PRIMARY PULMONARY TUBERCULOSIS

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Findings:

The examination from February 2002 is normal.However, right hilar and right paratracheal lymphadenopathy has developed in the setting of a positive PPD.



Diagnosis: Primary pulmonary tuberculosis.

Discussion:

Primary tuberculosis is the most common form of pulmonary tuberculosis in infants and children. However, its incidence has increased in adults, accounting for about 25% of all adult tuberculosis cases.The typical radiographic appearance of primary tuberculosis is parenchymal disease, lymphadenopathy, pleural effusion, miliary disease, or lobar or segmental atelectasis. However, approximately 15% of patients will have a normal chest radiograph.Primary pulmonary tuberculosis affects the areas of greatest ventilation, typically the right middle lobe, the lower lobes, and the anterior segment of the upper lobes. Other causes that may simulate tuberculous lymphadenopathy includes metastases and histoplasmosis in endemic areas.Fine, discrete nodular areas of increased opacity on chest radiographs is very suggestive of tuberculosis in the appropriate clinical setting. However, it may also be present in varicella pneumonia, sarcoidosis, histoplasmosis, metastases, pneumoconiosis, or hemosiderosis. At CT, primary tuberculosis typically manifests as air-space consolidation that is well-defined, dense, and homogeneous.

PGI forms out

PGI CHANDIGARH FORMS OUT

admission notice of PGI out... exam on 11 december for MD/MS exam.. last date to get form by post 26/10 check on the website for downloading forms--



www.pgimer.nic.in

DOUBLE BUBBLE SIGN

THE CLASSIC DOUBLE BUBBLE SIGN



DIAGNOSIS-duodenal atresia



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quote of the day

‘... You may be disappointed if you fail, but you are doomed if you don’t try.’

BEVERLY SILLS

orbital cysticercosis

SK SETHI, U HEMAL, RS SOLANKI, A BHAGRA

Ind J Radiol Imag 2004 14:1:93-94



A 16-year-old man presented with a two-month complaint of mild anterior protrusion of right globe. The onset was insidious with gradual progression. The visual acuity in both the eyes was 6/6. The conjunctiva showed chemosis and mild congestion. No other apparent clinical abnormality could be detected. Contrast enhanced CT (axial and coronal) was performed.



ORBITAL CYSTICERCOSIS



Axial post contrast CT image of orbit shows thickening of the right medial rectus muscle. Cystic lesion is noted in the medial rectus with pin-head area of increased attenuation representing the scolex.

Coronal CT image shows a bulky medial rectus with a well-defined cystic lesion.



With findings of thickened muscle, the cyst and the scolex inside a diagnosis of orbital cysticercosis was made. Patient was treated with oral albendazole15mg/kg once daily for one month and oral corticosteroids 1mg/kg in tapering dose. Marked clinical improvement was seen; with serial CT showing complete resolution. Cysticercosis is considered the most common parasitic disease of the central nervous system. It also affects the eye, skeletal muscle and subcutaneous tissue. The extaocular muscle form is the most common type of orbital cysticercosis. In the ocular form, the favoured sites are the vitreous and subretinal space. [1]

Human cysticercosis is caused by larval form of swine tapeworm Taenia solium. Man acts as the intermediate host of Taenia solium. Infection occurs on eating raw or inadequately cooked infected pork, consuming food or water contaminated with faecal matter containing ova, or due to autoinfection. The ovum reaches the stomach, develops into an embryo, which makes its way into circulation and lodges into various organs of the body. [2]Involvement of the extraocular muscles often mimicks orbital pseudotumour. Differentiation between the two is essential for management of the two conditions. On US ocular cysticercosis is seen as a ring-shaped lesion with a central/marginal echogenic nodule representing the scolex. On CT ocular cysticercosis is seen as ring enhancing lesion with pin-head area of increased attenuation representing the scolex. Sometimes the cyst wall may not be seen due to very low attenuation difference between the fluid in the cyst, vitreous and wall of cysticercosis. In the orbit focal thickening of the involved extra-ocular muscle is seen due to an inflammatory reaction. Pathognomonic appearance of the thickened muscle, the cyst and the scolex inside should lead to the diagnosis of cysticercosis. [3]

The extra-ocular muscle cysts with a visible scolex on CT scan can be treated with oral albendazole along with oral prednisolone. If the scolex is not visible on CT scan or US, an ELISA test may be of diagnostic help. Cystic extra-ocular muscle lesions without a visible scolex are treated with oral corticosteroids; if the cyst persists after treatment, oral albendazole is given. [4]

Unusual ophthalmic signs and symptoms in the presence of a proptosis especially in endemic country like ours should alert a clinician to the possibility of cysticercosis. Present study shows that CT is a useful method in diagnosing orbital myocysticercosis. Moreover pre- and post-therapy CT provides confirmation to both patients and the treating clinicians.

REFERENCES

Pushker N, Bajaj MS, Chandra M, Neena. Ocular and orbital cysticercosis. Acta Ophthalmol Scand 2001; 79:408-413.

Nath K, Gogi R, Krishna. Orbital cysticercosis. Ind J Ophthal 1977; 25:24-27.

Rauniyar RK, Thakur SKD, Panda A. CT in the diagnosis of isolated Cysticercal Infestation of the Extraocular Muscle. Clinical Radiology 2003; 58:154-156.

Sekhar GC, Lemke BN. Orbital cysticercosis. Ophthalmology 1997; 104:1599-1604.

PUTTY KIDNEY

"Putty kidney" from renal tuberculosis.



Findings: A large calcified mass is present in the right abdomen, and there is aortic calcification. CT images show extensive lobular calcifications of right kidney, a dilated left renal pelvis and proximal ureter, and atrophy of renal parenchyma. There is left renal parenchymal atrophy and pelvicaliectasis



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ultrasound simulators

Ultrasound Obstet Gynecol. 2004 Aug 3;24(5):581-585.



Ultrasound simulators:

experience with the SonoTrainer and comparative review of other training systems.

Maul H, Scharf A, Baier P, Wustemann M, Gunter HH, Gebauer G, Sohn C.Department of Obstetrics and Gynecology, Division of Obstetrics, Perinatal Medicine and General Gynaecology, Hannover Medical School (MHH), Hannover, Germany.



Ultrasound has become indispensable in prenatal diagnosis. Ultrasound training, however, still lacks proper quality assessment and control. Moreover, most fetal anomalies which must be diagnosed during pregnancy are extremely rare. Ultrasound simulators could provide an opportunity to overcome this dilemma. This review summarizes the potential benefits of simulator-based ultrasound training, briefly describes the properties of a variety of ultrasound simulators that have been developed for various applications including prenatal diagnosis, and presents the SonoTrainer sonography simulation system which makes it possible to run a real-time simulation of a complete prenatal ultrasound examination. We evaluated the system for the training of first- and second-trimester screening for both normal and pathological findings and found that physicians who received theoretical training and were additionally trained with the simulator (T + S) significantly improved their skills in measurements of nuchal translucency thickness (NT) and crown-rump length (CRL) as compared with colleagues who only underwent theoretical instruction (T) [mean +/- SD NT deviation: 0.31 +/- 0.1 mm (T + S) vs. 0.62 +/- 0.2 mm (T), P <>. We therefore conclude that simulator-based training would provide an ideal educational tool to test, improve and monitor a physician's or technician's ultrasound skills in detecting fetal anomalies.