Revealing an Uncommon Presentation of Chiari I Malformation With Diverse Craniovertebral Anomalies in the Absence of Syringomyelia and Atlanto-Occipital Subluxation: A Case Report.

A Chiari I malformation is a frequently encountered anomaly of the posterior fossa, occurring in a notable percentage of the population. It often coexists with various other craniovertebral junction abnormalities, albeit less frequently with Klippel-Feil syndrome. Interestingly, the majority of individuals with Chiari I malformation do not exhibit any symptoms. We present a rare case of a 25-year-old male with chronic neck and occipital pain, along with progressive weakness and sensory disturbances in all four limbs, urinary urgency, and elevated left shoulder. Examination unveiled spasticity, weakness, and brisk reflexes. On extensive radiological evaluation (X-ray, CT, and MRI), findings revealed various anomalies in the craniovertebral junction, including complete atlanto-occipital assimilation, basilar invagination, and platybasia. Furthermore, cervical segmentation abnormalities indicative of Klippel-Feil syndrome were observed, along with Sprengel's deformity. MRI confirmed Chiari I malformation with tonsillar herniation and myelomalacia, as well as compression at the cervico-medullary junction. This patient underwent a surgical procedure that included transoral odontoidectomy combined with occipito-cervical fixation, after which a good clinical response was observed. It emphasizes the necessity of radiological imaging for the diagnosis of Chiari and other associated abnormalities in the craniovertebral junction.

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.

An Aberrant Case of Pheochromocytoma in a Young Adult Presenting With Secondary Hypertension: A Case Report With Review of the Literature.

Pheochromocytoma (PCC) is a rare neuroendocrine catecholamine-secreting tumour of the adrenal gland. It originates from the chromaffin cells found within the adrenal medulla or the extra-adrenal paraganglia. We present a case report of a 24-year-old female who presented with hypertension, headache, palpitations, chest pain and blurry vision. On ultrasound evaluation, a right suprarenal mass was noted, which was further evaluated using contrast-enhanced computed tomography (CT). Based on our imaging findings, the patient was diagnosed with a case of right-sided pheochromocytoma. The patient was operated on, and our diagnosis was confirmed with histopathological examination.

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.

Chondrosarcoma of Iliac Bone Imaging Spectrum With Histopathological Correlation: A Case Report.

Chondrosarcoma is a rare form of carcinoma that originates in the cells of cartilage, the flexible tissue that cushions the joints and gives structure to various parts of the body. This malignant tumour primarily affects adults and is most commonly found in the bones of the arms, legs, pelvis, and ribs. The severity and prognosis of chondrosarcoma can vary widely depending on factors such as tumour size, location, and grade. We are reporting a case of an 83-year-old male patient who presented with swelling over the left hip joint. A mass was detected on radiograph and ultrasound that was further characterized using contrast-enhanced CT and MRI. Imaging findings suggested chondrosarcoma. The patient was diagnosed on histopathological examination.

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.

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.

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.

Validation of a Deep Learning Model for Detecting Chest Pathologies from Digital Chest Radiographs.

Purpose: Manual interpretation of chest radiographs is a challenging task and is prone to errors. An automated system capable of categorizing chest radiographs based on the pathologies identified could aid in the timely and efficient diagnosis of chest pathologies. Method: For this retrospective study, 4476 chest radiographs were collected between January and April 2021 from two tertiary care hospitals. Three expert radiologists established the ground truth, and all radiographs were analyzed using a deep-learning AI model to detect suspicious ROIs in the lungs, pleura, and cardiac regions. Three test readers (different from the radiologists who established the ground truth) independently reviewed all radiographs in two sessions (unaided and AI-aided mode) with a washout period of one month. Results: The model demonstrated an aggregate AUROC of 91.2% and a sensitivity of 88.4% in detecting suspicious ROIs in the lungs, pleura, and cardiac regions. These results outperform unaided human readers, who achieved an aggregate AUROC of 84.2% and sensitivity of 74.5% for the same task. When using AI, the aided readers obtained an aggregate AUROC of 87.9% and a sensitivity of 85.1%. The average time taken by the test readers to read a chest radiograph decreased by 21% (p < 0.01) when using AI. Conclusion: The model outperformed all three human readers and demonstrated high AUROC and sensitivity across two independent datasets. When compared to unaided interpretations, AI-aided interpretations were associated with significant improvements in reader performance and chest radiograph interpretation time.

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.

Groove pancreatitis: A unique case of focal pancreatitis.

Groove pancreatitis (GP) is an unusual form of chronic segmental pancreatitis that affects the "pancreatic groove" between the pancreatic head, the duodenum, and the common bile duct, also known as the groove area. Becker initially reported GP in 1973, and the term was given by Malde DJ et al. to define this unique type of segmental pancreatitis. Most physicians are still unfamiliar with an entity. Radiological diagnosis can be arduous since it can be difficult to distinguish it from other conditions affecting the prior mentioned groove area, such as pancreatic head cancer. It is a rare pancreatic condition with a difficult imaging diagnosis that can lead to treatment dilemmas. The hour needs to identify the infinitesimal differences between these two pathological entities, as their management and treatment differ significantly. Here, we present a case of GP in a 21-year-old man and discuss how this entity appears on ultrasonography and computed tomography.

Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program.

Aim The aim of the study is to determine improvements in perinatal mortality at the end of the first 2 years from the initiation of the Samrakshan program of the Indian Radiological and Imaging Association. Methods Samrakshan is a screening program of pregnant women that uses trimester-specific risk assessment protocols including maternal demographics, mean arterial pressure, and fetal Doppler studies to classify women as high risk or low risk for preterm preeclampsia (PE) and fetal growth restriction (FGR). Low dose aspirin 150 mg daily once at bedtime was started for pregnant women identified as high risk in the 11-13 6/7 weeks screening. The third-trimester screening focused on the staging of FGR and protocol-based management for childbirth and risk assessment for PE. Outcomes of childbirth including gestational age at delivery, development of PE, and perinatal mortality outcomes were collected. Results Radiologists from 38 districts of 16 states of India participated in the Samrakshan program that screened 2,816 first trimester, 3,267 second trimester, and 3,272 third trimester pregnant women, respectively. At 2 years, preterm PE was identified in 2.76%, preterm births in 19.28%, abnormal Doppler study in 25.76% of third trimester pregnancies, and 75.32% of stage 1 FGR delivered at term. The neonatal mortality rate was 9.86/1,000 live births, perinatal mortality rate was 18.97/1,000 childbirths, and maternal mortality was 58/100,000 live births compared with 29.5, 36, and 113, respectively in 2016. Conclusion Fetal Doppler integrated antenatal ultrasound studies in Samrakshan led to a significant reduction in preterm PE rates, preterm birth rates, and a significant improvement in mean birth weights. Perinatal, neonatal, and maternal mortality rates are significantly better than the targets for 2030 set by the Sustainable Development Goals-3.

A classic case of Solitary Pseudopapillary Epithelial Neoplasm of Pancreas - Case report with Review of Literature.

We report a case of a solid pseudopapillary epithelial neoplasm of the pancreas in a 19-year-old female who presented with abdominal pain. Computed tomography of the abdomen showed a heterogenous density mass in the tail of the pancreas. The mass had fluid density in the central region and soft tissue density in the peripheral region. Post-contrast evaluation showed enhancement in the peripheral solid component. Based on the radiological investigation carried out at our institute, a diagnosis of solid pseudopapillary epithelial neoplasm of the pancreas was established which was confirmed on histopathology.

Fetal Amelia With Hypoplastic Tibia and Terminal Fibular Hemimelia: A Case Report With Review of the Literature.

Congenital limb deformities, with a birth frequency of 0.55 per 1,000, are extremely rare prenatal defects that can present with either partial or complete lack of a limb or a specific portion of a limb. Amelia is a sporadic anomaly that is defined by the complete absence of a limb's skeletal elements, whereas hypomelia is defined by the incomplete development of a limb's skeletal elements. We present the case of a neonate with gross facial deformities in the form of the absence of both external ears and a saddle-shaped nose. The absence of the right lower limb bud was seen. The left lower limb was underdeveloped, noted only up to the thigh region with the hypoplastic distal part of the leg and absent foot. Genitals and the anus were absent. To the best of our knowledge, this case is exceptional in that congenital limb abnormalities are present at birth along with accompanying genital underdevelopment.

Evaluation of Fetal Central Nervous System Anomalies by Ultrasound and Its Anatomical Co-relation.

INTRODUCTION: Central nervous system anomalies are often severe and are the most common indications for therapeutic abortions. Ultrasound examination helps to identify and evaluate them well before birth. OBJECTIVES: Present study was undertaken to evaluate the incidence of central nervous system anomalies in utero by ultrasound and to confirm them by autopsy or postnatal examination. METHOD: Ultrasound screening of 7485 pregnant women was performed. Pregnancy with ultrasound findings of central nervous system anomalies were followed up. Prenatal ultrasound findings were confirmed by autopsy in cases of therapeutic abortions and fetal losses. In case of live birth postnatal findings were noted. RESULTS: Ultrasound detected central nervous system malformations in 24 fetuses. Ultrasound findings were matching in 83% on autopsy. Autopsy and postnatal findings together were matching with ultrasound in 85.7%. Two cases had additional minor findings on autopsy. CONCLUSION: The incidence of central nervous system malformations on ultrasound was 0.31%. Autopsy and postnatal examination showed high degree of correlation with ultrasound findings.

Omphalocele, exstrophy of bladder, imperforate anus and spinal defect (OEIS complex) - autopsy and prenatal ultrasound findings

Omphalocele, exstrophy of bladder, imperforate anus and spinal defect (OEIS complex) is a rare congenital anomaly with varied clinical presentation. A case report in a spontaneously aborted fetus of 20 weeks gestation and diagnosed on autopsy is discussed. External omphalocele sac, imperforate anus, kyphoscoliosis, ambiguous genitalia and bilateral congenital talipes were present. Omphalocele sac contained liver, coils of small intestine, spleen and stomach. The sac also contained right testis and right kidney. The presence of kidney and testis in the omphalocele sac is a very rare finding in this complex. Antenatal ultrasound at 18 weeks of gestation had demonstrated omphalocele, deformed spine, club feet, non-visualization of bladder and polyhydramnios. Imperforate anus could not be detected prenatally. Occasionally, Two-Dimensional (2-D) ultrasound (US) may fail to detect the full spectrum of the complex. For definitive and differential diagnoses, Three-Dimensional (3-D) ultrasound, color Doppler and fetal Magnetic Resonance (MR) can be used

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High-frequency ultrasound in parotid gland disease.

Parotid gland is involved in many inflammatory and neoplastic conditions. Many a times, it is difficult to ascertain the type of swelling by clinical examination. The anatomy and various abnormalities of the glands are very easily visualized by high-frequency ultrasound. Ultrasound can confirm the presence of the mass with sensitivity up to 100%. It can demonstrate whether a lesion is located in the parotid gland or outside. It can help in differentiating benign from malignant neoplasms and local staging of the mass in malignant lesions. In addition, ultrasound can identify those entities that may not need surgical intervention. The glands appear enlarged and show altered echopattern in acute inflammation and may be normal or reduce in size in chronic inflammation. Other pathologies that involve salivary glands are sialolithiasis and various benign and malignant neoplasms. Ultrasound many times suggests final diagnosis or supplies important differential diagnosis. In this article, the use of high-frequency ultrasound in parotid disease is discussed, and sonographic features of different parotid pathologies are reviewed with examples illustrated. High-frequency ultrasound is the first and many a times the only imaging investigation done for evaluation of parotid glands.