Courtesy: Department of Orthopaedics, CMC, Vellore.
HISTORY
This 5 year old child was seen with a history of stiffness in the neck. He had been in the past operated for an abscess in the back of the neck and a nodular swelling in the occiput region. Stiffness and torticollis has been worsening after surgery.
The clinical photographs are given below.
1. What investigations would you like?
2. What are the X-ray findings?
3. What is your diagnosis?
4. What are the features of this disease?
5. At what age does the patient present?
6. How will you treat this condition?
7. Will biopsy confirm the diagnosis?
Acknowledgement: Submitted by Dr. Vrisha Madhuri, Department of Orthopaedics, CMC, Vellore.
Courtesy: Department of Radiodiagnosis, CMC, Vellore.
HISTORY
A one year old boy was brought with history of recurrent episodes of bilious vomiting since birth. There were three episodes of vomiting and severe electrolyte imbalance in the past.
CLINICAL FEATURES
On examination the boy was malnourished and apart from a mildly distended abdomen, there were no other significant findings. A barium meal radiograph was done and the image is shown below.
1. What are the X-ray findings?
2. What is your diagnosis?
3. What is the normal rotation of the midgut?
4. Discuss the staging of the rotation of the gut?
Acknowledgement: Submitted by Dr. Aparna I, Dr. Shyamkumar NK, Dr. Shalini Govil, Department of Orthopaedics, CMC, Vellore.
Courtesy: Department of Endocrinology, CMC, Vellore.
PAST HISTORY
This gentleman complained of severe headache. He was initially reviewed by a neurologist who organised an MRI of the brain. The T1-weighted image revealed a homogenous spherical enlargement of the pituitary 1.3 cm in diameter. Before neurosurgery a hormonal profile revealed the following:
FSH: 0.4 mIu/l,
LH: 2.9 mIu/l. (ref for both <8mIu/l),
Cortisol 490 nmol/l (N<490nmol/l),
TSH: 320 mIu/l (Ref: 0.5-4.5),
FT4: 2.0 nmol/l (Ref: 8-21).
Visual fields are within normal limits.
1. What do you think is the cause of the headache?
2. What is this enlargement due to?
3. What investigations will confirm this enlargement?
4. What is the most appropriate line of treatment?
a. Trans-sphenoidal surgery alone.
b. Thyroxine alone.
c. Thyroxine followed by trans-sphenoidal surgery.
d. Thyroxine followed by trans-sphenoidal surgery and radiotherapy.
e. Radiotherapy alone.
5. What is usual the prognosis of this condition?
6. Mention some of the additional features these patients may have.
Acknowledgement: Submitted by Dr. Nihal Thomas, Department of Endocrinology, CMC, Vellore.
