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Objectives : Vertebral hemangiomas are benign vascular lesions occurring in spine. Though vertebral hemangiomas are frequently seen, they are rarely symptomatic. Pain is the commonest symptom. There is no agreement on single treatment modality for symptomatic lesions. Surgery, intralesional injection of absolute alcohol, methyl methacrylate injection are few methods used to treat them. Radiotherapy has been shown effective in many studies in terms of pain relief and at times in cord compression too. Results of radiotherapy in symptomatic vertebral hemangiomas treated in our centre are analyzed. Materials and methods: Six patients with symptomatic vertebral hemangiomas were treated with external radiotherapy to a dose of 36-40 Gy. Four patients had only pain as their symptom. Two patients had additional neurological deficits with paraperesis at presentation. Result in terms of pain relief was assessed at the end of RT and during follow up. Median follow up was four and half months. Results : Out of six patients, pain relief was seen in four patients who had only pain as their symptom. There was neither pain relief nor improvement in neurological deficits in remaining two patients. Conclusion : Radiotherapy is an effective and simple modality of treatment for symptomatic vertebral hemangiomas where pain is the main symptom without neurological deficits. It is non invasive and safe.

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Imaging features of extramedullary plasmacytoma of skull base with multiple myeloma is reported in a 65 year old woman patient presented with multiple cranial nerve palsies. Contrast Enhanced CT revealed a large homogeneously enhancing mass in the left parapharyngeal region with extension in left petrous apex, left cavernous sinus and upper two cervical vertebrae. An extramedullary plasmacytoma associated with multiple myeloma was diagnosed after biopsy from the mass and laboratory investigations.

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Castleman's disease is a rare, benign disease of unknown cause that induces reactive lymph node hyperplasia. It has two histologic subtypes: hyaline vascular and plasma cellular. A definitive diagnosis necessitates tissue biopsy. A specimen may be even misdiagnosed as lymphoma in frozen section. Surgery is the treatment of choice for the solitary form, whereas chemotherapy, radiotherapy, and steroids are proposed for the multicentric type. When this condition affects the neck, it usually presents as a solitary neck mass. Multiple neck masses are an uncommon presentation of Castleman disease affecting the neck. Most Castleman's disease lesions appear as nonspecific, well-defined hypoechoic masses on sonography. Sonography remains useful for the evaluation of cervical and axillary Castleman's diseases, in which the depiction of prominent peripheral vessels and penetrating feeding vessels on Doppler sonograms can suggest the diagnosis of this uncommon disease. Castleman's disease of the neck on CT and MRI scan has been described as well-circumscribed homogeneous mass lesion with moderate to intense enhancement.

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Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by progressive fibro fatty replacement of the right ventricular myocardium which constitutes a substrate for electrical instability and a focus of ventricular arrhythmias. Most of the patients have some degree of left ventricular involvement which also affects the right ventricle by the same disease process. From thirty percent to 50% of patients with ARVD have a family history of the disease. The most common pattern of inheritance is autosomal dominant. Clinically, ARVD usually presents with ventricular arrhythmias, and there is approving evidence that this is the underlying disease in a substantial number of sudden deaths among young, especially healthy individuals. The diagnosis of ARVD relies on the presence of structural and functional abnormalities of the right ventricle, electrophysiological abnormalities, and family history. The imaging modalities are conventional angiography, echocardiography (ECO), radionuclide angiography, ultra fast computed tomography, and magnetic resonance imaging. (MRI). We are presenting a case of ARVD with ECO, computed tomography (CT), and MRI findings.

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Purpose : To determine and compare the diagnostic performance of Dopler sonography of fetal middle cerebral artery (MCA), descending abdominal aorta (DAA), umbilical artery (UA), umbilical vein (UV) and inferior vea cava (IVC) for predictoin of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre-eclampsia (PET). Materials ad Methods : Fifty-eight Singleton pregnancies beyond 30 weeks of gestation complicated by intrauterine growth restriction and severe pre-eclampsia or both were prospectively examined with Doppler US of the UA, MCA, DAA, UV and IVC. Results : Thirty-six patients of the 58 included in the study population had at least one major or minor adverse outcome. Major adverse outcome criteria included perinatal deaths - includinag intrauterine and early neonatal deaths, hypoxic ischemic encephalopathy, intraventricular hemorrhage, periventricular leukomalacia, pulmonary hemorrhage and necrotizing enterocolitis. Minor outcomes included cesarean delivery for fetal distress, APGAR score below 7 at 5 minutes, admission to neonatal intensive care unit (NICU) for treatment. Conclusion S/D ratio of MCA/UA is the most sensitive and specific index in predicting major perinatal adverse outcome (83% and 75%), while umbilical artery S/D ratio is the most sensitive index (66.6%) in predicting any adverse perinatal outcome i.e. including both major and minor outcome. MCA pulsatility index (P.I) is the most specific index (90.9%) for predicting in any adverse perinatal outcome. The sensitivity of the Doppler studies can be significantly increased by studying multiple vessels (91.6%). Hence we conclude that Doppler studies of multiple vessels in the fetoplacental circulation can help in the monitoring of compromised fetus and can help us predicting neonatal morbidity. This may be helpful in determining the optimal time of delivery in complicated pregnancies.

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Endovascular occlusion of isolated internal iliac artery aneurysm is a safe and effective procedure. We report a case of coiling of a ruptured Internal Iliac artery aneurysm in a leukaemia patient with intramuscular haematoma achieving an excellent immediate result and no recanalisation on 6 month follow up.

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A case of intermittent claudication in a young male patient with short segment occlusion of popliteal artery is presented. Entrapment of the artery was recognised during attempted angioplasty by demonstration of extrinsic impression on the inflated balloon during forced plantar flexion. The importance of identifying this condition for definitive surgical management is stressed.

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