Coronavirus disease-19 (COVID-19) causes mild to moderate illness in most patients but in some cases a severe illness may manifest. Such patients usually present with hypoxaemic respiratory failure due to acute lung injury caused by a viral infection and host-mediated cytokine storm. The characteristic radiographic findings are ground-glass opacities with consolidation in posterior basal areas of bilateral lungs and rarely pneumothorax (PTX) and pneumomediastinum (PM). The incidence of these findings was notably higher in the second wave of the pandemic in India in 2021 as compared to the first wave in 2020. The etiopathogenesis of this life-threatening condition can be due to Macklin phenomenon post-cytokinemediated diffuse alveolar injury, patient self-inflicted lung injury (P-SILI), and barotrauma in mechanically ventilated patients. The presence of pneumomediastinum is associated with higher mortality rates, prolonged intensive care unit (ICU) stays making it a poor prognostic marker. There is no consensus regarding its management in COVID-19 patients although both aggressive and conservative strategies have been tried.

Introduction: Severe Acute Respiratory Syndrome-Coronavirus (SARS-CoV-2) infection, also known as Coronavirus Disease2019 (COVID-19) is the global pandemic, first described in Wuhan city of China in December of 2019. Its diagnosis depends upon real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). On chest Computerised Tomography (CT), it is almost similar to other viral pneumonia with extensive parenchymal involvement. Semiquantitative scores depicting this extensiveness of involvement could correlate with disease severity, laboratory parameters, mortality, like Intensive Care Unit (ICU) admission, requirements of ventilatory support and longer hospital stay. Aim: To define role of chest CT score in determining disease severity, predicting poor prognosis and mortality of COVID-19 pneumonia in short-term follow-up. Materials and Methods: This prospective study enrolled all admitted real-time RT-PCR positive patients for COVID19 at All India Institute of Medical Sciences, Rishikesh, India between 15th April and 31st May 2021. All patients were assigned semiquantitative CT scores based on the extent of lung parenchymal involvement of 20 lung regions in chest CT. Clinical severity was matched with chest CT scoring and laboratory findings. Survival curves along with univariate and multivariate analysis were applied to define the role of CT scoring in predicting short term prognosis. Results: Total 547 subjects were included in the study, of which the chest CT score showed a significant association with clinical severities (p-value <0.001). CT score were correlating significantly with increased serum C-Reactive Protein (CRP) (p-value=0.001) and D-dimer (p-value=0.01), and decreased lymphocyte count (p-value=0.003). A CT score ≥31 was found to be associated with an increased risk of mortality in both univariate and multivariate analysis {Odd Ratio (OR)=276.8; 95% Confidence Interval (CI)= 45.21-1695.43; p-value <0.001}. Conclusion: Chest CT score can be imaging measure of disease severity and predict a higher probability of mortality in score ≥31. It can also predict other defined variables of short-term prognosis. So, it has an advantage in speedy diagnostic workflow of symptomatic cases, timely referral of patients to higher centre, and better management of critical care resources.

Duplication of the gallbladder is a rare congenital anomaly, which Boyden first illustrated in 1926. No additional risk of cholelithiasis or malignancy with this congenital anomaly was documented. However, this congenital anomaly is associated with more risk for complications during and after laparoscopic cholecystectomy. So, preoperative diagnosis is essential in identifying anatomical abnormalities to avoid biliary injuries at the time of surgery or the performance of an incomplete operation. The removal of an asymptomatic double gallbladder remains controversial. Here, we are reporting a case of the incidentally detected duplex gallbladder in a teenager and review the literature that will enrich the reader’s knowledge regarding this rare congenital anomaly.

Background: Annular pancreas is an uncommon cause of duodenal obstruction and rarely causes complete duodenal obstruction. Due to its rarity of identification in the antenatal period and overlapping imaging features with other causes of duodenal obstruction; it is often misdiagnosed. Case presentation: A 33-year-old primigravida came for routine antenatal ultrasonography at 28 weeks and 4 days of gestational age. On antenatal ultrasonography, dilated duodenum and stomach were seen giving a double bubble sign and a hyperechoic band surrounding the duodenum. Associated polyhydramnios was also present. Fetal MRI was also done. Postpartum ultrasonography demonstrated pancreatic tissue surrounding the duodenum. The upper gastrointestinal contrast study showed a non-passage of contrast beyond the second part of the duodenum. Due to symptoms of obstruction, the neonate was operated on, and the underlying cause was found to be the annular pancreas. Conclusion: Diagnosis of duodenal obstruction due to the annular pancreas is very important in the antenatal period to plan for appropriate therapeutic interventions after birth. A double bubble sign is seen due to various etiologies however the presence of a hyperechoic band in the antenatal ultrasound may point to the diagnosis of the annular pancreas.

Periosteal chondroma or juxtacortical chondroma is a rare benign bone tumor of cartilaginous origin. It arises from the periosteum, particularly that of the long tubular bones. We present an interesting case of periosteal chondroma involving the phalanx of the right hand presenting as a palpable mass in a 22-year-old male. The slowly growing mass lesion was investigated in our institute. Characteristic imaging findings on the radiograph and MRI were correlated with histopathological findings to confirm the diagnosis. Establishment of benignity of the lesion guided the surgical management of the patient.