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Purpose: Our aim was to distinguish between low-grade and high-grade brain tumours on the basis of dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion and arterial spin labelling (ASL) perfusion and to compare DSC and ASL techniques. Material and methods: Forty-one patients with brain tumours were evaluated by 3-Tesla MRI. Conventional and perfusion MRI imaging with a 3D pseudo-continuous ASL (PCASL) and DSC perfusion maps were evaluated. Three ROIs were placed to obtain cerebral blood value (CBV) and cerebral blood flow (CBF) in areas of maximum perfusion in brain tumour and normal grey matter. Histopathological diagnosis was considered as the reference. ROC analysis was performed to compare the diagnostic performance and to obtain a feasible cut-off value of perfusion parameters to differentiate low-grade and high-grade brain tumours. Results: Normalised perfusion parameters with grey matter (rCBF or rCBV lesion/NGM) of malignant lesions were significantly higher than those of benign lesions in both DSC (normalised rCBF of 2.16 and normalised rCBV of 2.63) and ASL (normalised rCBF of 2.22) perfusion imaging. The normalised cut-off values of DSC (rCBF of 1.1 and rCBV of 1.4) and ASL (rCBF of 1.3) showed similar specificity and near similar sensitivity in distinguishing low-grade and high-grade brain tumours. Conclusions: Quantitative analysis of perfusion parameters obtained by both DSC and ASL perfusion techniques can be reliably used to distinguish low-grade and high-grade brain tumours. Normalisation of these values by grey matter gives us more reliable parameters, eliminating the different technical parameters involved in both the techniques.
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BACKGROUND: Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. MATERIAL/METHODS: This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. RESULTS: The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. CONCLUSIONS: Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries.
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OBJECTIVE: The purpose of this study was to compare the in vitro effects of date syrup with those of other contrast agents by qualitative and quantitative analysis and in vivo evaluation of the use of date syrup to improve the quality of MRCP images. MATERIALS AND METHODS: Phantoms containing date syrup, ferumoxsil, pineapple juice, and water were imaged by 1.5-T MRI with T2-weighted and MRCP sequences, and signal-to-noise ratios were calculated. Biochemical analysis of date syrup was performed to find the nature of iron in it, and the iron content was quantified by energy-dispersive x-ray spectroscopy. Sixty patients underwent MRCP before and 30 minutes after ingestion of 100 mL of date syrup. Unenhanced and contrast-enhanced images were scored for gastrointestinal tract signal suppression and visualization of various pancreaticobiliary structures. RESULTS: In vitro evaluation showed that images obtained with date syrup had a signal-to-noise ratio comparable to that of images obtained with ferumoxsil in T2-weighted and MRCP sequences. The iron concentration in date syrup was 2.6 mg/dL, and it was in ferric form. Images obtained after oral contrast administration had statistically significant improvement in gastrointestinal tract signal suppression (p < 0.001) and an increase in visibility of the common bile duct, cystic duct, and pancreatic duct (all p < 0.001). No adverse effects were noted in any of the patients. CONCLUSION: Date syrup can be used as a negative oral contrast agent for gastrointestinal tract signal suppression during MRCP and for improving visualization of various pancreaticobiliary structures.
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Bebidas , Ductos Biliares/anatomia & histologia , Colangiopancreatografia por Ressonância Magnética/métodos , Ductos Pancreáticos/anatomia & histologia , Phoeniceae/química , Extratos Vegetais/administração & dosagem , Administração Oral , Colangiopancreatografia por Ressonância Magnética/instrumentação , Meios de Contraste/administração & dosagem , Frutas , Humanos , Aumento da Imagem/métodos , Imagens de Fantasmas , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Perianal fistula is clinically diagnosed and commonly characterized using magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) and T2-weighted imaging are emerging techniques that can obviate the need for contrast injection in cases where contrast administration is not feasible or contraindicated. The main objective of our study was to compare the efficacy of the combination of DWI and T2 STIR (short tau inversion recovery) imaging with contrast-enhanced MRI for the diagnosis and characterization of perianal fistula. METHODS: Sixty-nine patients with clinical perianal fistula with at least one external opening were evaluated with DWI, T2 STIR, and contrast MRI. A comparative cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. The chi-square test was done to find the association between categorical variables. The Kappa test was done to estimate the agreement between two different tests in measuring the outcome. The validity of tests was measured using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: The combination of DWI and T2 STIR is equivalent to contrast-enhanced MRI in the evaluation of primary and complicated perianal fistula. The combination of DWI and T2 STIR is superior to DWI alone in the classification and characterization of perianal fistula. However, DWI is superior to T2 STIR in differentiating perianal inflammation with abscess from perianal inflammation without abscess and can be used as an alternative to post-contrast fat-suppressed T1-WI in the detection of perianal abscesses and disease activity. CONCLUSION: DWI can be used as an adjunct to T2 STIR, and the combination of DWI and T2 STIR can replace the post-contrast fat-suppressed T1 MRI sequence in the classification and characterization of perianal fistula.
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BACKGROUND: Perianal abscess is a clinical infective and/or inflammatory collection in the perianal region, one entity of a large group of anal and perianal disorders. Perianal abscesses are often seen as a complication of grade 2 and grade 4 perianal fistulas from St. James's University Hospital classification. Several imaging modalities have been tried in the past for adequate assessment of perianal abscess with contrast-enhanced magnetic resonance imaging (CE-MRI) providing the most accurate results. Diffusion-weighted imaging (DWI) is an emerging sequence that can provide comparable results to CE-MRI in diagnosing and characterizing perianal abscess. The main objective of this study is to assess the role of DWI in adequate identification and assessment of perianal abscess and compare the final results with contrast-enhanced images. METHODS: Twenty patients with complicated perianal fistula with clinically suspected perianal abscess were evaluated with DWI and CE-MRI. This study was a comparative cross-sectional study conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. Chi-square test was done to find the association between categorical variables. Kappa test was used to find the agreement between two different tests. Receiver operating characteristics (ROC) analysis was done to estimate the area under the curve in predicting the outcome. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were used to measure the validity of the tests. RESULTS: DWI is a very sensitive MRI sequence and is equivalent to CE-MRI to detect the location and analyzing the loco-regional extent of abscess in complicated perianal fistula cases. DWI is also very sensitive and superior to T2 short tau inversion recovery (STIR) in differentiating perianal abscess from perianal inflammation without abscess. CONCLUSION: DWI can be used as an alternative to post-contrast fat-suppressed MRI in precisely defining the location and extent of anal and perianal abscesses and disease activity in complicated fistula cases.
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Introduction The inguino-scrotal/labial region, anatomically defined as the juncture where the thigh meets the lower abdomen, encompassing the ipsilateral scrotal area in men and the inguino-labial area in women, exhibits a broad spectrum of masses. Traditionally, these swellings were clinically diagnosed with high accuracy, primarily due to the prevalence of simple hernias and hydroceles. However, contemporary observations reveal a surge in complex inguino-scrotal/labial swellings, particularly in referral hospitals, necessitating additional radiological and imaging modalities for precise diagnosis. Our interest in this subject was sparked by the escalating numbers of intricate inguino-scrotal/labial masses encountered in our medical setting, posing challenges for clinical diagnosis in both pediatric and adult populations. Materials and methods A prospective, observational study was conducted over two years (August 2021 to March 2023) involving 210 patients presenting with inguino-scrotal/labial swellings at our institute. Clinical data were meticulously collected using a designed pro forma, following informed consent procedures. Results Among the 210 patients with inguino-scrotal/labial swellings, males predominated (194) compared to females (16). The paediatric age group comprised 84 patients, while 126 were adults. Radiological investigations played a crucial role in diagnosing 40 patients and provided significant additional information in 12 cases. Radiological investigations contributed to the diagnosis in 52 patients (24.76%). The study revealed a spectrum of new entities in the inguino-scrotal/labial region, including malignancies, lymph nodal masses in the groin, and vascular, inflammatory, and congenital lesions, which might have been overlooked if solely relying on clinical parameters for diagnosis. Conclusion Inguino-scrotal/labial swelling patients, especially those facing diagnostic dilemmas or harbouring complex lesions, should undergo radiological assessment as an indispensable criterion, particularly when such facilities are readily accessible.
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BACKGROUND: Contrast-enhanced CT scan is the standard imaging for the characterization and evaluation of focal parenchymal lung lesions. It relies on morphology and enhancement patterns for the characterization of lung lesions. However, there is significant overlap among imaging features of various malignant and benign lesions. Hence, it is often necessary to obtain tissue diagnosis with invasive percutaneous or endoscopic-guided tissue sampling. It is often desirable to have non-invasive techniques that can differentiate malignant and benign lung lesions. CT perfusion is an emerging CT technology that allows functional assessment of tissue vascularity through various parameters and can help in differentiating benign and malignant focal lung lesions. OBJECTIVE: The purpose of this study was to assess the role of the CT perfusion technique in differentiating malignant and benign focal parenchymal lung lesions. MATERIALS AND METHODS: In this prospective observational study, CT perfusion was performed on 41 patients with focal parenchymal lung lesions from December 2020 to June 2022. The four-dimensional range was planned to cover the entire craniocaudal extent of the lesion, followed by a volume perfusion CT (VPCT) of the lesion. A total of 27 dynamic datasets were acquired with a scan interval of 1.5 seconds and a total scan time of 42 seconds. CT perfusion parameters of blood flow (BF), blood volume (BV), and k-trans of the lesion were measured with mathematical algorithms available in the Syngo.via CT perfusion software (Siemens Healthcare, Erlangen, Germany). RESULTS: The median BV in benign lesions was found to be 5.5 mL/100 g, with an interquartile range of 3.3-6.9 and a p-value < 0.001. The median BV in malignant lesions was found to be 11.35 mL/100 g, with an interquartile range of 9.57-13.21 and a p-value ≤ 0.001. The median BF for benign lesions was 45.5 mL/100 g/min, with an interquartile range of 33.8-48.5 and a p-value ≤ 0.001. The median BF for malignant lesion was 61.77 mL/100 g/min, with an interquartile range of 33.8-48.5 and a p-value ≤ 0.001. The median k-trans in the case of benign lesions was found to be 4.2 mL/100 g/min, with an interquartile range of 3.13-6.8 and a p-value ≤ 0.001. The median k-trans in the case of the malignant lesion was found to be 12.05 mL/100g/min, with an interquartile range of 7.20-33.42 and a p-value < 0.001. Our study has also shown BV to have an accuracy of 92.68%, sensitivity of 93.3%, and specificity of 90.01%. CONCLUSION: Our study has shown that CT perfusion values of BV, BF, and k-trans can be used to differentiate between benign and malignant focal lung parenchymal lesions. K-trans is the most sensitive parameter while BV and BF have greater accuracy and specificity.
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Fetus-in-fetu (FIF) is a rare congenital anomaly in which a malformed parasitic twin develops within the body of a live fetus or child. Abdominal teratoma, a type of germ cell tumor, can be a great imaging mimicker of FIF and vice-versa, as they both can present as a heterogeneous mass with calcifications and a fat component. Radiological differentiation of these 2 entities should be made because of the difference in surgical planning and treatment options. Features such as visualization of distinct bony vertebral elements and encysted cystic components are the specific features of Fetus in fetu [1]. In contrast, the presence of elevated serum markers can help diagnose teratoma. Here, we report a case of a 5-month-old girl presented with progressive distension of the upper abdomen for the last 2 months, noticed by her mother. Her initial imaging with abdominal X-ray and ultrasonography showed the presence of a large heterogenous solid-cystic mass in the upper abdomen with large elongated calcifications. A provisional diagnosis of teratoma vs FIF was considered. CECT abdomen showed clear identification of osseous structures of the axial and appendicular skeleton within a fat density mass, along with an encapsulated cystic component, strongly suggestive of FIF. Her serum tumor markers were within normal limits. The final diagnosis of FIF was confirmed on Laparotomy and postoperative specimens.
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BACKGROUND: Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. METHODS: A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. RESULTS: Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. CONCLUSION: POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.
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INTRODUCTION: Tuberculous meningitis (TBM) is a manifestation of extrapulmonary tuberculosis (EPTB) caused by Mycobacterium tuberculosis (MTB). The central nervous system is involved in about 1%-2% of all current tuberculosis (TB) cases and about 7%-8% of all EPTB. if not treated early, TBM leads to a high rate of neurological sequelae and mortality. OBJECTIVE: This study aimed to assess the diagnostic performance of the GeneXpert MTB/rifampicin (RIF) assay in patients with TBM. METHODS: A total of 100 suspected TBM cases were enrolled from various departments at tertiary care hospital, Bhopal, Madhya Pradesh, India, and classified as definite, possible, or probable TBM. The clinical samples were tested for microbiological and other cerebrospinal fluid (CSF) testing. RESULTS: Out of 100 cases, 14 (14%) were classified as definite TBM, 15 (15%) were having probable TBM, and 71 (71%) were having possible TBM. Out of a total of 100 participants, all were negative for acid-fast bacilli (AFB) staining. Of the 100 cases, 11 (11%) were positive by mycobacterium growth indicator tube (MGIT) culture, of which only four (36.36%) were positive by GeneXpert MTB/RIF. GeneXpert MTB/RIF detected three (3%) cases that were negative by MGIT culture. Ten (90.9%) of the 11 MGIT-positive culture isolates were found to be RIF sensitive while one (9.1%) was found to be RIF resistant. Three cases tested positive/sensitive by the GeneXpert MTB/RIF but negative by MGIT culture. Six (85%) of the seven GeneXpert MTB/RIF positive cases were RIF sensitive while one (15%) was RIF resistant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 36.36% (95% Confidence Interval (CI) (10.93% to 69.21%)), 96.63% (95% CI (90.46% to 99.30%)), 57.14% (95% CI (25.50% to 83.85%)), 92.47% (95% CI (88.70% to 95.06%)) and 90% (95% CI (82.38% to 95.10%)) for GeneXpert MTB/RIF assay, compared with MGIT culture as the reference standard. CONCLUSION: Our study found that the sensitivity is lower when compared to culture, so using GeneXpert MTB/RIF alone is not recommended. Overall performance of GeneXpert MTB/RIF assay is noteworthy. The GeneXpert MTB/RIF assay is a potentially accepted test for obtaining an earlier diagnosis, and if it tested positive, the treatment should begin immediately. However, culture must be performed in GeneXpert MTB/RIF negative cases.
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The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.
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Parto Obstétrico , Financiamento Governamental , Promoção da Saúde/métodos , Serviços de Saúde Materna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Complicações na Gravidez/prevenção & controle , Adulto , Feminino , Humanos , Índia/epidemiologia , Mortalidade Materna , Motivação , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidadeRESUMO
INTRODUCTION: Despite the rising prevalence of liver fibrosis and its potentially life-threatening complications, there are currently no recommendations or guidelines to screen individuals with diabetes mellitus (DM) or high body mass index (BMI) for non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH). This is mainly due to the uncertain performance and feasibility of presently available screening tools. This research was carried out to assess the diagnostic accuracy of non-invasive screening tools in predicting liver fibrosis in individuals with DM and metabolic syndrome. METHODS: For this study, 140 patients with DM and metabolic syndrome were identified between March 2020 and October 2021. Liver stiffness measurement by point shear wave elastography was considered the gold standard in our study. Five non-invasive scores such as aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, aspartate aminotransferase to platelet ratio index (APRI) score, fibrosis-4 (FIB-4) index, BARD score, and NAFLD fibrosis score were determined in all of the participants. Using receiver operator characteristic (ROC) curve analysis, sensitivity, specificity, both negative predictive value (NPV) and positive predictive value (PPV) were calculated for each of these scores. The area under the ROC curve (AUROC) was used to calculate the diagnostic accuracy of these scores. RESULTS: Of the 507 individuals screened, 140 were enrolled for the study. Among the 140 participants, 83 were male (59.29%), 30 (21.43%) had liver fibrosis as per liver stiffness measurement by point shear wave elastography, and 110 (78.57%) did not have fibrosis. The mean age and mean BMI were 54.53±12.42 and 27.37±2.73 respectively in the 'Fibrosis' group and 56.20 ±11.76 and 27.10±4.22 in the 'No fibrosis' group. The major finding of our study was that all these scores had relatively high NPV (>85 %) for predicting liver fibrosis in our cohort. The AST/ALT ratio had the highest NPV (90.28%) followed by APRI Score (88.94%). The AUROC for FIB-4 Score, NAFLD-fibrosis score, APRI score, AST/ALT ratio, and BARDd score were 0.6669, 0.657, 0.655, 0.637 and 0.599, respectively. The FIB-4 index (p=0.005) had the highest AUROC, followed by the NAFLD-fibrosis score (p =0.009). But all the scores had relatively low specificity (<60 %), PPV (<35 %), and accuracy (<63 %). CONCLUSION: The FIB-4 index and NAFLD-fibrosis score can be used reliably to exclude liver fibrosis in individuals with DM and metabolic syndrome in the Indian population, but may not be useful in accurately diagnosing liver fibrosis. Utilization of these non-invasive and cost-effective screening tools in routine practice may have promising results in predicting liver fibrosis in 'at risk' populations.
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Abdominal hydatid cyst disease mostly involves the liver. Involvement of the pancreas as an isolated primary organ is rare accounting for < 2% of all systemic echinococcosis cases. It mostly involves the head of the pancreas. Symptoms depend on the location, size, and associated complications; therefore, it can have varied presentations including acute pancreatitis. On imaging, it can mimic other common pancreatic cystic lesions like pseudocyst or cystic neoplasm. Accurate preoperative diagnosis is usually difficult and requires a very high index of suspicion even in endemic areas. Herein, a case of primary isolated hydatid cyst of the pancreas that was initially diagnosed and managed as acute pancreatic pseudocyst is reported.
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Mycetoma is a chronic granulomatous disease that is more common in tropical regions with predominant involvement of foot. Spinal mycetoma presenting as lumbar canal stenosis is extremely rare. We hereby present a case of fungal eumycetoma of vertebral column in a 42-year-old male who presented with chronic progressive low back pain and features of lumbar canal stenosis without any skin swelling or discharging sinuses. The "dot-in-circle" sign, a highly specific magnetic resonance imaging (MRI) and ultrasonography (USG) sign of mycetoma has been described in the literature as a pathognomonic feature of mycetoma involving the musculoskeletal system. We describe the importance of characteristic imaging features with dot in circle sign in the diagnosis of eumycetoma of lumbar spine.
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We report a case of 'occult' bilateral optic nerve aplasia (ONA) where pituitary dysfunction was discovered subsequently. The initial ultrasonography had missed ONA in a child with bilateral microcornea, small non-dilating pupils and roving eye movements. Due to presence of relevant clinical signs in this case, ONA was re-evaluated with MRI, and was subsequently discovered to be associated with life-endangering hypopituitarism. This case raises the possible underestimation of ONA, and hence also the risk of missing life-threatening endocrine disorders.
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Anormalidades do Olho/fisiopatologia , Hipopituitarismo/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Nervo Óptico/diagnóstico por imagem , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Diagnóstico Ausente , UltrassonografiaRESUMO
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by widespread areas of abnormal bone formation in muscles, ligaments, tendons and joint capsules. Typically, the symptoms begin in the first decade of life with episodes of painful inflammatory soft tissue swellings. Gradually, there occurs restriction of motion at various joints, severely limiting the activities of daily living and the quality of life of such patients by the third decade of life. There is no definite cure available for the disease and the current treatment options target symptomatic and palliative management. We describe the case of a 10-year-old child who presented to our institute with a severe disability of upper limbs due to joint contractures along with several bony masses at various locations of the body but without having any prior complaints of painful soft tissue lesions or the characteristic flare-ups of the disease ever. Identification of typical soft tissue ossified masses in the specific anatomic pattern, along with the presence of short and malformed great toes helped us in reaching the diagnosis. Surgical procedures including biopsies should be strictly avoided in such patients to prevent triggering the development of more lesions, which occurred in our patient after inadvertent removal of the first swelling by an orthopaedic specialist.
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Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented. Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst. Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.
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Hypertrophic olivary degeneration (HOD) is seen following lesions in the Guillain-Mollaret triangle. This is unique because the inferior olivary nucleus hypertrophies following degeneration unlike the typical atrophy seen in other structures. We report two cases of HOD in two different clinical scenarios.
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A 27-year-old man road traffic accident victim, in his initial CT, showed fractures in left lower ribs, pleural effusion and splenic and pancreatic lacerations. The left pleural effusion, drained with an intercostal tube, did not show any significant reduction in size and pleural fluid amylase was abnormally high. A diaphragmatic tear was suspected. Contrast was injected through the intercostal tube and a CT was performed, which revealed a small diaphragmatic tear and communication of the pleural space with peritoneum and the pancreatic laceration site.
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Diafragma/diagnóstico por imagem , Diafragma/lesões , Derrame Pleural/diagnóstico por imagem , Adulto , Meios de Contraste , Diagnóstico Diferencial , Humanos , Masculino , Intensificação de Imagem RadiográficaRESUMO
The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3(rd) of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive 'bird beak sign'. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller's Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.