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  Citation statistics : Table of Contents
   2011| October-December  | Volume 21 | Issue 4  
    Online since December 8, 2011

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Pictorial essay: Allergic bronchopulmonary aspergillosis
Ritesh Agarwal, Ajmal Khan, Mandeep Garg, Ashutosh N Aggarwal, Dheeraj Gupta
October-December 2011, 21(4):242-252
DOI:10.4103/0971-3026.90680  PMID:22223932
Allergic bronchopulmonary aspergillosis (ABPA) is the best-known allergic manifestation of Aspergillus-related hypersensitivity pulmonary disorders. Most patients present with poorly controlled asthma, and the diagnosis can be made on the basis of a combination of clinical, immunological, and radiological findings. The chest radiographic findings are generally nonspecific, although the manifestations of mucoid impaction of the bronchi suggest a diagnosis of ABPA. High-resolution CT scan (HRCT) of the chest has replaced bronchography as the initial investigation of choice in ABPA. HRCT of the chest can be normal in almost one-third of the patients, and at this stage it is referred to as serologic ABPA (ABPA-S). The importance of central bronchiectasis (CB) as a specific finding in ABPA is debatable, as almost 40% of the lobes are involved by peripheral bronchiectasis. High-attenuation mucus (HAM), encountered in 20% of patients with ABPA, is pathognomonic of ABPA. ABPA should be classified based on the presence or absence of HAM as ABPA-S (mild), ABPA-CB (moderate), and ABPA-CB-HAM (severe), as this classification not only reflects immunological severity but also predicts the risk of recurrent relapses.
  11 37,311 2,715
Differential diagnosis of breast lesions using ultrasound elastography
Ioana Andreea Gheonea, Zoia Stoica, Simona Bondari
October-December 2011, 21(4):301-305
DOI:10.4103/0971-3026.90697  PMID:22223946
Context: The recent introduction of elastography has increased the specificity of USG and enabled early diagnosis of breast cancer. Quantitative elastography, especially with strain ratio (SR) index, improves diagnostic accuracy and decreased number of biopsies. Aims: The purpose of this study was to assess the role of USG elastography in the differential diagnosis of breast lesions. Settings and Design: This prospective study was conducted in the University of Medicine and Pharmacy Research Centre of Craiova. Materials and Methods: Fifty-eight patients diagnosed with breast lesions between January 2009 and January 2010 were included in this prospective study. All the patients were examined in the supine position, and the B-mode USG image was displayed alongside the elastography strain image. For obtaining the elastography images we used a EUS Hitachi EUB 8500 ultrasound system with a 6.5-MHz linear probe. The elastography strain images were scored according to the Tsukuba elasticity score. Statistical Analysis: We performed receiver operator characteristic (ROC) analysis for assessment of the role of USG elastography in the diagnosis of breast lesions. Results: We obtained a sensitivity of 86.7% and a specificity of 92.9% for elasticity score and a sensitivity of 93.3% and a specificity of 92.9% for SR (when a cutoff point of 3.67 was used). There was very good correlation between SR and elasticity score (Spearman coefficient of 0.911). Conclusions: Elastography is a fast, simple method that can complement conventional USG examination. This method has the lowest cost/efficiency ratio and it is also the most noninvasive and accessible imaging method, with an accuracy comparable to MRI.
  8 10,261 1,096
Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques
S Timothy Chelliah, Shyamkumar N Keshava, Vinu Moses, Narayanam RS Surendrababu, Uday George Zachariah, CE Eapen
October-December 2011, 21(4):291-293
DOI:10.4103/0971-3026.90693  PMID:22223943
Aims: To evaluate the accuracy of measurement of hepatic venous pressure gradient by catheter wedge as compared to balloon wedge (the gold standard). Materials and Methods: Forty-five patients having a clinical diagnosis of intrahepatic portal hypertension were subjected to the two different types of pressure measurements (catheter wedge and balloon wedge) during transjugular liver biopsy under fluoroscopic guidance. Statistical Analysis: Spearman's rank correlation coefficient, Bland-Altman plot for agreement, and single measure intraclass correlation were used for analysis of data. Results: There was a close correlation between the results obtained by both the techniques, with highly significant concordance (P < 0.0001). Hepatic venous pressure gradients as measured by the catheter wedge technique were either equal to or less than those obtained by the balloon wedge technique. Conclusions: The difference in hepatic venous pressure gradients measured by the two techniques is insignificant.
  4 9,247 373
Case report: Calcifying fibrous tumor presenting as an asymptomatic pelvic mass
Angela A Giardino, Nikhil H Ramaiya, Atul B Shinagare, Jyothi P Jagannathan, Matthew D Stachler, Chandrajit P Raut
October-December 2011, 21(4):306-308
DOI:10.4103/0971-3026.90700  PMID:22223947
Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor most commonly found in the soft tissues of the extremities and pleura. It is characterized by hyalinized collagenous fibrous tissue, with bland spindle cells, psammomatous or dystrophic calcifications, and focal lymphoplasmacytic infiltrate. CFT of the gastrointestinal tract is exceedingly uncommon. We report a case of CFT arising from the small intestine and associated mesentery; this case was identified incidentally in an otherwise healthy 45-year-old man.
  3 7,265 267
Ultrasonography with color Doppler and power Doppler in the diagnosis of periapical lesions
Sumit Goel, Suma Gundareddy Nagendrareddy, Manthena Srinivasa Raju, Dayashankara Rao Jingade Krishnojirao, Rajul Rastogi, Ravi Prakash Sasankoti Mohan, Swati Gupta
October-December 2011, 21(4):279-283
DOI:10.4103/0971-3026.90688  PMID:22223940
Aim: To evaluate the efficacy of ultrasonography (USG) with color Doppler and power Doppler applications over conventional radiography in the diagnosis of periapical lesions. Materials and Methods: Thirty patients having inflammatory periapical lesions of the maxillary or mandibular anterior teeth and requiring endodontic surgery were selected for inclusion in this study. All patients consented to participate in the study. We used conventional periapical radiographs as well as USG with color Doppler and power Doppler for the diagnosis of these lesions. Their diagnostic performances were compared against histopathologic examination. All data were compared and statistically analyzed. Results: USG examination with color Doppler and power Doppler identified 29 (19 cysts and 10 granulomas) of 30 periapical lesions accurately, with a sensitivity of 100% for cysts and 90.91% for granulomas and a specificity of 90.91% for cysts and 100% for granulomas. In comparison, conventional intraoral radiography identified only 21 lesions (sensitivity of 78.9% for cysts and 45.4% for granulomas and specificity of 45.4% for cysts and 78.9% for granulomas). There was definite correlation between the echotexture of the lesions and the histopathological features except in one case. Conclusions: USG imaging with color Doppler and power Doppler is superior to conventional intraoral radiographic methods for diagnosing the nature of periapical lesions in the anterior jaws. This study reveals the potential of USG examination in the study of other jaw lesions.
  3 6,118 734
Technical note: Real-time sonoelastography evaluation of achilles tendon
Lalitha Palle, MCH Balaji Reddy, K Jagannath Reddy, M Vijaya Kumari
October-December 2011, 21(4):267-269
DOI:10.4103/0971-3026.90685  PMID:22223937
Sonoelastography (SE) is a new USG-based technique that is being used to assess the elasticity and pliability of various tissues and lesions. We evaluated normal and abnormal Achilles tendons and correlated SE findings with those of high-resolution USG. This article briefly discusses the principle and technique of sonoelastography and the variations in elasticity and pliability between normal and abnormal Achilles tendons.
  3 3,381 337
Case report: Isolated unilateral pulmonary vein atresia diagnosed on 128-slice multidetector CT
Rashmi Dixit, Jyoti Kumar, Veena Chowdhury, Krishnan Rajeshwari, Gulshan Rai Sethi
October-December 2011, 21(4):253-256
DOI:10.4103/0971-3026.90681  PMID:22223933
Unilateral pulmonary venous atresia is an uncommon entity that is generally believed to be congenital. Most patients present in infancy or childhood with recurrent chest infections or hemoptysis. Pulmonary angiography is usually used for definitive diagnosis. However, the current multislice CT scanners may obviate the need for pulmonary angiography. We report two cases diagnosed using 128-slice CT angiography. On the CT angiography images both these cases demonstrated absent pulmonary veins on the affected side, with a small pulmonary artery and prominent bronchial or other systemic arterial supply.
  2 7,775 460
Case report: Dot-in-circle sign - An MRI and USG sign for "Madura foot"
Anitha Sen, Rajesh Subramonia Pillay
October-December 2011, 21(4):264-266
DOI:10.4103/0971-3026.90684  PMID:22223936
Mycetoma is a chronic granulomatous disease that is more common in tropical than in temperate regions. Early diagnosis is important due to the therapeutic implications. Although biopsy and microbiological culture provide definitive diagnosis, they are time-consuming procedures and may not be able to provide a definite diagnosis in cases of fastidious organisms. The "dot-in-circle" sign has recently been proposed as a highly specific magnetic resonance imaging (MRI) and ultrasonography (USG) sign of mycetoma, which may allow a noninvasive as well as early diagnosis. We present a case of histologically proven mycetoma that demonstrated this sign.
  2 10,722 937
Case Report: Acute tuberculous laryngitis presenting as acute epiglottitis
Ahmed H El Beltagi, Pushpinder S Khera, Lamya Alrabiah, Noufa F.J Al Shammari
October-December 2011, 21(4):284-286
DOI:10.4103/0971-3026.90690  PMID:22223941
The incidence of laryngeal tuberculosis (TB), which had dropped dramatically after the institution of modern anti-TB chemotherapy, has shown recent reemergence. It is important to be aware of its possibility, especially as it can present with nonspecific upper airway symptoms and a frequent lack of constitutional manifestations. We report such a case presenting as acute epiglottitis, with diffuse involvement of the supraglottic larynx associated with reactivation lung TB.
  1 10,376 445
Case report: Periorbital intraosseous hemangiomas
Fabrício Guimarães Gonçalves, Juan Pablo Ovalle Rojas, Prasad Baladev Hanagandi, Rodolfo Valente, Carlos Ignacio Torres, Jeffrey Chankwosky, Raquel DelCardio-O'Donovan
October-December 2011, 21(4):287-290
DOI:10.4103/0971-3026.90691  PMID:22223942
Hemangiomas are hamartomatous proliferation of vessels. Intraosseous hemangiomas of the facial bones are rare and most commonly involve the zygoma, maxilla, mandible, and the nasal bones. A "sunburst" pattern is a typical appearance on CT scan and MRI and therefore a biopsy is not always necessary. Surgery is usually performed in symptomatic cases. The authors describe five typical periorbital intraosseous hemangiomas with a brief review of literature.
  1 5,199 235
Decision making in the treatment of peripheral arterial disease - A single-institution comparative study using information from color doppler and digital subtraction angiogram studies
Chiramel G Koshy, Binita R Chacko, Shyamkumar N Keshava, Edwin Stephen, Sunil Agarwal
October-December 2011, 21(4):294-297
DOI:10.4103/0971-3026.90694  PMID:22223944
Background: Numerous studies have compared the accuracy of color Doppler (CD) with that of digital subtraction angiography (DSA) in the diagnosis of peripheral arterial disease (PAD). However, only a few have looked at the influence of these diagnostic tests on the treatment decision in PAD. Aim: This study evaluated the differences in treatment decisions that were based on CD and with those based on DSA findings. Methods and Materials: Findings from CD and DSA studies obtained in 40 patients were entered on line diagrams by two radiologists working separately. These were randomized and sent to three experienced clinicians - two vascular surgeons and one interventional radiologist. The treatment decisions of the clinicians based on each proforma were collected and analyzed to look for the degree of agreement between Doppler-based and DSA-based decisions. Results: There was fair to moderate agreement between CD-based and DSA-based decisions for all three clinicians, with some improvement in agreement with the addition of clinical data. The vascular surgeons showed better agreement with each other on treatment decisions compared to the interventional radiologist who showed a fair-to-moderate level of agreement with the vascular surgeons, which did not significantly change with the addition of clinical data. Conclusion: There is a fair to moderate agreement between treatment decisions based on CD findings and those based on DSA findings. We conclude that CD along with clinical data is sufficient to make decisions in the treatment of PAD.
  1 4,009 367
MRI findings in cranial eumycetoma
Munawwar Ahmed, Jyoti Sureka, Geeta Chacko, Anu Eapen
October-December 2011, 21(4):261-263
DOI:10.4103/0971-3026.90683  PMID:22223935
Cranial eumycetoma (CE) due to direct inoculation of Madurella grisea into the scalp is extremely rare. We describe a case of CE caused by direct inoculation of M. grisea with the characteristic MRI findings of the "dot-in-circle" sign and a conglomeration of multiple, extremely hypointense "dots."
  1 4,010 268
Brain imaging: Case-Review series
Chandrasekharan Kesavadas
October-December 2011, 21(4):312-312
  - 2,193 382
Tough decisions
Bhavin Jankharia
October-December 2011, 21(4):241-241
DOI:10.4103/0971-3026.90679  PMID:22223931
  - 3,294 438
Lesions in the external auditory canal
Priyank S Chatra
October-December 2011, 21(4):274-278
DOI:10.4103/0971-3026.90687  PMID:22223939
The external auditory canal is an S- shaped osseo-cartilaginous structure that extends from the auricle to the tympanic membrane. Congenital, inflammatory, neoplastic, and traumatic lesions can affect the EAC. High-resolution CT is well suited for the evaluation of the temporal bone, which has a complex anatomy with multiple small structures. In this study, we describe the various lesions affecting the EAC.
  - 16,101 1,438
Management of empyema of gallbladder with percutaneous cholecysto-duodenal stenting in a case of hilar cholangiocarcinoma treated with common bile duct metallic stenting
Sheo Kumar, Pankaj Sharma, Ramesh Muthu, Sudipta Mohakund
October-December 2011, 21(4):298-300
DOI:10.4103/0971-3026.90695  PMID:22223945
Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. Treatment options include cholecystectomy or, in patients with comorbidities, drainage via percutaneous cholecystostomy, later followed by cholecystectomy. Here, we describe a 59-year-old man who presented with complaints of recurrent hiccups and was found to have cholangiocarcinoma causing obstruction to cystic duct drainage. The patient was managed successfully by percutaneous transhepatic cholecysto-duodenal self-expandable covered metal stent.
  - 4,166 218
Use of 3D CISS as part of a routine protocol for the evaluation of intracranial granulomas
Ashish Verma, Madhavi , Sriram Patwari, Arvind Srivastava, Ram Chandra Shukla
October-December 2011, 21(4):311-311
DOI:10.4103/0971-3026.90703  PMID:22223948
  - 3,254 271
Presacral hibernoma: Radiologic-pathologic correlation
Amit Pandya, Ashish P Wasnik
October-December 2011, 21(4):270-273
DOI:10.4103/0971-3026.90686  PMID:22223938
Hibernoma is a rare benign tumor of brown fat origin. It is found in locations where brown adipose tissue is present in the fetus. These locations include the neck, axilla, thorax, and extremities. Retroperitoneal hibernoma is an extremely rare site of presentation. We present a rare case of presacral hibernoma. Preoperative embolization of this highly vascular tumor was performed. To the best of our knowledge, this is the first reported case of a presacral hibernoma in the English literature.
  - 4,021 244
Bilateral hypoplasia of the internal carotid artery
Dhananjaya I Bhat, Sampath Somanna, Jerry M.E Kovoor
October-December 2011, 21(4):257-260
DOI:10.4103/0971-3026.90682  PMID:22223934
Agenesis and hypoplasia of the internal carotid artery (ICA) are rare congenital anomalies, occurring in less than 0.01% of the population. We report a rare case of bilateral hypoplasia of the ICA in a patient with post-traumatic subarachnoid hemorrhage. We describe the embryological development of the cerebral vasculature and present a review of literature.
  - 5,069 564
Web Review: Radiography and radiology atlases
IK Indrajit
October-December 2011, 21(4):309-310
  - 3,011 403
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