Akhila Prasad

Pulmonary Aspergillosis: What CT can Offer Before it is too Late!

Aspergillus is a large genus of saprophytic fungi which are present everywhere in the environment. However, in persons with underlying weakened immune response this innocent bystander can cause fatal illness if timely diagnosis and management is not done. Chest infection is the most common infection caused by Aspergillus in human beings. Radiological investigations particularly Computed Tomography (CT) provides the easiest, rapid and decision making information where tissue diagnosis and culture may be difficult and time-consuming. This article explores the crucial role of CT and offers a birds eye view of all the radiological patterns encountered in pulmonary aspergillosis viewed in the context of the immune derangement associated with it.

Case series: Cystic degeneration in uterine leiomyomas

Uterine leiomyomas are the commonest gynecological neoplasms. The typical appearances of leiomyomas are easily recognized on imaging. However, the atypical appearances that follow degenerative changes may cause confusion in diagnosis. Here we present the USG and MRI findings in two different patients with uterine leiomyomas that had undergone cystic degenerative changes, mimicking a complex adnexal cyst of ovarian origin in one case and a large myometrial cyst in the other.

Neuroradiological findings in GM2 gangliosidosis variant B1

GM2 gangliosidosis variant B1 is a very rare lysosomal disorder. As per our knowledge, to date, only one article depicting the magnetic resonance imaging (MRI) findings of GM2 gangliosidosis variant B1 is available in the literature. We are the first to describe the neuroradiological findings in an Indian patient diagnosed with GM2 gangliosidosis variant B1.

Unique features of polycythemia observed on plain non contrast CT scan of head

We present two cases of polycythemia secondary to a congenital cardiac anomaly presenting with acute neurological complications showing hyperdense venous sinuses and cerebral vasculature in association with cerebral abscess.

Elephantiasis neuromatosa of the lower limb in a patient with neurofibromatosis type-1: A case report with imaging findings.

Elephantiasis neuromatosa is the most impressive manifestation of neurofibromatosis type-1 (NF-1). We report a case of NF-1 who presented with elephantiasis neuromatosa of his right leg. Cross-sectional imaging not only assists in the correct diagnosis but also aids in imaging the vasculature of a plexiform neurofibroma, which is essential for proper surgical planning.

Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled.

The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.

Neurocutaneous melanosis: assessment on F-18 FDG and [11C]-methionine PET/CT and MRI.

Neurocutaneous melanosis is an extremely rare, nonfamilial neurocutaneous syndrome characterized by large cutaneous melanocytic nevi and excessive proliferation of melanocytic cells in the leptomeninges. We present the F-18 FDG and 11C -methionine PET/CT findings in a 16-yearold boy with neurocutaneous melanosis. Diffuse uptake was noted in the leptomeninges extending into the brain parenchyma with both tracers, which corresponded to hyperintensities on MRI. Histopathology revealed extensive melanocytic infiltration with no evidence of malignancy. The increased radiotracer accumulation may thus reflect overall increased cell glucose and amino acid metabolism of this rare disorder.

Imaging in Rare and Atypical Sinonasal Masses: An Interesting Case Series

Sinonasal tumours present a myriad of radiographic findings. While many of these tumours have been well described with regard to their typical sites of origin, age group and radiological appearance we have come across lesions in our daily practice which are exceedingly rare with regard to site of origin in sinonasal cavity. The radiological appearances of 4 such rare and unusual tumours arising in sinonasal region evaluated by cross sectional imaging (CT/MRI) have been illustrated in this article with a purpose to review the radio-pathological correlation of these tumours and to explain the utility of cross-sectional imaging CT and MRI in exploring diagnostic clues. Morphological features and radiological patterns of each tumour have been graded into mild, moderate and severe based on the extent of tumoural involvement. This review is intended to acquaint radiologists with the appearance of atypical sinonasal masses and their radiological appearance on cross sectional imaging to make an early diagnosis.

Severe visual loss following waterload for transabdominal ultrasound

Dear Editor, A 72-year-old male presented at the emergency services with sudden decrease in vision. The patient gave a history of preceding pelvic ultrasound for prostate evaluation. He was administered around 2 L of water over 10 min prior to the sonography to enable good visualization of prostate. Soon after leaving the radiology clinic, he noticed severe blurring of vision and heaviness in his eyes. His vision was finger counting close to face. He had severe corneal edema with intraocular pressure (IOP) of 54 mm Hg OD 60 mm Hg OS. He was immediately given intravenous mannitol and oral acetazolamide in conjunction with topical ocular hypotensives. The pressures were controlled and the vision improved to 20/40 after few hours and 20/20 the following day. He was a known ocular hypertensive who had been well-investigated 3 years back for glaucoma. Records revealed visual acuity of 20/20 both eyes, open angles, pachymetry of 540 μ OD and 532 μ OS, normal visual fields, and disc examination. His diurnal record had pressures in the range of 12-18 mm Hg in right eye and 14-18 mm Hg left eye with a maximum recorded IOP of 24 mm Hg either eye. The patient was advised 6 monthly follow-up to detect any conversion to open angle glaucoma. However, the patient did not return for follow-up and did not divulge his ocular diagnosis to the radiologist. After the present episode, the pressures normalized with treatment. The patient was emmetropic with bilateral open angles. There was no disc damage and few depressed points in fields left eye hinting toward probable early damage. The current optical coherence tomography is normal. The patient has shown a tendency for extreme response to the water overload and such situation may be repeated in daily life in lesser magnitude. After discussion with the patient, it was found feasible to start him on one medication as his compliance to follow-up visits was also doubtful. He has now been put on topical prostaglandin analogue once at night time both eyes and advised regular follow-up. The regulation of IOP is a complex physiologic trait that depends upon production of aqueous humor, resistance to aqueous humour outflow, and episcleral venous pressure.[1] After drinking water or any hypotonic fluid, there is a consequent rise in IOP. The ability of the eye to recover from this transient IOP rise depends on the outflow facility. Ocular hypertensives and glaucoma patients can have an exaggerated elevation of IOP following ingestion of more than 500 mL of water within a span of 5 min.[2] This pressure response even forms the basis of one of the provocative tests, the water drinking test, sometimes used for diagnosis of glaucoma. Armaly and coworkers[3,4] reported the pressure change after drinking water as one of five potential risk factors significantly related to the development of glaucomatous visual field defects in patients with ocular hypertension. An ignorance about such response in ocular hypertensives or glaucoma patients undergoing water loading can lead to irreversible visual loss. The protocols for a full bladder transabdominal sonography must include a slow ingestion of 500 mL of water as well as at least 90 min time for postprocedural observation and prompt referral to an ophthalmologist in case of need [Fig. 1]. Figure 1 Transabdominal ultrasound with full bladder