Nerve conduction assessment and magnetic resonance imaging for the diagnosis of localized hypertrophic neuropathy of the sciatic nerve and the lumbo-sacral plexus

Localized hypertrophic neuropathy (LHN) are slowly growing nerve lesions causing progressive nerve deficit and weakness. We present the case of a 32-year old woman with long history of motor and sensory deficit complains along the sciatic nerve territory. The muscles involved were featured by delay in F waves at nerve conduction assessment. Magnetic resonance imaging (MRI) showed specific patterns, low intense on T1 and abnormally hyper intense on short tau inversion recovery (STIR) and T2, with no obvious enhancement, features compatible with either LHN or intraneural perineurioma (IP) of the sciatic nerve and/or the lumbosacral plexus. Focal thickening and hypertrophy of the sciatic nerve with preserved fascicular configuration and progressive enlargement of the right lumbosacral plexus could be noted. A nerve conduction assessment followed by an MRI eventually allowed to diagnose LHN, without performing a nerve biopsy. Although similar, LHN and IP are two distinct lesions which should be diagnosed and differentiated as soon as possible, to avoid potential complications due to delayed diagnosis and/or misdiagnosis.

“Pulmonary target sign” as a diagnostic feature in chest computed tomography of COVID-19

BACKGROUND

In chest computed tomography (CT) scan, bilateral peripheral multifocal ground-glass opacities, linear opacities, reversed halo sign, and crazy-paving pattern are suggestive for coronavirus disease 2019 (COVID-19) in clinically suspicious cases, but they are not specific for the diagnosis, as other viral pneumonias, like influenza and some viral pneumonia may show similar imaging findings.

AIM

To find a specific imaging feature of the disease would be a welcome guide in diagnosis and management of challenging cases.

METHODS

Chest CT imaging findings of 650 patients admitted to a university Hospital in Tehran, Iran between January 2020 and July 2020 with confirmed COVID-19 infection by RT-PCR were reviewed by two expert radiologists. In addition to common non-specific imaging findings of COVID-19 pneumonia, radiologic characteristics of “pulmonary target sign” (PTS) were assessed. PTS is defined as a circular appearance of non-involved pulmonary parenchyma, which encompass a central hyperdense dot surrounded by ground-glass or alveolar opacities.

RESULTS

PTS were presented in 32 cases (frequency 4.9%). The location of the lesions in 31 of the 32 cases (96.8%) was peripheral, while 4 of the 31 cases had lesions both peripherally and centrally. In 25 cases, the lesions were located near the pleural surface and considered pleural based and half of the lesions (at least one lesion) were in the lower segments and lobes of the lungs. 22 cases had multiple lesions with a > 68% frequency. More than 87% of cases had an adjacent bronchovascular bundle. Ground-glass opacities were detectable adjacent or close to the lesions in 30 cases (93%) and only in 7 cases (21%) was consolidation adjacent to the lesions.

CONCLUSION

Although it is not frequent in COVID-19, familiarity with this feature may help radiologists and physicians distinguish the disease from other viral and non-infectious pneumonias in challenging cases.

Typical Covid-19 case with primary pneumomediastinum in a 37 year old male

We report the case of a 37-year-old man who was admitted to Baqiyatallah hospital in Tehran (Iran) for retrosternal pain, fever, fatigue, dyspnoea and severe non-productive cough. The patient was subsequently confirmed as positive for COVID-19 at real-time polymerase chain reaction (RT-PCR) test. Chest computed tomography (CT) revealed also the presence of pneumomediastinum. This case highlights the importance of chest CT imaging for COVID-19 pneumonia to detect co-existing conditions as pneumomediastinum.

Convalescent plasma therapy in a pregnant COVID-19 patient with a dramatic clinical and imaging response: A case report

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a novel very contagious infection which was designated a pandemic in all countries of the world in April 2020. Its presentation varies from mild to severe infection, but the majority of infected patients have mild manifestations. Many therapeutic choices have been suggested to treat the infection, but none are fully effective.

CASE SUMMARY

Herein we present a 26-year-old woman with a twin pregnancy at 36 wk and one day gestation with confirmed COVID-19 who responded dramatically to convalescent plasma therapy (CPT) and Favipiravir.

CONCLUSION

Although this case report shows the efficacy of CPT in addition to usual medications used for COVID-19, there are many questions that need to be answered regarding dosage, para-clinical efficacy, side effects and combination therapy.

Inguinal herniation of left ovary, fallopian tube and rudimentary left horn of bicornuate uterus associated with type 2 Mayer-Rakitansky-Kuster-Hauser (MRKH) syndrome in a teenage girl: A case report and literature review

The incidence rate of ovarian herniation in the inguinal canal is 3 %. Nevertheless, the herniation of ovary with uterus is extremely scarce. Most of these cases are accompanied with congenital genitourinary malformations such as Mayer-Rakitansky-Kuster-Hauser (MRKH) syndrome and Mullerian duct malformations. Herein, a 13-year-old girl presented with type2 MRKH syndrome together with left groin swelling and pain. Sonography reports ovarian herniation into left inguinal canal and magnetic resonance imaging (MRI) confirmed the diagnosis and demonstrated the left ovary, fallopian tube and rudimentary left horn of bicornuate uterus in the left inguinal canal accompanied with ectopic renal of left lower quadrant. Finally, the patient was designed for surgical inguinal exploration and left normal ovary, fallopian tube and rudimentary left horn of bicornuate uterus were replaced in the pelvis.