Pulmonary blastomycosis is an uncommon pathologic condition that is endemic to Canada and the upper Midwest of the United States. Blastomycosis has a variety of radiologic manifestations, including airspace consolidation, focal masses, intermediate-sized nodules, interstitial disease, miliary disease, and cavitary lesions. Affected patients may be asymptomatic or may present with clinical manifestations ranging from mild chronic cough to acute respiratory distress syndrome-like symptoms. Patients with acute symptoms are more likely to have airspace consolidation, whereas chronic manifestations may be associated with masslike lesions. Intermediate-sized nodules with accompanying airspace consolidation, particularly in the upper lobes, should raise suspicion for fungal disease. Lymphadenopathy and pleural effusions are quite uncommon, and calcification is not often seen. Blastomycosis may be aggressive and require treatment. Dissemination from the lung is not unusual and can involve any organ. Diagnosis is often delayed because blastomycosis can mimic many other disease processes, including bacterial pneumonia, malignancy, and tuberculosis. Radiologists can best contribute to the care of patients who live or travel in endemic areas by maintaining a high degree of suspicion for blastomycosis and being familiar with its myriad manifestations.

Post operative sore throat and hoarseness are common complications after endotracheal intubation. We conducted an experimental, randomized, double-blind study to compare the effectiveness of preoperative nebulisation with ketamine, budesonide and lignocaine in reducing the incidence and severity of post operative sore throat. MATERIAL & METHODS 120 patients (aged 20-60 years) scheduled for elective surgery under general anaesthesia were enrolled. Preoperatively , patients were nebulized with ketamine (Group 1) , Budesonide (Group 2) , Lignocaine (Group 3) and distilled water (Group 4). Number of attempts required for intubation, duration of laryngoscopy and anaesthesia were recorded. Patients were evaluated post operatively at various time intervals for sore throat, hoarseness and cough, pain and signs of mucositis in laryngopharynx. RESULTS The incidence of sore throat at different time intervals was found to be least in ketamine group at 1 hr, by lignocaine at 24 hrs and budesonide at 48 hrs.. Lignocaine reduced cough at 1 and 24 hrs. Incidence of hoarseness was comparable in all the groups. CONCLUSION Nebulisation with lignocaine was efficacious in reducing cough , and ketamine reduced sore throat in early post operative period , whereas long term outcome was better with budesonide.

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