Context:Based on Glasgow Coma Scale (GCS), head injury can be classified as minor (GCS 13–15), moderate (GCS 9–12), and severe (GCS 3–8). There is a lot of controversy in the use of computed tomography (CT) in head injury patients.Aims:This study was intended to estimate the rate of CT positivity in head injury patients and to define the criteria for doing CT in head injury patients.Settings and Design:This was a prospective observational study in the emergency department (ED) over a 12-month period. Subjects andMethods:Study involved all head injury patients attending ED. Risk factors studied were a loss of consciousness (LOC), vomiting, seizures, ear bleed, nosebleed, external injuries, and alcohol intoxication.Statistical Analysis Used:Comparison of CT positivity with the patient's demographics and clinical characteristics was carried out using Chi-square.Results:A total of 1782 patients were included in this study. Overall CT positivity was 50.9%. In minor head injury (MHI), CT positivity rate was 38%. The study showed significant association of CT positivity with five variables: LOC >5 min, vomiting, seizures, ear bleed, and nosebleed.Conclusions:From the study, we recommend following: CT is indicated in all patients with moderate and severe head injury (GCS ≤12). Low threshold for taking CT is advisable in elderly and alcohol-intoxicated patients. In MHI, CT is indicated if any one of the following risk factors are present: LOC >5 min, history of vomiting, history of seizures, history of ear bleed, and history of nosebleed.

BackgroundClear cell sarcoma of soft parts is most commonly found associated with the tendons and aponeuroses of distal extremities in young adults with a peak incidence in the third decade. Location in the abdominal wall and in a child is very rare.Case presentationA nine-year-old female child presented with a swelling in the anterior abdominal wall in the suprapubic region. Fine needle aspiration revealed predominantly discrete cells with loose clustering at places. The cytoplasm was abundant, finely granular, and eosinophilic with some cells exhibiting clear vacuolated zones. No pigment was seen. The nuclei were rounded and eccentrically placed with a striking single eosinophilic macro nucleolus present in all the cells. Taking into consideration, the history, age of the patient, location of the tumor and absence of melanin pigment, a diagnosis of soft tissue sarcoma was made, the differential including Clear cell sarcoma. This was subsequently confirmed on histopathological examination and immunohistochemistryConclusionThe atypical presentation of the case made the cytological diagnosis rather challenging. Clear cell sarcoma should be considered when cytology of a soft-tissue tumor shows uncharacteristically high cellularity and relatively uniform cells with macronucleoli.

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