Raju A. George

Computed tomographic demonstration of unusual ossification of the falx cerebri: a case report

Bony metaplasia of the falx cerebri is rare in human being. We describe a case of extensive ossification involving anterior half of the falx cerebri in a 47-year-old male. This was detected incidentally during computed tomographic examination of the brain for an unrelated cause. The pattern of ossification as demonstrated in the computed tomography scan comprised of dense cortical bone peripherally with medullary bone in the centre resembling the skull vault.

Congenital high airway obstruction syndrome—antenatal diagnosis of a rare case of airway obstruction using multimodality imaging

Received: 16.12.2010; Accepted: 19.09.2011 doi: 10.1016/S0377-1237(11)60111-1 An MRI study was carried out on a 1.5 Tesla scanner (Symphony, Siemens AG, Germany) using T2 weighted (halfFourier acquisition single shot turbo spin echo [HASTE]; TR 4.3 ms, TE 2.15 ms) and TrueFISP (TR 1000 ms, TE 83 ms) sequences in sagittal, coronal, and axial planes which showed large markedly hyperintense lungs (as compared to foetal skeletal muscle) causing inversion of the diaphragms. The dilated trachea was exquisitely demonstrated as increased signal with a gap at the level of the larynx. The cardiac findings and ascites were also confirmed and no additional anomaly could be demonstrated (Figure 2). Based on ultrasound and MRI findings, diagnosis of CHAOS due to laryngeal atresia was made. The parents were counselled regarding the relatively poor prognosis and the pregnancy was terminated.

Temporal evolution of emphysematous pyelonephritis in a renal allograft: imaging findings

Emphysematous pyelonephritis (EPN) is a rare, lifethreatening infection of the kidney characterized by the presence of gas within the renal parenchyma, renal collecting system, and perinephric tissue. It is usually seen in elderly diabetic patients. Although rare, EPN in a renal transplant allograft is a serious and potentially fatal complication. Management of EPN in a graft kidney has been a subject of controversy. Traditionally, graft nephrectomy has been the standard treatment of choice in such cases. Recently, there have been reports of successful nonsurgical management of EPN [1–4]. We describe the imaging findings of temporal evolution of EPN in a renal allograft recipient who was managed successfully with medical treatment alone.

Imaging in acute appendicitis: What, when, and why?

Acute appendicitis (AA) is the commonest cause of pain abdomen requiring surgical intervention. Diagnosis as well as management of acute appendicitis is mired in controversies and contradictions even today. Clinicians often face the dilemma of balancing negative appendectomy rate and perforation rate if the diagnosis is based on clinical scoring alone. Laboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article.

Virtual bronchoscopy in the era of multi-detector computed tomography: Is there any reality?

Virtual bronchoscopy, in conjunction with axial and MPR MDCT images, can enhance diagnostic accuracy of tracheo-bronchial endoluminal pathologies. We describe a few cases highlighting the utility of virtual bronchoscopy in the diagnosis of varied tracheo-bronchial pathologies encountered in the setting of a tertiary care Armed Forces Hospital of India.

Pulmonary metastases: a rare cause for pulmonary artery invasion and in situ pulmonary artery thrombosis—demonstration with multidetector computed tomography

Received: 25.08.2011; Accepted: 07.09.2011 doi: 10.1016/S0377-1237(11)60115-9 parameters were within normal limits. Systemic examination did not reveal any significant abnormality. On local examination, she was found to have a firm, mildly tender subcutaneous swelling measuring approximately 4 cm × 2 cm on the medial Pulmonary metastases: a rare cause for pulmonary artery invasion and in situ pulmonary artery thrombosis— demonstration with multidetector computed tomography

An unusual case of malignant oesophago-pulmonary fistula diagnosed by multidetector computed tomography

Acquired oesophago-respiratory fistulae are a well-known complication of oesophageal carcinoma. Most of these are either oesophago-tracheal or oesophago-bronchial fistulae. However, oesophago-pulmonary fistulae have also been rarely reported. We present a case of oesophago-pulmonary fistula secondary to oesophageal carcinoma where the diagnosis was made by multidetector computed tomography (MDCT) with the assistance of three-dimensional (3D) imaging reconstruction.

High Resolution Multi Detector Computed Tomography of Temporal Bone: Our Experience in a Tertiary Care Service Hospital

High resolution multi detector computed tomography (HRMDCT) is an excellent tool for evaluation of a variety of congenital and acquired conditions affecting the temporal bones. We describe our experience of HRMDCT of temporal bones of 145 patients in a tertiary care and teaching hospital of Armed Forces Medical Services of India over a period of three and half years. Hearing loss was the most frequent indication for HRMDCT and congenital bilateral profound sensorineural hearing loss for evaluation prior to possible cochlear implant formed the single largest group (62, 42%) among all indications for HRMDCT of temporal bones. Major vestibule-cochlear and semicircular canal anomalies were noted in 11 such cases. Seven patients of microtia were studied and all had positive CT scan findings. All patients of vertigo had normal HRCT study. Extent of temporal bone injuries and inflammatory conditions were clearly delineated in all cases. Thinner collimations allowing image reconstructions in planes of anatomical interest with near isotropic resolution has been a major advantage of HRMDCT of temporal bones.

Intravenous urography supplemented with computerised tomography urogram: A pragmatic hybrid imaging approach to hydronephrosis

Background: Image quality in an Intravenous Urogram (IVU) can occasionally be compromised by variables like bowel preparation, renal function and radiographic factors, posing a challenge to all Uroradiologists. The Computerised Tomography Urogram (CTU) yields better diagnostic information than an IVU, due to its inherent superior anatomic delineation and contrast sensitivity, against a trade-off involving radiation dose and cost. Our study was conducted to assess the utility and timing of performing a single-phase CTU, as a problem-solving tool, to clear the diagnostic dilemma in a selected subset of patients, in whom an ongoing IVU could potentially be inconclusive. Material and Methods: Five hundred and twelve patients who underwent IVU studies for urologic referrals at a tertiary care hospital, during the period of January to December 2009, formed the subject of the study, of whom 33 patients with inconclusive IVU findings after the first three radiographs underwent a single-phase CTU, to reach definitive imaging diagnoses. Results: The percentage of inconclusive IVU studies amounted to only 33 / 512 (6.4%), in whom a CTU study revealed definitive diagnoses in 30 patients and no abnormality in three patients, thus conclusively clearing the ambiguities raised on the IVU in all the selected patients. Conclusions: The concept of a CTU limited to a single-phase study to supplement an inconclusive IVU optimizes the contrast and radiation dose to the affected patients. It is a cost-effective, timely, and definitive ‘imaging intervention’ and should be considered a viable hybrid technique to be utilized selectively and judiciously.

Bilateral first rib fractures with pseudoarthrosis in a weight lifter

Fractures of the first rib from direct blunt trauma are quite rare and are usually associated with major chest and abdominal injuries.1 Isolated fractures of the first rib as a result of various sports activities have been described in several reports.2, 3 There are very few reports of stress fracture of the first rib in weight lifters.4 We report a rare case of bilateral first rib fracture with resultant pseudoarthrosis in a young weight lifter. We also discuss the role of multi-detector computed tomography (MDCT) in the evaluation of such cases and review pertinent literature.