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Microfilarial parasites can obstruct the lymphatic tree giving rise to varying lymphatic and extra-lymphatic symptoms. Renal manifestations can range from asymptomatic proteinuria, chyluria, and nephrotic syndrome, to acute glomerulonephritis. The diagnosis of filariasis is usually made by the demonstration of the parasite in the peripheral blood smear, with or without eosinophilia. The renal involvement by this parasite has been sparsely reported in the literature. We hereby report five cases of filariasis detected on histopathological examination of renal biopsies, performed for other indications, along with a brief report of the additional histological findings. Three native and two graft biopsies were included. All our patients were male, with a mean age of 47 years (range 37 to 66 years). The serum creatinine ranged from 1.2 to 12.9 mg/dL. The mean 24-hour urinary protein was 3.6 gm/day. Peripheral blood eosinophilia was not recorded in any case, however, ESR was raised in all cases. Urine examination revealed varying proteinuria, with hematuria in two cases. Histological examination revealed microfilaria in all five biopsies, along with focal segmental glomerulosclerosis in two cases, combined cellular and humoral rejection, minimal change disease and acute tubular necrosis in one case each respectively. All patients were treated with diethylcarbamazine 6mg/kg/day or 12 days, in addition to the renal medications. Diagnosing the parasite is crucial as the patient is likely to benefit due to the timely treatment of the disease. Reporting this case series highlights an interesting finding in nephropathology. [ABSTRACT FROM AUTHOR]

A 45-year-old gentleman underwent kidney transplantation in March 2010. He remained apparently healthy for the next 10 years when he developed anorexia and weight loss. Diagnostic workup revealed cytomegalovirus (CMV) pneumonia. While viremia resolved within 3 weeks of initiation of valganciclovir, he developed progressive breathlessness and hypoxia on exertion. Imaging of thorax revealed central peri-bronchovascular consolidation and fine reticulations with peripheral sparing. Computed tomography (CT)-guided percutaneous lung biopsy revealed organizing intra-alveolar exudates, suggestive of organizing pneumonia, with no evidence of active infection on biopsy as well as bronchoalveolar lavage (BAL) cytology. This atypical pattern of central distribution of opacities is not typical of organizing pneumonia where peripheral subpleural distribution is more common. Patient responded dramatically following escalation of steroids, with complete resolution of infiltrates on follow-up imaging. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. Purpose: To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. Material and Methods: This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher's exact tests. Results: CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. Conclusion: Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition. [ABSTRACT FROM AUTHOR]

Introduction: Crescentic glomerulonephritis (CrGN) characterized by the presence of crescents in most (≥50%) glomeruli on renal histology clinically presents as rapidly progressive renal failure. It can occur due to diverse etiologies with varying course and renal outcomes. We studied the prognostic significance of its classification as pauci-immune, anti-GBM, and immune-complex mediated CrGN. Materials and Methods: Renal biopsies diagnosed as CrGN over 9 years were included. Clinical, biochemical, serological, and histological features of various classes of CrGN were correlated with renal outcome. Results: 215 biopsies were diagnosed as CrGN during this period. A majority (63%) were immune-complex mediated while 32% were pauci-immune, followed by anti-GBM disease (5%). 85.5% of pauci-immune CrGN were ANCA associated. The levels of proteinuria and serum creatinine were significantly higher in anti-GBM CrGN as compared to the other two classes. The various histological features including Bowman's capsule rupture, peri-glomerular granulomatous reaction, fibrinoid necrosis, and vasculitis were more common in anti-GBM disease and pauci-immune CrGN. The median renal survival was 6.3, 5.3, 2.1 months in immune-complex mediated, pauci-immune, and anti-GBM CrGN, respectively. Conclusion: Immune-complex mediated is the commonest etiology of CrGN in India. Anti-GBM disease has the worst prognosis followed by pauci-immune and immune-complex mediated CrGN. Raised serum creatinine levels (>5mg%) and the degree of glomerulosclerosis at diagnosis were predictors of poor renal survival. High index of suspicion and prompt diagnosis can improve the outcome in these patients. [ABSTRACT FROM AUTHOR]

Objective: Adrenal enlargement occurs in various conditions such as infections, benign, and malignant neoplasms. Percutaneous computed tomography (CT)-guided adrenal biopsy is a safe method for obtaining tissue specimen in cases where diagnosis cannot be established on imaging and biochemical grounds. The study aims to evaluate diagnostic yield, accuracy, and complications of percutaneous CT-guided adrenal biopsies. Furthermore, CT findings of various adrenal lesions have been described. Materials and Methods: Data of CT-guided adrenal biopsies performed from September 2009 to May 2019 were analyzed. Biopsies were performed on a 64-slice or a 128-slice multidetector CT scanner using a coaxial technique. Pathological and microbiological reports were retrieved from the hospital information system. Clinical details were obtained from clinical case records. Results: CT-guided adrenal biopsies were performed in 48 patients, 37 males and 11 females. Adrenal insufficiency was present in 31 (64%) cases and bilateral adrenal glands were affected in 35 (73%). Biopsy yielded a diagnosis in 35 cases (72.9%). The final diagnosis was achieved in 43 (90%) cases. Combined accuracy of CT-guided biopsy for identifying malignancy and infection was 88.3%. Adrenal histoplasmosis (AH) was the most common entity diagnosed (44%). After combining histopathology and microbiology results, the sensitivity for diagnosing AH was 100%. One (2%) patient had a major complication in the form of intra-abdominal hemorrhage requiring transfusion. Local hematoma and mild stable pneumothorax were noted in one patient each. Conclusion: Percutaneous CT-guided biopsy is a safe procedure for the diagnosis of adrenal lesions. It has good accuracy for diagnosing adrenal conditions such as infections and malignancies. However, the specific diagnosis of benign adrenal lesions was difficult to make. AH, tuberculosis, and metastasis have overlapping imaging findings. [ABSTRACT FROM AUTHOR]

Context: Percutaneous computed tomography (CT)‑guided needle aspiration and biopsy technique have developed over time as a method for obtaining tissue specimen. Although this is a minimally invasive procedure, complications do occasionally occur. Aims: The aim of the study was to evaluate the diagnostic yield and complications of 265 percutaneous CT‑guided aspiration and biopsy procedures performed on various intrathoracic lesions. Settings and Design: Data of percutaneous CT‑guided aspiration and biopsy procedures of intrathoracic lesions performed over a 4 year period were retrospectively analyzed. Subjects and Methods: Procedure details, radiological images, and pathological and microbiological reports were retrieved from radiology records and hospital information system. Technical success, diagnostic yield, and complication rates were calculated. Results: Total 265 procedures were performed for lung (n = 179), mediastinum (n = 73), and pleural lesions (n = 13). Diagnostic yield for lung, mediastinal, and pleural lesions was 80.7%, 74.2, and 75%, respectively, for core biopsy specimens. Major complication was noted in only one procedure (0.4%). Minor complications were noted in 13.6% procedures which could be managed conservatively. Conclusions: Percutaneous CT-guided aspiration and biopsy procedures for intrathoracic lesions are reasonably safe with good diagnostic yield. Complications are infrequent and conservatively managed in most of the cases. [ABSTRACT FROM AUTHOR]