Tetralogy of Fallot, right aortic arch with isolated left subclavian artery: Rare synchronous triple occurrence!!!

We present a rare synchronous occurrence of tetralogy of Fallot, right aortic arch, and isolated left subclavian artery, highlighting potential clinical and therapeutic implications.

Imaging findings in Erdheim-Chester disease: what every radiologist needs to know.

Erdheim-Chester disease (ECD) is a rare sporadic non-Langerhans cell histiocytic (LCH) proliferative disorder with systemic predilection. It usually affects adults in the 5th-7th decades of life and has non-specific clinical manifestations. Its suspicion is often heralded by the presence of characteristic radiological findings and subsequently confirmed by demonstration of CD68-positive xanthogranulomatous infiltrates on histopathology. Despite being a non-malignant entity, it might be fatal due to organ dysfunction. Imaging plays a key role in the diagnosis, management, and follow-up. Imaging findings are essential to establish the diagnosis, assess actual disease burden, and explore the aetiopathogenesis and therapeutic options to halt disease progression and associated morbidity.

Imaging in Sternal Tumours: A Pictorial Review.

The sternum is an uncommon site for neoplastic involvement and metastases are far commoner than primary neoplasms. Of the primary tumours, malignant lesions are more frequent than the benign lesions. Early diagnosis and treatment is prudent in such neoplasms not only to halt disease progression but also to prevent circulatory compromise resulting from the mass effect on the mediastinum. Sound knowledge of neoplasms affecting the sternum and their imaging appearance is essential to arrive at an early diagnosis and also to obviate biopsy in cases with classical imaging findings. Neoplastic involvement of the sternum is extremely unusual and should be considered malignant unless proven otherwise. Imaging may help in arriving at the diagnosis of these lesions, together with other factors such as patient's age, type of lesion (lytic/sclerotic or mixed), matrix mineralization, multiplicity and involvement of other sites.

MR imaging of cavernous sinus lesions: Pictorial review.

The main purpose of this pictorial review is to highlight the important MR imaging findings of various conditions involving the cavernous sinus in addition to brief description of normal anatomy. The pathological conditions that can involve the cavernous sinus can be categorized into infective, inflammatory, granulomatous, vascular and neoplastic causes. Imaging, especially with MRI, plays an important role not only in detection but also in definition of disease extent and in characterization of the pathology. Currently, high-resolution MR images clearly show various components of cavernous sinus which help in making a proper diagnosis and thus appropriate further management.

Pneumothorax as a rare presentation in a case of phyllodes tumor of breast with cavitating lung metastasis.

ABSTRACT: The lung is the most common site of metastases in the case of phyllodes tumor of the breast followed by bone. However, pneumothorax as a presenting complaint in a patient of bilateral cavitating lung metastases from malignant phyllodes tumor of the breast has never been reported to our knowledge. We herein report a case of a 34-year-old female presenting with sudden onset of chest pain in already existing lung metastases who on imaging showed the development of bilateral pneumothorax. We should, therefore, be on the lookout for the potential development of spontaneous pneumothorax in such cases.

Cervical Erector Spinae Plane Block for Giant Dermatofibrosarcoma Protuberans of Neck and Chest Wall: A Case Report.

We encountered a giant dermatofibrosarcoma protuberans (DFSP) of the neck and chest wall which presented a challenge in terms of perioperative analgesia management. In recent years, erector spinae plane (ESP) block has emerged as an effective and safe analgesia technique for various surgical procedures as well as for chronic neuropathic pain without any untoward complications. A continuous lower cervical ESP block can be used successfully as an effective analgesic technique for extensive DFSP surgery involving the neck and chest wall area.

Role of CT in the detection and management of cancer related complications: a study of 599 patients.

Purpose: Cancer-related complications (CrC) and any potentially life-threatening findings detected on routine oncological imaging requires urgent intervention and needs proactive management. We conducted a retrospective study to highlight the role of imaging in the detection of CrC on computed tomography (CT)-scan while sharing our experience at a tertiary care cancer hospital. Materials and methods: All the reports of the CT scans performed in our department between January 2018 and December 2019 were reviewed and the imaging findings of CrC were recorded. Only the patients who had known malignancy and underwent imaging evaluation at our centre at baseline/follow up/surveillance were included. The clinical details of the patients were recorded and the findings were classified based on the system or organ involved and also on the basis of its impact on clinical management. Results: A total of 14,226 CT scans were performed during the study period, out of which 599 patients had CrC. Most of the CrC were seen involving thorax (265/599, 44.3%) followed by abdomen (229/599, 38.2%) and head and neck (104/599, 17.3%) regions. The commonly encountered CrC were pulmonary infections, superior vena cava obstruction and drug-induced lung changes. Conclusion: CrC have significant impact on the course of management of cancer patients and radiologist plays an important role in early diagnosis and initiation of prompt management of many such patients. CT is an excellent modality for early diagnosis of CrC which guides the oncologist for appropriate treatment.

Chronic lymphoedema: a nidus for squamous cell carcinoma.

Lymphoedema is a chronic debilitating condition characterised by diffuse swelling caused by lymphatic obstruction. The secondary form of lymphoedema is more common than the primary form. Untreated filariasis remains an important cause of lymphoedema in developing countries. The most common complication of chronic lymphoedema is cellulitis. It is also a risk factor for the development of neoplasms such as lymphangiosarcoma, squamous cell carcinoma, melanoma, lymphoma and malignant fibrous histiocytoma. We report a case of a woman in her 60s who developed squamous cell carcinoma in the background of chronic lymphoedema.

Robotic ultrasound: An initial feasibility study.

BACKGROUND: Performing ultrasound during the current pandemic time is quite challenging. To reduce the chances of cross-infection and keep healthcare workers safe, a robotic ultrasound system was developed, which can be controlled remotely. It will also pave way for broadening the reach of ultrasound in remote distant rural areas as well. AIM: To assess the feasibility of a robotic system in performing abdominal ultrasound and compare it with the conventional ultrasound system. METHODS: A total of 21 healthy volunteers were recruited. Ultrasound was performed in two settings, using the robotic arm and conventional hand-held procedure. Images acquired were analyzed by separate radiologists. RESULTS: Our study showed that the robotic arm model was feasible, and the results varied based on the organ imaged. The liver images showed no significant difference. For other organs, the need for repeat imaging was higher in the robotic arm, which could be attributed to the radiologist's learning curve and ability to control the haptic device. The doctor and volunteer surveys also showed significant comfort with acceptance of the technology and they expressed their desire to use it in the future. CONCLUSION: This study shows that robotic ultrasound is feasible and is the need of the hour during the pandemic.

Unusual giant pleural lipomas: imaging features.

Pleural lipomas are rarely encountered in the thoracic cavity. Sometimes, they infiltrate the intercostal space to have a component on either side of the intercostal space forming a hourglass configuration. They are generally solitary, small and asymptomatic. We present the case of a 49-year-old man with two giant pleural lipomas, both originating from the right parietal pleura, and one of which was passing through the intercostal space giving rise to a hourglass-shaped configuration. When they occur, although benign, considering the evolutionary potential, excision is recommended.

Avapritinib in advanced gastrointestinal stromal tumor: case series and review of the literature from a tertiary care center in India.

The therapeutic landscape in advanced gastrointestinal stromal tumor has evolved. Avapritinib and ripretinib have now been approved by the US FDA for platelet-derived growth factor alpha D842V-mutant and refractory gastrointestinal stromal tumor patients, respectively. Here we report five patients who have been on avapritinib under an expanded access program. Response assessment was available for four patients - a partial response in two patients and stable disease in one, while one patient had progressive disease. Though preliminary results of the VOYAGER trial have shown less activity of avapritinib and no significant difference in progression-free survival when compared with regorafenib, avapritinib may show some clinical benefit in a subset of patients refractory to approved therapies. We share our experience of five cases, with clinical benefit in three. We believe avapritinib should be further evaluated in clinical trials.

Comparison Between Time-Resolved Magnetic Resonance Angiography and Diagnostic Digital Subtraction Angiography in the Vascular Assessment of Nonspecific Aorto-Arteritis Patients: A Prospective Study.

PURPOSE: Nonspecific aortoarteritis (NSAA) is a chronic inflammatory vasculitis involving aorta and its branches. We conducted a study prospectively to compare time resolved magnetic resonance angiography (MRA) with diagnostic digital subtraction angiography (DSA) for the vascular assessment in the patients of NSAA. MATERIALS AND METHODS: Seventeen patients of NSAA were recruited in the study over the period of 3 years. Contrast enhanced MRA using Time-resolved angiography With Interleaved Stochastic Trajectories (TWIST) sequence and diagnostic DSA were performed in these 17 patients. RESULTS: The majority of the patients were young (median age was 25 years, range 8 to 46 years) and 11 patients were females. Erythrocyte sedimentation rate (ESR) was elevated in 9 patients and C-reactive protein (CRP) was elevated in 6 patients. Most commonly involved vessels in our patients were right renal artery (14 patients), abdominal aorta (12 patients) and left renal artery (11 patients). Left and right subclavian arteres were involved in 10 and 6 patients respectively. The sensitivity and specificity of time-resolved MRA using TWIST sequence is 100% as compared to DSA in the assessment of major vessels such as aorta, arch vessels, celiac artery and superior mesenteric artery. However, the sensitivity and specificity of time resolved MRA in the evaluation of renal arteries and vertebral arteries were 100%, 71.4% and 85.7%, 33.3% respectively. No significant association of MRI contrast enhancement with erythrocyte sedimentation rate (p = 1.00) and C-reactive protein (p = 0.600). CONCLUSION: Time resolved MRA images obtained using TWIST sequence were as qualitative as DSA images and can noninvasively evaluate the vascular involvement in NSAA patients.

Inadvertent arterial placement of central venous catheter: salvage using endovascular treatment.

The frequency of placing a central venous catheter (CVC) has increased and it is often performed in emergency situation for venous access. During such an emergency and placing without imaging guidance, sometimes inadvertent placement of CVC in subclavian artery (SCA) can occur. We hereby describe an unusual case of successful endovascular management of inadvertently inserted CVC in SCA by covered stent graft placement along with proper clinical context to manage a case of misplaced venous catheter in left SCA.

Loeffler's endocarditis with isolated left ventricular involvement on cardiac MRI.

Loeffler endocarditis is an uncommon restrictive cardiomyopathy associated with eosinophilia and endomyocardial fibrosis causing diastolic restriction, predominantly involving the right ventricle. Cardiac MRI plays a crucial role in early detection of disease. Early disease usually responds well to corticosteroids. We describe a case of Loeffler endocarditis with isolated left ventricular involvement on MRI in a young male having hypereosinophilia.

Unravelling chloroma: review of imaging findings.

Chloroma refers to the extramedullary proliferation of immature myeloid precursors occurring in a gamut of myeloproliferative and myelodysplastic conditions; acute myeloid leukaemia being the commonest. With non-specific clinical and imaging manifestations, it runs a high risk of misdiagnosis which may significantly affect the outcome of an otherwise treatable lesion. Also with these lesions heralding impending blast crises, awareness of the imaging findings becomes imperative. Imaging not only helps raise the suspicion but also guides further confirmation by demonstration of specific immunohistochemistry markers, ensuring timely institution of chemotherapy. In general, solid enhancing lesions in any haematological disorder could be chloromas, especially if multifocal with mass effect.

Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2†years follow-up.

A 35-year-old man with a 12-year history of idiopathic myelofibrosis (IMF) presented in 2014 with fatigue and abdominal distension. CT scan revealed massive hepatosplenomegaly with focal splenic lesions, soft tissue around renal pelvis, mesenteric masses compressing bowel loops and perilymphatic nodules in lungs. There was portal hypertension, ascites, pleural effusion, bilateral psoas abscesses and necrotic retroperitoneal lymphadenopathy. MRI additionally revealed hypointense periportal infiltrative lesions in liver, not seen on CT scan. None of these lesions showed diffusion restriction. Biopsy from mesenteric masses revealed extramedullary haematopoeisis. Aspiration from psoas abscess confirmed tuberculosis. Follow-up after 6 weeks of ruxolitinib (JAK2 tyrosine kinase inhibitor) and 9 months of antitubercular therapy revealed resolution of psoas abscesses and lymph nodes. Mild reduction was noted in mesenteric masses and ascites while perirenal soft tissue had increased. Follow-up imaging after another 1 year of ruloxitinib showed new-onset bilateral paravertebral and presacral foci of extramedullary haematopoeisis.

Imaging of peritoneal deposits in ovarian cancer: A pictorial review.

As per incidence, ovarian carcinoma is the second most common gynaecological malignancy in women. In spite of advanced technology, patient awareness and effective screening methods, epithelial ovarian cancer is usually diagnosed at an advanced stage (stage III). Surgical debulking of disease is mainstay of improving the patient survival even in advanced stages. Thus exact delineation of cancer spread in the abdominal cavity guides the surgeon prior to the surgery, help them to decide resectability of lesion and plan for further need of other surgical speciality or need of neoadjuvant chemotherapy. Imaging particularly well-planned contrast-enhanced computed tomography answers most of the queries raised by the treating surgeon. The aim of this article is to review the way ovarian carcinoma spread in the peritoneal cavity and to stress the accurate interpretation of cancer deposits on imaging which can help the treating team to reach optimal management of patients.

Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination.

Androgen insensitivity syndrome is a rare disorder of sex development and its clinical manifestations vary from subtle male infertility to an overt complete androgen insensitivity syndrome (CAIS) with a female phenotype. CAIS is often diagnosed at puberty or in adolescence during investigation for primary amenorrhoea. Undiagnosed patients have an increased risk of development of malignancy in the harboured testes. Inguinal hernia is the commonest mode of presentation of CAIS in childhood and various screening methods are available during the initial herniorrhaphy procedure. Controversy exists in the need to screen and the methods of screening in all cases of premenstrual girls with inguinal hernia. Abnormal observation in a suspicious case requires karyotyping for confirmation. We describe a case of CAIS with simultaneous presence of seminoma and a Sertoli cell adenoma in a 17-year-old patient who had a history of surgery for inguinal hernia at age of 5 years.