Sciatic nerve endometriosis - The correct approach matters: A case report.

Endometriosis is a chronic inflammatory condition affecting nearly 10-15% of women of reproductive age and most frequently occurs in the pelvis. Extrapelvic endometriosis leading to sacral neuropathy is rare. A 29-year old woman, para 1 (vaginal delivery 8 years previously), presented with worsening right hip and buttock pain radiating to the right leg, resulting in limping and other gait changes due to delayed diagnosis and treatment. A diagnosis of sciatic nerve endometriosis was made based on both clinical and imaging findings. The final diagnosis was confirmed on histopathological examination. Transgluteal excision of the sciatic nerve with concomitant laparoscopy for exploration of the pelvic part of the sciatic nerve and excision of the pelvic endometriosis were undertaken. The operating team included a gynaecologist, an orthopaedic surgeon and a neurosurgeon. Postoperative recovery was uneventful and physiotherapy was started. Pain and gait improved. Endometriosis of the sciatic nerve should be suspected if a patient complains of cyclical sciatica. Magnetic resonance remains the imaging modality of choice. This case report illustrates the benefit of a multidisciplinary approach.

Recurrent perineal scar endometriosis: A case report.

Introduction: Endometriosis is a chronic disease with the presence of endometrium-like tissue containing endometrial glands and stroma outside the uterus. The incidence of episiotomy scar endometriosis after vaginal delivery is 0.06-0.7%. Case presentation: A 28-year-old parous woman with two previous vaginal deliveries with episiotomy presented to the outpatient department with severe pain and swelling in the perineal region over the past year, leading to difficulty in sitting, coitus and routine essential activities like defecation. She had undergone local perineal nodule excision surgery twice, which confirmed her perineal scar endometriosis diagnosis one year earlier at another hospital with no improvement in symptoms. Physical examination revealed a firm, tender, deeply embedded palpable nodule measuring approximately 3 - 4 cm in the left posterolateral aspect of the distal vagina. Wide local excision of the nodule with a clear margin of 1 cm was performed. The nodule extended up to the left ischial tuberosity and apex up to the pudendal vessels complex. Discussion: The classic diagnostic triad of perineal endometriosis were present in this patient. Surgical intervention with wide local excision with a clear margin of approximately 1 cm of healthy tissue reduces the chance of recurrence. Conclusion: Awareness of this condition among medical practitioners will lead to early diagnosis and excision. Timely intervention in the form of excision with free margins is the definitive treatment and provides complete pain relief and good quality of life for endometriosis patients.

Fetal MR Imaging Analysis of Sirenomelia with Clinico Radiographic Correlation: A Case Report.

Sirenomelia is a social curiosity, a medical and diagnostic challenge prenatally compounded by varied diagnostic difficulties. Prenatal diagnosis of sirenomelia was and continues to be a challenge although von klippel et al., described a case at 10 weeks of gestational age. However, they needed a second imaging at 12(th) week for confirmation. First trimester or early second trimester anatomic survey on ultrasound and MRI is accurate for the diagnosis thereby avoiding unnecessary complex pregnancy. We report a case of second trimester diagnosed sirenomelia, with detailed analysis of image findings on ultrasound and fetal MRI.

Magnetic resonance imaging (MRI) evaluation of developmental delay in pediatric patients.

INTRODUCTION: Developmental delay is defined as significant delay in one or more developmental domains. Magnetic Resonance Imaging (MRI) is the best modality to investigate such patients. Evaluation of a child with developmental delay is important not only because it allows early diagnosis and treatment but also helpful for parental counseling regarding the outcome of their child and to identify any possible risk of recurrence in the siblings. Thus this study was undertaken to evaluate the developmental delay in Indian children which will help the clinicians in providing an estimation of the child's ultimate developmental potential and organize specific treatment requirement and also relieve parental apprehension. AIMS AND OBJECTIVES: To study the prevalence of normal and abnormal MRI in pediatric patients presenting with developmental delay and further categorize the abnormal MRI based on its morphological features. MATERIALS AND METHODS: It is a prospective, observational & descriptive study of MRI Brain in 81 paediatric patients (46 Males and 35 Females), aged between three months to 12 years; presenting with developmental delay in Deccan College of Medical Sciences, Hyderabad; over a period of three years (Sept 2011 to Sept 2014). MRI brain was done on 1.5T Siemens Magnetom Essenza & 0.35T Magnetom C with appropriate sequences and planes after making the child sleep/sedated/ anesthetized. Various anatomical structures like Ventricles, Corpus callosum, etc were systematically assessed. The MRI findings were divided into various aetiological subgroups. RESULTS: Normal MRI findings were seen in 32% cases and 68% had abnormal findings of which the proportion of Traumatic/ Neurovascular Diseases, Congenital & Developmental, Metabolic and Degenerative, neoplastic and non specific were 31%, 17%, 10%, 2.5% and 7.5% respectively. The ventricles and white matter mainly the corpus callosum were the most commonly affected anatomical structures. The diagnostic yield was found to be 68% and higher yield was seen in patients presenting with developmental delay plus. CONCLUSION: The clinical diagnosis of developmental delay should not be the end point, but rather a springboard for an effective search for causal factors. MRI is the best investigation with a high yield in such patients.

MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.

INTRODUCTION: Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined. AIM: To study pre and post core decompression MRI changes in avascular necrosis of hip. MATERIALS AND METHODS: This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version. RESULTS: Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location. CONCLUSION: Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.

Extrahepatic biliary atresia with choledochal cyst: Prenatal MRI predicted and post natally confirmed: A case report.

Extrahepatic biliary atresia (EHBA) is an uncommon cause of neonatal jaundice. Antenatal Magnetic Resonance Imaging (MRI) diagnosis of EHBA has not been published to the best of our knowledge till date. EHBA with cystic component is likely to be mistaken for choledochal cyst. A case that was antenatally predicted and postnatally confirmed by surgery and histopathology is being reported. All imaging signs are analyzed herewith. Imaging helps in the prediction of EHBA and also helps in early postnatal surgical referral which in turn improves the results of Kasai's portoenterostomy.