Jayanth Keshavamurthy

Lead pipe sign in mixed inflammatory bowel disease

A middle-aged female with inflammatory bowel disease (IBD) (with mixed features of ulcerative colitis and Crohns disease), iron deficiency anaemia and recurrent Clostridium difficile colitis presented to the emergency department with complaints of abdominal pain, haematochezia and diarrhoea. An abdominal plain film obtained during her work-up demonstrated …

Egg and banana sign of severe pulmonary arterial hypertension

The egg and banana sign can be seen on chest computed tomography (CT) in patients with severe pulmonary arterial hypertension (PAH). It is identified by the presence of the pulmonary artery (PA) lateral to the aortic arch with the aortic arch being described as the banana and the PA as the egg.

A diagnostic challenge: An incidental lung nodule in a 48-year-old nonsmoker

A 43-year-old female with a medical history of renal stones, hypertension, diabetes mellitus Type 2, and depression presented to her urologist with bilateral flank pain. She complained of worsening exertional dyspnea over the last several months with recent weight gain. She also endorsed night sweats and intermittent, scant hemoptysis over the past year. She denied fever, chills, nausea, vomiting, diarrhea, constipation, hematuria, or excessive joint or muscle pain. Physical examination was unremarkable. Computed tomography scan of abdomen and pelvis demonstrated bilateral nonobstructing renal stones and a 1.8 cm × 1.7 cm nodular opacity in the right lower lobe of the lung, not present on previous scan 1 year prior. Surgical wedge resection was performed and subsequent pathologic examination demonstrated a 1.2 cm × 0.6 cm × 0.5 cm soft, gelatinous well-demarcated mass in the right lower lobe wedge specimen without gross evidence of necrosis or hemorrhage confirming colloid adenocarcinoma of the lung.

Primary spontaneous pneumothorax in conjunction with Marfan syndrome

A 25-year-old man with a history of Marfan syndrome, asthma and smoking presented with worsening dyspnoea and right-sided chest pain worsened with deep breathing after a fall 2 days prior. Diagnostic imaging revealed a spontaneous right-sided pneumothorax due to ruptured subpleural bullae in the apex of the right lung. Smaller subpleural bullae were also noted in the apex of the left lung. A chest tube was placed to reduce the right pneumothorax successfully.

Imaging evaluation of catheter integrity prevent potentially fatal complication of pinch-off syndrome: illustration of two cases

Peripherally inserted central catheters (PICC) and implantable venous access devices with an attached catheter such as a Port-A-Cath are common types of central venous catheters (CVC) that are used to deliver chemotherapy and other medications. Subclavian vein (SVC) access for CVC, although widely practiced, presents risks for catheter complications such as the compression of the catheter in the space anterior to the first rib and posterior to the clavicle (1). This compression is rated on a scale of grades 0 to 3 pinch-off syndrome (POS). Grade 0 exhibits a regular catheter course without luminal narrowing; grade 1 exhibits an altered catheter course without luminal narrowing; grade 2 exhibits luminal narrowing; and grade 3 exhibits catheter fracture (2). POS may present with pain or swelling of the shoulder region but patients may also be asymptomatic (3). Additionally, POS can be an incidental finding seen on a chest X-ray (4). Regardless, clinicians should suspect a possible POS if there is patient-reported pain or an abnormal catheter pathway seen on a chest X-ray. Further investigation via radiographic or fluoroscopic evaluation is warranted. Early detection of POS requires only catheter replacement but failure to intervene may result in life-threatening complications caused by catheter fragmentation. In such cases, pieces of the catheter may break off to cause ventricular tachycardia, vessel embolization, and cardiac perforation (5-7). In this report, we discuss two cases of grade 3 POS that were detected based on clinical and radiographic signs.

Case-based approach to demonstrate utility of cardiac magnetic resonance imaging (MRI) for planning biventricular repair with inconclusive echo: Illustration of two cases

Congenital heart defects that present earlier in life and involving a hypoplastic ventricle are sometimes channeled towards single-ventricle repair because of anatomical or logistic challenges (1). With the single-ventricular repair, the final result is the shunting of venous return directly into the pulmonary artery and the utilization of the functioning ventricle for systemic circulation (2). Though singleventricular repair has remarkable short-term results, long-term survivors experience declines in exercise tolerance, heart failure, arrhythmias, and thromboembolic complications (3). Given long-term functional and survival advantages of a two-ventricle circulation, exploring feasibility of biventricular repair is essential for improving prognosis. However, a successful biventricular repair requires sufficiently functioning ventricles to sustain a balanced flow through the pulmonary and systemic circuit. To evaluate the functional adequacy of the ventricle with hypoplasia, echocardiogram is conventionally used.

Classic plain radiographic signs of monoarticular chronic haemophilic arthropathy

A 50-year-old man with haemophilia A had knee radiographs performed while being worked up for chronic knee pain. The radiographs showed classic features of monoarticular chronic haemophilic arthropathy of the right knee joint. These features are listed below and labelled in figures 1 and 2: 1. Widened intercondylar notch. Note the discrepancy in interchondylar notch width between the left and right knee. 2. Flattening …

Dural ectasia as an incidental finding on MRI in a patient with Marfan syndrome

A 48-year-old female with a history of Marfan syndrome and type A aortic dissection repaired with valve-sparing aortic root replacement and stable residual type B aortic dissection presented for surveillance MR angiography. At that time, dural ectasia was appreciated as an incidental finding with MRI showing high T2-weighted multilobar cerebrospinal fluid (CSF) spaces within the lower sacrum (figures 1 and …

Fibrinolytic administration via EKOS catheter used in pulmonary embolism

A 69-year old bed-bound woman presented with chest pain and diaphoresis. Diagnostic imaging led to the diagnosis of bilateral extensive pulmonary emboli extending into all segmental branches. Tissue plasminogen activator (tPA) was administered via 2 separate EKOS catheters. Repeat evaluation after 33 hours revealed improvement of right ventricular size and function. EKOS catheters are useful for administration of fibrinolytics in pulmonary embolism.

A Case Report of Patients with Persistence of Sciatic Artery

Persistence of sciatic artery is a rare vascular anomaly with an incidence of 0.03 to 0.06%. It has a high incidence of complications such as aneurysm formation and ischemia, either of which may lead to an amputation in 8%. We report three cases with incidental findings of persistence of sciatic arteries, which two of them were previously treated. One of our cases had additional vascular variants of a common trunk between the right brachiocephalic artery, a right hepatic artery branching from the superior mesenteric artery, and a left hepatic artery branching from the left gastric artery. This association was not previously reported and we postulate that there may be a link between these variants during the vascular embryogenesis.