Brij Bhushan Thukral

Cystic masses of neck: A pictorial review.

Cystic masses of neck consist of a variety of pathologic entities. The age of presentation and clinical examination narrow down the differential diagnosis; however, imaging is essential for accurate diagnosis and pretreatment planning. Ultrasound is often used for initial evaluation. Computed tomography (CT) provides additional information with regard to the extent and internal composition of the mass. Fine-needle aspiration cytology (FNAC) has a supplementary role for confirmation of diagnosis. Magnetic resonance imaging may be needed in some cases for preoperative assessment.

OHVIRA: Uterus didelphys, blind hemivagina and ipsilateral renal agenesis: Advantage MRI

We present here a case of an uncommon complex uterine anomaly – Obstructed HemiVagina with Ipsilateral Renal Agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 14-year-old girl along with sonographic (trans-abdominal and trans labial), and MRI findings. The patient underwent surgery wherein imaging findings were confirmed. An MRI has proved to be of great help in correct diagnosis avoiding surgical interventions/ laparoscopy, which were needed in past to diagnose this rare anomaly. We also discuss the development of this anomaly with the help of a relatively new theory of uro-genital development by Acien and review the literature.

Evaluation of MR Spectroscopy and Diffusion-Weighted MRI in Postmenopausal Bone Strength

Aim: To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women. Materials and Methods: Fifty postmenopausal women, who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (normal, osteopenia, and osteoporosis) based on T-score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD. Results: Vertebral marrow fat content was significantly increased in the osteoporotic group when compared with that of the osteopenic group and the normal bone density group. ADC values in the osteoporotic, osteopenic, and normal bone density groups were 338, 408 and 464, respectively, with statistically significant differences (P < 0.001). A statistically significant positive correlation between T-scores and ADC existed (r=0.694, p value <0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=–0.455, p< 0.001) and to marrow ADC (r= -0.302, p < 0.05). Conclusion: The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.

Radiography in the Initial Diagnosis of Biologic Activity or Growth Rate of Primary Bone Tumors

AJR 2013; 201:W770 0361–803X/13/2015–W770

Hepatic Venous Waveform, Splenoportal and Damping Index in Liver Cirrhosis: Correlation with Child Pugh's Score and Oesophageal Varices.

INTRODUCTION Clinical assessment of chronic liver disease is done by Modified Child Pughs and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative. AIM To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices. MATERIALS AND METHODS Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices. RESULTS Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pughs class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pughs total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pughs score (r=0.269; p=0.15). CONCLUSION Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices.

Differential Diagnosis of Upper Lobe–Predominant Diseases of the Lung

AJR 2013; 201:W518 0361–803X/13/2013–W518

Differential Diagnosis of Focal Renal Lesions in Pediatric Patients

AJR 2013; 201:W366 0361–803X/13/2012–W366

Supplemental Causes of Pulmonary Hyperlucency in Adults

AJR 2013; 201:W162 0361–803X/13/2011–W162

Giant aneurysm formation in sporadic renal angiomyolipoma

Angiomyolipomas are the most common mesenchymal renal neoplasms. Two types have been described: (i) sporadic angiomyolipoma and (ii) angiomyolipoma associated with tuberous sclerosis. Giant aneurysm formation is usually noted in angiomyolipomas associated with tuberous sclerosis and is rare in sporadic variety. Tumor diameter and aneurysm diameter have been used as predictors of rupture. We report a rare case of aneurysm formation in a sporadic angiomyolipoma.

Coracoclavicular Joint: A Rare Entity

We would like to highlight on the importance of a coracoclavicular joint being a rare synovial anomalous diarthrosis formed between the conoid tubercle of the clavicle and the superior surface of the horizontal part of the coracoid process of the scapula. It was first described in 1861 by Gruber. Kaur & Jit have studied the presence of a coracoclavicular joint in paired clavicles obtained from 1,000 adult subjects of northwest Indian population [1]. The coracoclavicular joint has been recognized as an uncommon osteological feature [2]. The incidence of coracoclavicular joint is more common in Asians than in Europeans or Africans [3,4]. It usually become symptomatic in adulthood and the probable etiology could be an underlying arthrosis of this synovial diarthrosis with advancing age. Surgical excision of a symptomatic congenital coracoclavicular joint in a patient has been described in the literature in a resistant case not responding to a conservative management [5]. Clinical symptoms usually are limited to pain around the shoulder joint mainly with hyperabduction. Very rarely it may present as thoracic outlet syndrome. The differential diagnosis includes an osteochondroma, post traumatic myositis ossificans. The recognition of a synovial joint between the conoid tubercle of clavicle and coracoid process of scapula indicates coracoclavicular joint and differentiates from osteochondroma and post traumatic myositis ossificans (Figures 1-3).