Shagufta Wahab

Children with significant cervical lymphadenopathy: clinicopathological analysis and role of fine-needle aspiration in Indian setup

OBJECTIVE To study the clinicopathological profile of children from India with cervical lymphadenopathy and the role of fine-needle aspiration cytology with special emphasis on tuberculosis as a cause. METHODS A total of 89 children in the age group of 10 months to 12 years, presenting to our hospital from April 2004 to March 2005, were included. All the patients underwent thorough clinical and investigational assessment vis-à-vis cervical lymphadenopathy. Outcome measurements included clinical status and ability of conventional tests to categorize different types of lymphadenopathy and their utility in diagnosing tubercular lymphadenitis. Interobserver variability was analyzed measuring kappa test and was found to be in agreement. RESULTS Reactive hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen staining, histopathology and culture in combination were able to perform the diagnosis in 85.7% of cases affected with tubercular etiology. CONCLUSIONS Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is non-diagnostic.

Relevance of MRI in prediction of malignancy of musculoskeletal system-A prospective evaluation

BackgroundThe purpose of this study is to evaluate the role of MRI in musculoskeletal tumours, especially, in prediction of malignancy & to compare whether the diagnosis made on MRI correlates with the cytological/histopathological diagnosis.Methods50 consecutive patients presenting in the Outpatient and Inpatient department of the Department of Orthopaedics or Casualty of Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, India were included in this study. They were subjected to MR examination on 1.5 Tesla superconducting system (MAGNETOM Avanto, Siemens). After localizer sequences, T1W and STIR images were obtained in longitudinal planes followed by T2W and post contrast T1W images in axial planes. Additional sequences were taken when required. Various imaging characteristics of tumours were evaluated statistically and their respective sensitivity and specificity in prediction of malignancy were obtained.ResultsFeatures associated with benign diagnosis in a large percentage of cases, are size less than 8 cm, sharp margination, homogeneous T2 signal, absence of oedema, necrosis, calcification and fluid-fluid levels. Similarly, malignant tumours are commonly associated with presence of irregular margins, inhomogeneous signal intensity, oedema, necrosis, haemorrhage, fascial penetration, bone changes and neurovascular involvement. A correct histological diagnosis is reached on the basis of imaging studies alone in 65% to 75% of cases. The sensitivity for a MRI diagnosis of malignant tumour was 95% and specificity was 84%.ConclusionDifferentiation of malignant from benign lesions of musculoskeletal system is best made by a combination of clinical and imaging parameters rather than by any single MR characteristic. When a lesion has a non-specific MR imaging appearance, it is useful to formulate a suitably ordered differential diagnosis based on tumour prevalence, patient age, and anatomic location. A systematic approach markedly improves diagnostic results.

Macrodystrophia lipomatosa: four case reports

AimMacrodystrophia lipomatosa is a rare cause of gigantism of limb which can be confused with other common causes like congenital lymphedema. It presents usually with loss of function and cosmetic problems. Four cases are described with emphasis on clinical presentation, differential diagnoses, imaging and treatment options.Methods & ResultsFour patients of macrodystrophia lipomatosa were thoroughly examined and subjected to investigations.ConclusionBesides diligent clinical examination, imaging and histopathology are crucial in clinching the diagnosis.

Left-sided strangulated Amyand’s hernia presenting as testicular torsion in an infant

The finding of an appendix in the hernial sac is termed Amyand’s hernia. There have been a few reports of perforated appendix in the hernial sac (right-sided) mimicking testicular torsion. We report an extremely rare case of a left-sided inguinal hernial containing sac containing perforated appendix which was never thought of in the preoperative assessment.

Isolated retroperitoneal hydatid cyst in a child: a rare cause of acute scrotal swelling?

Hydatidosis affects almost every region of the body. Although adults are mostly affected, children also suffer from the disease especially in endemic areas. The usual affected location is the liver, lung, spleen, brain, and kidney. We report a hydatid cyst located in a retroperitoneal location presenting with a sudden scrotal extension in a 7-year-old child. The finding presented a diagnostic dilemma vis-à-vis obstructed inguinal hernia.

Fibromatosis Colli: A Case Report

Fibromatosis colli or sternocleidomastoid tumor of infancy is a condition of benign proliferation of fibrous tissue within the sternocleidomastoid muscle leading to focal or diffuse enlargement of the sternocleidomastoid muscle and is often clinically associated with torticollis. Radiological imaging especially ultrasound, if performed by an expert radiologist plays an important role in differentiating this benign condition from other causes of neck masses in this age group, thereby preventing unnecessary investigations in a neonate and decreasing parent`s anxiety. We hereby, present a case report of a sternomastoid tumor in a two week old neonate diagnosed using high frequency ultrasound, signifying that every physician should be aware of this clinical entity in a neonate and refer them immediately for ultrasound.

Vein of Galen malformation

An 8-month-old baby boy presented to the paediatrics outpatient department with a complaint of enlargement of head size. General and cardiovascular examinations, as well as routine biochemical analysis were within normal limits. There was no evidence of skin lesions to suggest capillary malformation neither there was any limb hypertrophy, also there was no history of skin lesions, limb hypertrophy or vascular malformations in the family. Skull ultrasound (USG) done outside reported a heterogeneous, predominantly hypoechoic lesion in region posterior to third ventricle with dilated lateral and third ventricle and normal-sized fourth ventricle suggestive of obstructive hydrocephalus. Slow flow was …

Neonatal Intracranial Ischemia and Hemorrhage : Role of Cranial Sonography and CT Scanning

OBJECTIVE To evaluate the role of cranial sonography and computed tomography in the diagnosis of neonatal intracranial hemorrhage and hypoxic-ischemic injury in an Indian set-up. METHODS The study included 100 neonates who underwent cranial sonography and computed tomography (CT) in the first month of life for suspected intracranial ischemia and hemorrhage. Two observers rated the images for possible intracranial lesions and a kappa statistic for interobserver agreement was calculated. RESULTS There was no significant difference in the kappa values of CT and ultrasonography (USG) for the diagnosis of germinal matrix hemorrhage/intraventricular hemorrhage (GMH/IVH) and periventricular leucomalacia (PVL) and both showed good interobserver agreement. USG, however detected more cases of GMH/IVH (24 cases) and PVL (19) cases than CT (22 cases and 16 cases of IVH and PVL, respectively). CT had significantly better interobserver agreement for the diagnosis of hypoxic ischemic injury (HII) in term infants and also detected more cases (33) as compared to USG (18). CT also detected 6 cases of extraaxial hemorrhages as compared to 1 detected by USG. CONCLUSION USG is better modality for imaging preterm neonates with suspected IVH or PVL. However, USG is unreliable in the imaging of term newborns with suspected HII where CT or magnetic resonance image scan is a better modality.

The Role of MRI in the Management of Cases of Mayer-Rokitansky- Kuster-Hauser (MRKH) Syndrome

Mayer- Rokitansky- Kuster- Hauser (MRKH) syndrome is a rare entity characterized by congenital aplasia of the uterus and the upper part of 2/3rd of vagina in normal karyotype females with normal development of secondary sexual characteristics. The incidence rate is about 1 in every 4500 females. We report a case series of three different patients who presented with different clinical picture to various outpatient departments of our hospital. Magnetic Resonance Imaging of the pelvis was done in all these patients.

Sonographic diagnosis of primary hydatid disease in the breast: the scroll sign.

Primary hydatid disease of breast is a rare entity and is caused by the larval stage of Echinococcus granulosus. The disease is more commonly seen in sheep‐rearing populations and imaging plays a pivotal role in its diagnosis. Several imaging signs have been described in relation to hydatid cysts. However, the “scroll sign,” due to the infolding of the endocyst, has rarely been encountered, with only one similar case in literature, in which the imaging findings were inconclusive. We present a case of primary hydatid disease of breast in a young Asian woman, with the sonographic scroll sign.