnormality. Skin biopsy showed a thin epidermis with hyperkeratosis overlying a necrobiotic dermal collagen with sparse inflammatory infiltrate. The blood vessels were dilated with swelling of endothelial cells and luminal thrombosis. Scattered mucin deposits were also seen. Based on historical features, characteristic skin lesions, and a supportive histology, the patient was diagnosed with Degos disease. Aspirin (3 mg/kg) and dipyridamole (5 mg/kg) were prescribed. Within 48 hours, the patient improved. Irritability reduced significantly. Active lesions started healing. Abdominal pain improved but vomiting continued although frequency was reduced significantly. At the time of reporting, the patient is still admitted in our pediatric
A 31 years old female presented with swelling and pain above the right knee for three years. On examination, there was a tender swelling over the right knee more pronounced over the suprapatellar region. Plain X-ray, US, CT scan and MRI of the knee were suggestive of Primary synovial osteochondromatosis (PSC) of the suprapatellar pouch. Patient underwent total synovectomy and the diagnosis of synovial osteochondromatosis was confirmed histopathologically. Recognizing the imaging appearances of PSC is important to improve patient management.
Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. We demonstrate rare locations and unusual complications of this entity during past 6 years. Rare locations during our observation included lumbar spine, sacral spine, spleen, ovary, abdominal wall, diaphragm, pelvis and right kidney. Unusual complications included formation of bronchopulmonary fistula, complete collapse of left lung secondary to hilar location of Hydatid cyst and hydatiduria.
Hemichorea-hemiballismus, secondary to hyperglycemia, is a rare but easily treatable condition that is usually associated with type II diabetes mellitus. This is a case of a 68-year lady, with long-standing, poorly controlled diabetes mellitus, who presented with disabling right-sided hemichorea-hemiballismus. The T1-weighted magnetic resonance imaging revealed hyperintensity in the basal ganglia. The abnormal movements subsided within a few days after achieving euglycaemia with insulin therapy. This case highlights the importance of treatment of hyperglycaemia in a diabetic patient presenting with acute or sub-acute abnormal movement disorder.
Objective: To assess the diagnostic accuracy of trans-abdominal ultrasound (TAUS) in detecting choledocholithiasis, keeping MRCP as the gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Magnetic Resonance Imaging, Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun 2018 to May 2019.
Methodology: 102 patients of either gender, age 20-85 years with the clinical suspicion of choledocholithiasis and obstructive jaundice were included. Trans-abdominal ultrasonography was performed for radiological detection of disease. All selected cases then underwent MRCP for confirmation of findings.
Results: Mean age of the patients was 54.27 ± 15.14 years. 47 patients (46.1%) were males, and 55 (53.9%) were females. All patients were subjected to trans-abdominal ultrasound and MRCP. TAUS showed choledocholithiasis in 82 (80.3%) patients. MRCP confirmed choledocholithiasis in 81 (79.4%) cases, whereas 21 (20.5%) revealed no choledocholithiasis. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of TAUS were 96%, 80.9%, 95%, 85% & 87.86%, respectively.
Conclusion: Diagnostic accuracy of trans-abdominal ultrasonography in detecting choledocholithiasis is significantly high enough to be used as a first-line imaging modality as MRCP is available only in specialised care centres.
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