Itisha Bansal

Neonatal cranial sonography: ultrasound findings in neonatal meningitis—a pictorial review

Neonatal bacterial meningitis is a common manifestation of late onset neonatal sepsis. Cranial sonography (CRS) has a crucial role in assessment of infants with clinical suspicion of bacterial meningitis as well as follows up of its complications. CRS is performed with high frequency transducer through anterior fontanelle in both coronal and sagittal planes. Various sonographic findings range from echogenic and widened sulci, ventriculomegaly, ventriculitis, hydrocephalus, extra-axial fluid collections, cerebritis and brain abscess. Sonography is extremely beneficial in evaluating intraventricular contents, especially debris and intraventricular septations. Linear high frequency probe along with color Doppler interrogation are of utmost importance in evaluating extra-axial fluid collection and helps differentiating it from benign subarachnoid space enlargement. Due to low cost, easy portability, speed of imaging, no need for sedation and above all lack of ionizing radiation make it superior to other cross sectional imaging, like CT and MRI, in evaluation of these sick neonates. Apart from textbooks, there is paucity of recently available literature on cranial sonographic findings in neonatal meningitis. This article is written with an educational intent to review the spectrum of findings in neonatal meningitis, with stress on findings that will be beneficial in the clinical practice.

Some Stones Are Precious—Extraluminal Appendicoliths

Appendicoliths are commonly implicated in the etiopathogenesis of acute appendicitis. Extraluminal appendicoliths are not uncommon and are frequently encountered with ruptured appendicitis. The present image scenario focuses on the importance of identifying and subsequently retrieval of these extraluminal appendicoliths to prevent long-term complications, including intra-abdominal abscess.

Tennis Players and Water Polo Athletes Now Have Something in Common to Talk About: MRI Findings of Extensor Carpi Ulnaris Chronic Subsheath Injury

Pathologies of the extensor carpi ulnaris (ECU) tendon are often due to de Quervains tenosynovitis of the first dorsal compartment among the wrist tendon pathologies. A common cause for tendinitis and tenosynovitis of the ECU tendon is its dislocation. ECU dislocation is unique among all wrist tendon injuries due to its typical location within a fibro-osseous tunnel bordered by a fibrous sheath, which is termed as the subsheath. The subsheath is the main anatomic structure keeping the ECU tendon within the tunnel. Subsheath tears can lead to a fixed or dynamic pattern of ECU dislocation. This injury is more often seen in tennis players and golfers than in water polo athletes, as there are overall fewer water polo athletes when compared to tennis players and golfers. In this article, we will discuss the mechanisms, clinical presentation, magnetic resonance imaging (MRI) findings, differential diagnoses, and management options for chronic subsheath tears.

Kickboxing power hour: case report of fifth metatarsal apophysitis (Iselin disease) and its magnetic resonance imaging features

Youth now-a-days are getting more involved in mixed martial arts, with increasing number of cases of lateral foot pain due to various causes. The differential diagnoses of lateral foot pain in the pediatric population include avulsion fracture of the fifth metatarsal base, Jones fracture, diaphyseal stress fracture as well as os vesalianum pedis. We present a case of a 15-year-old athletic boy who presented with left lateral foot pain for a few weeks. The patient was actively involved in Kickboxing as well as active running. Left foot radiographs were normal, including normal radiographic appearance of the fifth metatarsal apophysis. Due to ongoing pain, magnetic resonance imaging of the left foot was performed, which revealed apophysitis of the fifth metatarsal, known as Iselin disease. Iselin disease has been postulated to be caused by traction on the fifth metatarsal apophysis by performing sidekicks or round kicks during the kickboxing practice. Iselin disease should be suspected in young children of 10-15 years age involved in physical activity presenting with lateral foot pain. Magnetic resonance imaging is extremely useful to correctly diagnose this condition and avoid misdiagnosis of a fracture.

Do we really care about incidental lung nodules?—Review of atypical lung carcinoid and a proposal for systematic patient follow up

Atypical lung carcinoids are intermediate-grade neuroendocrine tumors (NETs) with malignant potential. They are often detected incidentally on imaging done for non-related causes, as the patients are frequently asymptomatic. Histopathology is required to confirm the diagnosis with immunohistochemistry (IHC). Due to their indolent nature, these are often diagnosed only in the advanced stages. Treatment options include chemoradiation for widespread disease versus surgery for local or minimally invasive disease. This article describes a nonsmoker female with enlarging solitary pulmonary nodule who was initially lost to follow up, subsequently operated and with final pathology revealing atypical lung carcinoid. This case stress on the schematic follow up of these incidentally detected pulmonary nodules. Inspired from the mandatory lay mammography report letters recommended by ACR, this article proposes sending lay letters to patients for pulmonary nodule follow up, directly from the Radiology Department to reinforce the importance of timely follow up, which will complement the information provided to the patient from their primary care physician or pulmonologists office.

Modified palliative biliary stenting in situs inversus totalis patient with carcinoma gallbladder: feasibility and technical details

Knowledge of the anatomical variants is essential for all invasive hepatobiliary procedures such as endoscopy, surgery and radiologic interventions. Modification in standard therapeutic interventions may be required based on variant anatomy. We report a technical modification in a 75-year-old female with known situs inversus (SI) totalis with carcinoma gallbladder. Present case highlights the finer technical details of the modified percutaneous transhepatic biliary drainage (PTBD) procedure and biliary stenting in a SI patient with carcinoma gallbladder causing malignant biliary obstruction.

Penile fracture: role of ultrasound

Penile fracture is a rare surgical emergency which requires prompt diagnosis and immediate surgical repair. In most cases the diagnosis is clinical however, in equivocal cases ultrasound examination can help in establishing the diagnosis by demonstrating the site and extent of tunica albuginea disruption. In this article, we are presenting sonographic findings in two cases of penile fractures.

Poland Syndrome with Ipsilateral Hypoplasia of Gluteal Muscles and Contralateral Hidradenitis Suppurativa

Summary Background Poland syndrome (PS) is a rare congenital anomaly associated with absent or hypoplastic pectoralis major muscle and a wide spectrum of ipsilateral thoracic and upper extremity deformities. Hidradenitis suppurativa (HS) is a recurrent inflammatory follicular disease that commonly affects the apocrine-bearing skin and involves follicular occlusion and hyperkeratosis. Case Report We report a case of a 46-year-old male with a history of chronic recurrent hidradenitis suppurativa who was incidentally found to have a simple type of Poland syndrome with incidental hypoplasia of ipsilateral gluteal muscles. Conclusions Not only can PS present with HS, which we describe for the first time, but it is also associated with a wide variability of symptoms such as previously unknown co-existence of gluteal muscles hypoplasia.

Some Mushrooms are Hard to Digest: Gastrostomy Tube Exchange

Summary Background Percutaneous endoscopic gastrostomy (PEG) is an effective and safe mode of enteral nutrition for patients needing chronic enteric nutritional support. Exchanging PEG tubes may result in complications due to inexperience as well as due to lack of protocol. Case Report We encountered a 73 year-old female with unnoticed, accidently detached portion of the internal bumper of a PEG tube in the gastric lumen after a challenging gastrostomy tube exchange. Conclusions This case report discusses the complications associated with gastrostomy tube exchange and proposes a planned protocol for successful gastrostomy tube exchange.

Think outside the breast: Emergencies can present on screening mammogram!

A 53-year-old-female presented for annual screening mammogram. The technologist saw “something unusual” on the mammograms and asked the patient to wait; however, the patient was feeling uneasy and wanted to leave. Radiologist immediately looked at the screening mammogram, which revealed a few linear and curvilinear lucencies in the left axillary region (Figure 1). On physical examination, crepitus was palpated in bilateral axillary regions, chest wall and neck compatible with subcutaneous emphysema. Promptly frontal and lateral chest radiographs were obtained, which confirmed subcutaneous emphysema and unfolded the underlying mild pneumothorax and pneumomediastinum. The patient was transferred to the emergency department and a CT scan of the chest was performed. CT confirmed findings of bilateral mild pneumothorax, and better delineated pneumomediastinum and subcutaneous emphysema. The patient was admitted to ICU for further evaluation, which demonstrated interstitial lung with extensive lung fibrosis (Figure 2). This case highlights mammographic signs of air in the breast pneumomastia, which was due to extension of pneumothorax in this patient with chronic interstitial lung disease. Pneumomastia is frequently seen in postbreast biopsy mammograms for confirming the clip placement; however, we never think about the mammographic appearance of subcutaneous emphysema in the patient with