A rare case of isolated cysticercus involvement of inferior rectus muscle presenting with upward gaze restriction.

Cysticercosis is a parasitic infection caused by larvae known as cysticercus cellulosae. Orbital cysticercosis is usually a part of generalised systemic infestation. Isolated infection of the extra-occular muscle is an extremely rare entity. Involvement of orbital adnexas are rare even if associated with brain infection. Here, we report a case of an 18-year-old boy who presented with eccentric proptosis and restriction in upward gaze and was diagnosed with cysticercosis of inferior rectus.

Combined Aplasia of Frontal and Sphenoid Sinuses with Hypoplasia of Ethmoid and Maxillary Sinuses.

The paranasal sinuses are air filled spaces. The process of development of paranasal sinuses begins prenatally. The agenesis of paranasal sinuses in an unusual clinical condition and that is mainly confined to the frontal sinus unilaterally. Combined aplasia of multiple sinuses is extremely rare along with hypoplasia of other sinuses. Agenesis of sphenoid sinus is also rare in incidence. We report a case of a 54 years old female, who presented with complains of persistent headache with nasal blockage and found to have combined aplasia of bilateral frontal and sphenoid sinus with hypoplasia of bilateral maxillary and ethmoid sinus with unusual age of presentation. The findings were confirmed on non-contrast computed tomography scan of paranasal sinuses.

Diagnostic role of magnetic resonance cholangiopancreatography in evaluation of obstructive biliopathies and correlating it with final diagnosis and clinical profile of patients.

AIMS AND OBJECTIVE: We assessed the utility of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic tool in patients with obstructive biliopathies. MATERIALS AND METHODS: A prospective study was conducted on 54 patients with clinically suspected biliary obstruction. MRCP in these patients was compared and correlated with final diagnosis and their clinical profile. STATISTICAL ANALYSIS: Sample profile was described in terms of sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. Pearson's Chi-square statistics was used to assess the strength of association between diagnostic accuracy of MRCP and final diagnosis. RESULTS: Out of the 54 patients, 50 had biliary obstruction. The cause of biliary obstruction was finally identified on the basis of direct cholangiography/surgery/histopathology. In 52 of the 54 patients, MRCP agreed with final diagnosis in identifying the level of block. MRCP agreed with final diagnosis in identifying the cause of obstruction in 48 of the 54 patients (89%). Sensitivity of MRCP in identifying the level of obstruction in comparison with final diagnosis was 100%, while diagnostic accuracy of MRCP in identifying the level of obstruction in comparison with final diagnosis was 96.29%. The correlation between MRCP and final diagnosis in diagnosing cause of obstruction was 0.95 (Pearson's correlation coefficient, P = 0.017). CONCLUSION: MRCP is a safe ionizing radiation and iodinated contrast free modality which has the ability to display the biliary tree by combining the advantages of projectional and cross-sectional imaging.

Ascariasis of gallbladder: a rare case report and a review of the literature.

Ascariasis of the gallbladder is a very rare presentation. We report a case of a 15-year-old boy who presented with complaints of pain in the abdomen, vomiting, pruritus, and fever on-and-off for 10 days. On radiological examination, an ultrasonography of the abdomen showed a dilated gallbladder with multiple linear echogenic, tubular, parallel lines inside the lumen of the gallbladder, common bile duct and intrahepatic biliary radicles. The zigzag and coiling movement of a worm was noted in the lumen of the gallbladder on real time B-mode ultrasonography. The patient was successfully treated with an anthelminthic drug. On follow up no evidence of the worm was noted in the gallbladder or common bile duct lumen.

Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for detection of intrauterine growth restriction.

BACKGROUND AND OBJECTIVES: Intrauterine growth restriction is associated with increased perinatal mortality and morbidity, possibly extending also in adult life, as compared to fetuses and newborns presenting characteristics of normal growth. The present study had been planned to measure the pulsatility index (PI) and resistive index of the middle cerebral artery with pulsatility and resistive index of the umbilical artery in predicting fetal growth restriction. MATERIALS AND METHODS: A total of 60 pregnant women with a clinical history and grayscale-screened patients were taken for Doppler analysis, and a final comparison of accuracy of Doppler indices was done with perinatal outcome. STATISTICAL ANALYSIS: The statistical analysis was done using the Statistical Package for Social Sciences version 15.0 statistical analysis software. The values were represented in number (%) and mean ± SD. OBSERVATION AND RESULTS: The umbilical artery PI had maximum sensitivity at the third visit (32-37 weeks) and maximum specificity also at the third visit (32-37 weeks). The umbilical artery resistive index had maximum sensitivity at the second visit (28-32 weeks) and maximum specificity at the third visit (32-37 weeks). The MCA PI had an overall diagnostic accuracy of 52.8 %. CONCLUSION: The PI of the umbilical artery was more sensitive than the PI of the middle cerebral artery. Umbilical artery PI has the maximum overall diagnostic accuracy of 75 %.

Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites.

Aneurysmal bone cyst (ABC) is a benign solitary lesion. It usually occurs in the long bones but uncommonly in the calcaneum, mandible, femur and clavicle. Its frequency of occurrence in skull and mandible is 4%, clavicle and ribs is 5%, femur is 13% and foot is 3%. Only a few cases of ABC of these unusual sites have been reported till date. Here we report four cases of ABC at unusual sites namely the calcaneum, mandible, femur and clavicle diagnosed primarily on the basis of different imaging modalities and later confirmed on histopathology.

Macrodystrophia lipomatosa: radiologic-pathologic correlation.

Macrodystrophia lipomatosa (MDL) is a rare cause of congenital macrodactyly, characterised by progressive proliferation of all mesenchymal elements, with disproportionate increase in fibro-adipose tissue. It occurs most frequently in lower limbs along the distribution of the medial plantar nerve. MDL presents as localised gigantism of the hand or foot and comes to clinical attention for cosmetic reasons, mechanical problems secondary to degenerative joint disease, or development of neurovascular compression. Here, we report a case of MDL, with altered soft tissue growth due to an earlier surgery, making clinical diagnosis difficult. However, with a complete radio-clinical work-up and review of the history, a provisional diagnosis of MDL was made, which was confirmed by histopathology and during surgery.

Diagnostic dilemma in a neglected case of fetus-in-fetu solved with Magnetic Resonance Imaging and MDCT--a case report and review of literature.

Fetus-in-fetu (FIF) is a rare anomaly in which a vertebrate fetus is enclosed within the body of its twin in diamniotic monochorionic pregnancy. To the best of our knowledge, fewer than 100 cases have been reported in literature. Although a wide variety of presentations have been described in clinical reports, the characteristic features on MRI which distinguish FIF from teratoma have not been well delineated. Here we present a case of fetus-in-fetu in which characteristic MDCT and MR findings were used to diagnose FIF preoperatively and successfully differentiate it from teratoma. Although both CT and MRI can be used for definitive preoperative diagnosis of FIF, MRI is an ideal imaging modality due to inherent high tissue contrast and spatial resolution. Furthermore, MRI obviates the need for iodine contrast and eliminates the risk of ionizing radiation. We emphasize that MRI is an ideal valuable diagnostic tool for definite preoperative diagnosis of FIF and surgical planning.

Primary renal hydatidosis with associated macroscopic hydatiduria--a computed tomography urography diagnosis with pathological confirmation.

Primary renal hydatid disease which involves any other organ is extremely rare. Cystic rupture into the pelvicalyceal system, causing hydatiduria, is pathognomonic of renal hydatidosis, although it is usually microscopic and is seen in only 10-20% of renal hydatidosis cases. Gross hydaturia is uncommon but is present in the case discussed below. We report an exceptionally rare case of primary renal hydatidosis associated with the rupture of the cyst into the pelvicalyceal system diagnosed primarily on the basis of computed tomography urography. The diagnosis was confirmed on a pathological and surgical basis.

Diagnostic and prognostic role of MRI in spinal trauma, its comparison and correlation with clinical profile and neurological outcome, according to ASIA impairment scale.

AIMS AND OBJECTIVES: To evaluate the role of magnetic resonance imaging (MRI) as a non-invasive diagnostic tool in patients with acute and chronic spinal trauma and to compare and correlate the MRI findings with those of patients' clinical profile and neurological outcome according to ASIA impairment scale to assess prognostic and clinical value of MRI. MATERIALS AND METHODS: Sixty two patients of spinal trauma formed the study group in a prospective fashion. The patients undergoing MR imaging and magnetic resonance images were analyzed and correlated with findings on neurological examination according to American Spinal Injury Association (ASIA) impairment scale (AIS) at the time of MRI examination and subsequently at sub-acute interval to assess neurological outcome. STATISTICAL ANALYSIS: Sample profile was described in terms of 95% confidence limit and proportion. To describe strength of association between extent of spinal cord injury and outcome, odd's ratio, bivariate and multi variant analysis, was used. Pearson's chi square (χ) (2) statistics was applied to test the association between two categorical variables. Data were analyzed using statistical software package, STATA 9.2 and the difference was considered to be significant if 'P' value was <0.05. OBSERVATION AND RESULTS: The cord edema without hemorrhage was the most common MR finding (41.5%). The others were sizable focus of hemorrhage within the cord (33%), epidural hematoma (5.0%), and normal cord (26%). Majority of MR findings correlated well with clinical profile of the patient according to ASIA impairment scale. This study demonstrated that patients with presence of sizable focus of haemorrhage had larger cord edema and more severe grade of initial ASIA impairment scale( AIS) with poor recovery at follow up (P=0.032).Improvement in upper extremity was more than lower extremity. Severe cord compression was also associated with poor neurological outcome; however it was not statistically significant (P=0.149). CONCLUSIONS: With this study the authors concluded that various MRI findings in acute spinal cord injury correlated well with the initial clinical findings and on follow-up according to ASIA impairment scale. MRI is useful for initial diagnosis of acute spinal cord injury and its prognostication for predicting neurological recovery.