Journal of Case Reports and Scientific Images

Journal Information
ISSN / EISSN : 2708-0056 / 2708-0064
Published by: AkiNik Publications (10.22271)
Total articles ≅ 38
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Mounika Katyayani K, Vamsikrishna Reddy K, Vamsikrishna P, Kanta Kumari P, Vijaya Laxmi B
Journal of Case Reports and Scientific Images, Volume 3, pp 26-28; https://doi.org/10.22271/27080056.2021.v3.i2a.35

Abstract:
Alkaptonuria is a rare genetic disorder of tyrosine metabolism, due to deficiency of the enzyme homogentisate 1, 2 dioxygenase. This results in characteristic features like blackish urine discoloration, ochronosis, arthropathy, cardiac valve deterioration. In this paper, the authors presenta case report of a 4-month-old boy who was brought by his mother to the well-baby clinic, with a chief complaint of black staining of nappy, a few hours after voiding. A qualitative examination of urine after an hour of the collection showed dark black discoloration, Quantitative examination reveals the presence of homogentisic acid to the extent of200mg/dl. The Diagnosis of Alkaptonuria was confirmed and the infant was started on Vitamin C and put under regular follow-up.
Anshul Agrawal, Rashpal Singh Gill, Abhimanyu Rana, Ashish Goyal
Journal of Case Reports and Scientific Images, Volume 3, pp 36-39; https://doi.org/10.22271/27080056.2021.v3.i2a.38

Abstract:
Meralgia paresthetica characterised by pain, tingling and numbness in lateral aspect of thigh. A 48 year-old male with 2 years history of left lateral thigh paresthesias and burning pain consistent with meralgia paresthetica was referred to our clinic after failing trials of physical therapy, nonsteroidal anti-inflammatories and neuropathic medications. We performed lateral femoral cutaneous nerve block with corticosteroid, after that patient had good relief for 2 months; however, block provided only temporary relief and patient again started feeling same pain. As this pain was limiting the patient's ability to perform his functions as truck driver, we planned to perform a pulsed radiofrequency treatment of the lateral femoral cutaneous nerve left side under ultrasound guidance. After locating the lateral femoral cutaneous nerve with ultrasound and reproducing the patient's dysesthesia with stimulation, pulsed radiofrequency treatment was performed at 42°C for 120 seconds. The needle was then rotated 180° and an additional cycle of pulsed radiofrequency treatment was performed followed by injection of 0.125 % bupivacaine with 20 mg triamcinolone. At 2 and 4 month follow-up visits, the patient reported excellent pain relief with activity and improved ability to perform his duties. We have also described various aetiologies for meralgia paresthetica and multiple modalities available for the treatment of meralgia paresthetica.
Sathish Babu, Jagadeep, Arif Khan S, Vivek Kumar As, Suji M, Vinod S
Journal of Case Reports and Scientific Images, Volume 3, pp 17-20; https://doi.org/10.22271/27080056.2021.v3.i2a.33

Abstract:
Introduction: Knee joint injuries and disease conditions that cause disruption of ligament, menisci, articular cartilage and other structures causing painful knee result in significant morbidity and disability. Aim: To describe the MRI features of various types of traumatic and non-traumatic lesions associated with painful knee. Materials and Methods: This hospital based descriptive study was conducted in a tertiary care institute (n=50) using 1.5T MRI for patients being referred to Department of Radiodiagnosis for the evaluation of painful knee were included in the study and results analysed by a descriptive analysis. Results: Meniscal tears were the commonest soft tissue abnormality in our study. Posterior horn of the medial meniscus were commonly involved and mostly of Grade 3. Commonest type of meniscal tear was vertical tear and usually associated with history of trauma. The commonest manifestation affecting the ACL was tear, predominantly acute in nature. Complete PCL tear was the commonest manifestation among PCL abnormalities. One quarter of the patients had associated bone contusion, femur was predominantly involved followed by lateral tibial condyle. Acute ACL tears were particularly associated with bone contusions. Popliteal cyst was the commonest cystic lesion and usually associated with coexisting effusions and meniscal tears. Osteoarthritic process was most commonly involved in the Patello-femoral compartment. Conclusion: For evaluation of painful knee, MRI is an accurate, cost-effective and a non-invasive choice of investigation. MRI can demonstrate the exact nature and extent of bony as well as soft tissue abnormality and is helpful in clinical decision making. Multiplanar imaging capacity of MRI enables a satisfactory diagnosis in such patients in whom a complete clinical examination is almost impossible due to pain.
Moueden Mohamed Amine, Messaoudi Reda, Seghier Fatima, G Ramakrishna Reddy
Journal of Case Reports and Scientific Images, Volume 3, pp 12-13; https://doi.org/10.22271/27080056.2021.v3.i2a.31

Abstract:
Aim: To present a case report of CLL, with a false macrocytosis caused by an important lymphocytosis and to demonstrate how we were able to detect it and our action to correct it. Methodology: When we have double population RBC histogram we have to use another parameter is the red blood cells most frequent volume (R-MFV) that defines the peak of the curve and fits the MCV in normal distribution. Results: CBC revealed leucocytosis (60×109/L), moderate normochromic anaemia (haemoglobin of 11.9 g/dL, MCV of 125 fl, In our case R-MFV is of 107 fl. The macrocytosis is still present; but would not be expected to reach 125 fl. It is also necessary to recalculate the parameters which depend on the MCV. Liver laboratory tests are abnormal in relation to the liver failure. This explains the mild macrocytosis observed even after correction of MCV. Conclusion: Pronounced leukocytosis can lead to overestimation of the MCV, especially in chronic lymphoid leukemia, therefore we must be careful when we interpret the parameters of complete blood count.
Vinod S, Jagdeep, Suji M
Journal of Case Reports and Scientific Images, Volume 3, pp 07-11; https://doi.org/10.22271/27080056.2021.v3.i2a.30

Abstract:
Background: Shoulder pain is frequently caused by subacromial impingement or rotator cuff injuries and forms the major indications for presurgical evaluation using MRI. Rotator cuff tears are caused by either internal degenerative changes or extrinsic compression of the acromion on the rotator cuff tendons. Reduction in subacromial space and abnormal acromial morphologies contribute to rotator cuff damage. Hence identifying these acromial abnormalities forms an essential part of evaluation since these forms the main indication for corrective acromioplasty. Methods: This institution-based MRI study was evaluated in three groups as follows: Group1-15 patients with rotator cuff tear; Group 2-15 patients with subacromial impingement; Group 3-10 controls without subacromial impingement pathology and rotator cuff tear and assessed for type of acromion, Lateral Acromial Angle (LAA), Acromion Index (AI), and Acromio-humeral Interval. Results: The type II Acromion showed significant association with rotator cuff tear and subacromial impingement followed by Type III and Type I respectively in our study. However, Type II acromion is relatively commoner in the control study and showed 26.92%, subacromial impingement showed 30.7% and rotator cuff tear showed 42.31%. The distribution of Lateral Acromial Angles differed significantly between the three groups. In comparison to controls, patients with low lateral acromial angle had significant association with subacromial impingement and rotator cuff tears. The age distribution of the Acromial Index differed significantly between the three groups with higher predilection to rotator cuff tear and impingement as age advanced and higher acromial index. Between the three groups, the subjects with low acromio-humeral distance had significant association with rotator cuff tears and impingement. Conclusions: Low lateral acromial angle, larger acromial index, and smaller acromio-humeral interval are related with a higher incidence of subacromial impingement and rotator cuff tears on MRI assessment of the shoulder.
Muni Bhavani Itha, Yarlagadda Krishna Bharathi, Satyanarayana Veeragandham
Journal of Case Reports and Scientific Images, Volume 3, pp 01-04; https://doi.org/10.22271/27080056.2021.v3.i2a.28

Abstract:
Tuberculosis (TB) is a global public health problem and is a leading cause of death, especially in underdeveloped and developing countries. In the majority of instances, renal tuberculosis is caused by the secondary hematogenous transmission of mycobacterium from pulmonary lesions to the renal cortex either during the initial TB infection or reactivation/endogenous reinfection of an old tuberculous focus. Upper tract urothelial carcinoma is a relatively rare kind of genitourinary malignancy and the majority of them take their origin from the urothelial lining epithelium. The co-occurrence of both renal tuberculosis and upper tract urothelial carcinoma is a rare presentation, and several theories have been proposed to demonstrate the etiological relationship between these two conditions. Here we reported a case of co-existing renal tuberculosis and urothelial carcinoma in a 54-year-old female with a remote history of treated pulmonary tuberculosis and also discussed the possible etiological root causes for their co-occurrence.
Jagadeep, Vinod S, Vivek Kumar As, Suji M, Arif Khan S
Journal of Case Reports and Scientific Images, Volume 3, pp 32-35; https://doi.org/10.22271/27080056.2021.v3.i2a.37

Abstract:
Background: Geographic clustering has been discovered in the etiology of chronic kidney disease (CKD). The use of renal ultrasound (USG) to diagnose CKD is common, but USG features are known to differ depending on the etiology of CKD.Objectives: The aim of this study was to identify the etiological factors and USG features of CKD.Methods: Ultrasonogram was done in adult patients diagnosed with CKD (n=100) and a control group (CG) with normal renal function (n=90). The following information was collected: demographics, related co-morbidities, serum creatinine levels, renal length (RL), renal cortical echogenicity, and the number of renal cysts and the severity of CKD was assessed.Results: The most important etiological factors of CKD were hypertension (38%) and diabetes (17%). CKD severity was as follows: 35% grade3a, 39% grade3b, 11% grade2 and 15% grade4. Mean renal length of the CKD group (9.07cm; SD=0.84) was significantly lower (p
Rajnish Raj, Khushneel Baath, Gagandeep Singh
Journal of Case Reports and Scientific Images, Volume 3, pp 05-06; https://doi.org/10.22271/27080056.2021.v3.i2a.29

Abstract:
The association of extrapyramidal side effects (EPS) with the use of conventional antipsychotics is well established, however, EPS can occur during treatment with anticonvulsant medications as well. There are several case reports of the development of involuntary movement disorders including chorea and tic disorder after lamotrigine (LTG) treatment. However, LTG-induced involuntary eyelid movement disorder is extremely rare. Most of this side effect was reported in patients with partial and generalized seizures, and only very few cases were in nonepileptic patients. In contrast, we present the case of 42 years old bipolar patient who developed blepharospasm during LTG therapy and again during re-challenge with the same agent. The focus of discussion will be on common side effects of this medication and previous reports of lamotrigine associated blepharospasm. We will also discuss a possible underlying mechanism.
Shilpi Srivastava, Prabhat Saxena, Subhash C Sylonia
Journal of Case Reports and Scientific Images, Volume 3, pp 14-16; https://doi.org/10.22271/27080056.2021.v3.i2a.32

Abstract:
Background: Esophageal duplication cyst is an uncommon condition but, it is essential to be considered in the differential diagnosis of chronic cough and wheezing among young children. Surgery is indicated in symptomatic cyst, as early as possible to prevent complication and potential malignant transformation. Aim- We reported this case, as knowledge of esophageal duplication cyst's clinical features, imaging findings and knowledge of their mimics may help radiologists & clinicians to arrive at the correct diagnosis as earliest possible. Imaging Findings: We reported a case of 9 year old male child, admitted with fever, cough & decreased oral intake. Child was on oral treatment for last 8 days with no relief. His history was significant for recurrent episodes of cough and wheeze. Chest X ray showed a well defined homogenous, broad based opacity, projecting towards right mediastinum with smooth lateral borders, same as thymic shadow. CECT chest revealed a cystic paratracheal, paraesophageal mediastinal mass with fluid attenuation of 25 to 35 HU in right mediastinum obstructing the right lateral wall of trachea and esophagus. Patient got operated, histopathological examination confirmed a diagnosis of esophageal duplication cyst. Conclusion: Chest radiographs are initial Investigation of choice, however it is inconclusive, as it may mimic a thymic shadow on chest radiograph. CECT is the preferred imaging tool for the diagnosis of EDC. Usual approach is to surgically excise these lesions.
Sathish Babu, Sarath Chandran, Abdul Eksana As, Vinod S
Journal of Case Reports and Scientific Images, Volume 3, pp 21-25; https://doi.org/10.22271/27080056.2021.v3.i2a.34

Abstract:
Objective: A prospective study developed to determine the relationship between the ultrasonographic parameters (kidney length, parenchymal thickness and parenchymal echogenicity obtained from both kidneys) and glomerular filtration rate in patients with Chronic Kidney Disease. Materials and methods: A cross sectional study in 50 patients referred to the department of Radiodiagnosis, Sree Mookambika Institute of Medical Science, Kulasekharam, for ultrasound abdomen with abnormal renal function tests during the period of 12 months (June 2019- June 2020) and who fulfilled the inclusion and exclusion criteria were selected. Both kidneys were evaluated by Siemens ACUSON X300 scanner using a 5.0MHZ wide frequency band, phased assay probe. The US parameters renal length, mean parenchymal thickness and parenchymal echogenicity were evaluated for both right and left kidneys. All three parameters were scored for each kidney and sum of the average scores were used to calculate ultrasonographic CKD score. The eGFR was calculated by using MDRD equation. The correlation between the eGFR and the kidney length, parenchymal thickness, parenchymal echogenicity and ultrasonographic CKD score were made out separately. Results: The mean serum creatinine was 3.9±2.2 and estimated glomerular filtration rate is 22.8±15.1. No patients with eGFR > 90 ml i.e. stage I of kidney disease was studied. The mean renal length in stage V (8.0±1.4), stage IV (8.4±1.0), stage III (9.5±1.3) and stage II (9.8±0.6). The parenchymal thickness in stage V (10.2±3.2), stage IV (10.4±1.8), stage III (13.2±2.6) and stage II (14.2±2.1). The median parenchymal echogenicity in stage V (2.5), stage IV & III (2) and stage II (1). The sonographic CKD score from 4 to 13, stage V (7.9±2.4), stage IV (8.1±1.6), stage III (6.1±1.5) and stage II (5.0±0.7). Conclusion: The ultrasonographic CKD score calculated from the USG parameters such as renal length, parenchymal thickness and parenchymal echogenicity is useful for differentiation of CKD stage 3-5 compared to CKD stage 1-2. We concluded that the ultrasonographic CKD score provide more objective data in the assessment of CKD.
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