Condylus tertius with atlanto-axial rotatory fixation: an unreported association.

The "condylus tertius" or the "third occipital condyle" is an embryological remnant of the proatlas sclerotome. Anatomically, it is attached to the basion and often articulates with the anterior arch of the atlas and the odontoid apex; hence, it is also called the "median occipital condyle". It is a rare anomaly of the cranio-vertebral junction (CVJ) that can lead to instability and compression of important surrounding neurovascular structures. We report a case of a 16-year-old boy who presented with suboccipital neck pain, torticollis and right sided hemiparesis. Plain radiographs revealed an increased atlanto-dental interspace (ADI) with a retroflexed odontoid. Open mouth view showed asymmetry of the articular processes of the atlas with respect to the dens. Computed tomography (CT) of the CVJ delineated the third occipital condyle. Furthermore, on dynamic CT study, a type 3 atlanto-axial rotatory fixation (AARF) was clearly demonstrated. Magnetic resonance imaging (MRI) of the CVJ revealed severe right-sided spinal cord compression by the retroflexed and rightward deviated dens. It also revealed disruption of the left alar and transverse ligaments. The patient was treated with 8 weeks of cranial traction and reasonable alignment was obtained. This was followed by C1-C2 lateral mass screw fixation and C1-C2 interlaminar wiring to maintain the alignment. A review of the literature did not reveal any cases of condylus tertius associated with non-traumatic AARF. An accurate knowledge of the embryology and imaging features of this rare CVJ anomaly is useful in the prompt diagnosis and management of such patients.

Gender discrepancy in research activities during radiology residency.

OBJECTIVE: To investigate the presence of gender disparity in academic involvement during radiology residency and to identify and characterize any gender differences in perceived barriers for conducting research. METHODS: An international call for participation in an online survey was promoted via social media and through multiple international and national radiological societies. A 35-question survey invited radiology trainees worldwide to answer questions regarding exposure and barriers to academic radiology during their training. Gender differences in response proportions were analyzed using either Fisher's exact or chi-squared tests. RESULTS: Eight hundred fifty-eight participants (438 men, 420 women) from Europe (432), Asia (241), North and South America (144), Africa (37), and Oceania (4) completed the survey. Fewer women radiology residents were involved in research during residency (44.3%, 186/420 vs 59.4%, 260/438; p ≤ 0.0001) and had fewer published original articles (27.9%, 117/420 vs. 40.2%, 176/438; p = 0.001). Women were more likely to declare gender as a barrier to research (24.3%, 102/420 vs. 6.8%, 30/438; p < 0.0001) and lacked mentorship/support from faculty (65%, 273/420 vs. 55.7%, 244/438; p = 0.0055). Men were more likely to declare a lack of time (60.3%, 264/438 vs. 50.7%, 213/420; p = 0.0049) and lack of personal interest (21%, 92/438 vs. 13.6%, 57/420, p = 0.0041) in conducting research. CONCLUSION: Fewer women were involved in academic activities during radiology residency, resulting in fewer original published studies compared to their men counterparts. This is indicative of an inherent gender imbalance. Lack of mentorship reported by women radiologists was a main barrier to research.

Hysterosalpingography and ultrasonography findings of female genital tuberculosis.

Genital tuberculosis (TB) is an important cause of female infertility in the world, especially in developing countries. Majority of infertility cases are due to involvement of the fallopian tubes (92%-100%), endometrial cavity (50%), and ovaries (10%-30%); cervical and vulvovaginal TB are uncommon. Genital TB has characteristic radiological appearances based on the stage of the disease process (acute inflammatory or chronic fibrotic) and the organ of involvement. Hysterosalpingography (HSG) and ultrasonography (US) remain the main imaging modalities used in the diagnosis of genital TB. HSG is the primary modality for evaluating uterine, fallopian tube, and peritubal involvement and also helps in evaluating tubal patency. US, on the other hand, allows simultaneous evaluation of ovarian and extrapelvic involvement.

Retromandibular vein diverticulum: unique imaging findings with a novel therapeutic strategy.

Diverticula of the vascular system are rare. A diverticulum involving the retromandibular vein has not been described to date. We describe the imaging findings and a novel therapeutic strategy for the management of this rare diverticulum. A 25-year-old male presented with complaints of swelling behind the angle of mandible that enlarged on straining. On imaging, a retromandibular vein diverticulum was seen. The diverticulum was punctured percutaneously with the patient performing Valsalva maneuver and injected with sclerosant microfoam. There was no sclerosant reflux into the normal neck veins. At 6-month follow-up, the patient had complete resolution of his symptoms. We also have done a review of literature for patients with venous diverticula in the head and neck region treated by endovascular techniques.

Recurrent cerebral hyperperfusion syndrome after intracranial angioplasty and stenting: case report with review of literature.

Cerebral hyperperfusion syndrome (CHS) describes a syndrome of sudden onset focal neurological features, unilateral headache, and systemic hypertension. Recurrent CHS in the same patient has not been described to date. We describe a 55-year-old woman who first developed CHS post intracranial stenting with sudden-onset right focal seizures and associated acute focal edema on imaging. After one and half years, the patient developed symptomatic in-stent restenosis and underwent repeat angioplasty with stenting. Postprocedure, the patient had another episode of CHS in the form of acute bleed in the basal ganglia and died. A review of literature of patients for CHS postintracranial angioplasty and stenting also was performed. The present case describes a rare clinical scenario where the patient had recurrent CHS with different clinical and imaging features.

Cerebral hyperperfusion syndrome after endovascular reconstruction of carotid artery in high-flow carotid-jugular fistula.

We describe the occurrence of cerebral hyperperfusion syndrome (CHS) in a case of long-standing carotid-jugular fistula (CJF) treated by endovascular reconstruction of the carotid artery. A 43-year-old male with a high-flow CJF between the internal carotid artery (ICA) and internal jugular vein underwent endovascular reconstruction of the carotid artery using a stent graft. After treatment, the patient developed CHS. The patient succumbed to a large intracranial bleed in the left external capsule and parietal lobe on the fifth postoperative day. CHS following endovascular reconstruction of carotid artery is rare. We present the first reported case of CHS following endovascular reconstruction of ICA. A review of literature for patients treated by endovascular rerouting of blood flow to the cerebral parenchyma associated with hyperperfusion syndrome has been performed.