Comparison of ultrasound and magnetic resonance imaging findings in evaluation of fetal congenital anomalies: A single-institution prospective observational study.

Background: This study aimed to compare the ultrasound (USG) and fetal magnetic resonance imaging (MRI) findings in the evaluation of congenital fetal anomalies and to determine whether the management is changes significantly if MRI is combined with USG. Methods: In this prospective observational cohort study, we performed fetal MRI in 90 consecutive cases of fetuses diagnosed or suspected as having congenital anomalies on a prior level II USG scan. We then compared the USG and MRI findings of each anomaly according to the diagnostic information yielded by each modality. Results: Of 90 fetuses examined during 1 year study period, MRI and USG findings were equivalent in 13.3% of cases. MRI provided additional information in 68.8% cases, of which pregnancy management was changed in 5.6% cases. MRI provided additional information but did not change management in 63.3% of cases. USG provided additional information but did not change pregnancy management in 17.8% of cases. The difference was statistically significant with a p value of .000. Conclusion: Fetal MRI is a significantly better modality than USG for detecting additional findings in anomalies of specific organ systems. Because of its high diagnostic yield for central nervous system (CNS) anomalies, it can be combined with USG for this subgroup. For non-CNS anomalies of genitourinary system, thorax, or in syndromic/complex malformations/conjoint twin pregnancy, it may be used as an adjunct to USG on a case to case basis. MRI has the potential to change the pregnancy management in few cases, but benefit is small to advocate a complete integration of MRI and USG for fetal anomaly scanning at present.

Torsion of a Wandering Spleen Presenting as Acute Abdomen.

BACKGROUND: Wandering spleen is a rare condition which if uncorrected, can result in torsion and infarction. Clinical presentation of a wandering spleen can vary from asymptomatic abdominal mass to acute abdominal pain. Radiological investigations play a pivotal role in diagnosis as the clinical diagnosis is usually impossible. CASE REPORT: We present a case of wandering spleen with torsion and complete infarction that occurred in a 32-year-old multiparous female. The diagnosis was established preoperatively on colour Doppler and CT of the abdomen with subsequent confirmation on surgery. CONCLUSIONS: Wandering spleen is a rare clinical condition which can present as acute abdomen. An increased awareness of this entity together with the timely use of ultrasound and CT of the abdomen can play an important role in preoperative diagnosis and surgical management.

A Prospective Comparative Study of High Resolution Ultrasound and MRI in the Diagnosis of Rotator Cuff Tears in a Tertiary Hospital of North India.

BACKGROUND: To evaluate the accuracy of high resolution ultrasound (USG) and MRI in the diagnosis of rotator cuff tears (RCT) and to determine if high resolution USG compares favorably in sensitivity and specificity to MRI in the diagnosis of rotator cuff injury. MATERIAL/METHODS: In this prospective comparative study, 40 patients with clinically suspected rotator cuff tears underwent both ultrasound and MRI of the shoulder. Out of these 40 patients, 31 patients who had positive findings for rotator cuff tears on ultrasound and/or MRI were finally included in the study while the remaining 9 patients with negative or unrelated findings were excluded. The USG and MRI were interpreted by two radiologists experienced in musculoskeletal radiology and blinded to findings of each other. Comparison was done using MRI as a standard reference. RESULTS: The agreement between USG and MRI for diagnosis of RCTs was statistically excellent; USG showed a sensitivity of 86.7% and a specificity of 100% for full-thickness tears, and a sensitivity of 89.7% and a specificity of 98.8% for partial-thickness tears; observed accuracy for full thickness tears was 98.4% and 95.9% for partial thickness tears. The Kappa coefficient of association was 0.91 for full thickness tears and 0.90 for partial thickness tears. CONCLUSIONS: Considering the comparable diagnostic accuracy of USG and MRI, the former modality can be used as a first-line investigation for diagnosis of RCT. MRI should be used secondarily as a problem-solving tool either following an equivocal shoulder USG or for delineation of anatomy in cases where surgical correction is needed.

Magnetic Resonance Imaging (MRI) Characterization of Perianal Fistulous Disease in a Rural Based Tertiary Hospital of North India.

BACKGROUND: To diagnose and characterize the perianal fistulous disease using Magnetic resonance imaging (MRI) in a hilly and rural area of North India. MATERIAL/METHODS: This prospective hospital based study was conducted for a period of one year from April 2014 to April 2015 in the departments of Radiodiagnosis and Surgery of our institute. A total of 50 consecutive patients presenting with perianal fistulous disease fulfilling the inclusion and exclusion criteria were included in the study and taken up for MRI. The perianal fistulae were classified according to St James University hospital classification and tracks were assessed with regard to anatomical plane, length, ramifications, abscess formation, enteric communication, external cutaneous opening, enhancement and suprasphincteric extension. Surgical correlation was done in 31 patients who opted for surgical treatment. Rest of the 19 patients preferred alternative medicine for treatment or chose to postpone their surgery. RESULTS: The disease was much more prevalent in males in comparison to females with male to female ratio of 24:1. Grade 4 was the most common type of fistula (34%) while Grade 5 was the least common type (4%).MRI showed a high sensitivity of 93.7% and positive predictive value (PPV) of 96.7% when correlated with surgical findings. A substantial number of patients (38%) preferred alternative medicine or non surgical form of treatment. CONCLUSIONS: MRI is a very sensitive modality for the evaluation of perianal fistula. In our study group, the disease predominantly affected middle aged men. Ramifications and abscesses were commonly seen, affecting nearly half of the patients and majority of the patients had active fistulous tracks with posteriorly located enteric opening. Overall, transsphincteric fistulae were most common. Significant number of patients avoided surgery or showed preference for non surgical treatment.

Acute parkinsonism in a patient with myxedema crisis: A case report.

Both myxedema crisis and Sheehan's syndrome are uncommon conditions. The first-time presentation as myxedema crisis is rare in Sheehan's syndrome. The present study describes the case of a 31-year-old female patient who presented with altered sensorium in the emergency room. The patient was not a known case of hypothyroidism, but had a history of secondary amenorrhea and lactation failure following the birth of a child 11 years prior. Upon evaluation, she was found to have hypothermia, hypotension, the delayed relaxation of deep tendon reflexes, bradycardia and hyponatremia, which led to the suspicion of myxedema crisis. Her thyroid function tests were suggestive of secondary hypothyroidism and her pituitary hormonal profile revealed panhypopituitarism. The patient was managed on the lines of myxedema crisis with oral levothyroxine, hydrocortisone infusion, antibiotics and rewarming. Her clinical and biochemical parameters exhibited an improvement; however, her altered sensorium persisted. A repeat neurological examination revealed cogwheel rigidity with paraparesis, which led to the clinical suspicion of acute parkinsonism. Magnetic resonance imaging of the sella and brain was suggestive of an empty sella and extrapontine myelinolysis, substantiating the diagnosis of Sheehan's syndrome with acute parkinsonism. The patient was commenced on levodopa-carbidopa following which there was an improvement in symptoms. The patient improved over the ensuing 6 months and can now perform all household activities. On the whole, the present study indicates that the early suspicion of myxedema crisis, prompt treatment and the recognition of additional aetiology for persistent altered sensorium can result in a successful outcome for the patient.

Persistence of multiple emissary veins of posterior fossa with unusual origin of left petrosquamosal sinus from mastoid emissary.

Emissary veins are valveless veins which pass through the cranial apertures and connect the dural venous sinuses and the extracranial veins. The clinical importance of emissary veins is increasingly being appreciated. Some emissary veins like the petrosquamosal sinus and mastoid emissary vein may cause significant bleeding during middle ear and skull base surgeries. A dilated mastoid emissary vein or condylar emissary vein can sometimes be a rare cause of tinnitus. Radiological identification of these venous channels has been described in recent years and assumes significance in light of their clinical importance. We describe the CT and MRI findings of a rare case that had persistence of multiple emissary veins and presented clinically with tinnitus. The radiological findings included a dilated left mastoid emissary vein, bilateral petrosquamosal sinuses, posterior condylar veins, occipital emissary veins and an intrapetrous venule. The left petrosquamosal sinus had an unusual origin from the dilated mastoid emissary vein. The patient also had major anomalies of posterior fossa venous sinuses which are discussed. A relevant review of literature is included.

A queer case of Parry-Romberg syndrome with coexisting psychiatric ailment.

Progressive facial hemiatrophy or Parry-Romberg syndrome is a rare disorder of unknown etiology which is characterized by atrophy of the one side of the face and various neurological complications. Clinical overlap is sometimes seen with linear scleroderma or en coup de sabre. We present such a case that manifested clinically with partial epilepsy and novel psychiatric complaints of agoraphobia.

Morphometric Study of Lower End Femur by Using Helical Computed Tomography.

BACKGROUND: A mismatch between the prosthesis size and bone may result in a number of complications. Keeping this in view, it is essential to analyze the morphological differences of the knee observed across various ethnic groups to improve the performance of total knee arthroplasty (TKA). The current study was aimed at studying the computed tomography (CT) profile of distal femur in Indian population and evaluates it morphologically. MATERIALS AND METHODS: This descriptive study was conducted on 62 patients presenting to the Department of Orthopedics in a tertiary care center in rural north-west India for features suggestive of osteoarthritis and trauma of knee from September 17, 2015 to September 16, 2016. Helical CT of both knees was done, and the data were analyzed using Statistical Package for Social Sciences Version 17.0 statistical significance was assessed with the help of t-test and the value of P < 0.05 was considered to be statistically significant. RESULTS: The mean mediolateral (ML) value in male patients was 72.74 ± 4.45 while the mean ML value in female patients was lower (63.59 ± 2.61). The mean anteroposterior (AP) value in male patients was significantly (statistically) higher (49.62 ± 3.86) in comparison to mean AP value in female patients (45.11 ± 4.4). The mean anterior lateral condylar height (ALCH) value in male patients was higher (17.53 ± 2.72) in comparison to mean ALCH value in female patients (14.63 ± 3.42). CONCLUSIONS: The current study highlights the need to develop components and implants for use in TKA and fractures of distal femur keeping the age- and sex-specific anatomical features of people of different ethnic origins in view.

Lymphangiomatosis: Two cases with unique presentations, salience of nomenclature, and diagnosis.

We are presenting two unique cases of lymphangiomatosis without visceral and bony involvement and critically discussing the nomenclature used in the extant literature. The first case was a 12-year-old boy with ill-defined mass on the right cheek extending into the ipsilateral orbit leading to conjunctival lesion. The second case was of a 14-week-old infant showing diffuse swelling on nape of the neck. In addition there were raised patches on dorsal aspects of bilateral hands and feet. The biopsies from all the lesions showed similar histopathological features consistent with lymphangiomatosis. We propose that the term lymphangiomatosis should be used only in cases with histological features of lymphangiomatosis. The term should not be used in cases of multiple lymphangiomas. We conclude that the lesions clinically diagnosed as lymphangioma may turn out to be lymphangiomatosis. Extensive lymphangiomatosis without visceral or bony involvement may lead to intrauterine death.

Iatrogenic uterine perforation with abdominal extrusion of fetal parts: a rare radiological diagnosis.

BACKGROUND: Failure to detect uterine perforation during surgical abortion may result in adverse patient outcome besides having medicolegal implications. This rare case of uterine perforation was diagnosed seven days after abortion and underscores the importance of remaining vigilant for this complication during and after the procedure. CASE: A female underwent surgical abortion at sixteen weeks gestation and was discharged after the procedure, assuming no complication. She presented with abdominal pain seven days after the event. Ultrasound and CT revealed uterine perforation with abdominal expulsion of fetal parts. CONCLUSION: A patient complaining of abdominal pain following recent abortion related instrumentation should alert the clinician regarding possibility of perforation. Secondary signs on ultrasound may reveal the diagnosis even if rent is not identified. CT is valuable in emergent situations.

Branchial fistula arising from pyriform fossa: CT diagnosis of a case and discussion of radiological features.

Anomalies of third or fourth branchial apparatus origin are very uncommon and present as recurrent neck infections or thyroiditis with a predominant left-sided involvement. Radiological diagnosis requires a high index of suspicion and is critical for initiation of proper treatment. We describe a case of branchial sinus of pyriform fossa with external fistulization that presented in adulthood and was diagnosed on computed tomographic scan. The radiological features of this rare anomaly are revisited.

Case report: Colonic bezoar due to Box Myrtle seeds: A very rare occurrence.

Large bowel seed bezoars are rare and are mostly due to seeds of sunflower, prickly pear cactus, sesame and cucumber. We present a rare case of sigmoid colon seed bezoar due to Box Myrtle seeds because of an underlying benign stricture.

Dual thyroid ectopia: a case report.

Dual thyroid ectopia is a very rare clinical entity, and only 28 cases have been reported previously in the literature. We describe another case in which CT established the diagnosis preoperatively and prevented an unnecessary surgery.

Complete androgen insensitivity syndrome with microtia: a rare presentation.

Complete androgen insensitivity syndrome (CAIS) is a rare X-linked disorder characterized by a female body habitus and male genotype. The Müllerian duct derivatives are absent or rudimentary, and the testes are undescended. Microtia is characterized by a malformed auricle; and in some cases it is genetically transmitted with a non-sex-linked inheritance pattern. The presence of CAIS with microtia has not been documented previously, and this is the first case to describe the radiological findings of this rare presentation.