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Thyroid isthmus lesions are generally small sized and can be solid or cystic. Discerning isthmic origin of a large nodule, especially if purely cystic, can become a diagnostic challenge because of thin thyroid tissue in it. We report a case of a 68-year-old male patient who had 6 weeks history of non- inflammatory central neck swelling associated with recent dysphagia, for which he underwent ultrasound and computed tomography (CT) scan examinations. Colloid nodules usually do not require further attention. Despite being commonest and benign thyroid nodules, they may require treatment if causing pressure symptoms. Its imaging characteristics can be variable, but they usually exhibit comet tail artifacts on ultrasound. In equivocal cases, claw sign on CT scan is diagnostic to confirm the site. Radiologists have a principle role to rule out other differentials of cystic neck lesions by careful examination of imaging features. In our case, CT scan allowed to rule out primary differential of thyroglossal cyst and guided clinicians for specific management plan.

BACKGROUND The aim of this study was to assess the correlation of physical fitness scores (PFS) with serum adiponectin, resistin, and adiponectin/resistin ratio (AR ratio) in relation to body adiposity indices in healthy adult males. MATERIAL AND METHODS This cross-sectional study was conducted at the Clinical Physiology Unit, Physiology Department, King Saud University Medical City, King Saud University, Riyadh, from March 2017 to April 2018. We included 125 healthy adult males. Serum samples were obtained after overnight fasting. Analysis was performed for fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), basal insulin, lipid profile, resistin, and adiponectin. Bioimpedance analysis (BIA) was used to assess body composition. Based on ideal body composition, PFS were computed as previously published for all subjects and compared with serum markers. RESULTS There was a positive correlation of adiponectin with PFS (r=.218, p=0.015) and an inverse correlation with obesity degree (OD), OD (r=-.239, p=0.001), body mass index (BMI) (r=-.244, p=0.001), and waist/hip ratio (WHR) WHR (r=-.296, p=0.001). Moreover, it was correlated negatively with basal insulin (r=-.211, p=0.009) and homeostatic insulin resistance model (HOMA-IR) HOMA-IR (r=-.221, p=0.013). Resistin was correlated negatively with PFS (r=-.203, p=0.023), while its correlation with OD, BMI, WHR, and HOMA-IR was not significant. AR ratio was positively correlated with PFS (r=.286, p=0.001) and negatively with OD (r=-.210, p=0.019), BMI (r=-.222, p=0.013), WHR (r=-.308, p=0.001) and basal insulin (r=-.237, p=0.008). In linear regression analysis, the relationship of PFS was significant with adiponectin (r=.218, p=0.015), resistin (r=-.203, p=0.023) and AR ratio (r=.286, p=0.001). ROC curve analysis showed that individually the values of adiponectin and resistin were not significantly correlated with PFS, but they were significant with the combined AR ratio with AUC 64.6% (p=0.029). CONCLUSIONS Serum adiponectin was positively correlated and resistin was negatively correlated with physical fitness scores based on healthy body composition with low proportion of body adiposity and a higher proportion of fat-free mass. However, the combined effect of adiponectin/resistin ratio is an even better predictor of physical fitness. Moreover, the adiponectin/resistin ratio is even more highly associated with physical fitness than adiponectin or resistin alone.

Neuro-Behcet's disease is a rare neurological complication of Behcet's disease presenting between second and fourth decades of life. The etiology of Behcet's disease is still unknown but genetic predisposition has been described to play a role. The disease is reported more in males than females. Neurological involvement could cause brain parenchymal, vascular or meningeal changes with other distinct systemic symptoms, which may include orogenital ulcers, uveitis and skin lesions. Parenchymal neuro-Behcet's disease has a poor prognosis. MRI aids in diagnosing and differentiating it from other entities. Treatment includes anti-inflammatory drugs and immunotherapeutics. Our case is the youngest adult reported so far and is an unusual presentation of neuro-Behcet's disease, as the patient was already in remission and on infliximab infusion. Key Words: Neuro-Behcet's, MRI, Infliximab.

A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. His pelvic CT and CT cystogram revealed postsurgical urethral injury along with urinary extravasation, perineal and pelvic soft tissues air densities with fat stranding ascribed to Fournier gangrene, air in distended urinary bladder due to emphysematous cystitis and right common iliac vein air containing septic thrombus. CT chest spotted bilateral multiple septic pulmonary emboli. These radiological findings were promptly handled by uro-surgical team followed by alliance with other relevant departments. With hasty surgical drainage/debridement, urological restoration of urinary obstruction, aggressive broad spectrum antibiotics, anticoagulation and radiological follow-ups the patient withstood multisystem lethal complications and come up with excellent outcome except evisceration.

A 36-year-old ulcerative colitis male patient on treatment for 7 years was referred to dermatology with resistant alopecia universalis and hypopigmented patches on limbs for 5 months. During this time he also reported to ophthalmology with acute bilateral decreased vision for 5 days. His examination revealed hyperaemic discs, multifocal retinal detachments and choroidal granulomas. Taking into account the revised diagnostic criteria, atypical course of disease in the form of early cutaneous presentation followed by ophthalmic manifestations was attributed to Vogt-Koyanagi-Harada syndrome (VKHS) which was supported by relevant investigations including ophthalmic imaging, MRI and nerve conduction studies. Subclinical nerve conduction abnormalities and white matter demyelination were also seen for the first time in a patient of VKHS. Appropriate treatment was required to prevent visual complications; therefore, systemic corticosteroids with steroid sparing immunosuppressive drug therapy showed significant improvement in vision on follow-up. Cutaneous manifestations were resilient to the entire regimen.