Karan Manoj Anandpara

Wandering Spleen with Torsion Causing Pancreatic Volvulus and Associated Intrathoracic Gastric Volvulus: An Unusual Triad and Cause of Acute Abdominal Pain

CONTEXT Wandering spleen is a rare medical entity in which the spleen is orphaned of its usual peritoneal attachments and thus assumes an ever wandering and hypermobile state. This laxity of attachments may even cause torsion of the splenic pedicle. Both gastric volvulus and wandering spleen share a common embryology owing to maldevelopment of the dorsal mesentery. Gastric volvulus complicating a wandering spleen is, however, an extremely unusual association, with a few cases described in literature. CASE REPORT We present a case of a young female who presented with acute abdominal pain and vomiting. Radiological imaging revealed a intrathoracic gastric volvulus, torsion in an ectopic spleen, and additionally demonstrated a pancreatic volvulus - an unusual triad, reported only once, causing an acute abdomen. CONCLUSION The patient subsequently underwent an emergency surgical laparotomy with splenopexy and gastropexy.

Prenatal diagnosis of hypophosphatasia congenita using ultrasonography

Congenital hypophosphatasia is a rare fatal skeletal dysplasia. Antenatal determinants of Epub ahead of print lethality include small thoracic circumference with pulmonary hypoplasia and severe micromelia. These features were present in the fetus of a 25-year-old female who came for an anomaly scan in her second trimester of pregnancy. Additional findings of generalized demineralization and osteochondral spurs led to the diagnosis of hypophosphatasia congenita. The pregnancy was terminated, and the findings were confirmed on autopsy. Common differential diagnoses with clues to diagnose the above mentioned condition have been discussed here. Early and accurate detection of this medical condition is important as no treatment has been established for this condition. Therefore, antenatal ultrasonography helps in diagnosing and decision making with respect to the current pregnancy and lays the foundation for the genetic counseling of the couple.Congenital hypophosphatasia is a rare fatal skeletal dysplasia. Antenatal determinants of Epub ahead of print lethality include small thoracic circumference with pulmonary hypoplasia and severe micromelia. These features were present in the fetus of a 25-year-old female who came for an anomaly scan in her second trimester of pregnancy. Additional findings of generalized demineralization and osteochondral spurs led to the diagnosis of hypophosphatasia congenita. The pregnancy was terminated, and the findings were confirmed on autopsy. Common differential diagnoses with clues to diagnose the above mentioned condition have been discussed here. Early and accurate detection of this medical condition is important as no treatment has been established for this condition. Therefore, antenatal ultrasonography helps in diagnosing and decision making with respect to the current pregnancy and lays the foundation for the genetic counseling of the couple.

Radiological Illustration of Spontaneous Ovarian Hyperstimulation Syndrome

Summary Background The role of radiology is of utmost importance not only in diagnosing s-OHSS but also in ruling out other cystic ovarian diseases and to determine the underlying etiology and course of the disease. We presented a radiological algorithm for diagnosing the various causes of s-OHSS. Case Report A 26-year-old female, gravida one was referred to radiology department with history of lower abdominal pain, nausea and vomiting since 2 days which was gradual in onset and progression. The patient had no significant medical and surgical history. Conclusions This article illustrates and emphasizes that diagnosis of s-OHSS and its etiology can be completely evaluated radiologically. Biochemical markers will confirm the radiological diagnosis.

Imaging findings in lipoma arborescens

A 27-year-old man presented with painless swelling of the right knee of 4 months’ duration. There was no history of trauma or other joint involvement. The patients serum rheumatoid factor was negative. Radiograph of the knee revealed increased lucency in the prefemoral region (figure 1A). Ultrasonography depicted echogenic, frond-like hypertrophy of the synovium in the suprapatellar bursa (figure 1B). This hypertrophied synovium was of low density on CT (figure 1C). Additionally, there was mild joint effusion. MRI depicted a T1 and T2 hyperintense synovial mass (figure 2A), villous and globular in …

Juvenile Granulosa Cell Tumour of the Ovary with Unilocular Pure Cystic Presentation: A Case Report and Review of Literature

Summary Background Granulosa cell tumours of the ovary are rare, hormonally active, oestrogen-secreting tumours of the ovary existing in two forms: the adult form and the even rarer juvenile form. These tumours present as predominantly solid lesions while the cystic, unilocular presentation is uncommon. Case Report We present an 18-year-old unmarried girl who presented with complaints of chronic pain, abdominal distension and presence of facial hair. Radiological examination revealed a large, purely cystic, unilocular lesion without any solid components, debris or septations. Histopathological diagnosis was of a juvenile granulosa cell tumour. Conclusions Radiological criteria suggestive of malignant ovarian masses include thick, irregular walls and septae; papillary projections and solid, echogenic foci. Nonetheless, we propose that a malignant ovarian lesion should be included in the differential diagnosis of a unilocular, purely cystic ovarian lesion.

Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia.

Summary Background Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. Case Report We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. Conclusions Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis.

Imaging in median arcuate ligament syndrome.

An 18-year-old man presented with a 7-month history of abdominal pain, particularly in the epigastrium, and weight loss of 14 pounds. Symptoms were aggravated post meals. An abdominal sonogram, upper gastroendoscopy and colonoscopy, were inconclusive. A contrast-enhanced CT of the abdomen revealed kinking of the proximal coeliac artery due to the median arcuate ligament, creating a hooked appearance with post-stenotic dilation (figure 1). A repeat sonography with Doppler revealed a normal calibre coeliac artery in inspiration with a peak systolic velocity (PSV) of 147 cm/s (figure 2 …

CT findings in Fahr's disease

A 65-year-old man presented to our services with features of dementia and movement disorder for 2 years. The symptoms had worsened over the past month with development of auditory hallucinations. CT demonstrated extensive calcification in bilateral basal ganglia, grey–white matter junctions and dentate nuclei. Serum calcium, phosphate and parathormone levels were normal. Fahrs disease was diagnosed based on the clinical and imaging findings. Fahrs disease is an autosomal dominant inherited disorder characterised by basal ganglia and extraganglionic calcification, extrapyramidal symptoms and psychosis.1 Usual age of presentation is 40–60 years with no gender predilection. …

Classical imaging findings of Dyke-Davidoff-Masson syndrome

A 14-year-old girl, known case of seizure disorder since 10 years and mild mental retardation, presented with progressive left-sided hemiparesis and a recent increase in the frequency of seizures. Significant history included a developmental lag. A CT of the brain revealed marked cortical hemiatrophy on the right side with prominence of ipsilateral ventricular system (figure 1). Neuroparenchymal changes were accompanied with ipsilateral calvarial thickening and hyperpneumatisation of the paranasal …

Large Solitary Pulmonary Cryptococcoma Mimicking Lung Carcinoma in an Immunocompetent Patient

Cryptococcosis is a life-threatening mycosis typically seen in immunocompromised patients. Pulmonary cryptococcosis generally presents as multiple or solitary nodular opacities. Cryptococcal infection presenting as a destructing cavernoma (cryptococcoma) without diffuse infiltration of the lung is an extremely rare presentation, even in immunocompromised patients. This report presents a healthy, HIV negative, immunocompetent patient who presented with a large solitary lung mass provisionally diagnosed as a lung malignancy on radiological imaging that proved to be a large cryptococcoma after biopsy. The patient was treated with liposomal Amphotericin B and fluconazole, and the lesion showed regression on serial imaging. This case report thus highlights an unconventional presentation of pulmonary cryptococcosis in an immunocompetent individual.