Jayashree Mohanty

Extracranial carotid doppler correlation to multidetector CT angiography in ischemic stroke patients

The purpose of this study was to compare the diagnostic value of Color Doppler Ultrasound (CDUS), Computed Tomographic Angiography (CTA), and advantage of their combined use in defining the degree of stenosis and morphological character of atheromatous plaque in ischemic stroke patients. This was a cross-sectional study with a total of 60 patients having 120 carotid arteries were observed. The percentage of stenosis was measured at the narrowest point by modified NASCET criteria for both CDUS & CTA. Incidence of stroke was highest in the age group 50-70years with male population commonly affected. Frequency of carotid stenosis was more in male patients aged above 60 years. Hemiparesis was most common symptoms in stroke patients. The various risk factors of carotid atherosclerosis and stenosis included hypertension, diabetes mellitus, hyperlipidemia and cardiovascular disease. Atheromatous plaques with stenosis were most commonly found on right side. Carotid bifurcation was the common site for atheromatous plaque .There was significant correlation between Color Doppler Ultrasound and Computed Tomographic Angiography for detecting 70-100% stenosis. However CTA is more accurate in comparison to duplex ultrasonography in detecting 70-99% stenosis and total occlusion. There was no significant correlation between CDUS and CTA in detecting 20-49% stenosis. Duplex ultrasonography is more sensitive in detecting these lesions. Out of 49 plaques, in this study 11 were soft plaques, 26 were non-homogenous and 13 were ulcerative plaques. Color doppler has better role in plaque characterization. Besides degree of extracranial stenosis, length of the stenosis, site of intracranial stenosis and total number of stenotic sites are better assessed by CTA. Area of effected brain parenchyma and extent of collateral circulation are better assessed by CTA which aids in prognostic value. In conclusion, the advantage of the combined use of CDUS and the CTA in the identification and quantification of ICA stenosis is higher. However ultrasound had a better role in plaque characterization.

A case of Bochdalek hernia in adult misdiagnosed as pulmonary tuberculosis

Received 12 November 2016 Revised 01 December 2016 Accepted 01 December 2016 Early online 18 December 2016 Print 31 January 2017 Bochdalek hernias are congenital defects resulting from the failure of posterolateral diaphragmatic foramina to fuse in utero. Usually it manifests in the neonatal period and occasionally in childhood. Symptomatic Bochdalek hernias in adults are infrequent and may lead to gastrointestinal dysfunction or severe pulmonary disease. Patients are initially investigated and treated for other diseases, therefore diagnosis is purely incidental. Herein, we are reporting a case of symptomatic Bochdalek hernia in an 18-year-old female misdiagnosed as pulmonary tuberculosis and treated accordingly, but with no improvement. This case illustrates importance of high index of clinical suspicion and role of computed tomography in avoiding misdiagnosis and occurrence of serious complication if not treated early. Corresponding author

DETERMINATION OF SENSITIVITY AND SPECIFICITY OF ULTRASONOGRAPHY IN ACUTE APPENDICITIS: COMPARISON WITH PER-OPERATIVE FINDINGS AND HISTOPATHOLOGICAL REPORT

Objective: This study was under taken to compare the ultrasonographic findings with pre-operative findings and histo-pathological report and to evaluate the sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography in the diagnosis of acute appendicitis. Methods: It was a prospective study done in the department of radio-diagnosis, SCBMCH, Cuttack. Patients with provisional diagnosis of acute appendicitis were subjected to ultrasound of abdomen and pelvis. Patients with positive USG findings were followed up for pre-operative findings and histo-pathological results. All the obtained data were tabulated and subjected to statistical analysis. Results: Among the 100 cases studied, 77 cases were proved as acute appendicitis based on surgical and histopathological results. Male to female ratio was 1.5:1. The disease was found to be more prevalent in second and third decade of life. Location of affected appendix was most commonly retro caecal. Mean diameter of the appendix was 8.56 mm. Target sign and non-compressible bowel loop was the most commonly detected ultrasonographic sign and the ultrasonographic sensitivity was 96.1% and specificity was 95.65% in our study. Conclusion: High resolution sonography with graded compression is a very useful diagnostic tool for diagnosis of appendicitis in problematic cases and in women in their reproductive period. It is also helpful in detecting complications of appendicitis and other abdominal diseases that mimic acute appendicitis.

Leiomyosarcoma of the prostate—an unexpected histopathological outcome

Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for >0.1% of all primary prostate malignancies. We report a case of a patient, presenting with recurrent episodes of dysuria, who had been diagnosed and operated for benign prostatic hyperplasia 1 month earlier, and now presented with similar symptoms postoperatively. Trans-rectal biopsy of the prostate was carried out and histopathology revealed leiomyosarcoma of the prostate.