Rajul Rastogi

Pictorial essay: Salivary gland imaging.

Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy: A rare clinicoradiologic case

Pachydermoperiostosis (PDP) or primary hypertrophic osteoarthropathy is a rare syndrome with diverse radiological and clinical features. Though the diagnosis can be made on the basis of the classic clinical and radiological features, it is often missed due to variable presentations. A case of PDP that presented with dental complaints and had almost all the clinical and radiological features described in literature is reported. We also discuss the differential diagnosis.

Ultrasonography with color Doppler and power Doppler in the diagnosis of periapical lesions

Aim: To evaluate the efficacy of ultrasonography (USG) with color Doppler and power Doppler applications over conventional radiography in the diagnosis of periapical lesions. Materials and Methods: Thirty patients having inflammatory periapical lesions of the maxillary or mandibular anterior teeth and requiring endodontic surgery were selected for inclusion in this study. All patients consented to participate in the study. We used conventional periapical radiographs as well as USG with color Doppler and power Doppler for the diagnosis of these lesions. Their diagnostic performances were compared against histopathologic examination. All data were compared and statistically analyzed. Results: USG examination with color Doppler and power Doppler identified 29 (19 cysts and 10 granulomas) of 30 periapical lesions accurately, with a sensitivity of 100% for cysts and 90.91% for granulomas and a specificity of 90.91% for cysts and 100% for granulomas. In comparison, conventional intraoral radiography identified only 21 lesions (sensitivity of 78.9% for cysts and 45.4% for granulomas and specificity of 45.4% for cysts and 78.9% for granulomas). There was definite correlation between the echotexture of the lesions and the histopathological features except in one case. Conclusions: USG imaging with color Doppler and power Doppler is superior to conventional intraoral radiographic methods for diagnosing the nature of periapical lesions in the anterior jaws. This study reveals the potential of USG examination in the study of other jaw lesions.

Isolated pancreatic hypoplasia: A rare but significant radiological finding

Pancreatic hypoplasia refers to underdevelopment of pancreatic parenchyma which arises from either the ventral or dorsal anlage. Pancreatic hypoplasia secondary to agenesis of the dorsal pancreas is a rare congenital anomaly, with less than 20 cases reported till date.[1,2] Though the majority of these patients present with abdominal pain (which is either nonspecific or typical of pancreatitis) or diabetes mellitus, the disorder may rarely remain quiescent and be detected only incidentally.[2] Agenesis of the dorsal pancreas is usually associated with various anomalies, such as polysplenia syndrome, wandering spleen, interruption of the inferior vena cava, hemiazygos and azygos continuation, symmetrical liver, anomalous hepatic fissure or lobe, left-sided inferior vena cava, median gall bladder, inverted gallbladder and stomach, and intestinal malrotation; there may also be a combination of multiple visceral anomalies.[3] In this article, the authors report a rare case of hypoplasia of the pancreas that was detected incidentally on imaging; there was no other coexisting anomaly or complication. The case is reported because of its rarity. The emphasis is on the differential diagnosis, coexisting anomalies, and complications. A 45-year-old alcoholic, nondiabetic male patient with clinical hepatomegaly and an unremarkable past medical history came for ultrasonography of the abdomen. Laboratory tests, including blood glucose levels, HbAlc levels, liver function tests, and kidney function test were within normal limits. Ultrasonography revealed mild hepatomegaly with grade I fatty infiltration. The pancreas body and tail were not optimally visualized; however, the head of the pancreas appeared normal. The main pancreatic duct was not dilated. Contrast-enhanced computed tomography (CT) of the abdomen revealed complete absence of the neck, body, and tail of the pancreas [Figure 1]. The head of the pancreas, though normal in attenuation and pattern of enhancement, appeared flattened and truncated at the anterosuperior part [Figure 2]. Mild hepatomegaly was also noted. The other intra-abdominal structures, including the spleen, gall bladder, and inferior vena cava appeared unremarkable. Figure 1 Axial contrast-enhanced CT image shows absence of neck, body, and tail of the pancreas; there is a truncated head (black arrow) Figure 2 Axial contrast-enhanced CT image shows a normalappearing truncated head with a normal-appearing uncinate process (black arrow) Based on the clinical and CT findings, we arrived at the diagnosis of isolated, uncomplicated, agenesis of the dorsal pancreas or hypoplasia of the pancreas secondary to agenesis of the dorsal pancreas. Pancreatic hypoplasia refers to congenital underdevelopment of pancreas and is often referred to as partial agenesis of the pancreas; this agenesis can involve the ventral or dorsal anlage. Figure 3 shows the ventral and dorsal buds from which the head; and neck, body and tail of the pancreas, respectively, develop. When the dorsal bud fails to develop, agenesis of the dorsal pancreas results. Agenesis of the dorsal pancreas is more common than ventral agenesis. Complete agenesis of the pancreas is extremely rare and is incompatible with life.[1] Severe hypoplasia of the pancreas can be associated with mutations involving the HNF1β gene. Figure 3 Schematic figure shows embryonic development of pancreas from the ventral and dorsal buds arising from either side of the duodenum The common clinical presentation is abdominal pain, which may be nonspecific or secondary to pancreatitis. Recurrent pancreatitis is quite common.[2] Many patients present with diabetes mellitus.[4] Sometimes, the patient may present with steatorrhea or other signs of exocrine insufficiency.[5] Imaging in a case of agenesis of the dorsal pancreas reveals a short and truncated head of pancreas, with absence of the neck, body, and tail of the organ. Based on endoscopic retrograde cholangiopancreatography (ERCP), absence of the dorsal anlage is categorized as complete (when the duct of Santorini and the minor duodenal papilla are absent) and partial (when they are remnant).[1] ERCP and magnetic resonance cholangiopancreatography will show a short ductal system in the ventral pancreas, with absence of any ductal system in the body and tail region.[5] Important differential diagnoses are carcinoma of head of pancreas with secondary atrophy of the distal body and tail of pancreas, pancreatic lipomatosis (fatty replacement of pancreatic parenchyma), and pancreatic divisum. All can be differentiated easily by imaging. Treatment is not required in asymptomatic patients.[5]

Fahr's syndrome: a rare clinico-radiologic entity

Fahrs syndrome is a genetically dominant, degenerative disorder characterised clinically by multiple neurological and psychiatric symptoms occurring secondary to calcification in brain parenchyma with subsequent neuronal loss. Presence of bilateral and symmetrical intracerebral calcifications in the basal ganglia, thalamus, dentate nucleus and centrum semiovale region due to unknown aetiology is referred to as Fahrs disease or idiopathic striopallidodentate calcinosis. Fahrs syndrome includes Fahrs disease as well as secondary causes of striopallidodentate calcinosis.1, 2 Though the disease can present in childhood or adolescence the usual age of presentation is 4th–5th decade.

Esophagobronchial fistula - A rare complication of aluminum phosphide poisoning

Aluminum phosphide is a systemic lethal poison. Fistulous communication between esophagus and airway tract (esophagorespiratory fistula) has rarely been reported in the survivors of aluminum phosphide poisoning. We report a case of benign esophagobronchial fistula secondary to aluminum phosphide poisoning, which to best of our knowledge has not been reported in the medical literature.

Role of imaging in female infertility [Dr. K.M. Rai Memorial Oration Award]

Infertility in females is multifactorial in origin. Though hysterolaparoscopy is the gold-standard investigation, USG is usually the first-line investigation. MRI has expanded the usefulness of imaging in female infertility. This pictorial essay reviews the role of imaging in the evaluation of female infertility.

Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen.

Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.

Rectal Carcinoma with Osteosclerotic Metastases-A Rare Occurrence

Colorectal carcinoma is one of the most deadly cancers worldwide. Osseous metastases are unusual until late in the disease and usually follow hepatic & pulmonary metastases. Osseous metastases in rectal carcinoma are usually osteolytic or mixed with a minor proportion presenting solely as osteosclerotic metastases. In this article, we present a rare case of rectal carcinoma showing pure, multifocal, osteosclerotic metastases at first diagnosis without any pulmonary/hepatic metastases emphasizing the role of osseous evaluation in all patients whether early or late in the disease.

Osteoid Osteoma of Petrous Bone: A Rare Cause of SensorineuralDeafness

Osteoma of temporal bone is a rare benign neoplasm commonly arising from mastoid bone. Rarely, it may arise from petrous bone in cerebellopontine angle producing sensorineural hearing loss. This article describes computed tomography scan (CT scan) and magnetic resonance imaging (MRI) findings in a rare case of petrous bone osteoid osteoma producing ipsilateral sensorineural deafness.