Year 2017, Volume 1 - Issue 2

No Abstract

Background: Anorectal malformations (ARM) can present in different fashions. Rectovestibular fistula is one of the congenital ARM. There is abnormal connection between the rectum and vulval vestibule. ARM is called as rectovaginal fistula if it is within the hymen. Case presentation: We present a 7-years old female child who reported of passing feces and gas through the vaginal passage. The child was brought late by the parents because of rural background. She was evaluated by abdomen plain Xray, US, MRI and special investigation by injecting contrast from the common opening. The diagnosis was confirmed as that of congenital recto-vestibular fistula (CRF) by these radiological investigations. Conclusion: Radiological modalities are of great importance for the confirmatory diagnosis of rectovestibular fistula. This further helps in appropriate surgical management.

Background: Abnormal ocular movements may also mimic epileptic seizures, such as in paroxysmal tonic upward gaze, blepharospasm, ocular tics, and paroxysmal eyelid movements (PEM). From a diagnostic, management and prognostic perspective it is important to undertake an accurate assessment of whether abnormal ocular movements are epileptic in origin or not. Case Presentation: We present a child from a tertiary paediatric epilepsy centre in the United Kingdom with PEM associated with photoparoxysmal responses, which was a source of diagnostic confusion. EEG recordings captured the PEM episodes to confirm the diagnosis. Conclusion: The presentation of children with epilepsy with ocular abnormal movements, particularly in the presence of photoparoxysmal responses, should raise suspicion of possible PEM. Confirmation is essential by capturing these events on EEG.

Background: Hepatocellular cancer (HCC) is the fifth-leading cancer in men worldwide. Here we present two HCC patients who showed high diffuse renal parenchymal retention of 99mTc MDP on bone scan. Cases presentation: Bone scan with 99mTc MDP was performed in two known HCC patients, which showed skeletal metastases in one and absent in other case. Their kidneys showed high renal parenchymal retention of tracer with kidneys looking much HOT than adjacent bones. The differential diagnosis of hot kidneys include nephrocalcinosis, hypercalcemia, hyperparathyroidism, chemotherapy, sickle cell disease, acute renal injury, recent radiotherapy and aluminum breakthrough of 99Mo-99mTc generator. Our patients did not fit in any of these. Hot kidneys in patient with liver cirrhosis have been reported due to hepatorenal syndrome. Although chronic liver parenchymal disease was present in the background of HCC, but our patients were not having hepatorenal syndrome (normal renal function tests). Quality control of generator and MDP vials used showed absence of any aluminum breakthrough and labeling efficiency was greater than 95% respectively. So, the exact cause of hot kidneys in these cases cannot be ascertained and some altered metabolism in liver and hemodynamic changes in body due to HCC might be the cause. Conclusion: High diffuse renal parenchymal retention of 99mTc MDP might be seen on bone scan in HCC cases. Its clinical significance is unknown and needs further research to find out its exact mechanism and cause.

Background: Juvenile nasopharyngeal angiofibroma (JNA) also called as bleeding fibroma as this is highly vascular tumor. This is a benign tumor of prepubertal and young adults which is locally aggressive and has got tendency to bleed. The extension of the tumor takes place because of potential available nasopharyngeal space. Case presentation: We present two cases of juvenile nasopharyngeal angiofibromas in different stages with highlighting the role of contrast enhanced computerized tomography (CECT). Conclusion: We emphasize over the clinico-radiological evaluation for making the diagnosis. The correct pre-operative radiological staging is mandatory prerequisite for the surgical management.

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome manifests as a significant, medication-induced, adverse reaction with cutaneous, hematological and multi-organ involvement. Sero-negative autoimmune encephalitis is inflammation of the brain secondary to autoimmune processes in the absence of an identifiable autoantibody. Case presentation: We present a pediatric case of sero-negative autoimmune encephalitis who subsequently developed DRESS syndrome as a result of exposure to ceftriaxone, omeprazole or acyclovir. She did not respond to either high-dose steroids or intravenous immunoglobulins (IVIG). Plasmapheresis was successful in treating symptoms relevant to both DRESS and sero-negative autoimmune encephalitis. No side effects were encountered. Conclusion: To our knowledge, plasmapheresis has only been reported once to treat DRESS syndrome in a pediatric patient. Early recognition and treatment of this syndrome is paramount. We suggest that plasmapheresis is a relatively safe alternative treatment option for resistant cases especially within the context of other autoimmune conditions.

Background: Monorchism is having only one testis and cryptorchidism is undescended testis. This is usually congenital anomaly but can happen as a result of trauma or surgical procedure undertaken. There are great psychosocial factors related to this entity. The complete evaluation is of paramount importance. Radiological protocol for detailed search for the hidden testis is of utmost importance for future management procedure. Case presentation: We present 2-years old male child who was evaluated for having an empty scrotal sac. He underwent Ultrasound (US), and magnetic resonance imaging (MRI) for the evaluation. Diffusion weighting images (DWI) played a great role in the diagnosis. The child was having only left sided testis and that too was undescended. Conclusion: There is great value of cross-sectional imaging in diagnosing the hidden testis. The sonography remains the first investigation of choice. MRI should be undertaken to locate the testis but may fail also for the localization. Diffusion weighted imaging (DWI) plays an important role with great reliability in the diagnosis among pediatric cases being radiation-free modality.

Background: NMDA (N-methyl-D-aspartate, a glutamate receptor) receptor is involved in higher brain functions including learning and memory. Anti-NMDA receptor encephalitis is an autoimmune disorder with complex presentations that includes psychiatric symptoms, memory deficits and autonomic instability. It has been recognized as an important differential diagnosis in patients presented initially with psychiatric manifestations. Patients present variant signs that range from anxiety symptoms and seizure to unresponsive states, which may mislead diagnosis towards psychosis in the emergency department as this disease is a neurological disorder in psychiatric disguise. Case presentation: We present a case of a 6 years old girl with psychiatric manifestations in terms of change in behavioral aspects like being fearful, restless and anxious, which progressed to autonomic instability and decreased level of consciousness within days. EEG was carried out beside anti-NMDA receptor antibodies, and the patient was diagnosed with anti-NMDA receptor encephalitis, which was treated with monoclonal antibody (rituximab) and psychotropic medication, all symptoms subsided and full recovery was obtained after a few months. Conclusion: This case describes a treatable medical condition that may be missed in emergency settings. Hence, the awareness of this disorder is important for diagnosis as acute psychotic episodes. Correct diagnosis and right evaluation can lead to early intervention and better prognosis.

Background: Osteoid osteoma is a benign tumor, predominantly affects the younger age group with characteristic nocturnal symptoms, relieved by rest and anti-inflammatory drugs. It can affect any bone; the most common site is shaft of long bones of lower limb (90%). It is quite uncommon to find osteoid osteoma in acromion of scapula. Case Presentation: We describe a case of 46 year old male, presented with pain in left shoulder that simulated left shoulder joint arthritis. The diagnosis of osteoid osteoma involving acromion of scapula was made on bone scan. Tc99m MDP SPECT-CT images showed a distinct focus of increased uptake in the acromion of left scapula with characteristic central lucent nidus on CT images. Conclusion: Though Osteoid osteoma in acromion is very rare, shoulder pain in middle age group, when evaluated on nuclear medicine floor, should be evaluated with correlative SPECT-CT images to rule out such rare bony pathologies.

No Abstract