Imaging Spectrum of Severe Urinary Tract Infection Complications Presenting as a Seminal Vesicle Abscess, Prostatic Abscess, and Renal Abscess in Uncontrolled Diabetes Mellitus: A Case Report.

Urinary tract infections are more common and severe, and they carry worse outcomes for patients with type 2 diabetes mellitus. The infections are typically caused by resistant pathogens, leading to many complications. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. We present an imaging spectrum of a severe urinary tract infection presenting as renal, prostatic, and seminal vesicle abscesses in a patient with uncontrolled diabetes mellitus.

A Case of Lymphangioma of the Calf Region: Imaging Spectrum With Histopathological Correlation.

Lymphangioma, also known as cystic hygroma are benign malformations arising from abnormal development of the lymphatic system. Most often these lesions are found in the pediatric population, having a predilection for the neck/axilla, and are less common in extremities. Symptoms can vary based on size and location. Treatment is not usually indicated until they start impacting life due to deformity or symptoms such as pain, paraesthesia, etc. Here, we report a case report of lymphangioma located in the calf region of the right lower limb presenting in adult age.

Liver Tuberculosis Presenting As Fever of Unknown Origin: A Case Report and Imaging Spectrum With a Review of Literature.

Hepatic tuberculosis is not commonly seen, and it can be easily missed unless there is strong suspicion. It presents clinically with non-specific symptoms like pain in the upper right abdomen, tenderness, mild fever, sweating at night, losing weight, feeling tired, and a lump in the abdomen. We are reporting a case of a 41-year-old female who presented with an intermittent history of fever and right hypochondriac pain for 10 years. Ultrasound and contrast-enhanced computed tomography (CECT) scans of the patient revealed a mass lesion with classical imaging findings of tuberculosis. Subsequently, a biopsy was conducted, confirming the presence of liver tuberculosis.

A rare case of right renal ectopia with ureteral triplication in a 37-year-old male: a case report.

Ureteral triplication is one of the least encountered congenital malformations of the upper urinary tract. We report a case of a 37-year-old male patient with right renal ectopia with triplication of the ureter which was diagnosed via computed tomography (CT) urography. This is an intriguing example because, as we discovered after reviewing the literature, the presentation is distinctive.

Normal dimensions of the lacrimal gland on magnetic resonance imaging in Indian adult population: a retrospective study.

Introduction: the lacrimal gland size is affected by a variety of pathologic conditions like inflammatory, infections, neoplastic, autoimmune and granulomatous disorders. Earlier, the dimensions of the gland were estimated by extracting lacrimal glands from cadavers, later ultrasonography and computed tomography studies were used, but had limited soft tissue differentiation. The aim of this study was to retrospectively evaluate Magnetic Resonance Imaging (MRI) data from normal orbits and determine lacrimal gland dimensions. Methods: five hundred and twelve (512) consecutive MRI brain contrast scans (of 240 females, of 272 males; age range 40±20 years) for non-orbital diseases were evaluated retrospectively. The mean axial length (AL), axial width (AW), coronal length (CL), and coronal width (CW) of each lacrimal gland were measured separately. Results: five hundred and twelve (512) MRI brain contrast scans of 272 men and 240 women, with mean age of 40 ± 20 years were included. Right and left LG dimensions were similar, mean AL (13.2±1.35 mm versus 13.11±1.24 mm), mean AW [3.5±0.99 mm versus 3.3±0.82 mm], mean CL [16.3±2.5 mm versus 16.10±2.4 mm], and mean CW (4.15±0.89 mm versus 4.11±0.85 mm). The AL of both lacrimal glands and the CL and CW of right but not left lacrimal glands were significantly lower in women than in men. Age showed significant correlations with the AL and CL of both LGs. Conclusion: in this study, evaluation of normal morphometric parameters of the lacrimal gland in Indian population was established. LG dimensions are smaller in women than men, as well as correlating with side and age.

An Aberrant Case of Large Submandibular Gland Sialolith With Obstructive Sialadenitis in a Young Female.

Sialolithiasis is a major cause of salivary gland dysfunction. Submandibular sialolithiasis with obstructive sialadenitis is a relatively uncommon condition. Submandibular gland sialolithiasis with obstructive sialadenitis accounts for about 2% of all cases of sialadenitis. We are reporting a case of a 20-year-old female who presented with acute-onset swelling in the right submandibular region. The submandibular gland had a large calculus with pericalcular abscess development, which was clearly visible on pre- and post-contrast computed tomography. Subsequently, surgical excision of the lesion was performed, and calculus was removed.

Magnetic Resonance Imaging in the Diagnosis of Female Adnexal Masses: Comparison With Histopathological Examination.

Introduction Adnexal masses present a special diagnostic challenge because it is difficult to differentiate between benign and malignant lesions clinically. The diagnosis of malignancy is vital, and imaging is the most important part of the evaluation of adnexal masses. This study was conducted with the goal of comparing the accuracy of magnetic resonance imaging (MRI) in diagnosing female adnexal masses in comparison with histopathology examination (HPE). A total of 70 female patients with suspected adnexal lesions were selected for the study. After obtaining informed consent from the patients, an MRI was performed with a subsequent histopathological examination of the lesion. Results The study revealed that MRI demonstrated 27% non-neoplastic, 47% benign, and 26% malignant lesions. HPE, the gold standard for identifying and classifying pathological masses, positively identified the lesions and classified them as non-neoplastic, surface epithelial-stromal, germ cell, and sex cord-stromal tumors. The present study of 70 cases with adnexal masses showed a strong positive correlation between MRI and HPE findings. Conclusion MRI provides the added advantage of visualization of the tumor matrix with differential identification of the fatty and cystic tissue through heterogeneous signals and enhancement indicating aggressiveness and local spread. MRI has greater diagnostic accuracy when compared to ultrasonography (USG), with HPE as the gold standard for discriminating between benign and malignant adnexal masses.

An Aberrant Seminoma as a Complication in an Undescended Testis: A Case Report and Review of Literature.

Testicular germ cell tumors are testicular neoplasms in young and middle-aged men. Undescended testis dramatically increases the risk of testicular germ cell tumors. We report the case of a 33-year-old male who complained of swelling and pain in his lower abdomen. The patient also had an undescended left testis. An intrabdominal mass was detected on ultrasound that was further characterized using contrast-enhanced CT. Imaging findings suggested testicular germ cell tumor, developing as a complication in the undescended testis. The patient was operated and the diagnosis was confirmed on histopathological examination.

Chondrosarcoma of Sternal Origin: A Rare Case.

Chondrosarcoma of sternal origin is extremely rare. Here, we present the case of a 59-year-old male who presented with gradually increasing swelling and pain over the left sternoclavicular joint which was diagnosed as chondrosarcoma of sternal origin. We also present a review of the relevant literature.

Carotid body paraganglioma: a case report.

A highly vascular glomus tumor that develops from the paraganglion cells of the carotid body is called a carotid body tumor (CBT), also known as a chemodectoma or carotid body paraganglioma (CBP). It is situated near the carotid bifurcation, where the external and internal carotid arteries splay out characteristically. We present a case of a 30-year-old woman who had a slightly tender, slightly pulsatile, and slightly ballotable swelling over the lateral aspect of the neck on the right side. The surgical resection of the tumor was done based on the diagnosis made on clinical-radiological investigations as a carotid body tumor further confirmed by a histopathological study. We also provide a summary of the research on carotid body tumors clinical and imaging manifestations, assessment, and therapy.

An Aberrant Case of Foreign Body Granuloma in the Left Forearm Due to an Impacted Piece of Glass Bangle.

Foreign body granuloma is an inflammatory tissue reaction around retained foreign bodies after penetrating trauma. The granulomatous reaction is a natural mechanism of the body to heal wounds by restricting the damage done by a pathological agent and containing the pathological agent to the wound site only. Here we present a classic case of a foreign body granuloma on the dorsal aspect of the forearm. This case was evaluated radiologically on high-frequency ultrasound and X-ray imagining and was operated on afterward. A piece of broken glass bangle was found inside the granuloma.

An Aberrant Case of Sacrococcygeal Teratoma in a Female Infant Born of Twin Pregnancy.

Sacrococcygeal teratoma (SCT) is an uncommon infantile tumor. It has a female preponderance with malignant variants being more common in males. These usually manifest as palpable masses over the sacral region in infancy which may or may not be associated with neural tube defects. An initial radiological investigation is warranted to analyze the extent and components of the mass to guide an approach for surgical excision. We present a classic case of an SCT in a female infant born as a twin. This mass was evaluated radiologically by X-ray and ultrasound followed by histopathological correlation. This is a case of Altman Type-I lesion and was confirmed as a mature teratoma on histopathological examination.

Live Cervical Ectopic Pregnancy in a Patient With Previous Cesarean Section: A Case Report With Review of Literature.

Live cervical ectopic pregnancy is a rare type of ectopic pregnancy and accounts for <1% of all ectopic pregnancies. Prompt diagnosis and early management with systemic or local administration of methotrexate is the treatment of choice in most cases. If the pregnancy is complicated, it can lead to significant hemorrhage, which may require a hysterectomy to save the life of the patient. We report a case of live cervical ectopic pregnancy in a 26-year-old patient with a history of previous cesarean section and presenting with silent bleeding per vaginum for six hours.

Normal Reference Values of the Blackburne-Peel Ratio for Measuring Patellar Height in an Indian Population.

Background Historically, the quadriceps tendon has the largest sesamoid bone of the body, which is known as the patella. Patellar height is one of the important parameters in assessing patellar stability. The patella height has been found to vary in several diseases. As a result, ratios based on a variety of patellar bone indices are used to determine the norms. This study aimed to determine the typical patella height ratio in Indians, who have different sitting and squatting positions as opposed to Caucasians, by applying the Blackburne-Peel ratio to assess patellar height which is an alternative to the conventional Insall-Salvati ratio. Methodology A total of 100 normal lateral knee radiographs from the Indian population were used in this retrospective study. The Blackburne-Peel method (A/B) was used to calculate the ratios. It was calculated as perpendicular length measured from the inferior articular point of the patella to the point perpendicular (A) to the tibial plateau to the length of the articular surface of the patella (B). Results Patella height ratio for men was 0.67 ± 0.01, whereas, for women, it was 0.67 ± 0.02. The ratio did not differ significantly (p > 0.05) from the Western population. Conclusions The normal range of the Blackburne-Peel ratio for the Indian population was established, which can be used as a baseline and can be helpful in establishing patellar height in the Indian population. Similar to previous studies, our study shows that patella height ratios are stable regardless of gender or race and can be used to enhance and restore knee kinematics and functions.

Colo-Vesical Fistula: Relevance of Conventional Radiology in the Modern Era.

Colo-vesical fistula (CVF) is usually encountered in severe inflammatory and malignant conditions. Radiological imaging is crucial to the diagnosis of a colo-vesical fistula and helps gastroenterologists and surgeons select the best treatment option. This disorder is typically identified during follow-up of treatments for diverticulitis or chronic inflammatory bowel disease. The patients present with symptoms of pneumaturia and fecaluria. The most accurate imaging modality for diagnosing CVF is CT with rectal contrast.  In this case report, we present a case of a 58-year-old male patient with complaints of fecaluria and pneumaturia for three months. Ultrasonography and barium enema revealed a clear fistulous tract between the sigmoid colon and the urinary bladder. Subsequently, the patient underwent exploratory laparotomy and the specimen was sent for histopathological evaluation to rule out malignancy. The diagnosis on imaging was consistent with post-operative findings of a CVF. This case report will add to the knowledge of radiologists about the imaging features of CVFs and their identification on imaging.

Portable Chest Radiograph: A Boon for Critically Ill Patients With COVID-19 Pneumonia.

OBJECTIVE: In the present study, we evaluated the role of portable chest radiographs in critically ill patients with COVID-19 pneumonia in whom computed tomography (CT) of the chest was not feasible. METHODS: A retrospective chest X-ray study of patients under investigation for COVID-19 was performed in our dedicated COVID hospital (DCH) during the exponential growth phase of the COVID-19 outbreak (August-October, 2020). A total of 562 on-bed chest radiographs were examined comprising 289 patients (critically ill who couldn't be mobilized for CT) along with positive reverse transcription-polymerase chain reaction (RT-PCR) tests. We categorized each chest radiograph as progressive, with changes, or improvement in appearance for COVID-19, utilizing well-documented COVID-19 imaging patterns. RESULTS:  In our study, portable radiographs provided optimum image quality for diagnosing pneumonia, in critically ill patients. Although less informative than CT, nevertheless radiographs detected serious complications like pneumothorax or lung cavitation and estimated the evolution of pneumonia. CONCLUSION: A portable chest X-ray is a simple but reliable alternative for critically ill SARS-CoV-2 patients who could not undergo chest CT. With the help of portable chest radiographs, we could monitor the severity of the disease as well as different complications with minimal radiation exposure which would help in identifying the prognosis of the patient and thus help in medical management.

Dyke-Davidoff-Masson Syndrome: A Classic Case Report.

Dyke-Davidoff-Masson syndrome (DDMS) is a rare neurological disorder found in children as well as adults. It is characterized by hemi cerebral atrophy. To date, very few cases of this disorder have been reported. Radiological imaging including magnetic resonance imaging (MRI) and computed tomography (CT) are accurate tools for the diagnosis of DDMS. We present a case of a 13-year-old female child who came with complaints of multiple episodes of generalized tonic-clonic seizures. In our case, clinical history and imaging with CT and MRI were accurate enough to diagnose DDMS.

The Diagnosis and Treatment of Rasmussen's Encephalitis: A Case Report.

Rasmussen's encephalitis is a very rare type of chronic inflammatory disease of the brain. We report a case of a nine-year-old male patient who presented with seizures and cognitive impairment for six years. An MRI of the brain revealed significant cerebral hemiatrophy. The patient was on immunoglobulin therapy. We also engage in a review of the existing literature on Rasmussen's encephalitis.

Evaluation of Normal Inferior Vena Cava Diameters in the Indian Adult Population by Computed Tomography.

Background The imaging evaluation of inferior vena cava (IVC) diameters is essential for the estimation of vena caval pathologies and can also detect early hypovolemic shock. There are very few studies on normal IVC diameters on CT scan done in foreign countries, and none done in the Indian population. Aims The goal of this research is to assess the normal IVC diameter in the Indian adult population by performing a CT scan of the abdomen. Material and methods In this study, CT scans of 200 individuals (aged 19-83) without any circulatory and vascular disorders were analyzed retrospectively. The anteroposterior (AP) and transverse diameters of the IVC were measured at the level of the renal vein and at the level 2 cm proximal to insertion in the heart (usual area of measurement on ultrasonography). Results The study discovered normal adult mean AP and transverse dimensions of the IVC at the level of the renal vein as 16.3 ± 2.9 mm and 25.8 ± 3.5 mm, respectively, and 16.9 + 3.2 mm and 26.2 + 3.6 mm at the level 2 cm proximal to its insertion in the right atrium. Conclusions In this study, the normal morphometric dimensions of the IVC in the Indian adult population were established. The diameters of the IVC and the age of the participants in our study had no statistically significant correlation, however, the IVC changes its cross-sectional area and diameter due to changes in venous pressure and blood pressure and hence is a highly compliant vessel. The results of the study will be used as baseline data for the assessment of IVC disorders.

Interobserver Variability in CT Severity Scoring System in COVID-19 Positive Patients.

BACKGROUND:  Chest CT scans are done in cases of coronavirus disease 2019 (COVID-19)-positive patients to understand the severity of the disease and plan treatment accordingly. Severity is determined according to a 25-point scoring system, however, there could be interobserver variability in using this scoring system thus leading to the different categorization of patients. We tried to look for this interobserver variability and thus find out its reliability. METHODS:  The study was retrospective and was done in a designated COVID center. Some 100 patients were involved in the study who tested positive for COVID-19 disease. The research was conducted over six months (January 2021 to June 2021). Images were given to three radiologists with a minimum of 10 years of experience in thoracic imaging working in different setups at different places for interpretation and scoring further and their scores were compared. Before the study, the local ethics committee granted its approval. RESULTS:  There was no significant variability in the interobserver scoring system thus proving its reliability. The standard deviation between different observers was less than three. There was almost perfect agreement amongst all the observers (Fleiss' K=0.99 [95% confidence interval, CI: 0.995-0.998]). Maximum variations were observed in the moderate class.  Conclusion: There was minimum inter-observer variability in the 25-point scoring system thus proving its reliability in categorizing patients according to severity. There was no change in the class of the patient according to its severity. A 25-point scoring system hence can be used by clinicians to plan treatment and thus improve a patient's prognosis.