Unique features of polycythemia observed on plain non contrast CT scan of head

Distinct non-contrast computerized tomography head findings in a patient with secondary polycythemia in rural Nepal: a captivating case report highlighting diagnostic challenges

Introduction

Tetralogy of Fallot is a cyanotic congenital heart disease which if untreated leads to death by adulthood. In rare cases who survive this can lead to secondary polycythemia due to chronic hypoxia who can present with multiple indistinct symptoms leading to diagnostic dilemma.

Case presentation

The authors present a rare case of secondary polycythemia diagnosed in early fifties with the unique non-contrast computerized tomography head findings who presented with a spectrum of long standing symptoms and a history of neurological manifestations.

Clinical discussion

Patients diagnosed with polycythemia in adulthood can have a background of an untreated congenital heart disease, which can be complemented further by appropriate radiological investigations in a resource poor setting.

Conclusion

Polycythemia secondary to an untreated congenital heart disease in the age beyond 50 is a rare occurrence. The presentation of these patients might present clinicians with a diagnostic challenge which can be mitigated with an appropriate knowledge of the peculiar non-contrast computerized tomography head findings.

Non-Enhanced CT Mimicking Contrast Enhanced CT - A Case Report on Polycythemia

Diffuse hyperdense cerebral vasculature is sometimes encountered on nonenhanced computed tomography, and polycythemia is one of the conditions which appears the same. The current case report is of a case of 37-year-old female patient arrived with a complaint of feeling severe headache for the past 3 days which was insidious in onset, diffuse in nature and it did not respond to any medication. NECT brain study showed the hyperdense circle of Willis and cerebral venous sinuses. Contrast was not administered for computed tomography study of the brain. On blood investigations, the patient had raised hematocrit level (74%). The hyperdense vessel was due to raised hematocrit (Polycythemia Vera).

Clinics in diagnostic imaging (146). Polycythaemia vera (PV)

A 42-year-old Chinese man presented with left-sided chest pain and splenomegaly. Full blood count revealed erythrocytosis, while plain radiograph and computed tomography of the abdomen and pelvis revealed hepatosplenomegaly with splenic infarction. Further workup confirmed the diagnosis of polycythaemia vera. Clinical and imaging features of polycythaemia vera, as well as the potential pitfalls in image interpretation, are discussed in this article.