Ajay Gulati

Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature.

Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients.

The Mysterious Organ. Spectrum of Focal Lesions Within the Splenic Parenchyma: Cross-Sectional Imaging With Emphasis on Magnetic Resonance Imaging

Incidental splenic lesions are frequently encountered at imaging performed for unrelated causes. Splenic cysts, hemangiomas, and lymphomatous involvement are the most frequently encountered entities. Computed tomography and sonography are commonly used for initial evaluation with magnetic resonance imaging reserved as a useful problem-solving tool for characterizing atypical and uncommon lesions. The value of magnetic resonance imaging lies in classifying these lesions as either benign or malignant by virtue of their signal-intensity characteristics on T1- and T2-weighted imaging and optimal depiction of internal hemorrhage. Dynamic contrast-enhanced sequences may improve the evaluation of focal splenic lesions and allow characterization of cysts, smaller hemangiomas, and hamartomas. Any atypical or unexplained imaging feature related to an incidental splenic lesion requires additional evaluation and/or follow-up. Occasionally, biopsy or splenectomy may be required for definitive assessment given that some of tumours may demonstrate uncertain biologic behavior.

Imaging in pulmonary hydatid cysts

Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.

Primary twin ovarian pregnancy: Case report and review of the literature

Primary twin ovarian pregnancy is extremely rare. We present one such case in a 25‐year‐old primigravida who complained of lower abdominal pain and mild vaginal bleeding at 8 weeks after her last menstrual period. Transvaginal sonography revealed an empty uterus and presence of a gestational sac containing 2 dead embryos in the right ovary. The patient underwent unilateral oophorectomy, and histologic studies confirmed a uniovular‐diamniotic ovarian pregnancy. A brief review of the literature revealed that primary ovarian pregnancy may occur without any classical antecedent risk factors, and endovaginal sonography can be useful to establish early preoperative diagnosis of ectopic ovarian pregnancy.

Air in the heart: what should one do?

Air embolism is a serious and frequently underrecognized complication of vascular access device placement. Improper precautions during vascular catheter insertion result in inadvertent introduction of air into the vasculature. Systemic embolization into the cerebral, pulmonary, and coronary circulations can be catastrophic. We present a case of intracardiac air embolism after placement of a central venous catheter managed conservatively.

Spontaneous rupture of renal pelvis.

Spontaneous urine extravasation from the pelvicalyceal system into the perinephric space is an uncommon condition. It is most commonly seen in the setting of obstructive ureteric calculus. Other rare causes include neoplasms, trauma, and iatrogenic procedures. Most commonly described phenomenon is forniceal rupture, but renal pelvis rupture without forniceal rupture is extremely rare. We present a short series of 3 cases of spontaneous pelvis rupture, each with a different etiology. Diagnosis was confirmed by computed tomography. The follow-up and therapeutic approaches are discussed with a short review of literature.

Primary amyloidoma of lung treated with radiation: A rare case report

Amyloidosis is a collection of diseases in which different proteins are deposited as insoluble beta-pleated sheets, disrupting organ function. Distribution of these deposits may be diffuse or localized throughout the body, depending on the pathophysiology of the underlying amyloid type. Isolated deposition of amyloid proteins in lung is a very rare entity. They are frequently misdiagnosed as bronchogenic carcinoma, metastatic disease, or focal fungal infections. The treatment of solitary pulmonary amyloidosis is not well-defined. We have treated a 65-year-old female patient with external beam radiation and corticosteroids in palliative intent and she is leading a good quality of life after six months of follow up.

Urolithiasis: Comparison of diagnostic performance of digital tomosynthesis and ultrasound. Which one to choose and when?

OBJECTIVE To assess the diagnostic performance of digital tomosynthesis (DT) in detecting urolithiasis and compare it with ultrasonography (USG), keeping standard volumetric multi-detector computed tomography (MDCT) as the reference. MATERIALS AND METHODS This prospective analytical study was approved by our institutional ethical committee. A total of 66 patients were enrolled who had either clinical suspicion of urolithiasis or history of recurrent urolithiasis. All patients underwent DT, USG and MDCT within 24 h. In all these three investigations, the calculi were categorised according to their location and size by two radiologists. Sensitivity, specificity, positive and negative predictive values of DT and USG were calculated with MDCT as a reference standard. RESULTS Our study comprised of 66 patients (36 males and 30 females with age range of 19-73 years). A total of 121 calculi were assessed with 52 calculi <5 mm in size, 32 calculi measuring 5-10 mm and 37 calculi >10 mm. Kappa test of agreement was used to assess the interobserver agreement for all observations. The measurement of agreement kappa value was 1. The overall sensitivity of DT and USG in detecting urolithaisis was 50% (p value <0.001) and 50.4% (p value 0.005) respectively. No statistically significant difference was noted between USG and DT in detecting urolithiasis. The sensitivity of DT and USG in detecting renal calculi was 47.1% and 50.9% respectively and the sensitivity of DT and USG in detecting ureteric calculi was 74.9% and 39.2% respectively. We observed statistically significant difference between USG and DT in detecting ureteric calculi. CONCLUSION In our study, there was no statistically significant difference noted between USG and DT in diagnosis of urolithiasis. DT performed significantly better than USG in detecting ureteric calculi with a higher sensitivity. Hence, we are tempted to opine that DT may be preferred over USG for initial evaluation of patients with suspected ureteric calculi. However considering the strength of ultrasound in demonstrating associated signs as hydroureteronephosis, we are still of the opinion, that both DT and USG should be used as complementary techniques in resolving these common clinical screnarios.

Imaging of Pneumonia: An Overview

Purpose of reviewPneumonia is one of the common causes of morbidity and mortality in general population. Imaging plays an important role in the management of pneumonia.Recent findingsIn the current era, there has been an increase in the patients with extremes of age, immunocompromised status, underlying lung pathology, post-transplant status, and atypical infections. It is necessary to use cross-sectional imaging modalities like computed tomography (CT) due to atypical or non-specific chest radiograph findings in such cases. CT narrows down the differential diagnosis, for etiological agent. It helps in the evaluation of the causes of non-resolving pneumonia, pulmonary, and non-pulmonary complications of pneumonia. Pneumonia is classified into three main types as community-acquired pneumonia, hospital-acquired pneumonia, and aspiration pneumonia. It is important to differentiate these three types, since host factors and etiological organisms differ, thus changing the course and management in these patients.SummaryKnowing the clinical background and correlation with imaging findings may help in the early detection of pathogen and direct the physician toward appropriate management. Imaging also helps in follow-up of patients to look for response to therapy. Cross-sectional imaging can help in ruling out diseases mimicking pneumonia.

An adaptive hybrid technique for pancreas segmentation using CT image sequences

This paper briefly introduces a novel semiautomatic method to segment the pancreas volume from CT image sequences. Existing hybrid Level Set Methods (LSM) is applicable for extracting the full size pancreas from single abdominal CT image. To extract shape and size varying pancreas from continuous CT image sequences, an adaptive hybrid level set method is proposed. Proposed method uses Fast Marching Method (FMM) for rough segmentation followed by Distance Regularized Level Set Method (DRLSM) for final pancreas segmentation from single CT image. To make it adaptive for a set of CT images, the optimal values of time threshold and iterations number for FMM and DRLSM respectively are computed automatically. The proposed method is evaluated on a dataset of 9 abdominal CT image sequences, which includes 140 CT slices. The performance of proposed method is quantitatively evaluated by comparing the segmentation results with ground truth CT image slices, in which pancreas region is manually marked by experienced radiologist.