Roopak Dubey

Abstract

Background: Gallbladder cancer is frequently transmitted to the liver and other gastrointestinal organs through direct extension. Ovarian metastases of biliary origin are quite uncommon. Case Presentation: We report a rare case having Krukenberg tumours in both ovaries, an uncommon metastatic location of biliary cancer. A thorough analysis of the proposed tactics was carried out after a thorough critical review. The final diagnosis was made using a combination of radiology, histology, and serum markers. Conclusion: In the case of gallbladder cancer, the presence of a Krukenberg tumour should be examined. Keywords: Gallbladder cancer, Ovarian mass, Krukenberg tumor, bilateral

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Abstract

Background: CT scoring helps to stratify patient’s risk and predict short-term outcome of patients with COVID-19 pneumonia. we aim to assess the severity of COVID by examining the variations and degree of the pulmonary involvement on the HRCT thorax. We observed trend of increasing severity of COVID as predicted on HRCT in Eastern India population. HRCT Thorax of 2000 consecutive COVID positive patients were analysed to look for the patterns of lung involvement and to calculate a CT severity score. The CT severity score was compared with laboratory parameters like D-Dimer, CRP, ESR, Procalcitonin, WBC and Lymphocyte count by Pearsons correlation analysis. Results: Out of 2000 COVID positive patients 1220 (61%) patients were found to be radiologically positive on HRCT chest imaging while 780 patients (39%) had normal CT findings.Out of the 62 patients who died, 54 ( 87%) were having CTSS of > 15. Among the dead patient the prevalence of one or more comorbidities was significantly higher (49/62 patients, 79%) The proportion of patients having CT severity score between 16-25 (Severe patients) had increased from 4% in April-May to 27% in August. Conclusion: Trend of severity among COVID patients increased as the months passed from April to August. Most of the deaths in our cohort were associated with pre-existing comorbidities suggesting that the COVID was not the sole cause of these deaths. Among the biochemical markers D-Dimer and CRP correlated well with the CT severity score. Keywords: COVID, Severity, CT severity score, Morbidity, Mortality

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Abstract

Fahr’s disease (FD) is a rare disorder characterised by abnormal deposition of calcium in different parts of brain especially in basal ganglia, thalamus and dentate nucleus. Association of FD with ischemic stroke has been described in past but very less literature available showing association of FD with haemorrhagic stroke. We present here a case of 70 years old hypertensive male patient suffering from FD with left thalamic acute haemorrhage. Although basal ganglia is a common site for hypertensive bleed, but in this hypertensive patient, basal ganglia was spared. We assume that this could be due to presence of calcification within vessel walls of basal ganglia that strengthen the walls and hence act as a saviour for basal ganglia bleed in this case.   Keywords: Fahr's disease, Basal ganglia, Calcification, Haemorrhage, Hypertension

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Abstract

Pneumocephalus usually occurs because of a bony defect between the intracranial compartments and the paranasal sinus. We present a case of traumatic non tension pneumocephalus with accompanying subdural haemorrhage (SDH) and fractures of the roof of sphenoid sinus.We noticed complete resolution of pneumocephalus with in a day on repeat CT head done on the next day. Significant resolution of SDH was also noted. This was unexpected as usually it takes 2-3 weeks for the complete resolution of non tension pneumocephalus. We assume that fracture in the roof of sphenoid sinus lead to CSF and haemorrhagic leakage through the sphenoethmoidal recess located within the superior meatus. This was unusual as CSF leakage is itself a cause of development of pneumocephalus when intracranial pressure is expected to increases, according to Ball Valve theory. So, the resolution of pneumocephalus was before the development of sufficient intracranial pressure to cause Ball valve effect. Hence, a complete resolution of a significant pneumocephalus and prompt regression of SDH in head injuries, with in few hours, should raise an alarm to exclude the possible association of CSF rhinorrhoea. Keywords: Pneumocephalus, CSF rhinorrhea, Subdural haemorrhage, Sphenoid roof fracture.

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