With the ever increasing trend of using cross-section imaging in today's era, incidental detection of small solid renal masses has dramatically multiplied. Coincidentally, the number of asymptomatic benign lesions being detected has also increased. The role of radiologists is not only to identify these lesions, but also go a one step further and accurately characterize various renal masses. Earlier detection of small renal cell carcinomas means identifying at the initial stage which has an impact on prognosis, patient management and healthcare costs. In this review article we share our experience with the typical and atypical solid renal masses encountered in adults in routine daily practice.

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Sonography is an ideal, effective, noninvasive tool for evaluation of the spinal cord in neonatal and early infantile age groups owing to lack of ossification of the posterior elements of spine. Understanding normal anatomical appearances is a prerequisite for the interpretation of various pathologies of the spinal canal and its contents. This review elucidates normal appearances of the spinal cord in this age group, in both axial and sagittal planes. Usefulness of Doppler sonography is briefly discussed, and special emphasis is placed on normal anatomical variants that may mimic spinal abnormalities. Sonographic appearances of common intraspinal pathologies, both congenital and acquired, are exhaustively described. Key points regarding sonographic diagnosis of important spinal anomalies are emphasized and explained in detail. To conclude, spinal ultrasound is a reliable and widely available screening tool, albeit the usefulness of which is often underestimated.

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Background: Restricted diffusion within the splenium of the corpus callosum has been described by other authors in various conditions, however, restricted diffusion in the entire corpus callosum or isolated involvement of the splenium, genu, or body has been infrequently reported on magnetic resonance imaging (MRI) in neonatal hypoxic–ischemic encephalopathy. We report a series of cases showing different patterns of involvement. Methods and Materials: Perinatal imaging with MRI including diffusion-weighted imaging was performed in 40 neonates with hypoxic–ischemic encephalopathy, including 11 premature neonates. Sixteen out of 40 patients demonstrated restricted diffusion within the corpus callosum. Out of 16 patients, 9 showed restricted diffusion in the entire corpus callosum, 4 had isolated splenium involvement, 2 had body and splenium signal abnormality, and 1 showed diffusion restriction only in the genu. Conclusions: Changes in the corpus callosum were also associated with more severe clinical presentation of encephalopathy. Restricted diffusion within the corpus callosum in infants with hypoxic–ischemic encephalopathy is often associated with extensive brain injury and appears to be an early neuroradiologic marker of adverse neurologic outcome.

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Lymphatic malformations are congenital vascular malformations with lymphatic differentiation. Although the most common locations for lymphatic malformation are the neck and axilla, they can occur at several locations in the body including the abdomen. The abdominal location is rather rare and accounts for approximately 5% of all lymphatic malformation. Abdominal lymphatic malformation can arise from mesentery, omentum, gastrointestinal tract, and retroperitoneum. Clinical presentation includes an abdominal lump, vague abdominal discomfort, and secondary complications including intestinal obstruction, volvulus, ischemia, and bleeding. There is a broad spectrum of radiological manifestation. In the present review, we discuss the imaging appearance of abdominal lymphatic malformation. The diagnosis of lymphatic malformation in our series was based on the histopathological examination (in cases who underwent surgery) and fine needle aspiration cytology.

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We report two infants presenting with unilateral congenital facial palsy since birth. Magnetic resonance imaging (MRI) in both the cases revealed complete unilateral aplasia of facial nerve. To our knowledge, this is the first reported MR depiction of nonsyndromic isolated facial nerve aplasia. Imaging features and the pertinent anatomy is discussed along with a brief review of literature.

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Bezoars are masses formed by the concretion of stomach contents or debris within the gastrointestinal tract. Bezoars are rare and account for only 0.4–4% of all cases of gastrointestinal obstruction and mainly occur in the stomach or small intestine. Intestinal obstruction caused by colonic bezoars is extremely rare. A 39-year-old man with a transplanted kidney came to the hospital because of abdominal pain, constipation, and distension. We performed an abdominal computed tomography scan and found an ovoid intraluminal mass with a mottled gas pattern in the distal sigmoid colon. Subsequently, the patient underwent laparotomic surgery and removal of the bezoar. We report a rare case of large bowel obstruction due to colonic phytobezoar, which was confirmed intraoperatively.

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Prophylactic double J (DJ) stent insertion has been adopted as a routine procedure in renal transplant patients for internal urinary diversion and for protecting ureteroneocystostomy anastomosis. The timely and early removal of stent has been proved to reduce the occurrence of stent-associated complications such as migration, encrustation, and infection. The most commonly used procedure of stent removal via retrograde cystoscopic approach can sometimes be technically very difficult leaving antegrade approach as another alternative to open surgery as the last resort. Here, we describe a case of antegradely removed impacted DJ stent by pushing it free into the urinary bladder followed by cystoscopic removal.

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Purpose: The aim of this study was to compare the accuracy of magnetic resonance imaging (MRI) for the prediction of response to neo-adjuvant chemotherapy in triple negative (TN) breast cancer, with respect to other subtypes. Materials and Methods: There were a total of 1610 breast cancers diagnosed between March 2009 and August 2014, out of which 82 patients underwent MRI before and after neo-adjuvant chemotherapy but just before surgery. TN cancers were analyzed with respect to others subtypes. Accuracy of MRI for prediction of pathological complete response was compared between different subtypes by obtaining receiver operating characteristic (ROC) curves. The Statistical Package for the Social Sciences version 21 was used for all data analysis, with P value of 0.05 as statistically significant. Results: Out of 82 patients, 29 were luminal (HR+/HER2−), 23 were TN (HR−, HER2−), 11 were HER2 positive (HR−, HER2+), and 19 were of hybrid subtype (HR+/HER2+). TN cancers presented as masses on the pre-chemotherapy MRI scan, were grade 3 on histopathology, and showed concentric shrinkage following chemotherapy. TN cancers were more likely to have both imaging and pathological complete response following chemotherapy (P = 0.055) in contrast to luminal cancers, which show residual cancer. ROC curves were constructed for the prediction of pathological complete response with MRI. For the TN subgroup, MR had a sensitivity of 0.745 and specificity of 0.700 (P = 0.035), with an area under curve of 0.745 (95% confidence interval: 0.526–0.965), which was significantly better compared to other subtypes. Conclusion: TN breast cancers present as masses and show concentric shrinkage following chemotherapy. MRI is most accurate in predicting response to chemotherapy in the TN group, compared to others subtypes. MRI underestimates residual disease in luminal cancers.

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Möbius syndrome is an extremely rare congenital disorder. We report a case of Möbius syndrome in a 2-year-old girl with bilateral convergent squint and left-sided facial weakness. The characteristic magnetic resonance imaging (MRI) findings of Möbius syndrome, which include absent bilateral abducens nerves and absent left facial nerve, were noted. In addition, there was absence of left anterior inferior cerebellar artery (AICA) and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed.

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Immune reconstitution inflammatory syndrome (IRIS) is an exaggerated immune response which can occur with various coinfections in human immunodeficiency virus (HIV) infected patients, of which the most commonly implicated in central nervous system (CNS)-IRIS are progressive multifocal leukoencephalopathy (PML), cryptococcosis, and tuberculosis (TB). TB-IRIS is a known complication of pulmonary TB or TB lymphadenitis coinfection in HIV infected patients who are on antituberculosis treatment (ATT) after the initiation of antiretroviral therapy (ART). However, development of IRIS in extrapulmonary TB such as CNS TB is very rare. Our case is that of an isolated CNS-TB-IRIS, presenting as increase in the size and perilesional edema of the ring enhancing lesions in the brain, which was observed in two sequential magnetic resonance imaging done over a period of 2 months in a retropositive patient who presented with clinical deterioration after commencement of ART. As prompt diagnosis was made and specific management aimed at IRIS was started without delay, the patient improved symptomatically.

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The typical sonomorphology of homogeneously hypoechoic texture of an enlarged parathyroid gland (PG) is a reflection of uniform arrangement of the parathormone-producing chief cells. A variable cellular arrangement, hemorrhage, fibrosis, and adipocytes cause heterogeneous appearance. We describe a case of a 32-year-old male, a case of tertiary hyperparathyroidism, with increased serum parathormone levels, hypercalcemia, and enlargement of all four PGs, albeit with differing morphology. The left lower gland had two nodules, namely, superior and inferior. The inferior nodule of the left lower gland had an echogenic core surrounded by a sonolucent rim whereas the superior nodule was homogenously hyoechoic. The left upper gland had an echopattern exactly reverse of the inferior nodule of the left lower PG, i.e., hypoechoic gland surrounded by hyperechoic periphery. The appearance of the right-sided glands was that of the superior nodule of the left lower PG. On histopathology, the hypoechoic areas corresponded to numerous chief cells and congested vessels whereas edema gave rise to an increase in echogenicity. This report exemplifies atypical sonographic appearances of PG and their histopathologic correlation.

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Introduction: The objective of our study was to review the results of percutaneous angioplasty (PTA)/stenting in the treatment of patients who presented with symptoms and angiographic findings of chronic mesenteric ischemia (CMI). Materials and Methods: We performed a retrospective analysis of 13 consecutive patients from a single institution who underwent PTA/stenting for the treatment of symptoms suggestive of CMI. Results: All 13 patients in our study were men, and most common presenting symptoms were weight loss and postprandial pain. Atherosclerosis was the most common cause. PTA and stenting was performed in 9 patients and PTA alone was done in 4 patients. Primary technical success rate was 92% with complete resolution of symptoms within 2 weeks in all patients. No statistical difference was noted in primary clinical success rate based on the number of vessels treated or the method of treatment. However, in patients whom SMA was treated had longer duration of symptom-free survival as compared to other vessels. Conclusion: PTA and stenting are very effective therapeutic options for patients presenting with CMI symptoms. It should be considered as the first-line of management in such patients.

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Background: Trochlear dysplasia is the most commonly encountered congenital etiologic factor of anterior knee pain. Aims: The purpose of this study was to evaluate the relationship between trochlear dysplasia with medial patellar plica as well as to investigate the distribution of plica types according to types of dysplasia. Settings and Design: This is a retrospective case-control study. Materials and Methods: This study was conducted among 138 knee magnetic resonance imaging (MRI) scans. The presence of medial plica and its types were compared among 69 patients in whom trochlear dysplasia had been detected and 69 individuals with normal trochlear who were of the same age and gender as the patient group. Statistical Analysis: Trochlear dysplasia and medial plica was compared by Chi-square with Yates correction and Fisher's exact probability tests (P < 0.001). The data were presented as mean, standard deviation, minimum–maximum, frequency, and percentage. Results: Of all the patients (n = 138), the number of patients in whom plica was observed was n = 104 (75.3%), and the distribution of plica type was as follows: n = 70 (67.3%) Type 1, n = 25 (24%) Type 2, and n = 9 (8.6%) Type 3. Medial plica was more frequently observed in patients with trochlear dysplasia (P < 0.001). Type 2 and Type 3 medial plica were more frequently encountered in trochlear dysplasia (P < 0.001). Type 3 plica was not seen in patients with normal trochlea. Conclusion: Medial patellar plica is more frequently seen in trochlear dysplasia. As the type of trochlear dysplasia progresses, the prevalence of thicker and shelf-shaped plica increases.

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Inflammatory lesions may sometimes show intense tracer uptake and mimic neoplastic lesions on (18) F-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). We report one such false positive case on FDG PET/CT, where septic pulmonary emboli (SPE) mimicked pulmonary metastases. A 45-year-old man with stomach cancer had an indwelling central venous catheter (CVC) in situ while on neoadjuvant chemotherapy. He underwent FDG PET/CT scan for response assessment and the images revealed multiple, intensely FDG avid, peripheral, lung nodules with feeding vessels, which were suspicious for pulmonary metastases. A day later, the patient developed fever with chills and his blood culture showed bacterial growth (Enterobacter cloacae). A provisional diagnosis of SPE from an infected CVC was made. Chemotherapy was withheld, CVC removed, and the catheter tip was sent for bacterial culture. Following a 4-week course of antibiotic treatment, the patient became afebrile. Culture from the CVC tip grew the same organism, as was seen earlier in the patient's blood culture, thus pin-pointing the source of infection in our case. Diagnosis of SPE was clinched when follow-up CT chest done after completion of antibiotic course showed complete resolution of the lung lesions.

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Choriocarcinoma is a human chorionic gonadotrophin (HCG)-secreting tumor that comprises vascular channels. It has a tendency for widespread metastasis, common sites for which include the lung, vagina, brain, liver, bone, intestine, and kidney. We describe a 30-year-old female who presented with hepatitis-like features and bilateral diminution of vision, and subsequently developed hemothorax and hemoperitoneum—all rare and seemingly unrelated manifestations which were finally attributable to metastases from gestational choriocarcinoma. To further complicate the clinical scenario, the serum HCG of the patient was mildly raised (due to a phenomenon called hook effect). Subsequently, the patient developed disseminated intravascular coagulation and succumbed to her illness. In this report, we discuss the imaging findings of choriocarcinoma, its potential sites of metastases, and the hook effect.

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Splenogonadal fusion is a very rare congenital anomaly which often manifests as a scrotal mass and rarely as cryptorchidism. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. We report a rare case of discontinuous type of splenogonadal fusion in an adolescent male presenting as cryptorchidism. We emphasize the computed tomographic findings, which helped us in preoperative diagnosis and aided in appropriate management.

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Dacron grafts have been used as a conduit for large caliber arteries for many years successfully. However, these grafts can undergo complications such as aneurysm formation, rupture, and failure. Evaluation of these complications are of paramount importance because of its tendency to rupture and cause death. Imaging plays an important role in identifying and monitoring of these complications, and also provides a road map to the vascular surgeons for early intervention and revascularization.

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A 57-year-old female presenting with acute-onset paraplegia was referred for magnetic resonance imaging (MRI) of cervico-dorsal spine. On MRI, multiple tortuous dilated vessels were noted in the epidural space with long segment cord compression and imaging features of compressive myelopathy. Associated small acute cervico-dorsal epidural hematoma was also noted in the same region. Computed tomography (CT) angiography was performed subsequently which revealed post-ductal coarctation of aorta with multiple arterial collaterals in the chest wall and spinal canal. An extensive review of English language literature pertaining to the clinical presentations of adult aortic coarctation revealed only few reports of acute compressive myelopathy due to spinal epidural collateral vessels. Further, presentation at such a late age has not been reported before. In the present case, apart from a hypertrophied anterior spinal artery and perispinal collaterals, an anterior epidural hematoma was an additional important factor in the causation of myelopathy.

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Posttraumatic external carotid artery pseudoaneurysm with arteriovenous fistula is a rare condition. An 8-year-old child presented with painful pulsatile swelling in the preauricular region following a penetrating glass shrapnel injury. Detailed evaluation showed distal external carotid artery pseudoaneurysm with fistula, which was draining into the retromandibular vein. Endovascular treatment was performed. This case highlights the role of endovascular intervention for such rare complicated vascular pathologies.

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Aortic atresia with an associated ventricular septal defect and adequate sized left ventricle is extremely rare. We present two cases in which an alternate diagnosis was suggested on echocardiography because the hypoplastic aortic trunk was missed due to its small caliber. The final diagnosis was, however, clinched on dual source computed tomography, which not only showed the thin aortic trunk but also clearly depicted the coronary artery origins from the hypoplastic aortic root. To the best of our knowledge, use of multi-detector computed tomography in aortic atresia with well developed left ventricle has not been reported in literature till date.

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Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

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