Anupam Jhobta

Cystic pulmonary hydatidosis

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.

Virilizing Adrenal Oncocytoma

Adrenal oncocytoma is a rare adrenal neoplasm with only 57 cases reported in literature. Adrenal oncocytomas can achieve large sizes and are usually nonfunctioning. They are detected accidentally during abdominal scans. Most of these adrenal neoplasms are benign. A functioning adrenal oncocytoma manifested with virilization in a 16-year-old female child. There seems to be little benefit in biopsying these tumors and surgery remains the optimum management.

MR in complete dorsal pancreatic agenesis: Case report and review of literature.

The morphogenesis of the pancreas is a complex process having a very low frequency of anatomic variation. The congenital anomalies are rare. Complete pancreatic and ventral pancreatic agenesis are incompatible with life. Dorsal pancreatic agenesis is exceedingly rare with less than 100 cases reported in the world literature. Patients with this anomaly may be asymptomatic or may present with abdominal pain, hyperglycemia, diabetes mellitus, and acute or chronic pancreatitis. Such anomalies are rarely reported; therefore, clinical awareness of agenesis of the dorsal pancreas as a cause of these symptoms can expand the differential diagnosis and improve patient management.

Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia.

Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

Volumetric CT perfusion assessment of treatment response in head and neck squamous cell carcinoma: Comparison of CT perfusion parameters before and after chemoradiation therapy

Background and purpose World Health Organization estimated that there were 600,000 new cases of head and neck cancers and 300,000 deaths each year worldwide. Scientific modalities to predict the treatment outcomes are not available yet. We conducted this study to (1) compare CT perfusion parameters before and after chemoradiation among patients with head and neck squamous cell carcinoma and (2) to evaluate the prognostic value of each perfusion parameter in predicting the response to chemoradiation. Materials and methods We conducted a prospective study among all patients with head and neck squamous cell carcinoma registered for chemoradiotherapy (CRT) at Regional Cancer Research Center, Shimla, Himachal Pradesh, India during the period June 2012 through June 2013. CTp data were acquired on a 64-slice CT scanner (Light speed VCT Xte; GE Healthcare) with 14 cm z-axis coverage using Volume Helical Shuttle (VHS) feature at baseline, on completion of 40 Gy and 66 Gy of chemoradiation. We dichotomised the treatment outcome as complete response and non-response (partial responders/stable disease/progressive disease) using RECIST 1.1 criteria. We compared all perfusion parameters at baseline, 40 Gy and 66 Gy of CRT between responders and non-responders. We dichotomised the perfusion parameters as high (>median value) and low (≤median value) to analyze association between perfusion parameters and treatment outcome. We calculated the sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized perfusion parameter using Wilson Score method. Results We followed 24 patients (23 of them men) from start of the treatment till completion of it. All had Stage III or Stage IV of the disease. Blood flow (BF) and blood volume (BV) decreased and Mean Transit Time (MTT) increased significantly (p < 0.05) at 66 Gy among responders to CRT as compared to non-responders. Patients with high BF (>106 ml/100 g/min) at baseline were five times more likely (p = 0.004) to respond to treatment as compared to those with low BF. BF was found to be 83.3% predictive of complete response. Other perfusion parameters were not significantly predictive of outcome (p > 0.05) Combination of high BF (>106 ml/100 g/min) and low (≤47 ml/100 g/min) permeability surface (PS) was 100% predictive of response to CRT irrespective of the stage of tumor. Conclusions High BF at baseline is the single best predictor of response to chemoradiaton. A combination of high BF and low PS was found to be 100% predictive of complete response irrespective of the stage of the tumor.

Cephalothoracopagus Janiceps Asymmetros Twins: Antenatal Sonographic Diagnosis

Conjoined twins have been the subject of myth and legend since antiquity because of the rarity and peculiarity of their juxtaposition. Fortunately, modern medical technology and concurrent advancements in surgical techniques provide an opportunity for successful separation and hope of a normal independent existence for these unique children. Antenatal sonography allows timely detection of this condition so that further management may be planned.

Tibialis Anterior Muscle Hernia: A Case of Chronic, Dull Pain and Swelling in Leg Diagnosed by Dynamic Ultrasonography

Summary Background Symptomatic muscle hernias are not uncommon in the lower extremities and are a rare cause of chronic leg pain. They are most commonly seen in the tibialis anterior muscle, occurring through fascial defects, usually after trauma. There are about 200 cases of muscle hernias described in the literature. The diagnosis is challenging as most of the patients present with non-specific chronic leg pain. Dynamic muscle ultrasonography at rest and at stress is often used for the diagnosis. Case Report We describe a case of tibialis anterior muscle hernia presenting with persistent dull pain and swelling along the anterior aspect of the leg on straining the leg muscles. Dynamic ultrasonography was performed, which showed a defect in the fascial sheath of the muscle through which the tibialis anterior muscle herniated and produced a focal bulge along the anterior aspect of the leg. Based upon physical examination and dynamic ultrasonographic findings, a diagnosis of tibialis anterior muscle hernia was made. Conclusions Tibialis anterior muscle hernia is a rare diagnosis and should be included in the differential diagnosis in a patient with chronic leg pain and swelling. Dynamic ultrasound is crucial in confirming the diagnosis and should be done on straining the muscles of the affected limb.

Use of High-Resolution Computed Tomography (HRCT) in Diagnosis of Sputum Negative Pulmonary Tuberculosis

OBJECTIVES To study the role of high-resolution computed tomography (HRCT) in the diagnosis of pulmonary tuberculosis (PTB) in sputum smear negative patients and to design HRCT criterion to forecast the threat of pulmonary tuberculosis. MATERIAL AND METHODS We studied 69 patients having sputum smear negative for acid-fast bacilli (AFB) but still with clinical suspicion of PTB after taking written informed consent. We studied their medical characteristics, numerous separate HRCT-results and combination of HRCT findings to foresee the danger for PTB by utilizing univariate and multivariate investigation. Temporary HRCT diagnostic criteria were planned in view of these outcomes to find out the risk of PTB and tested these criteria on our patients. RESULTS Chronic cough and night sweats were highly linked to a greater risk of PTB among clinical features. On HRCT chest presence of cavity, centrilobular nodules, consolidation, ground glass opacity (GGO), lymphadenopathy, main lesion in S1, S2, S6, lobular consolidation, other minute nodules and tree in bud appearance was significantly linked to an elevated risk of PTB in linear regression analysis. While cavity, centrilobular nodules, interlobular septal thickening, pleural effusion and tree-in-bud appearance was significantly linked to a greater threat of PTB in multivariate regression analysis. Positioning of the patients utilizing our HRCT indicative criteria uncovered reliable sensitivity and specificity for PTB patients determining that HRCT is a useful tool in sputum negative PTB patients. CONCLUSION HRCT is useful in selecting individuals with greater chances of PTB in the sputum smear-negative setting.

Dystonia an unusual presentation in pediatric moyamoya disease: Imaging findings of a case

Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by idiopathic occlusion of bilateral internal carotid arteries and the development of characteristic leptomeningeal collateral vessels along anterior or posterior circulation. We present an unusual case of MMD presenting with generalized dystonia as the predominant manifestation.

Advanced abdominal pregnancy with successful outcome.

A 29-year-old pregnant woman with previous two normal vaginal deliveries was presented at 34 weeks with abdominal pain and decreased fetal movements. There was neither history of pelvic inflammatory disease nor prior surgery. No previous ultrasound had been obtained. Ultrasound revealed severe oligohydroamnios along with an empty uterus, seen separate from a viable 33 weeks fetus. A MRI revealed an extra-uterine fetus with placenta attached to the right cornu (Fig. 1a). Amniotic fluid was absent in between the fetus and the placenta (Fig. 1b). A girl baby weighing 2.3 kg was delivered by an emergency laparotomy, and the placenta was removed (Fig. 1c). Both mother and baby were discharged after 10 days. Abdominal pregnancy is a rare condition, and may go unnoticed if an ultrasound is obtained, which may appear normal [1]. In an abdominal pregnancy, the fetus grows and develops outside the uterus, tubes, ovaries and the broad ligament. Risk factors include pelvic inflammatory disease, previous pelvic surgery, previous ectopic gestation and intrauterine contraceptive devices. It may be classified as primary: when fertilization takes place in an extrauterine, intra-abdominal location, or secondary (more common): which is thought to be due to undetected rupture of an ectopic pregnancy during which the fetus after rupture continues to develop intra-abdominally [2]. Reported high maternal and perinatal fetal mortality rates are