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   Table of Contents - Current issue
July-September 2018
Volume 28 | Issue 3
Page Nos. 271-378

Online since Wednesday, September 26, 2018

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Ergonomics in radiology – Time to revisit p. 271
Chander Mohan
DOI:10.4103/ijri.IJRI_358_18  PMID:30319201
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Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study Highly accessed article p. 273
Shivaprakash B Hiremath, Amol A Gautam, Keerthy Sheeja, Geena Benjamin
DOI:10.4103/ijri.IJRI_70_18  PMID:30319202
Background and Purpose: The purpose of our study was to assess the prevalence of variations in the extent of sphenoid pneumatization in the Indian population and compare with existing literature. Materials and Methods: This retrospective study included 500 patients who underwent CT of the paranasal sinuses. The multiplanar reformations of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess, lesser wing, and anterior recess extensions. Results: The conchal, presellar, incomplete sellar, and complete sellar types comprised 0%, 1.2%, 22.2%, and 76.6% of patients. The extensions of pneumatization subtypes in the study population were clival in 76.6% subjects; lateral recess, lesser wing, and anterior recess in 59.7%, 20.4%, and 20.4% of sinuses, respectively. The pure forms were seen in 25.4% and combined forms in 61% of sinuses. The presellar type (1.2%) was less common and sellar type (98.8%) being common in our population compared to the Caucasian and East Asian population. The sphenoid sinuses were extensively pneumatized in our population compared to the Chinese and Caucasian population, the prevalence being 76.6%, 68%, and 44.5% for clival; 59.7%, 46%, and 28.3% for lateral recess; 20.4%, 32%, and 12% for lesser wing extension, respectively. The pure forms were relatively less common and combined forms being more common compared to the Chinese and Caucasian population in our study. Conclusion: The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sellar and central skull base lesions, and variability in different populations confirms that ethnicity influences the differences in prevalence.
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Plain CT vs MR venography in acute cerebral venous sinus thrombosis: Triumphant dark horse Highly accessed article p. 280
Poornima Digge, Koteshwar Prakashini, KV Bharath
DOI:10.4103/ijri.IJRI_328_17  PMID:30319203
Context: Most patients with cerebral venous sinus thrombosis (CVST) present with nonspecific signs and symptoms and are likely to undergo nonenhanced head computed tomography (NCT) at presentation, which may show a normal report in up to two-thirds of patients. However, in case of acute thrombosis, sensitivity of diagnosing CVST is high as sinuses are hyperdense. Though magnetic resonance imaging (MRI) is considered the imaging modality of choice for diagnosing CVST, it is not universally available in an acute setting. Aims: To evaluate whether increased attenuation in cerebral venous sinuses in acute condition can be used to diagnose acute CVST and to determine its diagnostic value. Materials and Methods: The study involves two independent groups. One group of patients with sinus thrombosis were confirmed by MR venography (group A). The other group included patients without sinus thrombosis (group B). The HU (CT attenuation), hemoglobin (HGB), hematocrit (HCT), and H: H (HU: HCT) ratio of both groups were compared. Thirty-six patients (59 thrombotic sinuses) were studied in group A and 40 in group B. Statistical Analysis: Average HU and H: H ratio were compared using two-tailed t-test, and linear regression analysis was used to assess correlation between HCT and HU. Results: Average HU (73.7 vs 48.6) and H: H ratio values were higher in group A patients compared to group B (P < 0.05). Linear regression analysis showed positive correlation between HGB and HCT with HU among both the groups (P < 0.05). Conclusions: Our study demonstrates that acute CVST can be diagnosed using HU values in NCT.
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3T proton MR spectroscopy evaluation of spinal cord lesions Highly accessed article p. 285
Babu Peter Sathyanathan, Bharathi Priya Raju, Kailasanathan Natarajan, Ravi Ranganathan
DOI:10.4103/ijri.IJRI_122_17  PMID:30319204
Objective: The objective of this study was to evaluate intramedullary spinal cord lesions using magnetic resonance spectroscopy and correlate the results with histo-pathological examination (HPE). Materials and Methods: Approval for this study was obtained from our institute ethical committee. Overall, 50 patients were recruited (29 male and 21 female), with a maximum age of 53 years and minimum age of 7 years. The mean age group of the study was 33 years. Standard magnetic resonance imaging (MRI) spine was done on a Siemens Skyra 3Tesla MRI scanner. MR Spectroscopy (MRS) was performed for all patients with intramedullary spinal lesions after getting written consent. It was performed using single-voxel method. The change in the metabolite peak was observed in each case and the results were compared with HPE. These collected data were analyzed using SPSS 16.0 version. Descriptive statistics, frequency analysis, and percentage analysis were used for categorical variables; and for continuous variables, mean and standard deviation were analyzed. McNemar's test was used to find the significance between conventional MRI MRS. In the above statistical tool, the probability value 0.05 is considered as significant level. Results: From our study, we observed that by applying routine MRI sequences alone, we could only detect around 58% of the cases correctly. However, when MRS was done along with the conventional MR imaging, the number of cases detected significantly increased to 84%. By applying McNemar's test and comparing the conventional MRI and MRS with HPE, it was found that statistically significant difference exists with P value of 0.007. Conclusion: MRS of the spinal cord is a promising tool for research and diagnosis because it can provide additional information complementary to other non-invasive imaging methods. It is an emerging tool and adds new biomarker information for characterization of spinal cord tumors, to differentiate benign from malignant lesions and to prevent unnecessary biopsies and surgeries.
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Myriad of MR imaging phenotypes of primary central nervous system lymphoma in a cohort of immunocompetent Indian patient population p. 296
Sankar Neelakantan, Sunitha P Kumaran, Sanjaya Viswamitra, Nandita Ghosal
DOI:10.4103/ijri.IJRI_23_18  PMID:30319205
PCNSL (primary central nervous system lymphoma) is a chemosensitive and radiosensitive tumor, and early diagnosis has a significant impact on management. Unlike many other brain tumors, radical surgical excision of PCNSLs is not indicated because these lesions are highly infiltrative and even partial resection leads to a bad prognosis. The goal of this study is to highlight the unusual radiological presentation of PCNSLs and increase the awareness, familiarity, and global database of our observations that pose a challenge on management.
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Conventional and advanced brain MR imaging in patients with sickle cell anemia p. 305
Pratibha Issar, Maya Nehra, Gurmeet Singh, SK Issar
DOI:10.4103/ijri.IJRI_166_17  PMID:30319206
Background: Sickle cell disease (SCD) is an autosomal recessive hemolytic disorder; its cerebrovascular complications include silent cerebral ischemia, infarct, and brain atrophy. Conventional magnetic resonance imaging (MRI) often underestimates the extent of injury. Diffusion tensor imaging (DTI) can demonstrate and quantify microstructural brain changes in SCD cases having normal routine MRI. Objective: To identify various neurological abnormalities in asymptomatic sickle cell patients using routine MRI and to evaluate the microstructure of various regions of the brain using DTI. Materials and Methods: A prospective, randomized case–control study was conducted over a period of 2 years. A total of 58 cases of SCD and 56 age- and sex-matched controls were included. Routine MRI and DTI were performed in both the groups following a standard protocol. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated in certain pre-defined regions. Primary data were analyzed using MS excel version 17. Analysis of variance test was performed and statistical significance was set at P < 0.05. Results: Thirty regions of interest with 60 variables were included in the final analysis. Patients with SCD showed statistically significant reduced FA values, increased ADC values, or both, clustered in several brain areas, including pons, cerebral peduncle, corpus callosum, frontal, temporal, parietal white matter, centrum semiovale, periventricular areas, basal ganglia, and left thalamus (P < 0.05). Conclusion: DTI is a promising method for characterizing microstructural changes, when conventional MRI is normal.
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Magnetic resonance imaging findings in brain resulting from high-voltage electrical shock injury of the scalp p. 312
Dileep P Chandrasekhar, Mohan L Noone, S P Harish Babu, V T Chandra Bose
DOI:10.4103/ijri.IJRI_368_17  PMID:30319207
We report a case of high-voltage electrical injury to scalp, focusing on the magnetic resonance imaging (MRI) findings in brain. A 51-year-old male suffered burns to the right side of scalp and loss of consciousness following electric shock. Brain abnormalities were detected on MRI taken 4 days after the insult. Right parietal lobe neuroparenchyma beneath the scalp burn defect demonstrated homogeneous hypointensity on T1-weighted MR images, while T2-weighted images depicted hyperintensity mainly in white matter forming finger-like projections. Follow-up MRI showed that the abnormality had disappeared, indicating that the cerebral edema was reversible.
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Triple-phase MDCT of liver: Scan protocol modification to obtain optimal vascular and lesional contrast p. 315
Sheoran Sween, Chatterjee Samar, Sekhar M Binu
DOI:10.4103/ijri.IJRI_75_18  PMID:30319208
Context: With advances in 16-slice multidetector computed tomography (MDCT), the entire liver can be scanned in 4–6 s and a single breath-hold dual-phase scan can be performed in 12–16 s. Consequently, optimizing the scan window has become critical. Aim: The purpose of our study was to optimize scan delays using bolus-tracking techniques for triple-phase CT of the liver. Settings and Design: Fifty patients with liver lesions were randomly divided into two groups with 25 patients each. The patients were subjected to triple-phase MDCT of liver with two different scan protocols. Materials and Methods: They were administered 1.5 mL/kg of 300 mg/mL of iohexol at a rate of 3.0 mL/s with a pressure injector. Using bolus-tracking program, scans were commenced at 4, 19, and 44 s and 8, 23, and 48 s for the first, second, and third phases, respectively. The mean CT values [Hounsfield unit (HU)] were measured in the aorta, hepatic artery, portal vein, hepatic vein, liver parenchyma, and lesion using circular region of interest cursor ranging in size from 5 to 20 mm in diameter on all phases. Statistical Analysis Used: Statistical analysis was carried out using paired Student's t-test. Results: In hepatic arterial phase, hepatic artery has shown better enhancement in Group B (8 s) (P = 0.0498) compared with Group A (4 s). In portal venous phase, there were no significant differences in contrast enhancement index (CEI) values at any of the six measured regions between the groups. In the hepatic venous phase, liver parenchyma has shown nearly significant (P = 0.0664) higher CEI values in Group B (48 s) when compared with Group A (44 s). Conclusion: A scan delay of 8 s, after trigger threshold (100 HU) is reached in the lower thoracic aorta, is optimal for the early arterial phase imaging, this phase being most helpful for assessment of hepatic arterial tree (CT angiography). The liver parenchyma showed maximum enhancement at 48 s scan delay.
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Characteristic changes of the ablation zone on contrast-enhanced computed tomography after radiofrequency ablation of hepatic metastases p. 320
Markus Zimmermann, Christiane Kuhl, Sebastian Keil
DOI:10.4103/ijri.IJRI_391_17  PMID:30319209
Purpose: Size and density measurements of the ablation zones on contrast-enhanced computed tomography (CT) after radiofrequency ablation (RFA) of hepatic metastases of primary breast or colorectal cancer were acquired over time. Materials and Methods: Twenty-five liver metastases [colorectal cancer (CRC): n = 16; mean size: 19.6 ± 8.5 mm; breast cancer (BC): n = 9; 27.9 ± 13.6 mm] in 15 patients (CRC: n = 11; age: 65.4 ± 6.5 years; BC: n = 4; 62.0 ± 13.8 years) treated by RFA were included in this retrospective study. All patients had undergone postinterventional serial follow-up using multidetector CT (MDCT) (1 day/1/4/7/10/14/18/23/>24 months) without evidence of local tumor recurrence during the follow-up. The ablation zones were evaluated using a commercial software tool (Syngo CT Oncology) in order to determine volumetric, RECIST-, WHO- and density changes over the course of time. Results were compared by applying repeated measures analysis of variance and displayed graphically. Results: The RF ablation zones demonstrated significant shrinkage (P ≤ 0.05) over the first 7 months (volume, RECIST, WHO) of the follow-up. Follow-up after 7 months did not show any significant changes in size (P > 0.05) (mean volume (ml): 55.2/34.7/26.3/16.5/12.7/10.0/8.9/8.1/7.5; RECIST (mm): 58.7/49.3/43.7/37.8/34.2/31.3/29.1/27.3/24.8; WHO (mm2): 2458.3/1769.3/1341.8/1027.1/870.1/720.2/649.0/570.4/511.3). Mean density values decreased significantly between 1 day (58.9 HU) and 1 month (47.5 HU) after the procedure. Conclusion: Typical changes in size and density values of RF-induced, recurrence-free ablation zones after RFA of hepatic metastases of colorectal and breast cancer were acquired, showing a significant decrease in density of the ablation zone within the first month and significant shrinkage within the first 7 months after RFA.
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Mucinous cystadenoma of pancreas with honeycombing appearance: Radiological-Pathological correlation p. 327
Beno Jefferson, Indiran Venkatraman, R Vinoth Kumar, Karkuzhali Ponnuswamy, Anbukkarasi , Prabakaran Maduraimuthu
DOI:10.4103/ijri.IJRI_469_17  PMID:30319210
Most mucinous cystadenomas of pancreas are solitary and multilocular with a few large compartments. Serous cystadenomas usually have a polycystic or microcystic (honeycomb) pattern consisting of collection of cysts (usually >6) that range from few millimetres up to 2 cm in size. Here we present a case of mucinous cystadenoma of pancreas showing an unusual appearance of honeycombing (which has not been described so far) using imaging studies such as endoscopic ultrasound and computed tomography with histopathological confirmation of the diagnosis.
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Pica and the radiologist – beyond the radiology report … digging deeper p. 330
Sameer R Kalgaonkar, Ravi Ramakantan
DOI:10.4103/ijri.IJRI_48_18  PMID:30319211
Pica is a psychological disorder of intentional and craving consumption of non-nutritive substances over a period of time. This is seen at an age when such a behavior is developmentally inappropriate. Substances such as wall paint, soil, hair, and feces have been reported as being consumed. Complications of this condition may range from being self-limiting to life-threatening. Radiological examinations play a crucial role in the diagnosis and management of this condition. We present a case of a 9-year-old boy who presented with chronic abdominal pain with history of persistent consumption of pencil erasers. Abdominal radiographs showed radio-opaque foreign bodies, and etiological diagnosis was made when the radiologist obtained a detailed history from the patient's mother. We also discuss the radiographic evaluation of the pencil eraser and the reason why it is densely radio-opaque.
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Bronchial anthracofibrosis: The spectrum of radiological appearances p. 333
Ashok Shah, Shekhar Kunal, Rajesh Gothi
DOI:10.4103/ijri.IJRI_339_17  PMID:30319212
Bronchial anthracofibrosis (BAF), caused by long-standing exposure to biomass fuel smoke, has emerged as a distinct pulmonary disease. It is usually seen in elderly females who have worked long hours in poorly ventilated kitchen full of smoke due to incomplete combustion of biomass fuel. The diagnosis is confirmed on bronchoscopic visualization of bluish-black anthracotic pigmentation along with narrowing/distortion of the affected bronchus. BAF has been associated with clinical conditions such as pulmonary tuberculosis, chronic obstructive pulmonary disease, pneumonia, and malignancy. Tuberculosis, once thought to be the causative agent for BAF, is now considered to be an association. BAF has a diverse radiological presentation and the presence of associated clinical conditions often confound the radiological picture. The imaging features of BAF include primary imaging characteristics, which pertains to the disease entity directly, and secondary features based on the presence of associated conditions. High-resolution computed tomography findings of multifocal bronchial narrowing and peribronchial cuffing are considered to be specific diagnostic features of BAF. In addition, the diagnostic probability is increased in the presence of mediastinal adenopathy and collapse/atelectasis with middle lobe syndrome being the most common presentation. This pictorial essay highlights the range of imaging appearances in patients with BAF.
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Magnetic resonance imaging as an adjunct to computed tomography in the diagnosis of pulmonary Hydatid cysts p. 342
Roopa Tandur, Aparna Irodi, Binita Riya Chacko, Leena Robinson Vimala, Devasahayam Jesudas Christopher, Birla Roy Gnanamuthu
DOI:10.4103/ijri.IJRI_121_18  PMID:30319213
Introduction: Although pulmonary hydatid cysts can be diagnosed on computed tomography (CT), sometimes findings can be atypical. Other hypodense infective or neoplastic lesions may mimic hydatid cysts. We proposed that magnetic resonance imaging (MRI) may act as a problem-solving tool, aiding the definite diagnosis of hydatid cysts and differentiating it from its mimics. The aim of this study is to assess the findings of pulmonary hydatid cysts on CT and MRI and the additional contribution of MRI in doubtful cases. Materials and Methods: This is a retrospective study of 90 patients with suspected hydatid cysts. CT and MRI findings were noted and role of MRI in diagnosing hydatid cysts and its mimics was studied. Descriptive statistics for CT findings and sensitivity and specificity of MRI were calculated using surgery or histopathology as gold standard. Results: Of the 90 patients with suspected pulmonary hydatid cysts, there were 52 true-positive and 7 false-positive cases on CT. Commonest CT finding was unilocular thick-walled cyst. In the 26 patients who had additional MRI, based on T2-weighted hypointense rim or folded membranes, accurate preoperative differentiation of 14 patients with hydatid cysts from 10 patients with alternate diagnosis was possible. There was one false-positive and one false-negative case on MRI. Conclusion: Although hydatid cyst can be diagnosed on CT on most occasions, sometimes there are challenges with certain mimics and atypical appearances. T2-weighted MRI can act as a problem solving tool to conclusively diagnose hydatid cyst or suggest an alternate diagnosis.
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Interventional radiology-operated endoscopy using the LithoVue disposable endoscope: Approach, technical success, clinical outcomes, and complications p. 350
Nishant Patel, Jeffrey Forris Beecham Chick, Joseph Gemmete, Rudra Pampati, Evan Johnson, Ravi Srinivasa
DOI:10.4103/ijri.IJRI_82_18  PMID:30319214
Purpose: To report the approach, technical success, clinical outcomes, and complications of interventional radiology-operated endoscopy using the LithoVue disposable endoscope. Materials and Methods: 12 patients, 6 (50%) males and 6 (50%) females, underwent interventional radiology-operated endoscopy using the LithoVue disposable endoscope between April 2016 and August 2017. Presenting complaint, reason for endoscopic evaluation, technical success, clinical success, procedure time, fluoroscopy time, hospital length of stay, and complications were recorded. Results: Interventional radiology-operated endoscopy using the LithoVue disposable endoscope was used in 8 (67%) biliary, 2 (16.5%) urologic, and 2 (16.5%) gastrointestinal procedures. Five (42%) patients required endoscopy to locate an ostium that could not be cannulated under fluoroscopy. Five (42%) patients had a biliary-enteric anastomosis with postoperative anatomy of the bowel which precluded endoscopic retrograde cholangiopancreatography and underwent endoscopy for removal of calculi. One (8%) patient underwent treatment of a stricture and one (8%) underwent biopsy. Technical success was 92% (11/12). Clinical success was 83% (10/12). Two complications, a perinephric hematoma and sepsis, occurred. Conclusion: Disposable endoscopes, including the LithoVue, may be used in a variety of procedures to improve patient care and limit fluoroscopy.
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Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings p. 354
S Rashmi, S Kamala, S Sudha Murthy, Swapna Kotha, Y Suhas Rao, K Veeraiah Chaudhary
DOI:10.4103/ijri.IJRI_78_18  PMID:30319215
Aim: To determine the correlation between mammography and ultrasound features of breast cancer with molecular subtypes and to calculate the predictive value of these features. Materials and Method: This is a prospective study of consecutive patients with breast cancer presenting between January 2016 and July 2017, who underwent mammography and/or ultrasound of breast and excision of the breast mass. Patients with contralateral breast mass, metastases, h/o prior cancer treatment, and other malignancies were excluded. On mammography, the presence or absence of microcalcification was noted. On ultrasound examination size, margins, microcalcification, posterior acoustic features, vascularity, and axillary nodes were assessed. Margins were categorized into circumscribed and non-circumscribed. Posterior acoustic features were classified into four categories: shadowing, enhancement, mixed, and no changes. Vascularity was assessed based on Adler's index into grades 0, 1, 2, and 3. Grades 0 and 1 were considered low and 2 and 3 were high. Results: Tumors with non-circumscribed margins and posterior acoustic shadowing were likely to be luminal A or B subtype of breast cancer [odds ratio (OR) 5.78; 95% confidence interval (CI) 3.68–9.80; P < 0.0001]. Tumors with non-circumscribed margins, posterior acoustic shadowing, and high vascularity were more likely to be luminal B subtype (OR 2.88; 95% CI 2–4.14; P- <0.0001). Tumors with microcalcification and posterior mixed acoustic pattern were strongly associated to be HER2-positive (OR 5.48; 95% CI 3.06–9.80; P < 0.0001). Tumors with circumscribed margins and posterior acoustic enhancement were highly suggestive of triple-negative breast cancer (OR 7.06; 95% CI 4.64–10.73; P < 0.0001). Conclusion: Microcalcification detected on mammography and certain ultrasound features such as circumscribed or non-circumscribed margins, posterior acoustic features, and vascularity are strongly correlated in predicting the molecular subtypes of breast cancer, and thus may further expand the role of conventional breast imaging.
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Endovascular management of a large retroperitoneal haemorrhage resulting from dual testicular and intra-renal arterial injury after renal biopsy p. 362
Munawwar Ahmed, Shyamkumar Nidugala Keshava, Vinu Moses, Anna T Valson
DOI:10.4103/ijri.IJRI_94_18  PMID:30319216
Percutaneous renal biopsy is a minimally invasive procedure in the work up of a chronic kidney disease patient. However, it is not free from the complications. Hematuria and abdominal haemorrhage due to intra-renal artery injury are the common complications. We report and discuss the management of a rare case of retroperitoneal haemorrhage resulting from dual arterial injury involving left testicular artery and intra-renal artery.
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Prenatal diagnosis of congenital high airway obstruction syndrome p. 366
Víctor Lago Leal, Luis Martínez Cortés, Carlos Seco Del Cacho
DOI:10.4103/ijri.IJRI_396_16  PMID:30319217
Congenital high airway obstruction syndrome (CHAOS) is a rare sequence due to a complete obstruction of the fetal airway that blocks the larynx or trachea, either intrinsic atresia or extrinsic compression (e.g., congenital neck mass). Despite the true incidence of CHAOS is unknown, an incidence of 1 per 50,000 newborns is described. If any obstruction occurs in the tracheobronchial airway, this secretion cannot be extricated. Because of this situation, a knock-on effect starts: the enlargement of the lungs squeezes the heart and great veins, what results in a replacement of the heart to the center of the chest becoming small and dysfunctional. Decreased venous return and the failure of cardiovascular system end in ascites and hydrops. The diaphragm planes or inverts according to the severity of the process. In case of unrecognized syndrome during the prenatal period, it usually results in stillbirth or death shortly after delivery. The overall prognosis remains fatal, and long-term medical and surgical challenges for survivors remain considerable even after overcoming fetal intervention.
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Segmental dilatation of ileum in a young patient presenting with anemia p. 369
Neha Nischal, Deepak Balachandra, Anil Kumar Agarwal, Sunil Kumar Puri
DOI:10.4103/ijri.IJRI_403_17  PMID:30319218
Segmental dilatation of ileum (SDI) is a less known uncommon entity with a confusing clinical scenario and no definite etiopathogenesis. The preoperative diagnosis is of exclusion. However, it has an excellent prognosis after surgery. We describe a case of a young patient who presented with anemia without any overt gastrointestinal (GI) bleed. Thorough radiological examinations were needed to reach the diagnosis of SDI which was confirmed postoperatively.
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Post radiation evolution of giant virchow-robin spaces in a case of pituitary macroadenoma p. 373
Manoj Gopinath, Chinmay Nagesh, Chandrasekhar Kesavadas
DOI:10.4103/ijri.IJRI_335_17  PMID:30319219
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Impact of revised atlanta classification of acute pancreatitis on generation of a score employing modified CT severity index p. 374
Yashant Aswani, Prashant K Singh
DOI:10.4103/ijri.IJRI_421_17  PMID:30319220
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OHVIRA and OSVIRA syndrome p. 375
Raj Bharatkumar Koticha
DOI:10.4103/ijri.IJRI_401_17  PMID:30319221
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Mid-sagittal section of the fetal face: Still a showstopper p. 376
Divya Singh, Ladbans Kaur
DOI:10.4103/ijri.IJRI_47_18  PMID:30319222
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Authors' reply p. 377
Madhai L Teegala, Dhamangaonkar G Vinayak
DOI:10.4103/ijri.IJRI_68_18  PMID:30319223
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