This  is  a  case  of  a  47  year-old  female  presenting  with  typical Cushingoid appearance and CSF rhinorrhea. MRI revealed a 4.4 cm x 2.9 cm x 4.5 cm enhancing intranasal mass with evidence of erosion of the left cribriform extending to the left anterior cranial fossa. Dexamethasone suppression  test  yielded  elevated  cortisol  level. Endoscopic nasal biopsy done showed a round cell tumor positive for  ACTH,  synaptophysin,  chromogranin  A,  and  S-100.  Patient subsequently  underwent  endoscopic  endonasal  excision  of  left intranasal mass with creation of pericranial flap for repair of CSF leak.  This  report  is  presented  to  discuss  a  rare  case  of  ACTH secreting esthesioneurblastoma including its diagnostic challenges and surgical options for repair of anterior cranial fossa defect to address CSF leak particularly by means of a vascularized pericranial flap.

Human ; Female ; Middle Aged ; Cerebrospinal Fluid Rhinorrhea ; Cranial Fossa, Anterior ; Synaptophysin ; Chromogranin A ; Hydrocortisone ; Nose ; Endoscopy ; Surgical Flaps ; Dexamethasone ; Adrenocorticotropic Hormone

OBJECTIVE: Our objective was to compare correctness of diagnosis from phonecamera MMS (Multimedia Messaging Service)-transmitted radiographic images to actual radiographs in confirming diagnosis of surgical conditions.

METHODS: After relaying history anAphysical examination findings through cellphones, 180 radiographs (30 each from General Surgery, Urology, Neurosurgery, Orthopedics, Thoracocardiovascular and Pediatric Surgery) were also captured and transmitted by residents. Images were interpreted at remote sites by surgical specialists who confirmed diagnosis and suggested prompt treatment. Upon arrival at hospital, surgical consultants compared diagnosis with actual radiographic films. Data were analyzed using Binomial Test at the 0.05 level of significance.

RESULTS: Clinical diagnoses were confirmed using 150 conventional radiograms, 28 CT scans and 2 angiograms. Phone-transmitted digital radiographs were compared with actual films viewed. Correctness of diagnosis was: 100 percent (30/30) from Neurosurgery; 93.3 percent (28/30) respectively from General Surgery, Urology, Orthopedics and Thoracocardiovascular Surgery; 90 percent (27/30) from Pediatric Surgery. Phone-transmitted radiographic image interpretations compared with actual radiographic readings showed statistically significant concordance of 96 percent (p = 0.01) for each surgical specialty.

CONCLUSION: Phonecamera MMS images of radiograms, CT scans and angiograms taken by surgical residents in the hospital and transmitted to cellphones of surgeons at remote sites had high correctness of diagnosis. When used to confirm diagnosis from clinical history and physical findings, prompt treatment decisions of different surgical specialty conditions may be made.

Human ; Male ; Female ; Cell Phones ; Telemedicine ; Teleradiology