Vinay Maurya

Clinical mimics of acute appendicitis: Is there any role of imaging?

Acute appendicitis (AA) is a common surgical emergency. Accurate and timely diagnosis of AA is essential for successful outcome. Imaging plays an important role in the diagnosis, exclusion of AA as well as diagnosing alternative clinical conditions which can closely simulate AA. A correct alterative diagnosis may obviate the need of unnecessary appendectomy or may even change the treatment regime altogether. This pictorial essay illustrates various clinical conditions which mimicked AA clinically during our day to day practice.

ENDOBRONCHIAL TUBERCUCLOSIS PRESENTING AS A BRONCHOCELE.

A bronchocele is a dilated mucous or pus filled bronchus secondary to obstructive pathology with collateral air drift which allows the affected lung to remain aerated and has a characteristic radiographic appearance [1]. A case of bronchocele as a result of endobronchial tuberculosis is presented.

Pulmonary Aspergilloma in Rheumatoid Arthritis

Aspergillus is a common opportunistic pathogen of the lungs especially in immunocompromised or immunosuppressed individuals. The radiological manifestations of aspergillosis include colonization of pie-existing cavity (Aspergilloma). invasive aspergillosis and allergic bronchopulmonary aspergillosis. Aspergillomas are also known to colonize rheumatoid lung. The aim of this presentation is to emphasize the evolution of the fungal ball in aspergillosis.

Septo-optic dysplasia: Magnetic Resonance Imaging findings

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient.

Spontaneous Pneumomediastinum in an Adolescent

Pneumomediastinum (mediastinal emphysema) may be defined as the presence of free air or gas in the mediastinal structures [1]. It is an uncommon, but important condition found in healthy young adults and children presenting with chest pain and shortness of breath. Surgical emphysema may be widespread in such cases and may involve the neck, face, chest and arms. We report a case of 15-year-old boy who presented with acute onset shortness of breath and was found to have a spontaneous pneumomediastinum.

INTRATHORACIC KIDNEY: A Case Report

Congenital intrathoracic kidney is a very rare occurrence. Usually, a congenitally ectopic kidney is present in the lower lumbar or pelvic region due to failure to ascend during fetal life. Unlike low ectopic kidneys, which are frequently the site of infection and stone formation, most intrathoracic kidneys function normally and require no medical or surgical therapy once identified. An intrathoracic kidney is mostly discovered as a posterior mediastinal or juxtadiaphragmatic “mass” by chest radiograph. Sonography [1, 4] and/or intravenous urography [1, 2, 3] allow differentiation from other significant lesions, thus avoiding surgery or biopsy. We discuss here a case of congenital intrathoracic kidney in a child diagnosed by sonography and confirmed by excretory urography. Case Report A 16 month old child who was operated for omphalocele at birth reported for review. This child was detected to have omphalocele on routine antenatal ultrasound. He was delivered by cacsarian section. Anterior abdominal wall repair was carried out electively two days later and again a week later. Presently on physical examination, the child was healthy with normal development for his age. Umbilical hernia was present with expansile cough impulse. Routine chest X-ray films showed a rounded, homogeneous, retrocardiac soft tissue density shadow above the posterior portion of left hemidiaphragm. Ultrasound revealed sub diaphragmatic right kidney (Fig-1) and left kidney in left hemithorax (Fig-2). Intravenous urogram confirmed the sonological findings and demonstrated normal functioning of both kidneys. The right kidney was high up superior to liver and the left kidney was intrathoracic in location (Fig-3 a&b). Urinanalysis. urine culture, and serum creatinine results were within normal limits. No treatment was necessary. Fig. 1 Ultrasound scan showing suprahepatic right kidney Fig. 2 Ultrasound scan showing supradiaphragmatic left kidney Fig. 3a & h Intravenous urogrpahy showing suprahepatic right and intrathoracic left kidney Discussion Unilateral thoracic or superior renal ectopia is a rare anomaly, encountered only in 2 cases in a series of 15,919 autopsies and accounting for less than 5% of all renal ectopies [1]. Unlike pelvic ectopic kidneys, which sometimes are obstructed, have calculi, or are infected, thoracic ectopic kidneys are usually normal otherwise. They are more common on the left side, like in our case and are usually isolated incidental findings [2]. Three instances of bilateral thoracic kidneys have been reported [3]. Except for the few cases in which thoracic ectopic kidney was thought to be caused by traumatic diaphragmatic disruption [3], most thoracic renal ectopies are assumed to be congenital. In some cases, anomalously superior origin of the renal vessels has been found [3], whereas in others the renal vessels are simply longer than normal [3], The relationship of the superior ectopic kidney to the diaphragm has been variable in those cases investigated by surgery or autopsy [3, 5]. Occasionally the kidney resides entirely above the diaphragm, but most often it occupies a posteromedial diaphragmatic defect that may or may not be capped by fibrous tissue [5]. A variety of embryologie causes have been proposed. Superior migration of the metanephros before completion of diaphragmatic development during the eighth week of gestation is the most common hypothesis of these theories [3, 5]. In our patient, the intrathoracic left kidney and high placed right kidney may have been caused because of decreased abdominal cavity due to omphalocele and the intra abdominal organs occupying the available space. In infants and children, the thoracic kidney may resemble a hernia of the foramen of Bochdalek, neurofibroma, or a pericardial cyst [1]. In the adult the thoracic kidney should be differentiated from these and other posterior mediastinal masses and from benign or malignant diaphragmatic, pleural, or pulmonary lesions [1]. This comprehensive review of the literature, accentuates the importance of including ectopic kidney in the differential diagnosis of a diaphragmatic or thoracic mass [1, 2]. Improper evaluation could lead to the interpretation of a renal mass to be a neoplasm, resulting in unnecessary thoracotomy. Failure to make an early diagnosis in the past has been due not only to the variable and uncertain clinical manifestations of ectopic kidney but more importantly to the fact that the condition was not considered in differential diagnosis.

INTERNAL JUGULAR PHLEBECTASIA.

Varicose veins are a common venous anomaly, where as phlebeetasia is rare. It is an abnormal dilation of an isolated vein. Any vein may be affected and the condition is usually asymptomatic [1]. Internal jugular phlebeetasia (IJP) is abnormal dilation of internal jugular vein (IJV). This report aims at clinical awareness of the condition.

Tubercular spondylitis: A review of MRI findings in 80 cases

Background Tuberculosis of spine is known as tubercular spondylitis or Potts spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Potts spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. Methods In this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. Results Of the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21-40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. Conclusion Tubercular spondylitis or Potts spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Lunate dislocation causing median nerve entrapment

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.

Doppler indices of the umbilical and fetal middle cerebral artery at 18–40 weeks of normal gestation: A pilot study

BACKGROUND Doppler indices form an integral component of noninvasive evaluation of fetal well-being. There is paucity of information about normal obstetric Doppler indices, particularly from the Indian subcontinent. The aim of the study was to find the values of pulsatility index (PI), resistive index (RI) of umbilical artery (UA), and fetal middle cerebral artery (MCA) and calculate cerebro-placental ratio (CP ratio) for 18-40 weeks of normal gestation so that a reference range of these Doppler values can be postulated. METHODS 200 patients were enrolled in the study for color Doppler study of UA and MCA and were serially followed up at 4-6 weeks interval for Doppler indices. Angle-independent Doppler indices like PI and RI for MCA and UA were obtained during each examination. CP ratio was calculated in each case. All the cases were followed up till delivery and the perinatal outcome was recorded. RESULTS & CONCLUSION The fetal MCA PI and RI showed a parabolic curve with plateau at 28-30 weeks of gestation. A significant correlation was noted between MCA PI and RI with gestational age. UA PI and RI showed a gradual fall over the gestational age with a strong negative correlation. There was a significant correlation between MCA PI and UA PI with their respective RI values. CP ratio has also shown a parabolic curve with turning point at 31-32 weeks of gestation. A significant correlation was noted between CP ratio and gestational age. CP ratio also showed a minimal positive correlation with MCA PI and a strong negative correlation with UA PI.