ABSTRACT.A 54-year-old man presented for radiology with pain and a feeling of fullness in the upper abdomen and an epigastric mass. Ultrasound revealed a large cystic mass with internal echoes, lying posterior and inferior to left lobe of the liver. The gallbladder was thick-walled and contracted, and contained a calculus and echogenic sludge. A cystic structure that produced swirling flow signals on colour Doppler was demonstrated within the gallbladder. The CT scan showed a thickened gallbladder with adjacent inflammation and a 2-cm pseudo-aneurysm in its wall. High-density material was present in the gallbladder lumen, in the extra-hepatic bile ducts and around the gastrohepatic ligament. A thick haemorrhagic pus, from which Escherichia coli was cultured, was drained from the gastrohepatic collection. An elective coeliac angiogram demonstrated a solitary pseudo-aneurysm of the medial branch of the cystic artery. Selective catheterisation of this artery with a micro-catheter enabled complete exclusion of the pseudo-aneurysm by a single micro-coil. Histological examination of the gallbladder, which was ultimately removed at open cholecystectomy, demonstrated xanthogranulomatous cholecystitis. Cystic artery pseudo-aneurysm (CAP) is a very rare entity [1]; only 14 cases have been described in the literature, and its precise incidence is not known. Patients usually present with haemobilia, rarely with upper gastrointestinal bleeding and haemoperitoneum.Most patients have a history of acute cholecystitis or have undergone a cholecystectomy. There is only one previously reported case in which a cystic artery aneurysm was associated with xanthogranulomatous cholecystitis (XGC). This patient presented with obstructive jaundice, later developed haemobilia and was diagnosed on CT as having CAP [2][3][4].Here, we report a second patient with XGC and CAP, who presented with gastrohepatic ligament haematoma and haemobilia. We have not encountered this particular combination of pathologies in the published English language literature, and, to the best of our knowledge, this is the first report of this presentation. The CAP was successfully treated with coil embolisation followed by elective open cholecystectomy. Another distinct feature of this case is the imaging presentation of XGC, which does not match that described in previously published reports. Case reportA 54-year-old man was referred for an ultrasound of the upper abdomen with a complaint of epigastric pain. The patient was under treatment for a superficial transitional cell carcinoma (TCC) of the urinary bladder and had undergone a transurethral resection of the lesion two months prior to presentation. one month after tumour removal, he developed vague abdominal pain. On the initial consultation, no definite clinical diagnosis could be made and the patient was symptomatically treated with analgesics. On follow-up, an epigastric mass was found on clinical examination. This led to the referral for an ultrasound scan, which revealed a large cystic mass with internal...
BACKGROUND:Lymphadenopathy is one of the commonest clinical presentation among the children (0-14years) having several etiologies and can pose a diagnostic dilemma to a pediatrician. FNAC is an important and rapid diagnostic modality for the etiologic workup in significant lymphadenopathy. AIMS AND OBJECTIVES: To know the incidence of various causes of lymphadenopathy in children. To know the advantages of FNAC over surgical biopsy. MATERIALS AND METHODS: The present study comprises of FNAC of lymph nodes of 120 cases in pediatric age between 0-14years with lymphadenopathy, who attended the OPD and those admitted in Khaja
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