NSAIDS induced cutaneous adverse drug reaction – a case series

Nonsteroidal anti-inflammatory drugs (NSAIDs) are common cause of cutaneous adverse reactions (CADR’s). Though there are fairly high numbers of agents which commonly cause CADR, NSAID’s holds no exception. NSAIDs can cause multiple cutaneous complications like urticaria, angioedema, acneiform eruption, stevens johnson syndrome (SJS), toxic epidermal necrolysis (TEN), vasculitis, fixed drug eruption (FDE) etc. NSAIDs are very frequently prescribed drugs and even one of the frequent over the counter sold medications, thus making it more important to have a more detailed knowledge of the vast cutaneous complications it can cause. The present case series focuses on the conglomeration of the few cases of cutaneous complications experienced by the patients on NSAID’s therapy.   Keywords: NSAIDs, severe cutaneous adverse reactions (SCARs), cutaneous adverse drug reactions (CADRs), stevens johnson syndrome (SJS), fixed drug eruptions (FDEs), fixed dose combination (FDC), over the counter (OTC

Magnetic Resonance Imaging Can Reliably Differentiate Optic Nerve Inflammation from Tumor Invasion in Retinoblastoma with Orbital Cellulitis

PURPOSE To investigate the prevalence and magnetic resonance imaging (MRI) phenotype of retinoblastoma-associated orbital cellulitis. Additionally, this study aimed to identify postlaminar optic nerve enhancement (PLONE) patterns differentiating between inflammation and tumor invasion. DESIGN A monocenter cohort study assessed the prevalence of orbital cellulitis features on MRI in retinoblastoma patients. A multicenter case-control study compared MRI features of the retinoblastoma-associated orbital cellulitis cases with retinoblastoma controls. PARTICIPANTS A consecutive retinoblastoma patient cohort of 236 patients (311 eyes) was retrospectively investigated. Subsequently, 30 retinoblastoma cases with orbital cellulitis were compared with 30 matched retinoblastoma controls without cellulitis. METHODS In the cohort study, retinoblastoma MRI scans were scored on presence of inflammatory features. In the case-control study, MRI scans were scored on intraocular features and PLONE patterns. Postlaminar enhancement patterns were compared with histopathologic assessment of postlaminar tumor invasion. Interreader agreement was assessed, and exact tests with Bonferroni correction were adopted for statistical comparisons. MAIN OUTCOME MEASURES Prevalence of retinoblastoma-associated orbital cellulitis on MRI was calculated. Frequency of intraocular MRI features was compared between cases and controls. Sensitivity and specificity of postlaminar optic nerve patterns for detection of postlaminar tumor invasion were assessed. RESULTS The MRI prevalence of retinoblastoma-associated orbital cellulitis was 6.8% (16/236). Retinoblastoma with orbital cellulitis showed significantly more tumor necrosis, uveal abnormalities (inflammation, hemorrhage, and necrosis), lens luxation (all P < 0.001), and a larger eye size (P = 0.012). The inflammatory pattern of optic nerve enhancement (strong enhancement similar to adjacent choroid) was solely found in orbital cellulitis cases, of which none (0/16) showed tumor invasion on histopathology. Invasive pattern enhancement was found in both cases and controls, of which 50% (5/10) showed tumor invasion on histopathology. Considering these different enhancement patterns suggestive for either inflammation or tumor invasion increased specificity for detection of postlaminar tumor invasion in orbital cellulitis cases from 32% (95% confidence interval [CI], 16-52) to 89% (95% CI, 72-98). CONCLUSIONS Retinoblastoma cases presenting with orbital cellulitis show MRI findings of a larger eye size, extensive tumor necrosis, uveal abnormalities, and lens luxation. Magnetic resonance imaging contrast-enhancement patterns within the postlaminar optic nerve can differentiate between tumor invasion and inflammatory changes

Extranodal involvement in lymphoma – A Pictorial Essay and Retrospective Analysis of 281 PET/CT studies

Objective(s): The aim of this study is to evaluate the role of PET-CT in identification of different patterns of extranodal involvement in Hodgkin’s disease (HD) and Non-Hodgkin’s Lymphoma (NHL) and to enlist the common sites of extranodal involvement in each histological type and compare our results with the existing literature. Methods: In this retrospective study of 281 cases of lymphomas of various histologies, we illustrate the spectrum of PET/CT features of extranodal lymphoma (ENL) of commonly involved organs and compare our result with the literature. Result: Extranodal appearance in lymphoma is strikingly varied. Diffuse large B cell lymphoma (DLBCL) is the commonest histological subtype and gastrointestinal tract is the commonest anatomical subsite in NHL. Skeletal system is the commonest site for involvement in HD. Conclusion: A broad spectrum of extranodal organs is involved in various subtype of lymphoma which can be depicted in PET-CT in the most appropriate manner. Familiarity with the pattern of involvement is essential for comprehensive management

Computed tomography angiographic study of internal mammary perforators and their use as recipient vessels for free tissue transfer in breast reconstruction

Context: The internal mammary artery perforator vessels (IMPV) as a recipient in free flap breast reconstruction offer advantages over the more commonly used thoracodorsal vessels and the internal mammary vessels (IMV). Aims: This study was designed to assess the anatomical consistency of the IMPV and the suitability of these vessels for use as recipients in free flap breast reconstruction. Patients and Methods: Data from ten randomly selected female patients who did not have any chest wall or breast pathology but had undergone a computed tomography angiography (CTA) for unrelated diagnostic reasons from April 2013 to October 2013 were analysed. Retrospective data of seven patients who had undergone mastectomy for breast cancer and had been primarily reconstructed with a deep inferior epigastric artery perforator free flap transfer using the IMPV as recipient vessels were studied. Results: The CTA findings showed that the internal mammary perforator was consistently present in all cases bilaterally. In all cases, the dominant perforator arose from the upper four intercostal spaces (ICS) with the majority (55%) arising from the 2nd ICS. The mean distance of the perforators from the sternal border at the level of pectoralis muscle surface on the right side was 1.86 cm (range: 0.9–2.5 cm) with a mode value of 1.9 cm. On the left side, a mean of 1.77 cm (range: 1.5–2.1 cm) and a mode value of 1.7 cm were observed. Mean perforator artery diameters on the right and left sides were 2.2 mm and 2.4 mm, respectively. Conclusions: Though the internal mammary perforators are anatomically consistent, their use as recipients in free tissue transfer for breast reconstruction eventually rests on multiple variables

Pathological Basis of Imaging in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most prevalent form of liver cancer with major risk factors being chronic liver disease (CLD) including chronic liver inflammation, steatohepatitis and certain viral infections (Hepatitis B and C). Due to the poor prognosis, early detection is key for effective management. Imaging of HCC has developed over the years with specificity as high as 95%. The Liver Imaging Reporting and Data System (LI-RADS) provides a standardized reporting format that can be followed by radiologists and clinicians alike. This article focuses on the pathological basis of imaging observations described in the LI-RADS lexicon. A clear understanding of the pathological basis of imaging will help the radiologist to be more confident to resolve unequivocal observations apart from achieving a high degree of specificity in the diagnosis of HCC