Estimation of extra-pancreatic necrosis volume and its correlation with the clinical outcome in acute pancreatitis

Background: The aim of study was to measure extra-pancreatic necrosis volume in acute pancreatitis and associate with the clinical outcome and to determine the threshold volume of extra-pancreatic necrosis that predicts severity of acute pancreatitis.Methods: Hospital based observational study was carried out in the department of radiodiagnosis, Armed forces medical college, Pune, Maharashtra. All cases referred for CT scan in suspected cases of acute pancreatitis (by clinical and/or biochemical parameters) as a part of institutional protocol were included in the study. Multiplanar reconstruction with volumetric analysis was done for measuring the extra-pancreatic necrosis volume (EPNV) using inherent CT scanner volume assessing software.Results: Out of total 41 patients studied, more than one cause was identified in 9 patients. The most common cause of acute pancreatitis was alcohol use 32 (64%), followed by gallstone and diabetes mellitus (8% each). There was a positive correlation between EPNV and duration of hospitalization which was statistically significant with Spearman's correlation coefficient of 0.579 and p<0.001.Conclusions: Our study showed highly significant correlation between the EPNV and the prediction of end organ failure, systemic infection, duration of hospital stay and need for intervention. Statistically patient presenting with EPNV of more than 100 ml was closely associated with end organ failure; hence EPNV may be used as a useful scoring system. This study has highlighted the convenient and easier technique of predicting clinical outcome in patient by simply assessing the severity of acute pancreatitis by measuring EPNV.

Comparative study of pre-operative high-resolution computed tomography in middle ear cholesteatoma with per-operative findings

Background: Imaging plays an important role in the management of middle ear pathology. Temporal bone imaging is challenging and involves deep understanding of the anatomy, especially in relation to high resolution computed tomography (HRCT) imaging. An HRCT scan can precisely determine the site and extension of cholesteatoma and its sac, assessing the erosion of ossicles, evaluating the facial nerve in its entire course, tegmen and sinus plate, and determining Dural, sigmoid sinus, and jugular bulb positions. Methods: This prospective descriptive study was performed from January 2018 to May 2019 in 60 patients with cholesteatoma who were referred to the Otolaryngology department of the Command Hospital Kolkata. Preoperative high-resolution temporal bone CT scans were carried out and compared with intraoperative findings. Results: Evaluation of 60 patients and their CT scans revealed excellent correlation for presence of soft tissue mass and its extent into the middle ear and mastoid, erosion of scutum, erosion of ossicular chain and tegmen plate, good correlation for facial canal dehiscence, labyrinthine fistula and sinus plate erosions. Conclusions: HRCT temporal bone is essential for anatomical determination of cholesteatoma and its complication. Careful and thorough evaluation is needed for the early diagnosis and treatment of the disease, to prevent complications and preserve hearing. The extent of disease and associated complications like facial nerve paralysis, labyrinthine fistula, and intracranial complications often will determine the aggressiveness of the surgical approach.

Multimodality imaging features of primary breast lymphoma – A rare entity

Primary lymphoma of breast is very rare which has no tell-tale imaging characteristics. Multimodality imaging helps not only in suggesting the possibility of lymphoma but also in its management. We present here one such case which was extensively worked up with various imaging modalities and was histologically proven as primary breast lymphoma