Anomalous origin of the left coronary artery from the right sinus of Valsalva with separate ostia and inter-arterial course: MDCT angiography depiction.

We describe a case of anomalous left coronary artery origin from the right coronary sinus with separate ostia of right and left coronary arteries detected by 128-slice computed tomography (CT) coronary angiography. Apart from separate ostia, the left coronary artery had inter-arterial course between the aorta and the pulmonary trunk, also called as a malignant course.

Giant left ventricular outflow tract pseudoaneurysm presenting as anterior mediastinal mass: diagnosis by MDCT.

We report a case of giant left ventricular outflow tract pseudoaneurysm diagnosed by multidetector computed tomography cardiac angiography. This report highlights the importance of preoperative computed tomography in the evaluation of left ventricular outflow tract pseudoaneurysm which can be kept as a differential diagnosis for anterior mediastinal masses.

A Rare Case of Isolated Conus Medullaris Neurenteric Cyst.

Spinal neurenteric cysts are very rare congenital anomalies and are commonly associated with other spinal malformations. They are usually located in intradural, extramedullary location. We report a rare case of intramedullary conus medullaris neurenteric cyst without any associated spinal malformation diagnosed preoperatively by magnetic resonance imaging.

Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation Between Malignant and Benign Thyroid Nodules.

INTRODUCTION: High resolution ultrasound is the most sensitive imaging test available for the examination of the thyroid gland and due to increase in use of ultrasound more incidental thyroid nodules are diagnosed. In this study we try to establish the specific grayscale, color and spectral Doppler characteristics of malignant and benign thyroid nodules. AIM: To determine the specific gray scale characteristics, angioarchitecture and cut-off values of Doppler indices of malignant and benign thyroid nodules. To assess the efficacy of grayscale, Doppler and combined conventional and Doppler using defined criteria in differentiating malignant from benign nodules. MATERIALS AND METHODS: We prospectively examined 194 thyroid nodules which were confirmed on FNAC. Each nodule was described according to size, number, contents, echogenicity, margins, halo, shape, calcification, local infiltration and lymphnode enlargement. Vascularity, RI and PI values of each nodule were assessed on Doppler. Each nodule was characterized as benign, indeterminate or malignant based on grayscale and Doppler characteristics. Cut-off RI and PI values for malignant thyroid nodules were obtained by ROC. RESULTS: Out of 194 nodules, 151 nodules were benign and 43 nodules were malignant. Significant relationship was observed between malignancy and hypoechogenicity, irregular margins, taller than wide, thick incomplete halo, micro calcifications, lymphnode enlargement and local infiltration. Intranodular vascularity was a significant criterion to suggest malignancy in thyroid nodules on color Doppler. Malignant nodules had a mean RI of 0.73 and mean PI of 1.3 which were significantly higher than the benign nodules. Accuracy of detecting malignant thyroid nodules by combining gray scale and Doppler is higher than either of them alone. CONCLUSION: Using specific morphological pattern recognition features like microcalcifications, hypoechogenicity, taller than wide, irregular thick halo, lymphadenopathy and local extra thyroidal invasion has helped in differentiating malignant from benign features. Intranodular vascularity and high RI indices were the specific Doppler signs for malignant thyroid nodules. Since, Gray scale and Doppler have their own strengths and weaknesses, they were complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules.

Age-Related Normogram for Ovarian Antral Follicle Count in Women with Polycystic Ovary Syndrome and Comparison with Age Matched Controls Using Magnetic Resonance Imaging.

INTRODUCTION: Antral Follicle count (AFC) is a reliable marker for ovarian reserve. Previous studies have used transvaginal ultrasound for estimation of AFC, however we used magnetic resonance imaging (MRI) for estimation of AFC and for creating an age-related normogram in patients with polycystic ovary syndrome (PCOS) and compared it with normal patients. AIM: The aim of this study is to create an age related normogram for AFC in women with PCOS and to compare that with women without polycystic ovarian syndrome using MRI. MATERIALS AND METHODS: A total of 1500 women were examined, out of which 400 fitted the criteria for PCOS. They all underwent MRI study and similar age matched women without PCOS also underwent MRI examination. Normogram for AFC were obtained using LMS software and a percentile chart was obtained. RESULTS: Normogram for AFC in PCOS women showed decline in number of AFC as the age progresses and the decline was linear. The normogram for AFC was compared with equal number of patients without PCOS and they also showed decline in AFC as the age progresses, however the decline was exponential and faster. CONCLUSION: Age related normogram for AFC is widely used and considered as best clinical predictor for ovarian response in assisted reproductive technology. Knowledge of ovarian reserve is important in PCOS and non-PCOS females as PCOS patients are at risk for ovarian hyperstimulation syndrome during gonadotrophin theraphy. MRI is an equally effective and in some times better alternative to transvaginal ultrasound as it has got its own advantages.

Idiopathic subareolar breast abscess in a male patient.

We present a case of left breast abscess in a young male patient who presented with acute onset swelling left breast. Imaging studies helped in accurate diagnosis and the case was managed by subareolar incision and drainage. Subareolar breast abscess is an uncommon entity in male and should be kept as a differential diagnosis for male breast swellings.

Omental infarct mimicking acute pancreatitis.

Omental infarction is a rare condition which is being increasingly reported in the literature due to the advancement in imaging techniques and its typical computed tomography appearance. Accurate diagnosis of omental infarct can be made on computed tomography, thereby avoiding exploratory surgery. We report a case of conservatively managed primary omental infarct which was clinically thought to be acute pancreatitis.

A Case of Dermatofibrosarcoma Protuberans of the Trunk.

Dermatofibrosarcoma protuberans is a rare, usually superficial soft tissue sarcoma, which is diagnosed by its typical clinical manifestations. We report a case of histopathologically proved dermatofibrosarcoma protuberans of the left upper posterior trunk in a 35-year-old female for whom complete surgical resection was done.

A Case of Exophytic Angiomyolipoma of the Liver.

Hepatic angiomyolipoma (AML) is a benign liver tumor, composed mainly of blood vessels, smooth muscle, and fat cells in varying proportions. We report on a case of resected hepatic AML which was diagnosed preoperatively using contrast-enhanced computed tomography scan.

Unusual cause for abdominal pain in cirrhosis : thrombosed intrahepatic portal vein aneurysms.

Portal venous system aneurysm is a rare condition with very few reported cases in English literature. With the increasing availability of advanced imaging modalities like Doppler ultrasound, computed tomography and magnetic resonance imaging, portal venous system aneurysms are being increasingly reported. Here, we report a rare case of multiple intrahepatic portal venous system aneurysms complicated by thrombosis in a young patient with chronic liver disease and portal hypertension.