Cough with acute breathlessness

A 26-year-old woman presented to the medical emergency with acute breathlessness and cough since morning since the day of admission. She had left sided chest pain which increased with inspiration and cough. 12 days before admission the patient had an episode of coughing out of about 150ml of yellowish material which was salty and sour in taste.
CT Scan image is shown below. What is the diagnosis?

a) Ruptured Hydatid Cyst
b) Tuberculosis
c) Wegener's Granulomatosis
d) Pulmonary Aspergillosis
e) Lung Abscess


Answer is a) Ruptured Hydatid cyst

CT Thorax showed cavitary lesion measuring involving left upper lobe. Folded membrane like structure was seen with in the cavity with demonstrable shift with the position of the patient. The rest of lung fields and mediastinum were normal. CT features suggested ruptured hydatid cyst with detached endocyst

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Inguinal discoluration

Baby born at term. What is the Diagnosis?

a) Bilateral cryptorchidism
b) Congenital aspenia
c) Congenital toxoplasmosis
d) Neonatal epididymitis
e) Retroperitoneal hemorrhage



Answer is e) Retroperitoneal Hemorrhage

A neonate presented after birth with scrotal and right inguinal ecchymosis. He had been born at term after a difficult vaginal delivery that ultimately required both fundal pressure and vacuum extraction. The thorax was not manipulated during birth. Despite the challenging delivery, the physical examination at birth was normal. A few hours later, however, the child appeared to be in discomfort, with moaning, and was newly noted to have cyanosis. Reexamination revealed ecchymosis of the scrotum and right inguinal region (Panel A). Laboratory results showed a decrease in the hematocrit from 41.2% at birth to 32.5%, normal measures of blood coagulation, and slightly elevated liver enzymes. Ultrasonography revealed three subcapsular lacerations of the liver (in the quadrate lobe and in segments 5 through 7). This case demonstrates an example of Bryant's sign (scrotal ecchymosis) and Stabler's sign (inguinal ecchymosis) caused by retroperitoneal hemorrhage. In this case, the retroperitoneal bleeding was caused by a perinatal liver laceration. The infant required no specific intervention and was discharged home after 1 week, with improvement of the inguinal ecchymosis


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