Bindey Kumar

Torsion in wandering spleen: CT demonstration of whirl sign

Wandering spleen is a rare occurrence. Torsion of the splenic pedicle is the major life-threatening complication of this entity. Preoperative diagnosis is based on radiological investigation. We report two consecutive cases, one adult and one child, in whom torsion in a wandering spleen was diagnosed based on a typical whirled appearance of the splenic vessels on computed tomography. We present a review of computed tomographic appearance of splenic torsion, and emphasize the “whirled appearance” as a specific sign for splenic torsion in wandering spleen.

Aberrant Renal Vessel Causing Hydronephrosis in Crossed-Fused Ipsilateral Ectopic Kidney: A Rare Case Report

A crossed-fused ectopic kidney is a rare congenital anomaly, and uncommonly we see an aberrant vessel as a cause of hydronephrosis in a kidney. We report a case of 4-year-old boy with crossed-fused right renal ectopia with hydronephrosis in the both kidneys. The aberrant renal vessel was found pressing the left pelvi-ureteric junction causing hydronephrosis. Dismembered pyeloplasty of the left kidney was performed anterior to the aberrant vessel. The patient is doing well in the follow-up visits and his renal function is stabilized. Aberrant blood supply may be a cause of hydronephrosis in the crossed-fused ectopic ipsilateral kidney. Keeping this entity in differential diagnosis will help in successful management of the crossed-fused ectopic kidney.

Role of color Doppler ultrasound in the diagnosis of nonpalpable testes

PurposeColor Doppler ultrasound has been used for the diagnosis of torsion of testes. The purpose of this study was to evaluate the sensitivity of this noninvasive tool in detecting impalpable testes. Patients and methodsTwenty-five children with nonpalpable testes were treated at the Department of Pediatric Surgery, Institute of Medical Science, Banaras, between 2007 and 2009. Color Doppler ultrasound was used for detecting the position, size, and vascularity of nonpalpable testes. These patients were subsequently revaluated by laparoscopy. ResultsOut of 25 cases, 15 cases were unilateral and 10 cases were bilateral (a total of 35 nonpalpable testes). The color Doppler ultrasound study successfully localized 30 of the 35 nonpalpable testes, which were confirmed by subsequent laparoscopic examination. The sensitivity of color Doppler in locating testes was 85.71% (95% confidence interval=0.64–0.97). ConclusionColor Doppler ultrasound is an effective noninvasive method for the initial diagnosis of impalpable testes and for planning its subsequent management.

Ectopic thoracic kidney in a child presenting with recurrent cough: a case report and review of literature

Ectopic thoracic kidney is a rare clinical entity in pediatric patients. It is usually an incidental finding on evaluation of patients with recurrent cough or mediastinal mass. Its clinical course is benign. We are presenting a case of right ectopic intrathoracic kidney diagnosed incidentally on contrast-enhanced computed tomography chest during evaluation of a child with recurrent cough.

Challenges in complete surgical resection of giant cystic hygroma

Background: Giant cystic hygroma is a benign cystic lesion that is disfiguring and a life threatening lymphatic malformation. Surgical resection is the main modality of treatment. Complete surgical resection of giant cystic hygroma is difficult and challenging. Patients and Methods: We discuss 10 cases of giant cystic hygroma wherein complete surgical resection was done. These cases were operated between 1996 and 2015. The preparation of patients, challenges, and outcome of the procedure were evaluated and recorded. Results: The age of the 10 cases we evaluated ranged from 1 month to 10 years. Five patients less than 1 year in age presented with respiratory embarrassment and feeding problems. Older children (5 patients) presented with disfigurement of face including visible non-tender mass. All children had some degree of feeding difficulties. One case had mediastinal involvement and presented with respiratory distress. Postoperatively, 6 patients had blood transfusion, while 5 required mechanical ventilation. Conclusion: This article focuses on difficulties encountered during surgical resection of giant cystic hygroma due to its varied clinical presentation, which is unique to the large size of the mass. These include anesthetic difficulties, operative difficulties in terms of identifying vital structures, bleeding, and cosmesis, and operative sequel and complications.

Biliary atresia with aneurysmal dilatation of hepatic artery: A rare anomaly

INTRODUCTION The coexistent biliary atresia with aneurysmal dilatation of hepatic artery is a rare association. To know these anomalies will avoid many per operative complications. It is also important to mention that these children require liver transplantation in the long run then these vascular anomalies become more relevant. PRESENTATION OF CASE A four month old male child presented with features of biliary atresia. On exploration a cystic expansile mass was detected beneath thread like common bile duct. Subsequent aspiration and studies proved it to be aneurysmal dilatation of hepatic artery. DISCUSSION With biliary atresia many vascular and cardiac malformations have been described but aneurysmal dilatation of hepatic artery is a rare association. These anomalies may have impact on aetiopathogenesis of biliary atresia and also future liver transplantation. CONCLUSION Awareness of rare association of hepatic artery aneurysm with biliary atresia will help in understanding aetiopathogenesis of biliary atresia and planning liver transplantation in such cases.

Gossypiboma mimicking posterior urethral stricture

INTRODUCTION Foreign bodies in the urogenital tract are not uncommon. Hairpins, glass rods, umbilical tapes, ball point pen are described in lower urogenital tract. Retained gauze piece (gossypiboma) in posterior urethra may cause diagnostic dilemma. Symptoms and investigations may mimic stricture of posterior urethra. PRESENTATION OF CASE Two cases of retained gauze pieces in the urethra are described here. The micturating cystourethrogram was suggestive of posterior urethral stricture. DISCUSSION Two cases described here had retained gauze piece as a cause of filling defect and abnormal appearance in the micturating cystourethrogram. Gossypiboma may be a possibility where posterior urethral stricture are seen after previous surgery in paediatric age group. CONCLUSION In the setting of previous urogenital surgery gossypiboma should be kept in the differential diagnosis where posterior urethral stricture are seen in the paediatric age group.

Echogenic Mobile Spherules in a Cyst as an Ultrasound Finding in Cystic Mediastinal Teratoma

Mature teratomas are the most common mediastinal germ cell tumor. They are mostly cystic. They are usually asymptomatic and diagnosed incidentally on chest X-ray or CT scan. The diagnosis of teratoma is usually confirmed by CT scan. It shows variable combination of fat, fluid, soft tissue component, and calcification. Ultrasound, a cheap and widely available imaging modality, also provides valuable characteristic appearances of mediastinal teratomas. We present a case of mediastinal cystic teratoma showing characteristic echogenic mobile spherules in the cyst and its brief discussion.