Chhavi Kaushik

Intermittent torsion of accessory hepatic lobe: An unusual cause of recurrent right upper quadrant pain

An accessory lobe of the liver is a rare congenital anomaly that can undergo torsion and present as an acute surgical emergency. It is rarely diagnosed preoperatively. We report the preoperative utility of CT scan and MRI in the diagnosis and surgical planning of a case of intermittent accessory hepatic lobe torsion.

Ectopic pituitary adenoma in persistent craniopharyngeal canal: case report and literature review.

An ectopic location of pituitary adenoma is rare. Nasopharyngeal location of ectopic pituitary adenoma has been attributed to remnants of the Rathke pouch. We describe an interesting case of ectopic pituitary adenoma in the setting of partially persistent craniopharyngeal canal. Embryological basis of ectopic pituitary adenoma and craniopharyngeal canal have been discussed.

Case series: Cystic degeneration in uterine leiomyomas

Uterine leiomyomas are the commonest gynecological neoplasms. The typical appearances of leiomyomas are easily recognized on imaging. However, the atypical appearances that follow degenerative changes may cause confusion in diagnosis. Here we present the USG and MRI findings in two different patients with uterine leiomyomas that had undergone cystic degenerative changes, mimicking a complex adnexal cyst of ovarian origin in one case and a large myometrial cyst in the other.

Unusual CT and MR Imaging Characteristics of Splenic Lymphoma

Lymphoma is the most common malignancy of the spleen. The imaging features of splenic lymphoma are nonspecific and mostly lymphomas present as a diffusely enlarged spleen. Focal lesions are described but remain of low density or intensity on CT or MRI, respectively. We describe a histologically proven case of splenic lymphoma that showed an atypical hyperdense/hyperenhancing appearance on imaging suspicious for a vascular pathology. To the best of our knowledge and based on review of English literature, such an appearance of splenic lymphoma is extremely unusual and rare.

Hypovolemic shock and hemoperitoneum from spontaneous avulsion of a large pedunculated uterine leiomyoma

Hemoperitoneum with hypovolemic shock from avulsion of a pedunculated leiomyoma is a rare but highly fatal condition that can occur spontaneously or as a result of trauma. We report a case of hemoperitoneum and hypovolemic shock secondary to a bleeding leiomyoma detected via computed tomography (CT) scan in a 39 year old premenopausal, gravida 0 female that presented with abdominal pain and became hemodynamically unstable in the emergency department. A preoperative bimanual exam revealed a mass consistent with a 20 week gestational uterus. Following fluid resuscitation, the patient underwent emergent myomectomy and ligation of the right uterine artery and was discharged home in good condition.

Gartner Duct Cyst: CT and MRI Findings

A 29-year-old woman came to the outpatient clinic with complaints of chronic pelvic pain and dyspareunia. Her physical examination was normal. Her blood work and laboratory investigations were within normal range. Ultrasonography revealed a cystic mass posterior to vagina and uterus. Computed tomography (CT scan) showed an oblong structure with fluid density contents (Fig. 1). Patient had a magnetic resonance imaging (MRI) scan which revealed a large 10 9 9 9 4 cm cystic structure posterior to the uterus, originating along the posterior vaginal wall, representing Gartner duct cyst (Fig. 2a, b). The cyst was excised, and benignity of the lesion was confirmed by a histologic study. The diagnosis was consistent with Gartner duct cyst. Discussion

Magnetic resonance imaging findings in apical ballooning syndrome or takotsubo cardiomyopathy

Cardiac magnetic resonance imaging (CMRI) plays an important role in the diagnosis and follow-up of apical ballooning syndrome (takotsubo syndrome), a recently described cardiac condition characterised by transient dyskinesia of the left ventricle secondary to an acute emotional event. We present the CMRI findings in a 53-year-old female diagnosed with apical ballooning syndrome and discuss its value in the diagnosis and follow-up of this condition.

Pantothenate Kinase 2 Deficiency: A Neurodegeneration With Brain Iron Accumulation

Pantothenate kinase 2 deficiency (previously known as Hallervorden-Spatz disease) is an unusual metabolic disorder characterized by progressive extrapyramidal dysfunction and dementia. A 27-year-old Caucasian presented with a major depression disorder and social phobia since adolescence. Patient had marked paranoia, auditory hallucinations, extrapyramidal dysfunction, poor memory, and gait abnormality. Laboratory tests including serum copper and ceruloplasmin were all normal. Magnetic resonance imaging (MRI) examination of the brain played an important role in the diagnosis in this patient.

Protean Manifestations of Amyloidosis

Amyloidosis is an acquired or hereditary multisystem disorder of abnormal protein folding, in which whole or fragments of normally soluble proteins are deposited extracellularly as abnormal, insoluble fibrils that accumulate, disrupt the structure and function of the affected organs, and cause disease.1 The extracellular deposit of amyloid invariably consists of three components: fibrillar protein made of fibrils arranged in a β-pleated sheet, serum amyloid P, and negatively charged glycosaminoglycans. The glycosaminoglycans and starch stain blue with iodine, giving the disease its name (amyloid is Greek for “starch”).2 Although there are several types of amyloidosis, most cases are either of the primary type (also referred to as amyloid light chain [AL] amyloidosis) or secondary type (or amyloid A [AA]). Primary amyloidosis has been associated with monoclonal plasma cell dyscrasia—at least 30% of patients with primary amyloidosis eventually progress to multiple myeloma. The median survival of primary amyloidosis is 1.5 years. Secondary amyloidosis is a result of chronic inflammatory disease (e.g., Crohn disease, adult or juvenile rheumatoid arthritis, Reiter syndrome, ankylosing spondylitis, chronic tuberculosis, cystic fibrosis) and has a mean survival of 4.5 years.2