Background COVID-19 is well known to result in pulmonary and multiple extra-pulmonary manifestations. Among them, head and neck manifestations were commonly recognized in the 2nd wave of the pandemic. With the growing global COVID-19 burden, imaging is of utmost importance in diagnosing the disease and its related complications. The study aims to enumerate the various head and neck manifestations and their complications in COVID-19. Additionally, in sinusitis patients, the invasion was correlated with the neutrophil–lymphocyte ratio (NLR). Results A cross-sectional observational study in which total of 78 COVID-19 cases that underwent head and neck imaging were retrospectively evaluated. The cohort included 52 males (66.7%) and 26 females (33.3%) with a mean age of 46.19 years (median = 49.0, SD = 16.47). The various head and neck manifestations included non invasive rhinosinusitis (n = 48), invasive sinusitis and its complications (n = 25), nasal septal abscess (n = 1), dacryoadenitis (n = 1), pre-septal and post-septal orbital cellulitis and its complications (n = 13), otitis media, mastoiditis and its complications (n = 6), parotitis (n = 2), neck vessel thrombosis (n = 2) and cervical lymphadenopathy (n = 3). An increase in the invasive nature of sinusitis was demonstrated among patients with comorbidities and elevated NLR. Conclusions Early diagnosis and management of head and neck manifestations of COVID-19 are aided by prompt imaging. It is imperative that we are armed with the knowledge of various head and neck manifestations and how they may bear semblance to other pathologies for us to ensure COVID as a differential, especially in the background of known infection.

Background Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease with Escherichia coli (E. coli) being the most common aetiology. Infection can involve the renal parenchyma, collecting system and perinephric tissues, and is commonly encountered in patients with uncontrolled diabetes mellitus. EPN complicated by suppurative thrombophlebitis of the inferior vena cava is a rare occurrence. Our case had thrombosis of the right common iliac vein as well, which is first of its kind reported with EPN. Case presentation We describe a case of a 59-year-old male patient, with uncontrolled diabetes mellitus, who presented to the emergency department with a history of high-grade fever and left loin pain. Clinico-laboratory findings were diagnostic for diabetes mellitus, complicated by upper urinary tract infection with sepsis. A preliminary ultrasound of the abdomen was indicative of left hydronephrosis with features of emphysematous pyelonephritis. Abdominal computed tomography (CT) was done to ascertain the cause of hydronephrosis. Left ureteric calculus complicated by emphysematous pyelonephritis (type 3a) with intraluminal air in the left renal vein and inferior vena cava (IVC). Culture grew E. coli. Patient was started on insulin and intravenous (IV) antibiotics, and bilateral DJ stenting was done. Patient was symptomatically better and was discharged. A month later, he was readmitted with relapse of symptoms; repeat CT showed left perinephric abscess, with left renal vein, inferior vena cava and right common iliac vein thrombosis. Repeat culture grew E. coli, stent was replaced, and subsequently he underwent ultrasound-guided aspiration for left perinephric abscess. Haemodialysis along with IV antibiotics and anticoagulant therapy was started. Conclusion Suppurative thrombophlebitis of the inferior vena cava in association with EPN is rare; however, the same is associated with higher morbidity and mortality. Prompt diagnosis, drainage procedure, antibiotics coupled with anticoagulants are the mainstay of treatment for deep venous thrombophlebitis.

Introduction: Cervical spondylosis is a degenerative disorder of the cervical spine and has varied pathological forms of presentation. It presents as either varying degrees of intervertebral disc bulge, spinal cord compression, altered cord signals, neural exit foraminal stenosis, annular tears, facet joint degeneration and ligamentum flavum hypertrophy in combination or isolation. Magnetic Resonance Imaging (MRI) being known for its excellent soft tissue resolution helps assess and grade these pathologies efficiently. Aim: To evaluate the flexion-extension MRI in regular cervical spondylosis imaging by assessing the effect of flexion and extension positioning on the severity of cervical spondylotic canal stenosis and spinal canal dimensions. Also, to compare the change in cervical canal dimensions on flexion and extension with that of neutral positioning. Materials and Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis, JSS Medical College, Mysuru, Karnataka, India, from January 2021-June 2022. A total of 50 participants, aged above 18 years with a clinical suspicion of cervical spondylosis and without history of trauma, tumour, infection, prior cervical surgery and with Nurick grade <3 were included in the present study. In all the subjects, spinal canal dimension, degree of stenosis was assessed and graded, further assessment for presence of foraminal stenosis, ligamentum flavum hypertrophy and facetal arthropathy were also documented. Data were statistically analysed using Chi-square test and Mc Nemer’s test. Results: Out of total 50 cases, 26 (52%) were males and the rest were females with mean age of 46 years. Least cervical canal space dimension of 0.4 cm at C6-7 level in the neutral position and at C3-4, C5-6 and C6-7 levels in extension were noted thus, proving the importance of extension positioning in recognising maximum levels and severity of involvement. Narrowest diameter was demonstrated on flexion and extension. Additionally, the elderly was seen more affected by central disc bulge, foraminal stenosis, facetal arthropathy and ligamentum flavum hypertrophy as compared to the middle aged and the younger patients, more so in extension (12%). Conclusion: Disc bulge and grade of stenosis vary extensively and are more conspicuous on additional flexion and extension imaging. Severity of the grade of stenosis and demonstration of maximum number of levels involved on extension as compared to flexion or neutral positioning thereby, benefitting clinical management plan.