Mukul Bhatia

Clinical mimics of acute appendicitis: Is there any role of imaging?

Acute appendicitis (AA) is a common surgical emergency. Accurate and timely diagnosis of AA is essential for successful outcome. Imaging plays an important role in the diagnosis, exclusion of AA as well as diagnosing alternative clinical conditions which can closely simulate AA. A correct alterative diagnosis may obviate the need of unnecessary appendectomy or may even change the treatment regime altogether. This pictorial essay illustrates various clinical conditions which mimicked AA clinically during our day to day practice.

Septo-optic dysplasia: Magnetic Resonance Imaging findings

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient.

Bilateral Emphysematous Pyelonephritis

Emphysematous or gas forming infections, a very small percentage of bacterial infections of the urinary tract attract importance because of their life threatening potential. The spectrum of gas producing infections include emphysematous pyelonephritis, emphysematous pyelitis and emphysematous cystitis. The first case of ‘pneumaturia’ was reported in 1898 [1] and since then more than 200 cases of emphysematous pyelonephritis have been reported. Bilateral emphysematous pyelonephritis is much rarer infection with fewer than 10% emphysematous pyelonephritis. More than 90% of emphysematous pyelonephritis occurs in patients with poorly controlled diabetes [2]. This report represents this rare infection.

Tubercular spondylitis: A review of MRI findings in 80 cases

Background Tuberculosis of spine is known as tubercular spondylitis or Potts spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Potts spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. Methods In this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. Results Of the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21-40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. Conclusion Tubercular spondylitis or Potts spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Lunate dislocation causing median nerve entrapment

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.

Lissencephaly with agenesis of corpus callosum: A rare anomaly

Lissencephaly means smooth cerebrum with lack of normal convolutions of brain. It is a rare disorder caused by defect in migration of neurons, which occurs between 12 and 24 weeks of gestation period. The prevalence of type I lissencephaly in Netherlands was found to be 11.7 per million births. It may be associated with other developmental anomalies in brain, such as cerebellar hypoplasia and pachygyria, but its association with agenesis of corpus callosum is very rare. We present a case of lissencephaly with corpus callosal agenesis.

Lipoma of the quadrigeminal plate cistern

Lipoma is regarded as the commonest benign mesenchymal tumor of the body and is ubiquitous in distribution. Although lipomas constitute approximately 4–5% of all benign tumors of the body, intracranial lipomas are rare and account for a mere 0.1% of all primary brain tumors.1, 2 Although no age is exempt, the peak incidence is in the fifth and seventh decades with a male-female ratio of 2:1.3 Unlike their subcutaneous counterparts which attract attention due to their cosmetic effects, the intracranial lipomas usually remain asymptomatic unless they are large enough to produce symptoms due to mass effect. Intracranial lipomas are most often detected incidentally when imaging is performed for some other indication.

Boerhaave's syndrome

Iatrogenic causes such as upper gastrointestinal endoscopy, nasogastric tube insertion, caustic injury, and surgery are commonest causes of transmural esophageal perforation; less common iatrogenic causes include difficult endotracheal intubation, palliative intubation and noninvasive ventilation,1 and preparation for colonoscopy.2 When the transmural perforation occurs following forceful vomiting, it has been termed as spontaneous perforation also known as Boerhaaves syndrome.3 We report a case of spontaneous rupture of esophagus in an individual while having his meals.

Hypoxic-Ischemic brain injury in an adult: Magnetic Resonance Imaging findings.

Hypoxic–ischemic brain injury (HIBI) is not uncommon in day to day clinical practice. It occurs in cases of cardiac arrest that are revived by cardiac resuscitation. Though the diagnosis of HIBI in these patients is never in doubt due to the sequence of events, however imaging is done to assess the amount of damage and to prognosticate the outcome. We present here magnetic resonance imaging (MRI) findings in a case of severe hypoxic ischemic brain injury.

Neonatal hepatic abscess with resolving portal vein thrombosis

Hepatic abscess in a neonate is a rare but serious disorder. Diagnosis of hepatic abscess requires a high index of suspicion in any septic neonate. CT scan and ultrasound of liver are the most sensitive diagnostic tests in detection of hepatic abscess.1 Portal vein thrombosis is a rare complication of hepatic abscess and very few cases have been reported in English literature. Our case report highlights the difficulty in diagnosis of neonatal hepatic abscess and describes the development of portal vein thrombosis with complete resolution on treatment.