Babu Philip

Multimodality imaging in Bertolotti’s syndrome: an important cause of low back pain in young adults

A 30-year-old woman presented to the orthopaedics outpatient department with low back pain (LBP) for 4 weeks, not relieved on medications. She had no known comorbidities. On examination, there was movement restriction of the lower spine and focal right posterior lumbar tenderness. Blood routines showed raised acute inflammatory markers. Imaging work-up included a routine frontal radiograph of the lumbar spine which showed a lumbosacral transition vertebra with enlarged right transverse process (figure 1). Sacroilliac joints appeared normal. Plain MRI of the lumbar spine was performed which revealed lumbosacral transitional vertebra (LSTV) with enlarged transverse process articulating with the sacral ala bilaterally forming diarthroidal joint (Castellvi type IIb) and the subchondral bone of this joint showed T2 short τ inversion recovery hyperintense signals and hypointense signals on T1-weighted images, which was suggestive of marrow oedema. The intervening cartilage was also hyperintense. There were no signal abnormalities on the left side. Rest of the lumbar spine was normal. These features were suggestive of inflammatory changes occurring in an underlying pseudoarthrosis between the right transverse process of L5 and right sacral ala (figures 2–⇓4). Thus, a diagnosis of Bertolotti’s syndrome (BS) was made. Correlative plain multidetector CT scan …

Get the GIST: A Case Series on Gastrointestinal Stromal Tumors

This case series illustrates CT appearances of gastrointestinal stromal tumors (GIST) involving the stomach, small intestine, mesentery, peritoneum and posterior mediastinum. GIST of the stomach is the commonest with majority having an exophytic growth, but it can also have an intra-luminal growth. Necrosis is a common feature of GIST irrespective of the location resulting in heterogenous enhancement on CT.

Hepatic pseudolesion in SVC obstruction - 99mtechnetium sulfur colloid scan equivalent of quadrate lobe hot spot sign on computerized tomography

An area of increased activity in segment IV of liver (quadrate lobe) on 99mTc-sulfur colloid (TSC) scans has been well documented in patients with superior vena cava obstruction. Similarly intense enhancement of the quadrate lobe in the arterial phase may be seen on computed tomography in patients of superior vena cava syndrome. We present this imaging finding in a case of malignant thymoma causing superior vena cava syndrome and discuss the physiological cause and importance of this sign.

Acute yellow phosphorus poisoning causing fulminant hepatic failure with parenchymal hemorrhages and contained duodenal perforation

White phosphorus is well known as a potent hepatotoxin and a severe local and systemic toxin causing damage to gastrointestinal, hepatic, cardiovascular, and renal systems. It is used in the manufacture of matches, fireworks, rodenticide, and fertilizers. Death results due to acute liver failure. Management of yellow phosphorus (YP) poisoning is supportive with no antidote available. Here, we present a case of acute YP poisoning in a 25-year-old female presenting with fulminant hepatic failure and duodenal perforation.

Hot cross bun and bright middle cerebellar peduncle signs in cerebellar type multiple system atrophy

A 52-year-old female patient presented with progressive gait unsteadiness for 6 months. Over the months, it has worsened to such an extent that she required support for walking. She also complained of frequent episodes of light-headedness on standing up from lying down or sitting down. She had no urge incontinence, urinary retention, increased frequency of micturition or constipation. She had no bradykinesia, rigidity, memory loss or features suggestive of dementia. There was no family history of similar complaints or dementia. On examination, she was found to have gait ataxia, nystagmus and intention tremors. The gait was broad based with sway towards left side. Her eye movements showed dysmetric saccades and jerky pursuit. She was also found to have postural hypotension. Her supine blood pressure was 170/90 mm Hg and her standing blood pressure was 140/70 mm Hg. She had no resting tremor, rigidity or bradykinesia. Babinski’s sign …

Hepatic hydatid disease presenting as secondary Budd-Chiari syndrome

A 51-year-old man presented with a history of vague abdominal pain and progressively increasing abdominal distension. Abdominal examination revealed hepatomegaly with a firm nodular liver palpable below the costal margin with mild tenderness in the right hypochondriac region. General examination revealed no pedal oedema, ascites or jaundice. No significant history or drug history was elicited. Imaging work up included a transabdominal ultrasound scan performed elsewhere which showed a multilocular cystic lesion in the right lobe of the liver with coarsened hepatic echotexture and surface nodularity. Serology was positive for hydatid disease. Contrast-enhanced CT scan (CECT) of the abdomen performed at our centre revealed a large multilocular cystic lesion in the right lobe of the liver with enhancing walls and daughter cysts within (figure 1), with extrahepatic extension into the gastrohepatic ligament and transdiaphragmatic extension into the middle mediastinum through the bare area of the liver (figure 2). The lesion was noted to cause extrinsic compression of the retrohepatic inferior vena cava (IVC) so that the right and middle hepatic veins were not visible (figures …