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Vankadari K, Alwala S, Kumar K, Ram S. Hypertrophic Pachymeningitis Presenting as “Eyebrows” Sign on 18F FDG PET/CT. World J Nucl Med 2022; 21:236-238. [PMID: 36060081 PMCID: PMC9436508 DOI: 10.1055/s-0042-1750014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypertrophic pachymeningitis refers to linear or nodular thickening of the dura mater covering the brain and spinal cord following various inflammatory/infective processes. Usually, magnetic resonance imaging brain shows uniform thickening with enhancement of involved meninges. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings of pachymeningitis are rarely reported in literature. We describe the PET/CT findings of a patient with hypertrophic pachymeningitis involving the bilateral supraorbital regions depicting as “eyebrows” on brain maximum intensity projection image.
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Affiliation(s)
- Kousik Vankadari
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
| | - Surendar Alwala
- Department of Radiology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Telangana, India
| | - Sai Ram
- Department of Nuclear Medicine, Yashoda Hospital, Secunderabad, Telangana, India
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Sahu M, Shah M, Mallela VR, Kola VR, Boorugu HK, Punjani AAR, Kumar RV, Kumar S, Manusrut M, Kumar SCR, Rathod R, Babu DM, Gonuguntla HK, Yedlapati GK, Mallu GR, Reddy YS, Reddy VV, Alwala S, Bongu VK, Kamalesh A, Kumar RNK, Jaishetwar GS, Bagapally RS, Srinivas JS, Balasubramaniam A, Rajagopalan BK, Pullikanti B, Prakasham SP, Nimmala P, Nagaraju B, Sahoo PR. COVID-19 associated multisystemic mucormycosis from India: a multicentric retrospective study on clinical profile, predisposing factors, cumulative mortality and factors affecting outcome. Infection 2022; 51:407-416. [PMID: 35922704 PMCID: PMC9362592 DOI: 10.1007/s15010-022-01891-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM). METHODS A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021. RESULTS Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients. CONCLUSION Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.
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Affiliation(s)
- Monalisa Sahu
- Department of Infectious Diseases, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India.
| | - Milap Shah
- Department of Pathology, Yashoda Hospital, Hyderabad, India
| | | | - Venkat Raman Kola
- Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | - R Vijay Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Sairaj Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Manusrut Manusrut
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - S Ch Raghu Kumar
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
| | - Rajkumar Rathod
- Department of Laboratory and Transfusion Medicine, Yashoda Hospital, Hyderabad, 500003, India
| | - Dilip M Babu
- Department of Nephrology, Yashoda Hospital Somajiguda, Hyderabad, 500028, India
| | | | | | | | - Y Sai Reddy
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Vedire Vishnu Reddy
- Department of Anaesthesia, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Surendar Alwala
- Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | - A Kamalesh
- Department of Medicine, Yashoda Hospital, Hyderabad, India
| | - R N Komal Kumar
- Department of Neurology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Ganesh S Jaishetwar
- Department of Hematology and BMT, Yashoda Hospital, Somajiguda, Hyderabad, 500082, India
| | - Ravi Shankar Bagapally
- Department of Gastroenterology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Jammula S Srinivas
- Department of Plastic and Cosmetic Surgery, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | | | | | | | | | - Pavani Nimmala
- Department of Microbiology, Yashoda Hospital, Hyderabad, India
| | - Barla Nagaraju
- Department of Pulmonology, Yashoda Hospital, Secunderabad, Hyderabad, 500003, India
| | - Pradipt R Sahoo
- Department of ENT and Head and Neck Surgery, Yashoda Hospital, Hyderabad, India
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Giragani S, Balani A, Mallu GR, Yedlapati G, Maturu VN, Babu VL, Alwala S. Endovascular glue embolization for control of massive hemoptysis caused by peripheral pulmonary artery pseudoaneurysms: Report of 7 cases. Lung India 2019; 36:8-13. [PMID: 30604699 PMCID: PMC6330807 DOI: 10.4103/lungindia.lungindia_458_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose: Pulmonary artery pseudoaneurysms are a rare cause of massive hemoptysis and need to be considered as a differential with prompt recognition preventing mortality from life-threatening hemorrhage. We report the clinical details and imaging findings for a series of patients presenting with massive haemoptysis due to peripheral pulmonary artery pseudoaneurysm, managed by endovascular glue embolization. Methods: Hospital based retrospective study wherein records and image database of patients presenting with massive hemoptysis between January 2014 and March 2016 were studied. The immediate technical success, reintervention rate, and recurrence of massive hemoptysis were recorded. Results: Among patients with massive hemoptysis who underwent endovascular management in our department, seven patients fulfilled the inclusion criteria. The mean age was 54.3 years; mean lesion diameter was 10.8 mm (range 6–14 mm); underlying pathology being infective (tuberculosis) in all cases (n = 7). All lesions were treated with endovascular glue embolization. The technical success was 100%. Mean follow-up was 11.7 months. There was no case of recurrence of massive hemoptysis. There were no major complications with a single case of minor complication (in the form of chest pain and discomfort) which resolved with medical management. Conclusion: The endovascular approach using glue (N-butyl cyanoacrylate) is a minimally invasive and technically feasible, effective technique for emergent management of pulmonary artery pseudoaneurysms presenting as massive hemoptysis.
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Affiliation(s)
- Suresh Giragani
- Department of Interventional Radiology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Ankit Balani
- Department of Interventional Radiology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Gangadhar R Mallu
- Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | | | - Venkata N Maturu
- Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - V Lakshman Babu
- Department of Pulmonary Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Surendar Alwala
- Department of Radiology, Yashoda Hospitals, Hyderabad, Telangana, India
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Giragani S, Pavunesan SK, Balasubramaniam A, Agrawal V, Alwala S, Kumar A. Rete mirabile of posterior inferior cerebellar artery: A rare cause of subarachnoid hemorrhage. Interv Neuroradiol 2018; 24:662-665. [PMID: 29973082 DOI: 10.1177/1591019918782147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rete mirabile is a congenital aberrant arterial collateral network resulting from abnormal embryonic activity during native vessel formation. Even though frequently observed in mammals, this entity is rare in humans except when there is hypoplasia, aplasia or narrowing of native vessels. Rete mirabile is reported involving internal carotid and vertebral arteries. Rete mirabile of the posterior inferior cerebellar artery (PICA) is not described in the literature. We report the clinical presentation, imaging findings and management of PICA rete mirabile formation with subarachnoid hemorrhage.
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Affiliation(s)
- Suresh Giragani
- 1 Department of Vascular and Interventional Radiology, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
| | - Santhosh K Pavunesan
- 1 Department of Vascular and Interventional Radiology, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
| | - Anandh Balasubramaniam
- 2 Department of Neurosurgery, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
| | - Vikas Agrawal
- 3 Department of Neurology, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
| | - Surendar Alwala
- 4 Department of Radiodiagnosis, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
| | - Anjani Kumar
- 4 Department of Radiodiagnosis, Yashoda Super Specialty Hospitals, Secunderabad, Telangana, India
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Giragani S, Balani A, Reddy V, Bommakanti KT, Alwala S, Kumar A. Spontaneous Isolated Inferior Mesenteric Artery Dissection With Chronic Mesenteric Ischemia: Case Report and Endovascular Management. Vasc Endovascular Surg 2018; 52:561-564. [PMID: 29716480 DOI: 10.1177/1538574418773472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the clinical details, imaging findings, and management for a 39-year-old female presenting with recurrent episodes of pain in abdomen due to systemic lupus erythematous vasculitis associated with spontaneous isolated inferior mesenteric dissection. Spontaneous mesenteric artery dissection is an uncommon cause of mesenteric ischemia. Symptomatic spontaneous isolated inferior mesenteric artery (IMA) dissection is a rare condition, and its association with systemic lupus erythematosus is not previously described in the English literature. The optimal treatment options are debatable and include medical management, surgical reconstruction, and endovascular therapy. We wish to highlight spontaneous isolated IMA dissection as a rare etiology for chronic mesenteric ischemia and its management by endovascular methods.
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Affiliation(s)
- Suresh Giragani
- 1 Department of Interventional Radiology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Ankit Balani
- 1 Department of Interventional Radiology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Viswanath Reddy
- 2 Department of Gastroenterology, Yashoda Hospitals, Secunderabad, Telangana, India
| | | | - Surendar Alwala
- 4 Department of Radiology, Yashoda Hospitals, Secunderabad, Telangana, India
| | - Anjani Kumar
- 4 Department of Radiology, Yashoda Hospitals, Secunderabad, Telangana, India
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