Ekram Ullah

Primary hyperparathyroidism having multiple Brown tumors mimicking malignancy

Primary hyperparathyroidism is a disease characterized by excessive secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption of the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bony changes which is called Brown tumor. Skeletal manifestations in the form of Brown tumors are rare and according to literature occur in less than 2% of patients suffering from any form of hyperparathyroidism. Such rare and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present a case of a 23-year-old Indian woman who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of primary hyperparathyroidism.

Relevance of MRI in prediction of malignancy of musculoskeletal system-A prospective evaluation

BackgroundThe purpose of this study is to evaluate the role of MRI in musculoskeletal tumours, especially, in prediction of malignancy & to compare whether the diagnosis made on MRI correlates with the cytological/histopathological diagnosis.Methods50 consecutive patients presenting in the Outpatient and Inpatient department of the Department of Orthopaedics or Casualty of Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India were included in this study. They were subjected to MR examination on 1.5 Tesla superconducting system (MAGNETOM Avanto, Siemens). After localizer sequences, T1W and STIR images were obtained in longitudinal planes followed by T2W and post contrast T1W images in axial planes. Additional sequences were taken when required. Various imaging characteristics of tumours were evaluated statistically and their respective sensitivity and specificity in prediction of malignancy were obtained.ResultsFeatures associated with benign diagnosis in a large percentage of cases, are size less than 8 cm, sharp margination, homogeneous T2 signal, absence of oedema, necrosis, calcification and fluid-fluid levels. Similarly, malignant tumours are commonly associated with presence of irregular margins, inhomogeneous signal intensity, oedema, necrosis, haemorrhage, fascial penetration, bone changes and neurovascular involvement. A correct histological diagnosis is reached on the basis of imaging studies alone in 65% to 75% of cases. The sensitivity for a MRI diagnosis of malignant tumour was 95% and specificity was 84%.ConclusionDifferentiation of malignant from benign lesions of musculoskeletal system is best made by a combination of clinical and imaging parameters rather than by any single MR characteristic. When a lesion has a non-specific MR imaging appearance, it is useful to formulate a suitably ordered differential diagnosis based on tumour prevalence, patient age, and anatomic location. A systematic approach markedly improves diagnostic results.

Atypical multifocal hydatid disease of cranial vault: simultaneous orbital and extradural meningeal involvement.

Hydatid disease is endemic in regions where livestock is raised. Liver and lungs are the most commonly affected organs by the disease. Cranial vault and orbital hydatid disease is extremely rare. Signs and symptoms along with serological investigation are often inconclusive in cranial hydatid, making radiological diagnosis extremely important. Surgical removal of the cyst is the mainstay of treatment. Postoperative medical therapy, along with regular follow-up, is the key to detect any recurrence. We report an unusual case of cranial hydatid which showed diffuse scalp infiltration along with oribital and extradural extension.

Spontaneous spinal epidural hematoma during pregnancy: a rare obstetric emergency.

Spontaneous spinal epidural hematoma is a rare obstetric emergency which warrants immediate management to prevent permanent neurological deficit. Only 12 cases have been reported in the literature so far [1], and most of them are located in the dorsal epidural space. Hematomas in ventral epidural space are rare because the posterior longitudinal ligament is tightly adhered to the anterior dura while the dorsal epidural space is filled with fat [2]. We present a case of spinal epidural hematoma in pregnancy, restricted to the ventral epidural space.

Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning

OBJECTIVE To evaluate the role of cranial sonography and computed tomography in the diagnosis of neonatal intracranial hemorrhage and hypoxic-ischemic injury in an Indian set-up. METHODS The study included 100 neonates who underwent cranial sonography and computed tomography (CT) in the first month of life for suspected intracranial ischemia and hemorrhage. Two observers rated the images for possible intracranial lesions and a kappa statistic for interobserver agreement was calculated. RESULTS There was no significant difference in the kappa values of CT and ultrasonography (USG) for the diagnosis of germinal matrix hemorrhage/intraventricular hemorrhage (GMH/IVH) and periventricular leucomalacia (PVL) and both showed good interobserver agreement. USG, however detected more cases of GMH/IVH (24 cases) and PVL (19) cases than CT (22 cases and 16 cases of IVH and PVL, respectively). CT had significantly better interobserver agreement for the diagnosis of hypoxic ischemic injury (HII) in term infants and also detected more cases (33) as compared to USG (18). CT also detected 6 cases of extraaxial hemorrhages as compared to 1 detected by USG. CONCLUSION USG is better modality for imaging preterm neonates with suspected IVH or PVL. However, USG is unreliable in the imaging of term newborns with suspected HII where CT or magnetic resonance image scan is a better modality.

Bilateral Persistent Hyperplastic Primary Vitreous: A Close Mimic of Retinoblastoma

Bilateral persistent hyperplastic primary vitreous (PHPV) is a rare disorder of eye. It is one of the most important differential diagnoses of retinoblastoma, hence early and accurate diagnosis is important. We here report a case of an 11-month-old child which was referred to ocular OPD with complaints of bilateral leukocoria. Examination revealed greyish-white masses posterior to both lenses, raising the clinical suspicion of retinoblastoma. Ultrasonography demonstrated echogenic masses extending from the posterior surface of the lens to the optic disc with reduced axial lengths. These masses demonstrated flow on color Doppler evaluation. CT scan revealed hyperdense masses behind the lens without any evidence of intralesional calcification. Clinical features and imaging findings point towards the diagnosis of bilateral PHPV. PHPV is a developmental disorder of the globe in which the hyaloid vasculature fails to regress normally. While unilateral PHPV is common, bilateral PHPV is a rare entity. It is one of the most important conditions mimicking retinoblastoma; hence early and accurate diagnosis is required. Ophthalmological examination is still the best way to confirm the diagnosis. However, if the diagnosis remain unclear, further evaluation using ultrasonography, Color Doppler, and CT scan is useful.

Kirner's Deformity Misdiagnosed as Fracture: A Case Report.

Kirner`s deformity or dystelephalangy is a rare entity which presents with painless, progressive, bilateral radiovolar curving of the terminal phalanges of the little fingers. It is a clinicoradiological diagnosis. Herein, we present a case where the patient was being treated as having a fracture of the distal phalanx because of misdiagnosis of Kirner`s deformity. Given the rarity of the deformity, we believe it useful to present our case report as a contribution to the literature.

Neurocutaneous melanosis: Review of a rare non-familial neuroectodermal dysplasia with newer association of cerebellopontine angle cistern lipoma

Neurocutaneous melanosis is a rare neuroectodermal dysplasia with a grave prognosis. It is actually a disorder of neuronal migration at the time of the embryogenesis hence classified as a neurocristopathy. The patients are initially identified by the skin manifestations of the disease in the form of melanocytic naevus which can be hairy or non-hairy. These patients may or may not present with neurological symptoms but often show CNS abnormalities especially on MRI of the brain and the spine. A lot has been described about the disease since the first case described by Rokitansky in 1861, but every time a new CNS pathology is being added to the long list of currently documented pathologies. Herein we describe a case of a 5 yr old boy with seizures and hairy melanocytic naevus over the trunk and back who was diagnosed as a case of Neurocutaneous melanosis on subsequent evaluation by CT and MRI. We also describe the new association of CP angle cistern lipoma with neurocutaneous melanosis.

Neonatal sacrococcygeal teratoma with acute renal failure

Teratomas are germ cell tumours composed of multiple types of cells derived from more than a single germ cell layer. The most common site of an extragonadal teratoma is the sacrococcygeal region. We report a case of a 16-day-old female child with a large swelling in the sacrococcygeal region extending laterally into the buttocks with severely deranged renal functions. Ultrasonography and CT helped in making the diagnosis and, more importantly, to delineate the extent of the tumour and the involvement of adjacent organs and tissues: in our case, lower bilateral ureters. Imaging findings and clinical presentation led to the diagnosis of sacrococcygeal teratoma with renal failure.

Hydranencephaly: a rare cause of delayed developmental milestones

A 2-year-old female child presented with a history of delayed developmental milestones. According to her mother, the child was born out of a normal vaginal delivery and was apparently well after birth. However, by 6 months of age, the mother noticed that she was not interactive and did not recognise her. The child had failed to achieve head control by that time, but due to the ignorance and poverty of her family she did not get proper medical attention. At the time of presentation, she was still unable to recognise …