A Rare Variant of Zuckerkandl Tubercle: Thyroid Ring.

Zuckerkandl tubercles are posteromedial projections of normal thyroid gland with relations with important neck structures. In our case, we reported "Thyroid ring", that is a ring configuration of the thyroid gland encasing the trachea and esophagus, without compression symptoms. Ring was formed by the elongated zuckerkandl tubercles, passing through the column between the esophagus and vertebral body and abutting each other at left posterolateral border of esophagus. Reporting of these relations and variations is important as it helps the operating surgeon in planning the approach to the procedure. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04079-4.

Unusual Presentation of Paraosteal Lipoma in Skull.

Paraosteal lipomas are rare benign neoplasm composed of mature adipose tissue with underlying bone changes. They are extremely rare to occur in head and neck region. We present a case of a 40-year-old male with a paraosteal lipoma of occipital region. The diagnosis of the lesion was reached by clinical examination and confirmed on computed tomography (CT) and Magnetic resonance imaging (MRI). Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03494-x.

Acardius acephalus with spontaneous umbilical cord occlusion: Reporting a rare case.

Twin reversed arterial perfusion syndrome is a rare obstetric condition that occurs in monochorionic twin pregnancies, resulting in coexistence of a normal "pump" twin and an acardiac twin. The acardiac twin is dependent upon the normal twin to provide circulation by means of vascular anastomosis, thereby putting the pump fetus at risk of high output cardiac failure. Overall only 50% of pump twins survive. Mortality for acardiac twin is 100%. We present a case of 26-year-old primigravida female presenting with 8 months of amenorrhea with unsure LMP. Ultrasonography followed by fetal MRI was carried out which revealed acardius acephalus twin with absence of blood flow in umbilical vessels. Pump twin had multicystic dysplastic left kidney with single umbilical artery. Following delivery, the pump twin survived well and the deformed fetus showed features of twin reversed arterial perfusion syndrome.

Predictors of Metabolic Syndrome among Polycystic Ovary Syndrome Sisters.

AIMS: Metabolic syndrome among PCOS sisters may vary depending on the phenotype. The aim of the present study was to analyze the prevalence of metabolic syndrome among different phenotypes of PCOS sisters. DESIGN: Case control study. MATERIALS AND METHODS: Two hundred sisters of PCOS patients and 99 age matched healthy controls underwent history, clinical examination, biochemical parameters for metabolic syndrome and hormonal assessment. RESULTS: Of 200 sisters, 85 were unaffected (UA group), 21 sisters had hyperandrogenemia (HA group), and 94 sisters had irregular periods or hyperandrogenemia. We observed that the frequency of metabolic syndrome among PCOS sisters was comparable to age and weight matched controls (30% vs 27%). The prevalence of metabolic syndrome was higher in HA and AFFECTED sisters (around 30% in both) compared to UA sisters (20%). The presence of metabolic syndrome was significantly associated with age, BMI, HOMA-IR and free testosterone. After correction for age and BMI, metabolic syndrome was significantly associated with HOMA-IR (P - 0.05) and free testosterone (P - 0.03). CONCLUSION: Based on above findings, we conclude that affected sisters and those with higher age, BMI and hyperandrogenemia have a high risk of metabolic syndrome compared to unaffected sisters.

Can preoperative clinicoradiological parameters predict the difficulty during laparoscopic retroperitoneal simple nephrectomy? - A prospective study.

INTRODUCTION: Urologists tend to prefer retroperitoneal approach for open nephrectomy and transperitoneal route for laparoscopic nephrectomy. Urologists consider retroperitoneal laparoscopic approach difficult to learn and perform. There is a need to objectively define predictors of difficulty during laparoscopic retroperitoneal simple nephrectomy (LRSN) for the proper preoperative selection. To the best of our knowledge, this is the first study to prospectively assess the factors associated with difficulty during LRSN. MATERIALS AND METHODS: All adult patients of nonfunctioning kidneys (due to benign causes) planned for simple nephrectomies from November 2014 to January 2017 were included in the study. Various clinical and radiological parameters were noted along with intraoperative difficulty parameters (difficulty score, total operative time, and estimated blood loss). Renal and perirenal parameters were assessed and noted on computed tomography scan. Difficulty scale was calculated based on the three difficulty parameters and was used to objectively categorize the patients in easy and difficult group. RESULTS: A total of 44 patients were included in the study. There were 23 patients in Group I (Easy) and 21 patients in Group II (Difficult). Various preoperative clinical and radiological parameters were analyzed and compared between these two groups. History of pyonephrosis and presence of nephrostomy tube were the only two statistically significant factors associated with difficult cases (Group II). None of the factors were statistically significant in multivariate analysis. CONCLUSION: Based on the findings of our study, history of pyonephrosis and presence of nephrostomy are the most significant factors predicting difficulty during LRSN.

Health Issues among Radiologists: Toll they Pay to their Profession.

In modern era, with tremendous competition, long working hours and more demanding workstyle, nearly every profession is associated with some or the other health hazards. These may develop and progress rapidly or in a gradual way but ultimately add up unwanted morbidities and in long run affects the production and work output. Unfortunately, doctors and other health professionals who look after the health of society, are not the exceptions to this rule and depending upon their specialty, they have to face some or the other health issues. This article highlights some important though underestimated health issues among radiologists and some remedies. It aims to sensitize radiologists about such health issues so that they can take timely remedial measures before it is really late.

Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled.

The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.

Pulmonary Aspergillosis: What CT can Offer Before it is too Late!

Aspergillus is a large genus of saprophytic fungi which are present everywhere in the environment. However, in persons with underlying weakened immune response this innocent bystander can cause fatal illness if timely diagnosis and management is not done. Chest infection is the most common infection caused by Aspergillus in human beings. Radiological investigations particularly Computed Tomography (CT) provides the easiest, rapid and decision making information where tissue diagnosis and culture may be difficult and time-consuming. This article explores the crucial role of CT and offers a bird's eye view of all the radiological patterns encountered in pulmonary aspergillosis viewed in the context of the immune derangement associated with it.

Imaging in Rare and Atypical Sinonasal Masses: An Interesting Case Series.

Sinonasal tumours present a myriad of radiographic findings. While many of these tumours have been well described with regard to their typical sites of origin, age group and radiological appearance we have come across lesions in our daily practice which are exceedingly rare with regard to site of origin in sinonasal cavity. The radiological appearances of 4 such rare and unusual tumours arising in sinonasal region evaluated by cross sectional imaging (CT/MRI) have been illustrated in this article with a purpose to review the radio-pathological correlation of these tumours and to explain the utility of cross-sectional imaging CT and MRI in exploring diagnostic clues. Morphological features and radiological patterns of each tumour have been graded into mild, moderate and severe based on the extent of tumoural involvement. This review is intended to acquaint radiologists with the appearance of atypical sinonasal masses and their radiological appearance on cross sectional imaging to make an early diagnosis.

Back pain, lower limb immobility and ulcers as indicators of abdominal aorta occlusion below the origin of renal arteries, Leriche syndrome.

A 33-year-old female, presented with fever, lower limb ulcers and severe backache. The present history evolved four weeks after the complaints of claudication of buttocks, thighs and calves. Lower limb arterial pulsations were not detectable. Colour Doppler and Computed Tomograph (CT) Angiography revealed blockage of abdominal aorta below the origin of renal arteries. The cause of the fever, lower limb ulcers and cruciate backache could be related to this occlusion. This obstruction which was first described by Leriche and is not known to endow with such perplex symptomatology and that too, to a dermatologist with acute febrile illness, severe backache and lower limb ulcers.

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

OBJECTIVE: Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. MATERIALS AND METHODS: A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. RESULTS: Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. CONCLUSION: Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

Imaging features of pediatric musculoskeletal tuberculosis.

Tuberculosis (TB) is widely prevalent in developing nations and has recently made a comeback in industrialized countries, with the rise in immunocompromized patients. Musculoskeletal TB in children presents a diagnostic challenge because it is difficult to recognize in the early stages of the disease, and imaging features mimic other entities. The clinical onset is insidious, with an indolent course and a resultant late presentation. It leads to significant morbidity; a delay in diagnosis can cause potentially serious neurological complications and bone and joint destruction. Conventional radiographs are the initial imaging modality and US, CT and MRI are used in conjunction to better delineate the disease extent and morphology. Radiologists should be familiar with the spectrum of imaging features of TB, including plain radiographs and MRI, and aid the clinician in making an early diagnosis. Aspiration or biopsy with examination for acid-fast bacillus and histological evaluation is required to confirm the diagnosis.

Neuroradiological findings in GM2 gangliosidosis variant B1.

GM2 gangliosidosis variant B1 is a very rare lysosomal disorder. As per our knowledge, to date, only one article depicting the magnetic resonance imaging (MRI) findings of GM2 gangliosidosis variant B1 is available in the literature. We are the first to describe the neuroradiological findings in an Indian patient diagnosed with GM2 gangliosidosis variant B1.

Unique features of polycythemia observed on plain non contrast CT scan of head.

We present two cases of polycythemia secondary to a congenital cardiac anomaly presenting with acute neurological complications showing hyperdense venous sinuses and cerebral vasculature in association with cerebral abscess.

Elephantiasis neuromatosa of the lower limb in a patient with neurofibromatosis type-1: A case report with imaging findings.

Elephantiasis neuromatosa is the most impressive manifestation of neurofibromatosis type-1 (NF-1). We report a case of NF-1 who presented with elephantiasis neuromatosa of his right leg. Cross-sectional imaging not only assists in the correct diagnosis but also aids in imaging the vasculature of a plexiform neurofibroma, which is essential for proper surgical planning.