Dr.sunilkumar Kommana... 💩

DM Gastroenterology Resident 🥼 | Cinephile | Music Lover🥁 | Always up for good times with friends | Balancing medicine, movies, and melodies 🎥🎵🩺

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@drpankajroyal https://t.co/3nAlqdNNYY

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🫁 HRCT Chest in Tuberculosis: Active vs Healed TB
⚠️ Findings suggesting ACTIVE Pulmonary TB
🔴 Tree-in-bud nodules
🔴 Centrilobular nodules
🔴 Thick-walled cavity (especially upper lobes)
🔴 Consolidation with cavitation
🔴 Necrotic mediastinal / hilar lymph nodes

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🫁 HRCT Chest in Tuberculosis: Active vs Healed TB
⚠️ Findings suggesting ACTIVE Pulmonary TB
🔴 Tree-in-bud nodules
🔴 Centrilobular nodules
🔴 Thick-walled cavity (especially upper lobes)
🔴 Consolidation with cavitation
🔴 Necrotic mediastinal / hilar lymph nodes

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🫃💧 Patient with long-standing ascites secondary to chronic liver disease develops an umbilical hernia with spontaneous fluid leakage from the umbilicus…
📸 What is this condition called?
🤔 How would you manage this patient?

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🫃💧 Patient with long-standing ascites secondary to chronic liver disease develops an umbilical hernia with spontaneous fluid leakage from the umbilicus…
📸 What is this condition called?
🤔 How would you manage this patient?

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🟢 Pleural thickening/calcification
🟢 Apical pleural cap
➡️ Stable old lesions alone ≠ active TB
➡️ No ATT needed unless clinical/microbiological evidence of active disease 🚫💊
#Tuberculosis #TB #HRCT #Pulmonology #Radiology #MedTwitter #InternalMedicine #ChestMedicine

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🫁 HRCT Chest in Tuberculosis: Active vs Healed TB
⚠️ Findings suggesting ACTIVE Pulmonary TB
🔴 Tree-in-bud nodules
🔴 Centrilobular nodules
🔴 Thick-walled cavity (especially upper lobes)
🔴 Consolidation with cavitation
🔴 Necrotic mediastinal / hilar lymph nodes

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

✅ Findings suggesting HEALED / OLD TB
🟢 Dense calcified granuloma
🟢 Calcified hilar/mediastinal lymph nodes
🟢 Thin fibrotic bands/scarring
🟢 Volume loss with stable fibrosis
🟢 Traction bronchiectasis (stable)
🟢 Thin-walled residual cavity without activity

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@witchdrkochi https://t.co/KkRCT7ZDRQ

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🧵1/ MELD & Na-MELD Score Explained!
Let’s break down how we assess liver disease severity and predict mortality 🧠🩺
#MELD #Hepatology #LiverDisease #MedTwitter #FOAMed #Gastroenterology

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@DrAkhilX Sending all investigation without any indication when u have diagnostic dilemma

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

What is flood syndrome??

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@EndoCollabcom PDF

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@allisonoconn @ebtapper Probability of HCC in LI-RADS 3-37%
LI-RADS 4-74%
LI-RADS 5 -95%
We apply this scoring system only if patient has underlying cirrhosis and hepB infection and prior HCC

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@allisonoconn @ebtapper Features suggestive of LI-RADS 5 are size
1) morethan 1 cm
2) arterial phase hyperenhancement
3)washout in portal or delayed phase
4) enhancing capsule
5) Threshold growth ( increase in size >50% in less than 6 months)
Probability of HCC in LI-RADS 5 is 95%

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@DrAkhilX Lactulose in Hepatic encephalopathy
Grade 4 to grade 1 over night

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@DrAkhilX India drug index ,clinical key

[Dr...Yalavarthi Susmitha..👩‍⚕️ @susmitha1223]

Approaching a liver space-occupying lesion (SOL) can be tricky 🩻🧑‍⚕️
Here’s a 🧵 breaking down common lesions with their CT & MRI pearls — high-yield for gastro-hepatology practice and exams 👇

---

1/7 Hemangioma

CT: Hypodense, peripheral nodular enhancement → centripetal fill-in.

MRI T1: Dark.

MRI T2: Very bright (“light bulb”).

Post-contrast: Progressive centripetal fill-in.

---

2/7 FNH (Focal Nodular Hyperplasia)

CT: Iso/slightly hypodense, central scar (delayed enhancing).

MRI T1: Iso/dark.

MRI T2: Iso/slightly bright

Post-contrast: Homogeneous arterial enhancement, scar delayed.

---

3/7 Hepatic Adenoma

CT: Variable, may be hyperdense if bleed.

MRI: Often T1 bright (fat/hemorrhage).

Post-contrast: Arterial hyperenhancement ± washout.

---

4/7 Simple Hepatic Cyst

CT: Well-defined, 0–10 HU, no enhancement.

MRI: T1 dark, T2 very bright, no enhancement.
✅ Simple cyst never enhances!

---

5/7 Abscess

CT: Hypodense, rim enhancement ± gas.

MRI: T1 dark, T2 bright, rim enhancement post-contrast.
🚩 Septal enhancement → abscess, hydatid, or cystic neoplasm.

---

6/7 HCC (Hepatocellular Carcinoma)

CT/MRI: Arterial hyperenhancement + venous/delayed washout.

Capsule may enhance.

🚩 Often shows tumor thrombus in portal vein.
🔥 “Arterial enhancement+ venous washout + tumor thrombus” = HCC until proven otherwise.

---

7/7 Cholangiocarcinoma

MRI T2: Hyperintense.

Post-contrast: Peripheral → progressive delayed arterial enhancement.

Often with biliary dilatation, vascular encasement.

🚩 Can cause bland portal vein thrombosis (non-tumor).

---

Final Tweet:
🔑 Liver SOL pearls

Central scar → FNH

Centripetal fill-in → Hemangioma

Arterial enhancement+venous washout + tumor thrombus → HCC

Progressive delayed arterial enhancement+ bland thrombosis → Cholangiocarcinoma

No enhancement ever+ T2 hyperintense → Simple cyst

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@ibdtweets @AmCollegeGastro @CrohnsColitisFn @CrohnsColitisUK @getgutsycanada @saia_ibd @Y_ECCO_IBD @AmerGastroAssn @SSMHealth @SSMHealthSaints @SSMIBDCare Hello sir
I'm doing my gastro residency india
Want to ask a doubt regarding IBD related case
Can I get a message when ur free
Thank you

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@DrAkhilX https://t.co/zcdRzpZT8t

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

🚨 Attention Medicine Residents! 🚨
Ready for some 🔥 antibiotic pearls you can actually use on rounds? 👩‍⚕️!🧠💊

Stay tuned 👇
#MedTwitter #IDPearls #AntibioticStewardship #MedResidents #HospitalMedicine

[Dr.sunilkumar Kommana... 💩 @sooneelkumar23]

@nihardesai89 @BrownJHM @anujtiwari11 @Aspirin150mg @DrAkhilX @DrDhruvchauhan @drkeithsiau @Gastronaut___ @Gaurz3 @GonzaloBentoli1 Peripheral smear shows sickle cell+ howell jolly bodies
Acute chest syndrome due to SCD