Computed Tomography of the Chest in COVID-19: A Pictorial Review of Indian Patients

The Coronavirus disease 2019, caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), has evolved into a pandemic and has affected more than 130 million people globally to date and continues to infect more. The disease primarily involves the respiratory system and manifests as fever, dry cough, dyspnea, and myalgia. Nearly half of the infected patients may be asymptomatic. The real-time reverse transcriptase polymerase chain reaction (RT-PCR) performed on the blood or respiratory samples is the diagnostic test with high accuracy. Although imaging with CT is not routinely indicated in this disease, this modality may provide a quick answer and assist in making a diagnosis in certain situations. In addition, imaging with CT also aids in evaluating the progress of the disease and in prognostication. A thorough knowledge of the common findings on the CT scan helps a radiologist in suggesting a diagnosis when it is performed in unsuspected patients. In this review, we describe the common and uncommon chest findings of COVID-19 on the CT scan

Malignant Schwannoma of the Esophagus: A Rare Case Report

Neurogenic tumors are the most prevalent tumors of the mediastinum, and schwannomas are the most common type of neurogenic tumor. Primary neurogenic neoplasm of the esophagus is uncommon and malignant schwannoma of the esophagus is extremely rare. We report a case of a 27-year-old female presenting with dysphagia and palpitations who was found to have a lobulated tumor in the mediastinum that was compressing the esophageal lumen. The tumor was successfully treated surgically without recurrence. The final diagnosis, on histopathological examination of the specimen, was malignant schwannoma

Acute hemorrhagic encephalitis: An unusual presentation of dengue viral infection

Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made

Body Composition in Crohn’s Disease and Ulcerative Colitis: Correlation with Disease Severity and Duration

Background. Results on body composition in Crohn’s disease (CD) and ulcerative colitis (UC) have been heterogeneous and are lacking from Asia. Present study assessed body composition in CD/UC and correlated it with disease severity/duration. Methods. Patients of CD/UC following between Dec 2014 and Dec 2015 who consented for bioimpedance analysis for body fat measurement were included. Lean mass and fat-free mass index (FFMI) were calculated with standard formulae. Visceral fat area (VFA), subcutaneous fat area (SCA), and visceral to subcutaneous fat ratio (VF/SC) were evaluated in CD patients on abdominal CT. Results. Lean mass in CD (n=44, mean age: 41.2±15.8 years, 73% males) was significantly lower than UC (n=53, mean age: 33.2±11.2 years, 68% males; 44.2±7.8 versus 48.3±8.4 Kg, p=0.01). In both UC/CD, disease severity was associated with nonsignificant decline in BMI (UC: 22.1±4.9 versus 20.2±3.2 versus 19.9±3.2 kg/m2, p=0.23; CD: 22.1±4.2 versus 19.9±2.3 versus 19.7±4.2 kg/m2, p=0.18) and fat mass (UC: 10.9±8.9 versus 8.1±5.9 versus 5.7±3.6 kg, p=0.14; CD: 11.2±7 versus 7.9±4.4 versus 7.2±5.9 kg, p=0.16), and disease duration was associated with significant decline in FFMI (p<0.05). In CD, disease severity was associated with nonsignificant decline in SCA and increase in VF/SC. Conclusions. CD patients have lower lean mass than UC. Body fat decreases with increasing disease severity and fat-free mass decreases with increasing disease duration in both UC/CD

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB

Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn’s disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research