Bronchial Artery Pseudoaneurysm from a Tuberculous Lymph Node.

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Renal Volumetry-based Prediction of the Presence of Accessory Renal Artery: Computed Tomographic Angiography-based Study with Clinical Implications on Renal Doppler.

BACKGROUND: The objective was to validate the hypothesis and evaluate whether the presence or absence of accessory renal artery can be predicted on the basis of volumetric parameters of kidney and diameter of the main renal artery (mRA). METHODS: This retrospective analysis was performed in a total of 60 kidneys in 30 patients, who had computed tomographic (CT) angiography. The kidneys were segregated into control and study groups depending on the absence or presence of accessory renal artery. The total renal volumes were measured using renal length, breadth, and height in mm3. The renal artery diameters were also measured in mm, in the postostial segment. Renal volume/renal artery diameter (V/d) was measured for each kidney in two groups, and the difference in mean V/d values (in mm2) in two groups was measured for statistical significance. RESULTS: The mean V/d value in the study group with presence of the accessory renal artery was found to be 23,444.7 mm2 (range: 16,229.1-32,490.0). The V/d value in the control group with the absence of accessory renal artery was found to be 19,717.15 mm2 (range: 13,704.6-28,000.0). The mean values in the two groups showed a statistically significant difference in the V/d with a P value of 0.001 (P < 0.05). CONCLUSION: The study suggests that the possibility of the presence of the accessory renal artery is directly proportional to the total renal volume and inversely proportional to the diameter of mRA. The use of integrated volumetric parameter (V/d) is therefore likely to play a key role in the prediction of the presence of accessory renal artery on imaging studies. Renal volumetry on CT angiography may help predict the presence of accessory renal artery and thus may have implications on renal Doppler studies.

Renal Allograft Dysfunction: Evaluation with Shear-wave Sonoelastography.

Purpose To evaluate whether shear-wave sonoelastography can help differentiate stable renal allograft from acute allograft dysfunction and chronic allograft dysfunction and to correlate shear-wave sonoelastography measurements with resistive index (RI), serum creatinine level, estimated glomerular filtration rate (eGFR) obtained with the Nankivell equation, and biopsy findings. Materials and Methods A prospective study of 60 patients who had undergone renal transplantation was conducted between October 2014 and March 2016. Patients were classified as having stable allograft, acute allograft dysfunction, or chronic allograft dysfunction on the basis of clinical parameters. Mean parenchymal stiffness was compared. The Banff score was used wherever applicable. Receiver operating characteristic curves were drawn to evaluate the feasibility of differentiation. Results Thirty patients had graft dysfunction (acute in 19 patients and chronic in 11). Mean parenchymal stiffness values in stable allograft, acute allograft dysfunction, and chronic allograft dysfunction were 8.51 kPa ± 2.44, 11.06 kPa ± 2.91, and 24.50 kPa ± 4.49, respectively (stable vs acute dysfunction, P = .010; stable vs chronic dysfunction, P < .001; acute sysfunction vs chronic dysfunction, P < .001). The allograft parenchymal stiffness values for patients with Banff grade I (mild interstitial fibrosis and tubular atrophy) differed significantly from those with Banff grade II (moderate interstitial fibrosis and tubular atrophy) (P = .02). Parenchymal stiffness showed a negative correlation with eGFR (r = -0.725; P < .001) and a positive correlation with RI (r = 0.562; P < .001) and serum creatinine level (r = 0.714; P < .001). The sensitivity was 73.68% and specificity was 80% in the differentiation of stable graft from acute graft dysfunction (threshold value, 10.11 kPa). Conclusion Shear-wave sonoelastographic evaluation of renal parenchymal stiffness may help differentiate stable allograft from acute and chronic allograft dysfunction. The inverse correlation of parenchymal stiffness with eGFR and positive correlation with RI and serum creatinine level show that shear-wave sonoelastography may reflect functional status of the renal allograft.

Hystero-Salphingography in current clinical practice-old flames, die hard!

Hysterosalpingography (HSG) remains a valuable diagnostic tool in current clinical practice, offering crucial insights into endometrial cavity, fallopian tubes and the adjoining part of the pelvic peritoneal cavity. Despite the emergence of alternative imaging and non-imaging options, HSG continues to be widely utilized due to its diagnostic accuracy, cost-effectiveness, and easy accessibility. Due attention to the correct technique and optimal image interpretation will further enhance its diagnostic accuracy and precision in the work-up of patients with fertility problems.

Mutations in extracellular matrix genes NID1 and LAMC1 cause autosomal dominant Dandy-Walker malformation and occipital cephaloceles.

We performed whole-exome sequencing of a family with autosomal dominant Dandy-Walker malformation and occipital cephaloceles and detected a mutation in the extracellular matrix (ECM) protein-encoding gene NID1. In a second family, protein interaction network analysis identified a mutation in LAMC1, which encodes a NID1-binding partner. Structural modeling of the NID1-LAMC1 complex demonstrated that each mutation disrupts the interaction. These findings implicate the ECM in the pathogenesis of Dandy-Walker spectrum disorders.

Type Va Duplication of the Common Bile Duct With Type IIIa Intrahepatic Bile Duct Anatomy: A Rare Combination of Dual Biliary Ductal Anomaly With Difficulty to Extract Common Bile Duct Stone.

Extrahepatic duplication of the common bile duct (CBD) is an extremely rare anatomic variation seen in the biliary tract. It represents failure of regression of the primitive duplicated biliary ductal system, resulting in five different subtypes of the duplicated CBD as described by Choi et al. To date, only few such cases have been reported in the literature. Associated variation in branching of intrahepatic bile ducts presenting as combined dual ductal anomaly is even rarer phenomena to be seen. We report a case of a 67-year-old man with chronic kidney disease and obstructive jaundice resulting from choledocholithiasis. Evaluation revealed type IIIa branching of intrahepatic bile ducts with type Va duplication of the CBD.

A Comprehensive Comparison of Clinical Presentation and Outcomes of Kidney Transplant Recipients with COVID-19 during Wave 1 versus Wave 2 at a Tertiary Care Center, India.

Data comparing the clinical spectrum of COVID-19 in kidney transplant recipients (KTRs) during the first and second waves of the pandemic in India is limited. Our single-center retrospective study compared the clinical profile, mortality, and associated risk factors in KTRs with COVID-19 during the 1st wave (1st February 2020 to 31st January 2021) and the second wave (1st March-31st August 2021). 156 KTRs with PCR confirmed SARS-CoV-2 infection treated at a tertiary care hospital in New Delhi during the 1st and the second waves were analyzed. The demographics and baseline transplant characteristics of the patients diagnosed during both waves were comparable. Patients in the second wave reported less frequent hospitalization, though the intensive care unit (ICU) and ventilator requirements were similar. Strategies to modify immunosuppressants such as discontinuation of antinucleoside drugs with or without change in calcineurin inhibitors and the use of steroids were similar during both waves. Overall patient mortality was 27.5%. The demographics and baseline characteristics of survivors and nonsurvivors were comparable. A higher percentage of nonsurvivors presented with breathing difficulty, low SpO2, and altered sensorium. Both wave risk factors for mortality included older age, severe disease, ICU/ventilator requirements, acute kidney injury (AKI) needing dialysis, Chest Computerized Tomographic (CT) scan abnormalities, and higher levels of inflammatory markers particularly D-dimer and interleukin-6 levels. Conclusions. KTRs in both COVID-19 waves had similar demographics and baseline characteristics, while fewer patients during the second wave required hospitalization. The D-dimer and IL-6 levels are directly correlated with mortality.

Renal transplant evaluation: multimodality imaging of post-transplant complications.

With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive "one-stop" modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist"s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.

'Hepato-diaphragmatic fat interposition' and 'increased right hemi-diaphragmatic thickness': new imaging signs for early diagnosis of hepatic cirrhosis on routine CT abdomen.

BACKGROUND: Cirrhosis of liver is often a silent disease and need early diagnosis for effective treatment strategy. OBJECTIVES: The present article aims to describe new imaging signs for early diagnosis of cirrhosis on routine CT. These are 'hepato-diaphragmatic fat interposition' (HDFI) and 'increased right hemi-diaphragmatic thickness' (increased r-DT sign). MATERIALS AND METHODS: This was a retrospective study based on the presence or absence of cirrhosis of liver (n = 100). 'HDFI sign' was labeled as positive if F is more than 50% of D; where F is the medio-lateral extent of the intra-abdominal fat along the postero-medial margin of liver and D is the distance from the lateral vertebral margin to the medial margin of the outer-most rib in the same axial image. Increased 'r-DT sign' is labeled when the dimension on right side exceeds left side by at least 0.2 cm. Pearson χ2 was performed to calculate the p value. A p value of < 0.05 was considered to indicate a significant difference. RESULTS: There was a significant difference between cirrhotic and normal group, The sensitivity, specificity, positive predictive value and the negative predictive value of HDFI sign was found to be 94%, 62%, 71.21% and 91.17%, while that of increased r-DT sign was found to be 96%,52%, 66.66% and 92.85%. The area under the ROC curve for the HDFI sign was found to be 0.78 as compared to 0.74 for the increased r-DT sign. CONCLUSION: Both these new signs should be used as additional imaging signs for early diagnosis of cirrhosis.

Optimal utilization of MSK imaging during COVID-19 pandemic.

The COVID-19 pandemic has caused multi-dimensional global crisis in the recent times. There is an increasing necessity of understanding and developing a strategy for optimal utilization of healthcare resources in this time of crisis. Radiology department remains the backbone for diagnosis and for appropriate management of orthopaedic ailments. Amidst COVID-19 pandemic, there is a need to change in imaging algorithm, for various clinical conditions taking care of the exposure risk to patients and healthcare workers and to handle the volume of diagnostic and intervention work. Radiology preparedness is to set the workflow protocols and policies applicable to radiology investigations for different clinical conditions, which will help to attain these objectives. Radiologists are in best position to decide the most appropriate imaging investigation and protocol making it vital to have a frequent Orthopaedic surgeon-Radiologist interaction, which is one of the most important steps in patient management pathway.

Prenatal Presentation of Medulloepithelioma: Case and Literature Review.

Congenital brain tumors (CBTs) are extremely rare and account for only 0.5%-1.9% of all pediatric brain tumors. Medulloepithelioma is one of the rare tumors with an incidence of about 1% among all CBTs with a very dismal prognosis and typically diagnosed at the median age of 24 months. The objective is reporting medulloepithelioma presenting in the intrauterine period with very few prior cases being reported in the prenatal period, and to add to the limited existing literature on medulloepithelioma. We present a rare case of medulloepithelioma referred to us in the antenatal period at 27 weeks and subsequently causing intrauterine fetal demise. Prenatal MRI of the fetal brain and postnatal histopathological findings on autopsy were suggestive of intracranial medulloepithelioma.

Prenatal diagnosis of congenital harlequin ichthyosis with fetal MRI.

Most of the fetal deformities are caused due to genetic abnormalities. Although magnetic resonance imaging (MRI) may be used to accurately diagnose these deformities, it has been reported that gene analysis is a more accurate diagnostic method. Harlequin ichthyosis (HI) or Ichthyosis fetalis (IF) is a rare and extremely severe hereditary skin disorder with autosomal recessive inheritance. The ultrasound features have been described well and the diagnosis can be made with a fair degree of confidence. However, the final diagnosis needs to be established by prenatal invasive tests. In the present study, we describe the diagnosis of HI in the third trimester on fetal MRI referred to our department with suspicion of anterior encephalocele which was later confirmed through postnatal genetic evaluation.

Minimum-intensity projection images in high-resolution computed tomography lung: Technology update.

Chest physicians need to be aware about MinIP images, as these are increasingly being used for the evaluation of a wide range of lung diseases in HRCT study of lungs. MinIP images highlight the areas with reduced CT attenuation in the lung parenchyma. This allows prompt and early diagnosis of cystic lung diseases or airway, vascular or parenchymal disorders, which manifest with hypoattenuation, mosaic attenuation or air trapping. MiniP images are therefore useful for accurate pre-operative planning and disease monitoring.

Double Posterior Cruciate Ligament Sign on Magnetic Resonance Imaging: Imaging Variants, Mimics, and Clinical Implications.

INTRODUCTION: Double posterior cruciate ligament (PCL) sign is a sign on magnetic resonance imaging (MRI) which is suggestive of a bucket- handle tear (BHT) of the meniscus. We undertook this study to assess the presence of a double PCL sign and its correlation with arthroscopic findings. We also discussed the various mimics and variants of the double PCL sign. CASE REPORT: All the patients with a double PCL sign on the MRI and who underwent knee arthroscopy between January 2012 and December 2016 (total of 5 cases, 4 males and one female) were included in the study. A correlation between the imaging findings and the MRI findings was done. All these young patients were aged between 22 and 41 years. Two patients underwent arthroscopic partial meniscectomy, and three patients underwent arthroscopic meniscal repair using all inside technique. CONCLUSION: It is necessary for the sports physician to understand and recognize this important and subtle sign on MRI which is suggestive of a BHT of the meniscus. It is also important to identify the mimics of this sign and its variants for better management planning and patient prognostication.

Prospective evaluation of prostate with transrectal spectral Doppler with biopsy correlation: a clinicopathologic study.

OBJECTIVES: To compare the transrectal (TR) spectral Doppler findings between benign prostatic hyperplasia group and prostate cancer group. METHODS: All the patients were assessed for adequate preparation, and informed consent was obtained prior to the procedure. The control group (n = 33) comprised patients who were negative for malignancy on biopsy. The study group (n = 22) were positive for malignancy and were also divided into three groups on the basis of the Gleason score. Study parameters included mean values for resistive index (RI), pulsatality index (PI), systolic/diastolic ratio (S/D) and peak systolic velocity (PSV). These were separately measured for bilateral capsular and urethral branches and compared between groups. In patients with unilateral tumour, these were compared between the tumour and non-tumour sides. Finally, the parameters were compared with patient's age. Mann-Whitney U test was used to evaluate the statistical significance. RESULTS: The mean values of RI, PI, S/D and PSV were found to be 0.84/1.03, 1.8/1.99, 3.93/4.45 and 15.52/16.15 cm s(-1), respectively, in the control and study groups which were not statistically significant. In patients with unilateral malignancy (n = 16), there was no significant difference from the non-tumour side. Doppler parameters showed statistically significant relationships with age. The mean of minimum RI was found to be 0.60 in patients less than 60 years of age and 0.76 in patients more than or equal to 60 years of age in the benign category (p-value = 0.014). The PI and S/D also showed significant difference in the benign category. CONCLUSION: TR spectral Doppler parameters did not reveal any significant difference in patients with or without prostatic malignancy, irrespective of the Gleason grade. Doppler parameters, however, showed significant correlation with age and were lower in younger patients. ADVANCES IN KNOWLEDGE: TR spectral Doppler is unlikely to emerge as a diagnostic and prognostic tool for prostate carcinoma.

Imaging Complications of Renal Transplantation.

Renal transplant complications are categorized as those related to the transplant vasculature, collecting system, perinephric space, renal parenchyma, and miscellaneous complications including posttransplant lymphoproliferative disorder. Many of these renal transplant complications are diagnosed with imaging. Medical complications including rejection, acute tubular necrosis, and drug toxicity also can impair renal function. These medical complications are typically indistinguishable at imaging, and biopsy may be performed to establish a diagnosis. Normal transplant anatomy, imaging techniques, and the appearances of renal transplant complications at ultrasound, computed tomography, and MR imaging are reviewed.