Charu S. Thakur

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.

Encephalocraniocutaneous lipomatosis with calvarial exostosis - Case report and review of literature.

Encephalocraniocutaneous lipomatosis (ECCL), also known as Haberland syndrome, is a rare syndrome with unknown etiology. The syndrome is characterized by a triad of unique cutaneous, ocular, and central nervous system (CNS) manifestations. The cutaneous hallmark, nevus psiloliparus (NP), along with overlying alopecia is a constant feature. Choristoma of the eyelid is the most common ocular manifestation, while intracranial lipoma is the predominant CNS finding. Genetic counseling is required to emphasize that the disorder, although congenital, is not inheritable. We present a 21-year-old female with cutaneous, ocular, and CNS features satisfying the diagnostic criteria for ECCL. To our knowledge, this is the first case of ECCL having a large temporal exostosis. The objective of this article is to better understand the phenotypic spectrum of this syndrome whose molecular basis is still unknown.

Mystery Case: Pneumorrhachis: A radiographic diagnosis

A 29-year-old man presented with a penetrating injury in the posterior aspect of his neck. His vital signs were stable. On plain CT head and neck, pneumorrhachis along with air in subcutaneous plane was seen (figures 1 and 2).

Adult Small Gut Intussusception Caused by Ascaris as a Lead Point

A 35-year-old woman presented with generalized abdominal pain for the past 2 years. The pain was intermittent and moderate in intensity. There was no anorexia, vomiting, or fever. Her bladder and bowel habits as well as physical and abdominal examination were normal. The routine blood and urine tests were also unremarkable. The ultrasound done as a first-line imaging investigation showed normal solid organs with normal caliber of gut loops. However, contrast-enhanced computed tomography (CECT) was done to ascertain any pathology missed on sonography. CECT showed small gut intussusception with worms as lead point (Figure 1 ). The patient was reviewed on ultrasound the next day by a consultant radiologist. The patient was prepared by making her drink 1.5 L water in 1 hour to distend the small gut by water as air hinders sonographic evaluation. Sonography showed no feature of intussusception that was seen on CECT, but the worms could be delineated (Figure 2 ). So it was a rare and interesting case of transient entero-enteric intussusception with worms as lead point. The patients stool examination was positive for ova of Ascaris lumbricoides. There was no acute symptom so she was managed conservatively with oral albendazole. Figure 1. (A, B) CECT images show a part of small gut loop along with its mesentery invaginating into the lumen of contiguous gut loop giving “bowel-within-bowel” configuration suggestive of entero-enteric intussusception (long black arrow). No ... Figure 2. (A, B) Sonographic images show linear parallel echogenic structures that look like “railway tract” on longitudinal imaging and “bulls eye” on transverse imaging (small white arrows). There is no posterior acoustic shadowing. ... A. lumbricoides is a common cause of bowel obstruction in children in tropics and subtropics (Supplemental Video). But A. lumbricoides as a cause of intussusception in adults is very unusual and described as a handful of case reports.1 The abdominal complications can be broadly categorized into intestinal and extraintestinal. The gastrointestinal complications include mechanical bowel obstruction, volvulus, intussusception, appendicitis, peritonitis, or even perforation.2 The extraintestinal abdominal complications are biliary colic, cholelithiasis, cholecystitis, liver abscess, and pancreatitis.

Role of hepatobiliary tract anatomy and morphology of gallstones in causation of acute pancreatitis

Introduction: Gall stone disease is a common cause of acute pancreatitis. At present the pattern of gall stones complication are largely unpredictable. Little research has been done to identify gall stone morphology and biliary tract anatomy in the causation of gall stone induced pancreatitis. Aims and Objectives: The present study was done at IGMC Shimla to study the relationship of gallstone characteristics to the risk of gall stone pancreatitis and to compare and evaluate the biliary tract anatomy in patients of gall stone induced pancreatitis and cholelithiasis by MRCP. Materials and Methods: The prospective study included 25 patients each of symptomatic cholelithiasis and gall stone induced pancreatitis divided into Group A and Group B respectively. All the patients were subjected to MRCP preoperatively. All the patients were operated by laproscopic or open method. Postoperatively the gall stone were collected and analyzed. Results: On MRCP- In Group A Single calculus was present in 11 (44%) patients and 1 (4%) patients had associated sludge, 14 (56%) patients had multiple calculi and 3 (44%) patients had associated sludge.In Group B 22 (88%) patients had multiple calculi and 16 (56%) patients had associated sludge, 3 (12%) patients had single stone, and 2 (8%) patients had associated sludge. In Group A, CBD stones were seen in 3 (12%) patients, cystic duct diameter ranged from 3 mm to 5.2 mm, CBD diameter ranged from 5 mm to 9 mm and pancreatic duct diameter ranged from 2.7 mm to 4 mm.In Group B, CBD stones were seen in 7 (28%) patients, cystic duct diameter ranged from 4 mm to 6.4 mm, CBD diameter ranged from 5 mm to 12 mm and pancreatic duct diameter ranged from 2.6 mm to 4.8 mm In Group A, Common channel was seen in 8 (32%) patients. In Group B, Common channel was seen in 18 (72%) patients Gall Stone Morphology- In Group A, Single calculus present in 11 (44%) patients and 1 (4%) patient had associated sludge. Multiple calculi present in 14 (56%) patients and 3 (12%) patients had associated sludge. In Group B, Single calculus present in 3 (12%) patients and 2 (8%) patients had associated sludge. In group A, 15 (60%) patients had round stones and 14 (56%) patients had multifaceted stones and 6 (24%) patients had associated sludge. In Group B, 5 (20%) patients had round stones and 14 (56%) patients has multifaceted stones and 6 (24%) patients had associated sludge. Sludge <2 mm diameter was present in 6 patients each in Group A and B. Weight ranged from 2 to 3.8 gm in Group A and in Group B from 1.6 to 3.25gm. Conclusion: The present study clearly established an association between multiple, multifaceted stones, sludge, wide cystic duct and presence of common channel with increased incidence of Gallstone induced pancreatitis, MRCP also proved to be an excellent diagnostic modality in Gall stone induced pancreatitis.

Isolated primary craniosynostosis in an adult: Imaging findings of a case

Craniosynostosis means premature closure of calvarial sutures. It may be primary or secondary. The patient presents with unexplained neuropsychological impairment and radiological imaging clinches the diagnosis. We present a case of 31-year-old female having primary isolated craniosynostosis who survived into adulthood without any surgical intervention. The imaging findings of such a case are rarely described in the literature.