Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of primary hyperparathyroidism.

Diaphragmatic agenesis is the most extreme form of congenital diaphragmatic defect, and it may be unilateral or bilateral. Diaphragmatic agenesis is a rare diagnosis, typically made early in infancy and is generally associated with other genetic anomalies, especially anueploidy syndromes. It is associated with a high mortality, if not treated in infancy. However, a few patients have survived till adulthood. In this report, we describe the case of an adult female who presented with progressive shortness of breath during third trimester of pregnancy with complete agenesis of the right side of the diaphragm. A new diaphragm was created using polypropylene mesh after which she improved symptomatically and the lung showed good expansion.

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

Unusual clinical presentations of intra cranial suppurative complication of sinusitis make it difficult to be to be diagnosed and make it a challenging task. Even in present time this pathology is known to produce significant morbidity and mortality. A short review of the literature on ICS has been done with our experience of two cases who had varying clinical presentations and inspite of their management with limited available resources, both the cases recovered fully with limited morbidity. The first case, a 12 years old boy had no clinical evidence of sinusitis but had high fever, signs of increased intra cranial pressure, orbital cellulites and abscesses on left upper eye lid and on same side of forehead. The CT scan revealed Fronto-Maxillary sinusitis, periorbital cellulites, lid and forehead abscesses along with oedema in brain for which an external Fronto-Ethmoido-Maxillary antrostomy [Lynch-Howarth operation] was done along with drainage of extra cranial abscesses in the eyelid and forehead.The second case, a 21 years old female, known to have nasal allergies had a high fever, right eye congested and proptosed and had signs of increased ICP. The CT and MRI revealed that she had a subdural empyma, Frontal sinusitis and a periorbital Cellulites. The subdural empyma was drained by a neuro-surgeon and the sinus abscesses were drained [Lynch Howarth operation] by an Otolaryngologist, at the same time. Both the patients recovered in 4 to 6 week. In conclusion, the diagnosis of ICS requires a high index of suspicion and early radiographic imaging [CT/MRI] of the head and paranasal sinuses. An aggressive medical therapy is indicated and it may require drainage of the sinus abscess and the intra cranial abscess, at the same time. Synopsis:The objective is to gain insight into patterns of presentation, imaging, microbiological aspects and management of a suppurative ICS, a pathology with high rate of morbidity and mortality. It becomes more challenging if it has to be managed with limited resources including a lack of FESS technique of draining the sinus abscesses.