Sima Mukhopadhyay

Evaluating Patients with Cirrhosis for Hepatocellular Carcinoma : Value of Clinical Symptomatology, Imaging and Alpha-Fetoprotein

Objective: This study was undertaken to assess the value of clinical symptomatology, abdominal ultrasound (US), triple-phase CT (TPCT) and serum alpha-fetoprotein (AFP) estimation in predicting presence of hepatocellular carcinoma (HCC) among patients with cirrhosis. Materials and Methods: In this cross-sectional study, Child’s A/B cirrhosis patients were subjected to clinical evaluation, US, TPCT and serum AFP estimation. Sensitivity and specificity of clinical symptoms and of AFP at different cut-off levels were determined. Detection rate of HCC and agreement between US and TPCT was estimated. Results: A high proportion of enrolled subjects had HCC at first presentation (40.7%). Significantly higher prevalence of abdominal pain, weight loss, and anorexia was seen in patients with cirrhosis with HCC compared to those without HCC. Sensitivity and specificity of any of these symptoms was 73 and 79%, respectively (positive and negative predictive values of 65 and 85%, respectively). A 100% agreement between TPCT and US was observed for diagnosing HCC cases. However, TPCT detected a greater number of smaller HCCs. Sensitivity of AFP at 400 ng/ml cut-off was only 25.7%, too low to be useful. Best mix of sensitivity (77.2%) and specificity (78.1%) of AFP was found to be at 10.7 ng/ml cut-off which falls within the conventional limits of normalcy. Conclusion: The study highlights the importance of symptomatology of weight loss, abdominal pain or anorexia as markers for HCC in patients with cirrhosis. AFP was not found to be a useful screening test. TPCT should be undertaken in all cirrhotics presenting to the hospital for the first time.

Bony ankylosis of the temporomandibular joint: a computed tomography study.

Bony ankylosis of the temporomandibular joint is a disabling disease that almost invariably manifests itself in the first two decades of life. CT of the temporomandibular joints was performed in 50 patients--axial CT in 2 and coronal CT in 48--of whom 43 (86%) had received trauma to the joints. New bone of variable form and thickness was observed in 64 joints (the involvement was bilateral in 14 patients). These joints were classified into one of two categories: type I, medially angulated condyle with deformed articular fossa and a mild-to-moderate amount of new bone formation; and type II, no recognizable condyle or fossa but instead a large mass of new bone. Type I was etiology-specific and seen only when trauma was the antecedent, whereas type II was a sequelae of either insult. A pseudofracture in the new bone was seen in 49 (77%) joints. Six joints showed subtle deformities but no new bone. Since coronal CT fully characterizes the lesion at acceptable radiation exposure levels, it appears to be valuable in the preoperative workup of these patients.

Coronary artery anomalies in tetralogy of fallot

Coronary angiograms of 296 patients with Fallots tetralogy were reviewed. Group I abnormalities in the origin and distribution of the coronary arteries, found in 32 (11.8%) cases, consisted of a single coronary artery from the left sinus of Valsalva in 7 cases, left anterior descending artery from the right coronary artery in 7 cases, and an accessory left anterior descending from the right coronary in 18 cases. Of the 7 cases with a single coronary artery, the right coronary branch was anterior to the aortic root, crossing the right ventricular outflow in two cases. Group II acquired abnormalities were found in 11 cases and consisted of an enlarged conus artery in 9 cases and 1 case each of coronary bronchial collateral and right ventricular branch from the left anterior descending artery. Except in 12 patients requiring selective coronary angiography, aortic root angiography was sufficient to outline the coronary anatomy. Awareness of a coronary anomaly helps in deciding the time and type of operative procedure to be performed, especially in infants, since injury to a large vessel perfusing the left ventricle usually results in increased morbidity and mortality.

Isolated cerebral hydatid cyst with pathognomonic CT sign

SummaryIn a 9-year-old girl with an isolated cerebral hydatid cyst, computed tomography displayed the pathognomonic feature of multiple small low-density daughter cysts within the primary mother cyst.

Angiographic abnormalities of the morphologically left ventricle in the presence of Ebstein's malformation

Cineangiography of the morphologically left ventricle was performed in 10 patients with Ebsteins malformation. The angiographic findings included left ventricular contour abnormalities (8), mitral valve prolapse (7) and global hypokinesia (5). Left ventricular abnormalities were present whether the left ventricle was normally placed or in mirror-image position in congenitally corrected transposition. Abnormalities of the morphologically left ventricle in Ebsteins malformation have received little attention in the past. Frequent occurrence of these abnormalities should make careful evaluation of the morphologically left ventricle mandatory in all patients with Ebsteins malformation.

Helical CT evaluation of aortic aneurysms and dissection A pictorial essay

The relative noninvasive nature, easy accessibility, convenience and accuracy of helical CT in the rapid evaluation of not only the aorta and its branches, but the entire thorax/abdomen, makes it the best suited imaging modality for use in evaluation of aortic aneurysms and dissection. Excellent vascular opacification, the advantage of reconstructing overlapping scans without respiratory misregistration, multiplanar reconstruction and 3D rendering of the vessels highlight the benefits of helical CT. Helical CT evaluation combines the advantages of conventional CT, giving true information about the exact transverse and longitudinal extent of the aneurysm, the vessel wall, luminal thrombus and structures around the aorta, and those of aortography in the form 3D volumetric information display. The purpose of this essay is to present a spectrum of aortic aneurysms and dissection to highlight the role of helical CT in their evaluation.

Amoebic Liver Abscess: Rupture into Retroperitoneum

The first documented case of amoebic liver abscess which ruptured into the retroperitoneum is reported.

Mediastinal paraganglioma presenting as an intracardiac mass with superior vena caval obstruction.

A case of mediastinal paraganglioma presenting with superior vena caval obstruction is reported. The tumour extended into the right atrium and ventricle. Tru-Cut biopsy under ultrasonographic guidance was performed safely to provide a diagnosis before death.

Collateral arteries arising from the coronary circulation in tetralogy of Fallot

Semi-selective aortic root and some selective coronary angiographic studies were performed in 330 patients with tetralogy of Fallot over a period of four years. Collateral vessels arising from the coronary arteries were found in 11 cases and a direct communication between the coronary artery and pulmonary arteries in one case (3.6%). Electrocardiographic features of myocardial ischaemia were not present in any patient. It is important to localize the collateral arteries since coronary steal and myocardial ischaemia have been known to occur in their presence.

Computed tomographic evaluation of aortocoronary bypass grafts

An analysis of 17 dynamic computed tomographic studies for noninvasive visualisation of 53 aortocoronary bypass venous grafts is presented. Computed tomographic scan forms an excellent modality for visualisation of these grafts using a noninvasive technique. It was most consistent in demonstration of the right group of grafts (100%). Twenty out of 23 (86.5%) left group of grafts and 13 out of 18 (72.2%) belonging to the posterior group could be visualised. The grafts were seen as enhancing dots or streaks at characteristic locations. Meticulous care regarding bolus injection of contrast; understanding the pattern of enhancement of the structures identified as grafts; avoiding artefacts from metallic clips and prior knowledge of the number and position of grafts placed are essential for proper interpretation of the scan. A scan in the immediate postoperative period would form an excellent baseline study.