Clinical, Sonographic and MRI Assessment of Sports Injury of Knee: A Comparative Study

Aim: To understand the relative diagnostic sensitivity,specificity and accuracy of each modality.Introduction: Internal de-arrangement of knee requires utmostdiagnostic accuracy especially in professional sportspersonnel’s. MRI is the most advanced modality to date forsuch injuries and there is a trend among most of the patientsand treating young doctors to order for an MRI, in almost all theinjuries, obvious and occult, with the result that there is a heavyrush of workload on MRI and it is difficult to cope with the workload, resulting in a long waiting list.Method: In view of the above situation and conflicting reports,regarding the efficiency of ultrasound and total neglect ofclinical diagnosis this comparative study of clinicalexamination, ultrasonic diagnosis and MRI was conducted inour tertiary care centre, from March 2017 to March 2018, as aprospective double blind study.Results: Among the 104 patients who participated in this study106 lesions were diagnosed clinically, where in 10 lesions werefalse positives as confirmed by MRI, in only 96 cases. Resultsof ultrasound analysis were quite encouraging as it coulddiagnose IDK in 95 cases meaning only one case as falsenegative. Lateral meniscus (LM) was diagnosed clinically in 16cases, sonographically in 17 cases and by MRI in 18 cases.Medial Meniscus (MM) was diagnosed as torn clinically in 38cases, ultrasonographically and MRI in 36 cases. ACL wasdetected as torn clinically in 32 cases while 28 and 27 by USGand MRI while as PCL was detected as torn clinically in 1 andin 2 cases by USG and MRI. Medial collateral (MC) wasdetected as torn clinically in 7 cases and by USG and MRI In10 cases while as Lateral Collateral (LC) was detected as tornclinically in 2 cases while 3 by USG and MRI.Overall, sensitivity, specificity and accuracy (SSA) of clinicalexamination was 75.7%, 79.6% and 78.1%. Mean SSA ofultrasound was 96.8%, 98.4% and 97.4%. The study provesthat ultrasound is a reasonably sensitive, specific and accuratein expensive diagnostic tool and is underutilized, as in experthands its results match that of MRI.

Clinicoradiological and Histopathological Comparative Study of Nodal Metastasis in Head and Neck Cancers.

Background: Detection of regional lymph nodes in head and neck cancers greatly modifies the staging, treatment and prognosis of the patient and helps in planning the management of these patients. Methods: A prospective study was conducted in the Department of E.N.T., S.M.G.S. Hospital, G.M.C. Jammu, in collaboration with the Department of Radio diagnosis and Imaging, G.M.C. Jammu & Department of Radiation Oncology GMC, Srinagar from 2008 to 2012 in which patients attending / admitted in the Department of E.N.T., with cancer of head and neck, were assessed for lymph node metastasis (at different levels). 16 patients, all cases of squamous cell carcinoma head and neck, underwent appropriate neck dissections. The patients were examined clinically as well as with ultrasonography for detection of various enlarged lymph nodes at different levels. Computed tomography and magnetic resonance imaging were done, wherever indicated. Patients were subjected to fine needle aspiration cytology in cases of palpable lymph nodes. The removed lymph nodes were examined histopathologically. Results: The findings of clinical, radiological and histopathological studies were compared. We concluded that clinical palpation should be supplemented by ultrasonography in every case of head and neck cancer. However, since computed tomography picks up lymph nodes missed by ultrasonography in a significant number, is important in imaging primary tumour and picks up necrosis and extracapsular spread at the most, it should be included in each case of head and neck cancer. Conclusion: Magnetic resonance imaging being equivalent to computed tomography in picking up the nodes, but lagging behind the criteria such as picking up of nodal necrosis and extra capsular spread of lymph nodes, and is too costly, so may be included as an imaging modality wherever computed tomography is contraindicated.

Hepatic Papillary Process - An Anatomic Variant of Liver.

Hepatic Papillary process is an anatomic variant of liver. When large can simulate mass lesion in pancreatic head region or periportal lymphnode on imaging however liver tissue characteristics and continuity of the process with the caudate lobe facilitate the differentiation between extrahepatic portocaval mass and papillary process. CT is the modility of choice for the right diagnosis of liver anatomical variants.

Fine Needle Aspiration Cytology of Ameloblastoma.

Ameloblastoma is the most common tumor of odontogenic origin. It is more common in the mandible than in the maxilla. It often presents as a slow growing, painless swelling. There is often delay in its diagnosis because of its slow growing nature. Fine needle aspiration cytology (FNAC) of jaw lesions is a rapid and non-invasive procedure for the initial evaluation of these lesions. It provides helpful information about them and avoids hasty and unnecessary surgical biopsy. Here we present a case of ameloblastoma diagnosed by fine needle aspiration cytology.

Role of Magnectic Resonance Imaging of Brain in Paediatric Patients with Partial Seizures.

The study was carried out for one year to find out the role of magnetic resonance imaging brain in pediatric patients with partial seizures. Children from age 28 days to 18 years who presented with partial seizures were included and the information obtained from the history, clinical examination and investigations particularly MRI brain were noted down and analyzed.Maximum numbers of patients were in the age group of 5-10 years (48.84%).27.91% had simple seizures and the rest 72.09%had complex partial seizures with none having secondary generalization. The risk factor for seizures were present in 54.19% of cases. Most of the lesions involved parietal region (44.19%) followed by temporal lobe involvement in 13.95%. 55.81% had findings of neurocysticercosis (NCC), 29.91% showed tuberculoma, 8.30% had normal MRI findings and 6.98% had findings suggestive of cerebritis, sturge weber syndrome and porencephalic cyst. 89.74% lesions showed contrast enhancement on MRI. Contrast enhancement MR altered the radiological diagnosis in many patients with partial seizures. It helped to diagnose infections like tuberculoma and NCC in various stages of evolution and also helped to rule out other structural lesions, thus helping in planning modalities of treatment.

Bilateral Asymmetrical Traumatic Hip Dislocation in an Adult.

Bilateral hip dislocation occurring as a result of trauma is a rare condition. Simultaneous anterior and posterior traumatic dislocation of both hips is even more unusual. A case is reported of bilateral asymmetrical traumatic hip dislocation in previously normal hips in a 20 year old adult male without an associated fracture of the pelvis or femur. An unusual mechanism for this injury is also described.

Duodenal Tuberculosis

Duodenal tuberulosis is uncommon. We present here a case of duodenal tuberculosis who presented with pain abdomen, vomiting and fever. Duodenoscopy revealed deep irregular ulcers in duodenum. Histopathology of duodenum showed features of tuberculosis.