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Summary: Background: Point‐of‐care echocardiography (POC‐Echo) is an essential intensive care hemodynamic monitoring tool. Aims: To assess POC‐Echo parameters [i.e., cardiac index (CI), systemic vascular resistance index (SVRI) and cirrhotic cardiomyopathy (CCM) markers] and serum biomarkers in predicting circulatory failure (need for vasopressors) and mortality in patients with acute‐on‐chronic liver failure (ACLF) having sepsis‐induced hypotension. Methods: We performed serial POC‐Echo within 6 hours (h) of presentation and subsequently at 24, 48 and 72 h in patients with ACLF and sepsis‐induced hypotension admitted to our liver intensive care unit. Clinical data, POC‐Echo data and serum biomarkers were collected prospectively. Results: We enrolled 120 patients [59% men, aged 49 ± 12 years, 56% alcohol‐related disease and median MELDNa of 30 (27–32)], of whom 68 (56.6%) had circulatory failure, with overall mortality of 60%. CCM was present in 52.5%. The predictors of circulatory failure were CI (aHR −1.5; p = 0.021), N‐terminal brain natriuretic peptide (aHR −1.1; p = 0.007) and CCM markers; e′ septal mitral velocity (aHR −0.5; p = 0.039) and E/e′ ratio (aHR −1.2; p = 0.045). Reduction in CI by 20% and SVRI by 15% at 72 h predicted mortality with a sensitivity of 84% and 72%, and specificity 76% and 65%, respectively (p < 0.001). The MELD‐CCM model and CLIF‐CCM model were computed as MELDNa + 1.815 × E/e′ (septal) + 0.402 × e′ (septal) and CLIF‐C ACLF + 1.815 × E/e′ (septal) + 0.402 × e′ (septal), respectively, based on multivariable logistic regression. Both scores outperformed MELDNa (z‐score = −2.073, p = 0.038) and CLIF‐C ACLF score (z score = −2.683, p‐value = 0.007), respectively, in predicting 90‐day mortality. Conclusion: POC‐Echo measurements such as CCM markers (E/e' and e' velocity) and change in CI reliably predict circulatory failure and mortality in ACLF with severe sepsis. CCM markers significantly enhanced the CLIF‐C ACLF and MELDNa predictive performance. [ABSTRACT FROM AUTHOR]

Hepatic angiosarcoma is an uncommon primary malignancy of the liver. It carries a poor prognosis because of very aggressive nature of the tumor. Clinical presentation of hepatic angiosarcoma is variable, most common being hepatomegaly or abdominal mass. Here we report a case of primary hepatic angiosarcoma presented with spontaneous rupture and hemoperitoneum, which was managed successfully by transarterial embolization. [ABSTRACT FROM AUTHOR]

The present article reports clinical findings of two pregnant women diagnosed with acute fatty liver of pregnancy (AFLP); emphasizing the serious consequence of caesarean delivery and the need for careful consideration in the decision making process of mode of delivery. [ABSTRACT FROM AUTHOR]

A 46-year-old gentleman presented to the emergency department with a 3-day history of severe abdominal pain, progressive abdominal distention, vomiting, and fever. After adequate resuscitation, abdominal erect x-ray identified pneumoperitoneum and abdominal supine x-ray identified air (pneumo) tracking along the Arantius ligament (ligamentum venosum) (Fig. Endoscopic and clinical features of gastric ulcers in Japanese patients with or without Helicobacter pylori infection who were using NSAIDs or low-dose aspirin. [Extracted from the article]

Amoebic liver abscess is the most common extra-intestinal manifestation of amoebiasis. It usually responds well to treatment with metronidazole together with drainage, if indicated. Uncommonly, the abscess may rupture into the pleura, peritoneum or pericardium, bile duct at its hilum, or produce septic emboli. We present a patient with two rare complications: venous thrombosis and jaundice secondary to bilhaemia. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aims Methods Results Conclusion We assessed clinical, procoagulant and genetic risk factors and clinical outcomes in dabigatran‐treated patients with non‐tumoural acute and acute‐on‐chronic portal vein thrombosis (PVT).Patients with a new diagnosis of non‐tumoural acute and acute‐on‐chronic PVT between January 2021 and January 2024 (aged ≥ 18 years) in those without/with cirrhosis (Child‐Pugh (CP)‐A/B/C ≤ 10) were started on dabigatran and followed and compared with those on vitamin K antagonist (VKA) and untreated individuals.Dabigatran was prescribed in 119 patients with PVT type 1 (61, 51.3%), type 2 (34, 28.6%), type 3 (24, 20.2%); 72 (60.5%) with cirrhosis [CP‐A (27, 37.5%), CP‐B (43, 59.7%) and CP‐C10 (2, 2.8%)]. Procoagulant factors noted were JAK2V617F (10.1%), CALR (2.5%) and factor V Leiden (1.6%) mutations, antiphospholipid syndrome (APS, 15.2%), isolated Protein C (14.3%) and Protein S (16.8%) deficiency. Comparators: 28 patients who declined anticoagulation/were unable to come for follow‐up, and six with CP‐C received VKA. Overall recanalization rate (RR) on dabigatran was 56 (47.1%); 25 (21%) complete recanalization, 31 (26%) partial recanalization and 63 (52.9%) stable PVT over median follow‐up of 32 months. Patients not anticoagulated had a spontaneous RR in 21.4% (28 patients; p = 0.005 compared with dabigatran group) and none recanalized on VKA. On multivariable analysis, predictors of recanalization on dabigatran were Factor VIII Antigen level (FVIII:Ag, HR 0.6; 95% CI 0.3–0.9, p = 0.032), non‐occlusive PVT (HR 3.5, 95% CI 1.9–5.6, p = 0.025) and acute PVT (HR 2.1; 95% CI 1.5–3.2, p = 0.003). Mortality was 14 (11.8%).On dabigatran, 47% of 119 patients achieved portal vein recanalization over 32 months of follow‐up which was higher than the spontaneous RR (21.4%) in an untreated cohort. High Factor VIII:Ag was a predictor of non‐recanalization. Dabigatran was safe in cirrhosis (CP‐A and B) while further work is needed in CP‐C. [ABSTRACT FROM AUTHOR]

Retroperitoneal hemorrhage in the form of spontaneous adrenal hemorrhage or bleeding into a renal tumor can have varied and non-specific presentations in pregnancy. In the absence of risk factors, these life-threatening conditions are rarely suspected. We present our experience with three patients who presented to us in the third trimester of pregnancy with hemorrhage in retroperitoneal organs. One of the patients had a spontaneous adrenal hemorrhage and the other two had a hemorrhage in the renal tumor. None of the patients was known to have pre-existing tumors, coagulopathy, or trauma. Both the patients with hemorrhage in the renal tumor had intrauterine fetal demise at the time of presentation. Immediate resuscitation and recruitment of a multidisciplinary team resulted in optimal maternal outcomes in all cases and a healthy fetal outcome in the patient with adrenal hemorrhage., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Singla et al.)

Introduction: Adult granulosa cell tumor (AGCT) is a rare ovarian sex-cord malignancy notorious for late recurrences and metastases. The cytologic features of AGCT at the metastatic sites have been documented sporadically. Hence, knowledge of the characteristic cytomorphologic features is essential for an accurate diagnosis and distinguishing it from its pathologic mimics, especially at the metastatic sites., Materials and Methods: This was a retrospective study conducted over six years. The cytopathology electronic database was searched for the fine needle aspirates (FNA) reported as metastatic AGCT. A detailed cytomorphologic assessment was done for multiple cytologic features, including overall cellularity, cellular arrangement of the tumor cells, cell size, cell shape, nuclear pleomorphism, nuclear grooving, chromatin pattern, nucleolar prominence, mitotic figures, amount and character of cytoplasm, and the extracellular background., Results: There were 6 cases reported as metastatic AGCT on aspiration cytology. The smears in all the cases were cellular, with tumor cells arranged in loose aggregates, three-dimensional clusters, perivascular papillary fronds, and scattered singly. The most consistent cytologic features included microfollicular arrangement of monomorphic tumor cells with round-oval nuclei, fine chromatin, longitudinal nuclear grooving, and scant cytoplasm. Typical Call-Exner bodies and metachromatically stained extracellular hyaline material were noted sporadically. None of the smears showed anaplasia, prominent macronucleoli, atypical mitoses, or necrosis., Conclusions: The current study not only outlines the distinct cytologic attributes of AGCTs across various metastatic locations but also highlights its prevalent cytologic mimics. Additionally, it outlines key clinicopathologic traits that can aid in distinguishing and precisely diagnosing these tumors through cytological analysis., Competing Interests: None., (AJTR Copyright © 2023.)

A young teenage boy was referred to this tertiary care centre with a history of penetrating trauma to the flank. He had severe pain abdomen and gross haematuria on presentation. Imaging studies revealed a high flow direct fistulous communication between the renal artery and the inferior vena cava. On further work-up, the patient was also diagnosed with SARS-COV 2. Considering the young age of the patient, haemodynamic stability and the presence of a high flow arteriovenous fistula, endovascular management was opted. Diagnostic runs confirmed a high flow fistulous communication between the renal artery and the inferior vena cava. However, on account of logistic challenges at the time due to pandemic related restrictions, hardware accessibility was limited and hence simple coiling was contemplated. During the course of the procedure, the first coil which was deployed ran off via the fistulous communication into the inferior vena cava and got lodged in the right atrium. A separate venous access was obtained and the coil was retrieved with the help of a snare. The coil embolisation was next attempted again by starting distal to the pseudoaneurysm neck and proceeding proximally. In the end, successful coil embolisation of the fistula was done using slightly oversized coils., (© 2023 The Authors. Published by the British Institute of Radiology.)