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   2016| July-September  | Volume 26 | Issue 3  
    Online since September 14, 2016

 
 
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NEUROIMAGING
Imaging in spinal posterior epidural space lesions: A pictorial essay
Foram B Gala, Yashant Aswani
July-September 2016, 26(3):299-315
DOI:10.4103/0971-3026.190406  PMID:27857455
Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.
  31,330 2,637 -
Magnetic resonance imaging spectrum of perinatal hypoxic–ischemic brain injury
Binoj Varghese, Rose Xavier, VC Manoj, MK Aneesh, PS Priya, Ashok Kumar, VK Sreenivasan
July-September 2016, 26(3):316-327
DOI:10.4103/0971-3026.190421  PMID:27857456
Perinatal hypoxic–ischemic brain injury results in neonatal hypoxic–ischemic encephalopathy and serious long-term neurodevelopmental sequelae. Magnetic resonance imaging (MRI) of the brain is an ideal and safe imaging modality for suspected hypoxic–ischemic injury. The pattern of injury depends on brain maturity at the time of insult, severity of hypotension, and duration of insult. Time of imaging after the insult influences the imaging findings. Mild to moderate hypoperfusion results in germinal mazatrix hemorrhages and periventricular leukomalacia in preterm neonates and parasagittal watershed territory infarcts in full-term neonates. Severe insult preferentially damages the deep gray matter in both term and preterm infants. However, associated frequent perirolandic injury is seen in term neonates. MRI is useful in establishing the clinical diagnosis, assessing the severity of injury, and thereby prognosticating the outcome. Familiarity with imaging spectrum and insight into factors affecting the injury will enlighten the radiologist to provide an appropriate diagnosis.
  25,771 2,872 -
PEDIATRIC
The Abernethy malformation-myriad imaging manifestations of a single entity
Samarjit S Ghuman, Saumya Gupta, T B S Buxi, Kishan S Rawat, Anurag Yadav, Naimish Mehta, Seema Sud
July-September 2016, 26(3):364-372
DOI:10.4103/0971-3026.190420  PMID:27857464
Abernethy malformation, also known as congenital extrahepatic portosystemic shunts (CEPS) is a rare clinical entity and manifests with different clinical symptoms. CEPS are abnormalities of vascular development where there is shunting of portal blood into the systemic venous system. Multidetector computed tomography (MDCT) is a fast and effective modality for evaluation of CEPS. CT displays all the information desired by the surgeon as well as the clinician including the anatomy of the splenic and superior mesenteric veins, size and site of the shunt, presence or absence of the portal vein radicles, and helps to plan the therapy and even the follow-up of these patients. Contrast-enhanced magnetic resonance imaging (MRI) has also emerged as a promising tool for the evaluation of liver lesions associated with the malformation. The Radiologist should be aware of the various imaging appearances of this entity including its complications. In this article, we describe the imaging appearances of CEPS, their complications, and their imaging appearances on CT and MRI. We have also described various associated anomalies.
  12,343 988 -
MUSCULOSKELETAL
Thumb ultrasound: Technique and pathologies
Jatinder P Singh, Shwetam Kumar, Atman V Kathiria, Rachit Harjai, Akram Jawed, Vikas Gupta
July-September 2016, 26(3):386-396
DOI:10.4103/0971-3026.190408  PMID:27857468
Ultrasound is ideally suited for the assessment of complex anatomy and pathologies of the thumb. Focused and dynamic thumb ultrasound can provide a rapid real-time diagnosis and can be used for guided treatment in certain clinical situations. We present a simplified approach to scanning technique for thumb-related pathologies and illustrate a spectrum of common and uncommon pathologies encountered.
  10,092 640 -
NEUROIMAGING
Multiparametric 3T MRI evaluation of hereditary spastic paraplegia: A case report
Sonam Priya, Naznin Siddique, Ruchira Das, Archana Singh
July-September 2016, 26(3):328-331
DOI:10.4103/0971-3026.190413  PMID:27857457
Hereditary spastic paraplegia (HSP) is a rare heterogeneous group of familial neurodegenerative disorders characterized by degeneration of the corticospinal tracts and posterior column of the spinal cord. Previously described radiological findings included nonspecific brain abnormalities such as brain atrophy and white matter lesions, as well as atrophy of the corpus callosum and spinal cord. Magnetic resonance spectroscopy may reveal reduced concentrations of normal brain metabolites and elevated levels of myoinositol. Diffusion tensor imaging shows increased mean diffusivity and reduced fractional anisotropy in the periventricular white matter, which is compatible with damaged myelinated axons. We present here two cases of HSP in a single family with typical imaging findings.
  3,627 295 -
ABDOMINAL IMAGING
CT manifestations of small bowel ischemia due to impaired venous drainage-with a correlation of pathologic findings
Chung Kuao Chou
July-September 2016, 26(3):342-351
DOI:10.4103/0971-3026.190426  PMID:27857460
Acute abdominal pain may result from a wide variety of medical and surgical diseases. One of these diseases is small bowel ischemia, which may result in a catastrophic outcome if not recognized and treated promptly. Computed tomography (CT) by its faster image acquisition, thinner collimation, high resolution, and multiplanar reformatted images has become the most important imaging modality in evaluating the acute abdominal conditions. In this article, the author presents a description of the histology of the small bowel, pathophysiology of small bowel change, and a correlation of the pathologic and CT findings of the small bowel injuries due to impaired venous drainage. A convincing correlation of the microscopic mucosal condition with the enhancement pattern of the thickened small bowel wall on CT is useful in definitely describing the mucosal viability.
  3,278 307 -
MISCELLANEOUS
Young patient with generalized lymphangiomatosis: Differentiating the differential
Tharani Putta, Aparna Irodi, Balamugesh Thangakunam, Ashwin Oliver, Rajesh Gunasingam
July-September 2016, 26(3):411-415
DOI:10.4103/0971-3026.190416  PMID:27857472
We present the case of a 19-year-old man who was extensively evaluated in multiple centres for long-standing cough, dyspnea, and hemoptysis without a definitive diagnosis. His chest radiograph at presentation showed mediastinal widening, bilateral pleural effusions, and Kerley B lines. Computed tomography of the thorax showed a confluent, fluid-density mediastinal lesion enveloping the mediastinal viscera without any mass effect. There were bilateral pleural effusions, prominent peribronchovascular interstitial thickening, interlobular septal thickening and lobular areas of ground glass density with relative sparing of apices. There were a few dilated retroperitoneal lymphatics and well-defined lytic lesions in the bones. In this case report, we aim to systematically discuss the relevant differentials and arrive at a diagnosis. We also briefly discuss the treatment options and prognosis along with our patient's course in the hospital and final outcome.
  3,327 250 -
PEDIATRIC
Patent ductus venosus presenting with cholestatic jaundice in an infant with successful trans-catheter closure using a vascular plug device
Anith Chacko, Celeste Kock, Jayneel A Joshi, Lindi Mitchell, Samia Ahmad
July-September 2016, 26(3):377-382
DOI:10.4103/0971-3026.190419  PMID:27857466
Persistent ductus venosus as a cause of cholestatic jaundice is very rare. Treatment varies, but is usually reserved for infants in whom complications develop. We report a 5-week-old female infant with cholestatic jaundice caused by a patent ductus venosus and subsequent successful treatment via a transcatheter occlusion using a vascular plug device.
  3,002 143 -
EDITORIAL
Clinical culture in radiology: Time to embrace change
Chander Mohan
July-September 2016, 26(3):297-298
DOI:10.4103/0971-3026.190417  PMID:27857454
  2,424 261 -
PEDIATRIC
Unusual imaging presentation of infantile atypical Kawasaki disease
Nishith Kumar, Mahesh Kumar Mittal, Mukul Sinha, Arpita Gupta, Brij Bhushan Thukral
July-September 2016, 26(3):373-376
DOI:10.4103/0971-3026.190415  PMID:27857465
Kawasaki disease is a systemic medium vessel vasculitis of unknown etiology affecting children under 5 years of age. There are no specific diagnostic tests, and thus, the diagnosis of the disease is primarily made on the basis of clinical criteria. Unusual presentations of Kawasaki disease have been variably reported from different parts of the world. However, presentation of the disease in the form of peripheral thromboembolism and florid non-coronary aneurysms has rarely been described This report describes the imaging findings in infantile atypical Kawasaki disease with aneurysms of multiple medium-sized arteries, including coronary arteries, emphasizing the detection of clinically silent aneurysms in the disease.
  2,465 175 -
MUSCULOSKELETAL
Holding versus seeing pathology. Three-dimensional printing of the bony pelvis for preoperative planning of a complex pelvis fracture: A case report
Parang S Sanghavi, Bhavin G Jankharia
July-September 2016, 26(3):397-401
DOI:10.4103/0971-3026.190414  PMID:27857469
Pelvic injuries are not uncommon. The complex anatomy of the pelvic bones, the complex pattern of injuries, associated important structures such as neurovascular bundles, and difficult access make the reduction and fixation of these fractures difficult. Often the surgical outcomes are not satisfactory. Three-dimensional (3D) imaging using computed tomography (CT) scan (3DCT) has been the mainstay of preoperative evaluation since the 1980s, however, even with these images it may be difficult to understand complex injury patterns. Preoperative printing of a 3D model using the same CT scan data allows surgeons to hold the pelvis in their hands and then plan appropriate treatment. We report one such case of complex pelvic injury and its management using the novel method of preoperative 3D model printing.
  2,349 139 -
NEUROIMAGING
Primary diffuse leptomeningeal oligodendrogliomatosis: A case report and literature review
Amarnath Chellathurai, Jay S Vaidya, Gopinathan Kathirvelu, Periakaruppan Alagappan
July-September 2016, 26(3):337-341
DOI:10.4103/0971-3026.190424  PMID:27857459
Primary leptomeningeal oligodendrogliomatosis (PLO) is a rare low-grade intracranial and spinal canal subarachnoid neoplasm without an obvious primary neoplasm in the brain or spinal cord parenchyma. We present here the serial progression of radiological findings of this rare disease in a 2-year-old male child whose clinical status deteriorated over a period of 4 months with the main complaint of partial seizures. During this period, the MR findings progressed from mild hydrocephalus with minimal leptomeningeal enhancement to leptomeningeal multiple cystic lesions in the entire neuraxis including the spine.
  2,255 165 -
Magnetic resonance neurographic confirmation of extensive Plexiform neurofibroma in neurofibromatosis-1 presenting as ambiguous genitalia
Ishan Kumar, Ashish Verma, Ritu Ojha, Priyanka Aggarwal, Ram C Shukla, Arvind Srivastava
July-September 2016, 26(3):332-336
DOI:10.4103/0971-3026.190423  PMID:27857458
Genitourinary involvement of neurofibromatosis is uncommon and genital neurofibromatosis is even rarer. Involvement of clitoris by neurofibroma can lead to clitoromegaly masquerading as a male penis. We report such a case of ambiguous genitalia in a 7-year-old female child presenting with clitoromegaly since birth, in which magnetic resonance imaging (MRI) revealed the presence of extensive neurofibromatosis in the clitoris and lumbosacral regions. We emphasize the central role of MRI in evaluation of hormonal and non-hormonal causes of ambiguous genitalia. We further discuss the merits of including MR neurography in the imaging protocol for comprehensive delineation of neurofibromatosis.
  2,231 116 -
ABDOMINAL IMAGING
Sclerosing liposarcoma of epididymis: Role of chemical shift magnetic resonance imaging
Subramaniyan Ramanathan, Vineetha Raghu, Devendra Kumar, Venkata R P Sempiege
July-September 2016, 26(3):356-359
DOI:10.4103/0971-3026.190425  PMID:27857462
Sclerosing liposarcoma of epididymis is a rare extratesticular scrotal tumor with variable prognosis. Ultrasonography is the initial imaging modality of choice for the evaluation of scrotal mass and helps to differentiate testicular and extratesticular masses, thereby narrowing down the differential diagnosis. Magnetic resonance imaging with its excellent soft tissue resolution can help in the further characterization of the nature of the tumor. In this case report, we highlight the role of chemical shift imaging in making a confident preoperative diagnosis of liposarcoma thereby guiding optimal and timely management.
  1,975 120 -
CHEST RADIOGRAPHY
The routine pre-employment screening chest radiograph: Should it be routine?
V John Samuel, Sridhar Gibikote, Henry Kirupakaran
July-September 2016, 26(3):402-404
DOI:10.4103/0971-3026.190409  PMID:27857470
Background and Objective: A routine chest radiograph is mandatory in many institutions as a part of pre-employment screening. The usefulness of this has been studied over the years keeping in mind the added time, cost, and radiation concerns. Studies conducted outside India have shown different results, some for and some against it. To our knowledge, there is no published data from India on this issue. Materials and Methods: A retrospective review of the reports of 4113 pre-employment chest radiographs done between 2007 and 2009 was conducted. Results: Out of 4113 radiographs, 24 (0.58%) candidates required further evaluation based on findings from the screening chest radiograph. Out of these, 7 (0.17%) candidates required appropriate further treatment. Interpretation and Conclusions: The percentage of significant abnormalities detected which needed further medical intervention was small (0.17%). Although the individual radiation exposure is very small, the large numbers done nation-wide would significantly add to the community radiation, with added significant cost and time implications. We believe that pre-employment chest radiographs should be restricted to candidates in whom there is relevant history and/or clinical findings suggestive of cardiopulmonary disease.
  1,817 191 -
NUCLEAR MED
Efficacy of 18F-FDG PET/CT in investigation of elevated CEA without known primary malignancy
Simon Sin-man Wong, Wong L Yu, Ki Wang, Anil T Ahuja
July-September 2016, 26(3):405-410
DOI:10.4103/0971-3026.190412  PMID:27857471
Aim: To evaluate the efficacy of 18flurodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) in investigating patients with elevated carcinoembryonic antigen (CEA) and without known primary malignancy, and the impact of PET/CT findings on patient management. Setting and Design: PET/CT scans done in a tertiary hospital between December 2007 and February 2012 for elevated CEA in patients without known primary malignancy were retrospectively reviewed. Materials and Methods: The PET/CT findings, patients' clinical information, level of CEA, histological diagnosis, and subsequent management were retrieved by the electronic patient record for analysis. Statistical Analysis: Data were analyzed using SPSS version 19. Results: One hundred and one PET/CT scans were performed for patients with elevated CEA. Fifty-eight of these were performed for patients with known primary malignancy and were excluded; 43 PET/CT scans were performed for patients without known primary malignancy and were included. Thirty-three (77%) had a positive PET/CT. Among the 32 patients with malignancy, 15 (47%) suffered from lung cancer and 8 (25%) suffered from colorectal cancer. The sensitivity (97%), specificity (82%), positive predictive value (94%), negative predictive value (90%), and accuracy (93%) were calculated. Thirty (91%) patients had resultant change in management. The mean CEA level for patients with malignancy (46.1 ng/ml) was significantly higher than those without malignancy (3.82 ng/ml) (P < 0.05). In predicting the presence of malignancy, a CEA cutoff at 7.55 ng/ml will achieve a sensitivity of 91% and a specificity of 73%. Conclusion: PET/CT, in our study population, appears to be sensitive, specific, and accurate in investigating patients with elevated CEA and without known primary malignancy. In addition to diagnosis of underlying primary malignancy, PET/CT also reveals occult metastases which would affect patient treatment options.Its role in investigating patients with elevated CEA and without known primary, compared with other investigation modalities, remains to be studied.
  1,883 97 -
ABDOMINAL IMAGING
Bolster material granuloma masquerading as recurrent renal cell carcinoma following partial nephrectomy
Abhishek Singh, Shrikant Jai, Sanika Ganpule, Arvind Ganpule
July-September 2016, 26(3):352-355
DOI:10.4103/0971-3026.190418  PMID:27857461
Nephron sparing surgery has seen a phenomenal rise in its application over the past few decades. The use of Surgicel and gel foam for closure of defect created after partial nephrectomy has become a routine practice at many centers. In this case report, we describe radiological artifact secondary to a surgical bolster mimicking a residual disease or an early recurrence in the kidney. This case highlights two facts; first, reapproximation of the renal tissue is best done without the use of Surgicel bolsters. Second, bolsteroma should always be kept in mind as a differential diagnosis in a case where computed tomography (CT) imaging is showing early recurrence. If the surgeon is sure about the surgical margins being negative and the CT image shows a bolsteroma, the patient should be observed and a repeat scan should be done at 3–6 months, which would show regression or disappearance of the lesion proving it to be an artifact rather than malignant lesion.
  1,808 102 -
WOMENS IMAGING
Isolated eosinophilic infiltration of the breast
Anushri Parakh, Jyoti Arora, Smita Srivastava, Ruchika K Goel
July-September 2016, 26(3):383-385
DOI:10.4103/0971-3026.190407  PMID:27857467
We report the eighth case of eosinophilic mastitis and the first one without an association with peripheral eosinophilia or systemic involvement. A 51-year-old diabetic presented with a painful right breast lump. The mammogram, ultrasound, and magnetic resonance imaging suggested a diagnosis of periductal mastitis, however, a sinister etiology of breast carcinoma could not be ruled out. Diagnosis was made by vacuum assisted biopsy which revealed features of eosinophilic mastitis.
  1,783 119 -
VASCULAR AND INTERVENTIONAL RADIOLOGY
Transmural coil embolization—alternative technique for management of arterial perforation during subintimal angioplasty
Karthikeyan Damodharan, Amman Bolia
July-September 2016, 26(3):360-363
DOI:10.4103/0971-3026.190422  PMID:27857463
Subintimal angioplasty of lower limb arterial occlusion carries a relatively higher risk of vessel perforation compared to transluminal angioplasty. Vessel perforation is a potentially life threatening complication which requires prompt recognition and management. They are usually managed by endovascular techniques such as low-pressure balloon tamponade, covered stents, and coil embolization of the ruptured artery. We describe a technique of treating vessel perforation following balloon angioplasty. Patient developed a large perforation of the proximal superficial femoral artery (SFA) after balloon inflation during subintimal angioplasty of complete SFA occlusion. Following failure of balloon tamponade in sealing the perforation, we successfully treated it by deploying an embolization coil at the site of perforation through the vessel wall followed by balloon tamponade. Our technique could be a useful relatively inexpensive alternative treatment option in the management of vessel perforation compared to covered stents.
  1,645 98 -
LETTERS TO THE EDITOR
Embryogenesis of vagina and embryopathogenesis of Herlyn–Werner–Wunderlich syndrome
Yashant Aswani
July-September 2016, 26(3):417-418
DOI:10.4103/0971-3026.190411  PMID:27857474
  1,516 130 -
Beyond warfarin: The advent of new oral anticoagulants
Konark Malhotra, Monica Khunger
July-September 2016, 26(3):419-420
DOI:10.4103/0971-3026.190428  PMID:27857476
  1,467 104 -
Endovascular management of post traumatic giant renal arteriovenous fistula using occluder device
Chandan J Das, Kumar Rahul, Sanjay Sharma, Amlesh Seth
July-September 2016, 26(3):416-417
DOI:10.4103/0971-3026.190427  PMID:27857473
  1,460 93 -
Significance of color doppler imaging in leprosy
Yashant Aswani
July-September 2016, 26(3):418-419
DOI:10.4103/0971-3026.190410  PMID:27857475
  1,366 120 -
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