CT in pulmonary hydatid disease: unusual appearances

OBJECTIVE

To study the CT features of pulmonary hydatid disease.

PATIENTS

Thirty-two consecutive patients with surgically proven pulmonary hydatid cysts.

SETTING

SheriKashmir Institute of Medical Sciences, Srinagar, Kashmir, India, a tertiary-care referral center.

INTERVENTIONS

CT of the chest was obtained in all cases on Somatom DR double rotate CT scanner (Siemens; Erlangen, Germany).

RESULTS

Forty cysts of different size and shapes were encountered, 34 of them being ruptured. CT density of the cysts varied from - 42 to 160 Hounsfield units (HU; median, 15.5 HU). Apart from the classically described features of pulmonary hydatid disease, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was seen in three cysts, and a bleb of air in the wall of two as-yet unruptured cysts (signet ring sign). Thick wall (>10 mm) was observed in four cysts, and each of them had associated evidence of infection.

CONCLUSIONS

Inverse crescent sign, signet ring sign, high CT density, and thick wall should be recognized as features of pulmonary hydatid cysts on CT.

The foam mattress-back syndrome

BACKGROUND

Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms.

OBJECTIVE

To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital.

METHODS

One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed.

RESULTS

Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel.

CONCLUSION

Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.

Hypocomplementemic urticarial vasculitis and lower cranial nerve palsies

A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.