Sunil Kumar Bajaj

OHVIRA: Uterus didelphys, blind hemivagina and ipsilateral renal agenesis: Advantage MRI

We present here a case of an uncommon complex uterine anomaly – Obstructed HemiVagina with Ipsilateral Renal Agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 14-year-old girl along with sonographic (trans-abdominal and trans labial), and MRI findings. The patient underwent surgery wherein imaging findings were confirmed. An MRI has proved to be of great help in correct diagnosis avoiding surgical interventions/ laparoscopy, which were needed in past to diagnose this rare anomaly. We also discuss the development of this anomaly with the help of a relatively new theory of uro-genital development by Acien and review the literature.

Metanephric stromal tumor: An unusual pediatric renal neoplasm

A renal tumor in a 14-month- old child, who was initially diagnosed as mesoblastic nephroma, but on review post surgery was diagnosed as hyper-differentiated metanephric stromal tumor, with its excellent prognostic outcome. An attempt is made to document imaging features that may enable one to suspect this rare condition. The literature is reviewed with emphasis on its distinction from its look-alikes in the pediatric age group.

Clinicoradiological aspects of pontine tegmental cap dysplasia: Case report of a rare hindbrain malformation

Malformations involving the brainstem are very rare and present with a varied spectrum of clinical symptoms due to multiple cranial nerve palsies and pyramidal tract involvement. Of these, pontine tegmental cap dysplasia is a very unusual malformation, characterized by ventral pons hypoplasia and an ectopic dorsal band of tissue, projecting into the fourth ventricle, from dorsal pontine tegmentum. A 4-year-old male child, presenting with left facial nerve palsy, revealed hypoplastic ventral pons and an ectopic structure on magnetic resonance imaging (MRI). The ectopic structure was isointense to pons, arose from the left side of dorsal pontine tegmentum, at pontomedullary junction and protruded into the fourth ventricle, impinging upon the left seventh and eighth cranial nerves. Diffusion tensor imaging (DTI) depicted abnormal white matter tracts in ectopic tissue with absent transverse pontine fibres and abnormal middle and superior cerebellar peduncles. The typical MRI appearance, coupled with DTI, helped us reach an accurate diagnosis of pontine tegmental cap dysplasia, in a setting of neurological dysfunction.

Gravid Uterus in post caeserian incisional hernia - a rare occurence

Incisional hernia following section caesarean is a not so uncommon a complication following sepsis in the postoperative period. An ever rising primary caesarean rates in many developed countries like USA and emerging economies like China is leading to rising trend of incisional hernia following c-section. The contents of hernial sac in these cases are usually small gut loops or omentum. Only about a dozen cases having gravid uterus as hernial content have been recorded in literature. Paucity of cases has meant that there are no established guidelines for its management, which is totally individualized. We report here a very rare case of protrusion of gravid uterus in post caesarean incisional ventral hernia and its successful management resulting in delivery of a healthy baby.

Complete Hydatidiform Mole with Coexisting Twin Fetus: Usefulness of MRI in Management Planning

Complete hydatidiform mole with coexistent twin fetus is a rare condition. Only one out of a total reported 16 cases before the 1980s was diagnosed antenatally; hence, there was really no need to take a clinical decision. The number of cases of CHMCTF has since gone up dramatically with the availability of advanced ultrasound and emerging IVF techniques including newer ovulation drugs [1]. The optimal management is a challenge that remains a clinical dilemma. The present viewpoint is tilted toward expectant management with strict surveillance to prevent/treat complications early, so as to be able to deliver a normal baby in many of these patients. No difference in the risk of developing persistent gestational trophoblastic disease (PGTD) and gestational trophoblastic neoplasia (GTN) in patients undergoing termination of pregnancy as well as patients allowed to continue pregnancy has permitted the clinician to delay intervention till after delivery, while successfully managing the complications associated with trophoblastic disease. The role of MRI in addition to ultrasound in correctly distinguishing this condition from the partial hydatidiform mole is discussed, thus assisting in the management plan.