Yashant Aswani

Wandering Spleen with Torsion Causing Pancreatic Volvulus and Associated Intrathoracic Gastric Volvulus: An Unusual Triad and Cause of Acute Abdominal Pain

CONTEXT Wandering spleen is a rare medical entity in which the spleen is orphaned of its usual peritoneal attachments and thus assumes an ever wandering and hypermobile state. This laxity of attachments may even cause torsion of the splenic pedicle. Both gastric volvulus and wandering spleen share a common embryology owing to maldevelopment of the dorsal mesentery. Gastric volvulus complicating a wandering spleen is, however, an extremely unusual association, with a few cases described in literature. CASE REPORT We present a case of a young female who presented with acute abdominal pain and vomiting. Radiological imaging revealed a intrathoracic gastric volvulus, torsion in an ectopic spleen, and additionally demonstrated a pancreatic volvulus - an unusual triad, reported only once, causing an acute abdomen. CONCLUSION The patient subsequently underwent an emergency surgical laparotomy with splenopexy and gastropexy.

Venous Complications of Pancreatitis: A Review

Pancreatitis is notorious to cause vascular complications. While arterial complications include pseudoaneurysm formation with a propensity to bleed, venous complications can be quite myriad. Venous involvement in pancreatitis often presents with thrombosis. From time to time case reports and series of unusual venous complications associated with pancreatitis have, however, been described. In this article, we review multitudinous venous complications in the setting of pancreatitis and propose a system to classify pancreatitis associated venous complications.

Prenatal diagnosis of hypophosphatasia congenita using ultrasonography

Congenital hypophosphatasia is a rare fatal skeletal dysplasia. Antenatal determinants of Epub ahead of print lethality include small thoracic circumference with pulmonary hypoplasia and severe micromelia. These features were present in the fetus of a 25-year-old female who came for an anomaly scan in her second trimester of pregnancy. Additional findings of generalized demineralization and osteochondral spurs led to the diagnosis of hypophosphatasia congenita. The pregnancy was terminated, and the findings were confirmed on autopsy. Common differential diagnoses with clues to diagnose the above mentioned condition have been discussed here. Early and accurate detection of this medical condition is important as no treatment has been established for this condition. Therefore, antenatal ultrasonography helps in diagnosing and decision making with respect to the current pregnancy and lays the foundation for the genetic counseling of the couple.Congenital hypophosphatasia is a rare fatal skeletal dysplasia. Antenatal determinants of Epub ahead of print lethality include small thoracic circumference with pulmonary hypoplasia and severe micromelia. These features were present in the fetus of a 25-year-old female who came for an anomaly scan in her second trimester of pregnancy. Additional findings of generalized demineralization and osteochondral spurs led to the diagnosis of hypophosphatasia congenita. The pregnancy was terminated, and the findings were confirmed on autopsy. Common differential diagnoses with clues to diagnose the above mentioned condition have been discussed here. Early and accurate detection of this medical condition is important as no treatment has been established for this condition. Therefore, antenatal ultrasonography helps in diagnosing and decision making with respect to the current pregnancy and lays the foundation for the genetic counseling of the couple.

Spinal Hydatid as a Rare Cause of Posterior Mediastinal Lesion: Understanding Cervicothoracic Sign on Chest Radiography.

Summary Background Location of an intrathoracic lesion on chest radiograph is facilitated by application of ‘silhouette sign’. This helps narrow down the differential diagnoses. The list of probable diagnoses reduces further on determination of the density of the lesion. A spinal hydatid presents as a fluid-density posterior mediastinal lesion on chest radiograph with destruction of the vertebral body and preservation of the disc space. Spinal hydatid is, however, rare. Case Report We describe a case of a 30-year-old female with gradual-onset paraperesis since six months. Chest radiograph was suggestive of a posterior mediastinal lesion with fluid density and destruction of D4 vertebra. MRI findings were consistent with spinal hydatid. The patient was started on perioperative benzimidazole therapy with resection of the hydatid cyst. The drug therapy was continued for six months post-operatively. Conclusions A chest radiograph helps localise the site and possible contents of the lesion. It also guides further investigations. MRI is the imaging modality of choice for spinal pathologies causing cord compression including spinal hydatid. Echinococcal involvement of the spine is a rarity but needs to be considered in the differential diagnoses for spinal causes of gradual-onset paraperesis.

Imaging findings in lipoma arborescens

A 27-year-old man presented with painless swelling of the right knee of 4 months’ duration. There was no history of trauma or other joint involvement. The patients serum rheumatoid factor was negative. Radiograph of the knee revealed increased lucency in the prefemoral region (figure 1A). Ultrasonography depicted echogenic, frond-like hypertrophy of the synovium in the suprapatellar bursa (figure 1B). This hypertrophied synovium was of low density on CT (figure 1C). Additionally, there was mild joint effusion. MRI depicted a T1 and T2 hyperintense synovial mass (figure 2A), villous and globular in …

Juvenile Granulosa Cell Tumour of the Ovary with Unilocular Pure Cystic Presentation: A Case Report and Review of Literature

Summary Background Granulosa cell tumours of the ovary are rare, hormonally active, oestrogen-secreting tumours of the ovary existing in two forms: the adult form and the even rarer juvenile form. These tumours present as predominantly solid lesions while the cystic, unilocular presentation is uncommon. Case Report We present an 18-year-old unmarried girl who presented with complaints of chronic pain, abdominal distension and presence of facial hair. Radiological examination revealed a large, purely cystic, unilocular lesion without any solid components, debris or septations. Histopathological diagnosis was of a juvenile granulosa cell tumour. Conclusions Radiological criteria suggestive of malignant ovarian masses include thick, irregular walls and septae; papillary projections and solid, echogenic foci. Nonetheless, we propose that a malignant ovarian lesion should be included in the differential diagnosis of a unilocular, purely cystic ovarian lesion.

Pancreaticopleural Fistula: A Review

Pancreaticopleural fistula is a rare complication of chronic pancreatitis consequent to posterior disruption of the pancreatic duct. The fistulous track ascends into the pleural cavity and gives rise to large volumes of pleural fluid. Pancreaticopleural fistula thus poses a diagnostic problem since the source of pleural fluid is extrathoracic. To further complicate the matter, abdominal pain is seldom the presenting or significant feature. The pleural effusion is typically rapidly accumulating, recurrent and exudative in nature. Pleural fluid amylase in the correct clinical setting virtually clinches the diagnosis. Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography and computed tomography may delineate the fistula and thus aid in diagnosis. Endoscopic retrograde cholangiopancreatography has emerged both as a diagnostic as well as therapeutic modality in select patients of pancreaticopleural fistula while magnetic resonance cholangiopancreatography is the radiological investigation of choice. Besides delineating the ductal anatomy, magnetic resonance cholangiopancreatography can help stratify patients for appropriate management. A near normal or mildly dilated pancreatic duct responds well to chest drainage with octreotide while endoscopic stent placement benefits patients with duct disruption located in head or body of pancreas. Failure of medical or endoscopic therapy calls in for surgical intervention. Besides, a primary surgical management may be tried in patients with complete ductal obstruction, ductal disruption in tail or ductal obstruction proximal to fistula site.

Imaging in median arcuate ligament syndrome.

An 18-year-old man presented with a 7-month history of abdominal pain, particularly in the epigastrium, and weight loss of 14 pounds. Symptoms were aggravated post meals. An abdominal sonogram, upper gastroendoscopy and colonoscopy, were inconclusive. A contrast-enhanced CT of the abdomen revealed kinking of the proximal coeliac artery due to the median arcuate ligament, creating a hooked appearance with post-stenotic dilation (figure 1). A repeat sonography with Doppler revealed a normal calibre coeliac artery in inspiration with a peak systolic velocity (PSV) of 147 cm/s (figure 2 …

CT findings in Fahr's disease

A 65-year-old man presented to our services with features of dementia and movement disorder for 2 years. The symptoms had worsened over the past month with development of auditory hallucinations. CT demonstrated extensive calcification in bilateral basal ganglia, grey–white matter junctions and dentate nuclei. Serum calcium, phosphate and parathormone levels were normal. Fahrs disease was diagnosed based on the clinical and imaging findings. Fahrs disease is an autosomal dominant inherited disorder characterised by basal ganglia and extraganglionic calcification, extrapyramidal symptoms and psychosis.1 Usual age of presentation is 40–60 years with no gender predilection. …

Classical imaging findings of Dyke-Davidoff-Masson syndrome

A 14-year-old girl, known case of seizure disorder since 10 years and mild mental retardation, presented with progressive left-sided hemiparesis and a recent increase in the frequency of seizures. Significant history included a developmental lag. A CT of the brain revealed marked cortical hemiatrophy on the right side with prominence of ipsilateral ventricular system (figure 1). Neuroparenchymal changes were accompanied with ipsilateral calvarial thickening and hyperpneumatisation of the paranasal …