Paraneoplastic syndromes-a diagnostic dilemma

Dr.Shyamala (Medicine, )

71 year old Male, a reformed smoker since 10 years,presented with repeated admissions for symptomatic hyponatremia to different centers. He had been investigated for common causes including endocrine conditions. At admission,Na +was 104.During examination, patient was noted to have clubbing. Chest xray was not helpful.but a CT thorax revealed the hidden culprit-a malignant lesion in the left lung.The case has been handed over to the oncologist

Hyponatremia - keep endocrine causes in mind during evaluation

Dr.Mini (Endocrinology, )

A 60 year old male presented with the third episode of symptomatic hyponatremia within a span of 10 months. Prior to the first episode , he had been on hydrochlorothiazide - losartan combination for hypertension and this was subsequently changed to Telmisartan-Cilnidipin combination. TSH was 1.09. During the current episode, TSH was 1.48 and T4 was 4.03(low) suggestive of secondary hypothyroidism. An MR imaging showed a pituitary macroadenoma with suprasellar and bilateral parasellar extension.

Fistulated Colonic carcinoma

Dr.Kanakambaran (General Surgery, )

A case of carcinoma of sigmoid colon fistulating into jejunum diagnosed by Be Enema is presented. The contrast from large bowel which has imged the jejunum suggestive of fistula which can be due to Crohn's disease, tuberculosis or malignancy. Here since filling defect is suspected in the colon possibility of carcinoma colon fistulating into jejunum was considered, proved by laparotomy. Another condition when jejunum is imaged by Ba Enema happens, in one of the very rare complications of the most popular operation for chronic duodenal ulcer upto 1980s-- GASTRO JEJUNO COLIC FISTULA.

Choledocho duodenal fistula? Iatrogenic

Dr.Kanakambaran (General Surgery, )

BaMeal xray showing the common bile duct well imaged. Patient underwent? endoscopic sphincterotomy. Details not available

Small intestinal intussusception in anadult

Dr.Kanakambaran (General Surgery, )

Forty two year old woman presented with colicky abdominal paln and vomiting. On abdominal examination a firm mass in the supra umbilical area She was put on nasogastric aspiration and iv fluids initially and BaMeal xray was done which showed typical watch spring appearance suggestive of intussusception. Laparotomy done and jejunojejunal intussusception due to submucous lipoma.

another reason to stay away from mosquitos in Cochin

Dr.Jobi (Laparoscopy, )

a 45 yr old lady presented with a 2 cm subcutaneous inflammatory swelling over manubruim sterni of 3 weeks .It responded to antibiotic therapy , but the swelling persisted with itching. She is diabetic and gives a H/O carcinoma right breast treated 10 yrs back. since the swelling persisted , she underwent an excision biopsy which revealed Dirofilaria worm in subcutaneous fat nodule. Dirofilaria is a vector-borne parasitic disease of dogs and cats and is transmitted by mosquitoes. human are accidental hosts and can present with subcutaneous nodules or occualr filariasis

Thrombocytopenia-simple causes

Dr.Shyamala (Medicine, )

4o year old referred with isolated TCP. History of epistaxis 1 month back-no active treatment. Recurrence of epistaxis and menorrhagia since few days.Investigations revealed platelet count of 30000 with normal rbc and wbc count.ana mildly positive, anti-aiv _ve.referral for sle. On thorough perusal, MCV-110,MPV high.patient vegetarian. Vit.b12 low normal.treated with Vit.b12 and folic acid and marked response noted in 7 day"s time.

Diagnostic Conundrum

Dr.George (Medicine, )

In Dec we saw 2 similar cases with 1 common funny lab result-1st was a 48 yr old lady who had a thyroidectomy for multinodular goitre in 1986-with 2ry hypoparathyroidism & b/l abductor palsy on long term oral calcium & activated vitamin D supplements –at the last visit a serum 25OH vit D was done was 148 ng/ml(30-100)..seeing this her rocaltrol was stopped ..she promptly developed tetany 3 days later needing iv Ca gluconate & settled after restarting rocaltrol 2nd - 48 yr old lady, post op thyroidectomy 2005 with identical clinical picture & Rx-she came 4 days later very alarmed about a vitamin D level done outside which was >150 mng/ml since local GP had said “vitamin D toxicity”-