Congenital Intraoral Dermoid and Epidermoid Cyst with Orocutaneous Fistula Presenting with Life-threatening Airway Obstruction in an Infant.

Dermoid cysts and epidermoid cysts in the floor of the mouth are rare in the pediatric age group. In this case report, we have discussed the presentation, management, and literature review of a 6-month-old female child presenting with both dermoid and epidermoid cysts in the floor of the mouth with an orocutaneous fistula.

Efficacy of MRI Over Ultrasound in Evaluation of Abnormal Uterine Bleeding With Histopathological Correlation.

Introduction Abnormal uterine bleeding (AUB) is one of the most common problems in gynecologic practice. In the peri- and postmenopausal age group, it accounts for more than 70% of all gynecological complaints. The current study's objective was to compare the effectiveness of MRI and ultrasonography (USG) in detecting the cause of abnormal uterine bleeding with pathological correlation. Material and methods We conducted an observational study involving subjects with abnormal uterine bleeding. Patients who presented with abnormal uterine bleeding were referred to the department of radiodiagnosis and underwent USG of the abdomen and pelvis, followed by an MRI of the pelvis. Findings were analyzed and compared with the histopathological examination (HPE) of the samples of hysterectomized uterus, polypectomy, myomectomy, and dilation and curettage (D&C) of the endometrium. Results Among the study population, USG reports showed two patients (4.10%) with polyps, seven patients (14.58%) with adenomyosis, 25 patients (52.08%) with leiomyomas, and 14 patients (29.16%) with malignancies. On MRI examination, three patients (6.25%) were diagnosed with polyps, nine patients (18.7%) with adenomyosis, 22 patients (45.8%) with leiomyomas, and 14 patients (29.16%) were reported to have malignancies. The measure of agreement with the kappa value for MRI and HPE in evaluating the causes of abnormal uterine bleeding is 1.0 (very good). Whereas the kappa agreement value of USG and HPE in evaluating the causes of abnormal uterine bleeding is 0.903 (acceptable). The sensitivity of USG in diagnosing polyps, adenomyosis, leiomyoma, and malignancy was observed at 66%, 77.78%, 100%, and 100%, respectively. The sensitivity of MRI in diagnosing polyps, adenomyosis, leiomyoma, and malignancy was 100% for each. Conclusion MRI is the most effective method for accurate identification of the location, number, and characterization of lesions, extensions, and staging of carcinomas.

Role of Multidetector Computed Tomography in the Evaluation of Maxillofacial Trauma.

INTRODUCTION: Maxillofacial fractures are among the commonest injuries occurring in trauma patients. Multislice computed tomography (CT) is a widely used radiological investigation that accurately reveals the number, location, and extent of the fractures as well as concomitant soft tissue injuries and has been found to be superior in the diagnosis of maxillofacial fractures owing to high sensitivity and specificity. This study was performed to assess the efficacy of axial, coronal, sagittal, and three-dimensional (3D) reformatted images in the detection of fractures in maxillofacial trauma. MATERIALS AND METHODS: This was a cross-sectional descriptive study conducted on 49 adult patients with maxillofacial injuries undergoing multislice CT using a multidetector SiemensSOMATOM Emotion eco 16 slice CT scanner (Siemens AG, Munich, Germany). CT protocol consisted of non-contrast axial 16-slice helical series beam collimation ~ 3 mm, pitch ~ 0.8 - 1, tube current ~ 270 mAs, voltage ~ 130 kV, Total exposure time ~ 18 seconds, total radiation ~ 200 mGy. Along with the axial, coronal and sagittal images were reconstructed with 0.5 mm increment. 3D volume-rendering images were also obtained. 3D images were compared with axial images, coronal and sagittal plane images. RESULTS: The maximum number of cases was in the age group of 21-30 years with the male: female ratio being 5.12:1. The most common cause of injury was road traffic accidents (RTA). Mandible fractures were found to be the most common (20 patients, 40.8%) followed by fractures of nasal bone (18 patients, 36.7%). The incidence of frontal bone fractures was found to be the least (six patients, 12.24%). Our study found that 3D images are superior to axial in assessing the extent and degree of displacement of maxillofacial fractures in general. The maxillary sinus was found to be the most commonly fractured sinus (19 patients, 38.7%). Sphenoid sinus fractures were the least common (seen in two patients, 4.08%). CT findings correlated with the operative findings in most types of fractures. CONCLUSION: Multidetector CT with multiplanar and 3D reformation is highly accurate in the identification of fractures and assessing the extent and degree of displacement of fractures; hence, it is the imaging modality of choice in maxillofacial trauma. 3D images are much better for the detection of maxillofacial fractures compared to axial, coronal, or sagittal views, especially in maxilla and mandibular bone fractures. It is also found to be better at providing information on the patterns of the fracture lines and the displacement of the fracture fragments. Another added advantage of multidetector CT is that it is a non-invasive technique with good accuracy and a short scan time.

Role of Magnetic Resonance Imaging in Morphometric Alterations of Corpus Callosum in Stroke Patients.

BACKGROUND: Corpus callosum plays a role in interhemispheric integration, language, intelligence, and creativity of individuals, hence variations in corpus callosum size are seen in various neurological diseases such as Alzheimer's and bipolar affective disorder. While the dimensions differ based on gender, age, and ethnicity, pathological variations are seen with some diseases such as vascular dementia, leukoaraiosis, stroke, and carotid artery stenosis. This study was conducted to compare the morphometric alterations of the corpus callosum between normal subjects and stroke patients using magnetic resonance imaging (MRI). METHODS: This was a case-control study conducted on 84 subjects divided into cases and control groups. The widths of the genu, body & splenium, and anterior-posterior (AP) diameter of the corpus callosum were measured and the values were compared among the two groups. Student's t-test and regression analysis were utilized for the analysis of data and p<0.05 was considered statistically significant. RESULTS: Sixteen patients (19.04%) belonged to the age range of 18-40 years, 32 (38.09%) belonged to the age range of 41-60 years and 36 (42.8%) belonged to the age group of >60 years. There was no discrepancy between cases and controls or between the age groups. The mean width of genu, body & splenium, and AP diameter was compared between normal individuals and stroke patients. It was noted to be significantly lesser in cases than in controls. The morphometric indices i.e., width of genu, body & splenium, and AP diameter of the corpus callosum in cases versus controls were noted to be 9.8 ± 1.2 vs. 10.27 ± 0.3 mm, p=0.12; 5.1±0.9 vs. 5.3±0.24 mm, p=0.25; 12.11 ± 9.65 vs. 12.52 ± 13.9 mm, p=0.04 (significant) and 71.22±3.1 vs. 72.32±1.2, p=0.23, respectively. CONCLUSION: This study showed that patients with stroke have a significant reduction in morphometric indices i.e., width of genu, body & splenium, and the AP diameter of the corpus callosum when compared to normal individuals.

Congenital Short Bowel Syndrome With Annular Pancreas Presenting as Neonatal Intestinal Obstruction.

Congenital short bowel syndrome (CSBS) is a very rare gastrointestinal anomaly of unknown etiology. We report a case of a six-week-old male with CSBS who presented with features of intestinal obstruction and failure to thrive. The abdominal radiograph was suggestive of a central gasless abdomen, and a provisional diagnosis of malrotation of the gut with volvulus was considered. On exploration, the duodenum was hugely dilated with annular pancreas, which was not obstructing the duodenum. The length of the intestine was 20 cm from the duodenojejunal junction to the ileocecal junction. Duodenal web was ruled out. Total parenteral nutrition (TNP) was started postoperatively. Early and long-term parenteral nutrition and referral to specialist centers with intestinal rehabilitation programs have improved the overall outcome; however, the challenges are entirely different in developing countries.

Susceptibility weighted magnetic resonance imaging of brain: A multifaceted powerful sequence that adds to understanding of acute stroke.

CONTEXT: To evaluate the additional information that susceptibility weighted sequences and datasets would provide in acute stroke. AIMS: The aim of this study were to assess the value addition of susceptibility weighted magnetic resonance imaging (SWI) of brain in patients with acute arterial infarct. MATERIALS AND METHODS: All patients referred for a complete brain magnetic resonance imaging (MRI) between March 2010 and March 2011 at our institution had SWI as part of routine MRI (T1, T2, and diffusion imaging). Retrospective study of 62 consecutive patients with acute arterial infarct was evaluated for the presence of macroscopic hemorrhage, petechial micro-bleeds, dark middle cerebral artery (MCA) sign and prominent vessels in the vicinity of infarct. RESULTS: SWI was found to detect hemorrhage not seen on other routine MRI sequences in 22 patients. Out of 62 patients, 17 (10 petechial) had hemorrhage less than 50% and 5 patients had greater than 50% area of hemorrhage. A "dark artery sign" due to thrombus within the artery was seen in 8 out of 62 patients. Prominent cortical and intraparenchymal veins were seen in 14 out of 62 patients. CONCLUSIONS: SWI has been previously shown to be sensitive in detecting hemorrhage; however is not routinely used in stroke evaluation. Our study shows that SWI, by virtue of identifying unsuspected hemorrhage, central occluded vessel, and venous congestion is additive in value to the routine MR exam and should be part of a routine MR brain in patients suspected of having an acute infarct.

Soft tissue cysticercosis - Ultrasonographic spectrum of the disease.

This case series emphasizes the role of USG in the diagnosis of isolated soft tissue cysticercosis. We assessed its value for identifying features such as the location of the cyst, the presence or absence of abscess, and the presence or absence of a scolex within the cyst. Three USG patterns were seen and are described.