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   2014| July-December  | Volume 21 | Issue 2  
    Online since June 17, 2014

 
 
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CASE REPORTS
Right renal pelvic calculus mimicking an extrarenal pelvis
Olalekan Ibukun Oyinloye, Mutiu Oladapo Atobatele, Mohammed Saliu Ibrahim
July-December 2014, 21(2):99-101
DOI:10.4103/1115-1474.134623  
A 57-year-old man presented with recurrent intermittent colicky right flank pain of 1-year duration. Intravenous urogram (IVU) on two separate occasions suggested a right-sided, extrarenal pelvis. However, when pain became recurrent and persistent, he had a non-contrast computed tomography (CT) examination, which revealed a calculus in the renal pelvis. Diagnosis was missed in the initial imaging modalities because apart from the dilated pelvis, there was no evidence of hydronephrosis or calculus seen, hence a diagnosis of extrarenal pelvis. This case report highlights the superior utility of CT in imaging of suspected urolithiasis, especially when the patient remains symptomatic. Radiologists should be wary, especially in symptomatic patients with features of extrarenal pelvis on IVU.
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ORIGINAL ARTICLES
The role of ultrasound and magnetic resonance imaging in the evaluation of musculotendinous pathologies of the shoulder joint
Shoubhi Bhatnagar, Rajesh Kuber, Digish Shah
July-December 2014, 21(2):68-74
DOI:10.4103/1115-1474.134611  
Aim: To evaluate and characterize the musculotendinous pathologies of shoulder joint using ultrasound (USG) and magnetic resonance imaging (MRI). Background and Objectives: The glenohumeral joint, being the most mobile and unstable of all the joints, is often prone to injuries. To compensate for its unstable bony anatomy, the shoulder is protected anteriorly, posteriorly, and superiorly by a capsule and tendons that form the rotator cuff. Sonography is often considered the first-line imaging modality in the assessment of cuff as well as in nonrotator cuff disorders. MRI is of value in cases of extensive abnormality that is often incompletely characterized by the initial sonographic examination, as in case of sonographically inaccessible areas. However, musculoskeletal imaging is truly a multimodality approach and in order to identify and characterize the lesion, a combination of modalities should be used. Materials and Methods: A prospective study was carried out on 75 patients in the Department of Radiodiagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from July 2011 to September 2013. Patients from all age groups including both men and women with shoulder pain, suspected to be arising from the musculotendinous tissues of the shoulder joint, were taken up for study. Results: In our study, USG showed a sensitivity of 95.2%, specificity of 88.8%, and positive predictive value of 80% for demonstrating full-thickness tears. In case of partial-thickness tears, USG showed overall sensitivity of 94.7%, specificity of 85.7%, and positive predictive value of 90%. Overall accuracy of USG in detecting full-thickness as well as partial-thickness tears was 91%. Conclusion: In patients with shoulder complaints, USG is a reliable dynamic diagnostic tool. It reveals high diagnostic accuracy in detecting rotator cuff pathologies including cuff tears and tendinopathy. However, MRI has always been successful in overall assessment of joint structure. Its ability to evaluate labrum and various glenohumeral ligaments cannot be superseded by USG.
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CASE REPORTS
Aberrant right subclavian artery in association with common trunk of both carotid arteries: Diagnosis with CT
Dharmraj Meena
July-December 2014, 21(2):80-84
DOI:10.4103/1115-1474.134615  
The aberrant right subclavian artery (ARSA) is an anatomical abnormality encountered by anatomists and pathologists and more recently radiologists, interventional cardiologists and thoracic surgeons. The incidence of ARSA is 0.2-2% in the population. Cases of an ARSA in retro-tracheal and retro-oesophageal courses in association with common trunk of both carotid arteries have been rarely reported in literature. We reported the case of a retro tracheal RSCA, which originated distally along the left aortic arch and coursed behind the trachea and the oesophagus, diagnosed on computerized tomography angiography (CTA). This was associated with a rare variant of the aortic arch; in which the arch had a common trunk as first branch, which subsequently bifurcated to give the right and left common carotid arteries without any aneurysmal dilatation.
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Joubert syndrome - A case report with classical MRI features
Sumantro Mondal, Sumit Chakrabarty, Debanjali Sinha, Tony Ete, Arijit Nag, Atanu Chakraborty, Amod Prasad
July-December 2014, 21(2):102-104
DOI:10.4103/1115-1474.134625  
Joubert syndrome a rare disorder characterized by malformation of the mid- and hindbrain. Here we report a classical case of Joubert syndrome in a 2-year-old boy who presented with respiratory irregularities, hypotonia, and developmental delays. Magnetic Resonance Imaging (MRI) of the brain showed the "molar tooth sign" with "bat wing" appearance of fourth ventricle.
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ORIGINAL ARTICLES
Role of ultrasound elastography in the differentiation of breast lesions
Owvass Hamied Dar, Pankaj Sharma, Shaheen Hassan Dar, Maqsood Ahmad Dar
July-December 2014, 21(2):49-52
DOI:10.4103/1115-1474.134599  
Background: Breast biopsy remains the gold standard for diagnosis of breast lesions; however, most of the breast specimens reveal benign results. Therefore, in order to avoid unnecessary breast biopsies, noninvasive diagnostic tools have been developed. Ultrasound elastography (USE) is a noninvasive technique which helps in reducing the frequency of breast biopsies. Aims: The aim of the study was to study the role of ultrasound elastography in differentiation of breast lesions which will ultimately help in better patient diagnosis. Materials and Methods: In this study, 54 patients with 66 breast lesions were first assessed with sonography and then with USE after obtaining informed patient consent. The examination was carried out in Department of Onco Imaging, Delhi State Cancer Institute, Delhi, India. from July 2011 to February 2012. Statistical Analysis: Statistical analysis was performed using SPSS software (version 20.0). Results and Conclusion: The lesions were classified on elastography using scoring system described by Itoh et al., 2006 with elasticity score of 1,2,3 as benign and score of 4 and 5 as malignant. The sensitivity of USE was found to be 88.57% with specificity of 90.32% and positive predictive value of 91.18%. Thus, we conclude that in the present scenario, USE can be used in early diagnosis and differentiation of breast masses into benign and malagnant and henceforth, can be influential in reducing the number of breast biopsies.
  3,067 32 -
CASE REPORTS
Mural ameloblastoma of the Mandible: Radiological-pathological correlation
Yadavalli Guruprasad, Dinesh Singh Chauhan, Amit Byatnal, Shrinivas C Koppal, Umashankar Kura, Pradeep Mattighatta Rudraiah
July-December 2014, 21(2):94-98
DOI:10.4103/1115-1474.134622  
Ameloblastoma is a benign odontogenic neoplasm, which frequently affects the mandible. The term 'ameloblastoma' includes several clinicoradiological and histological types. The radiological appearance is most commonly of a multilocular radiolucent type, with a high incidence of poorly defined borders. Definitive diagnosis of mural ameloblastoma can only be done by histopathological examination and cannot be predicted preoperatively on clinical or radiographical grounds. We are presenting a case of mural ameloblastoma in the body and ramus of the mandible in a 65-year-old female patient, with emphasis on its radiographical and histopathological appearances.
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ORIGINAL ARTICLES
Incidental findings on computed tomographic scans in patients with head trauma in Ilorin, Nigeria
Oyinloye Olalekan Ibukun, Yusuf Ayodeji Salman, Jimoh Kamaldeen Olayori
July-December 2014, 21(2):75-79
DOI:10.4103/1115-1474.134612  
Background/aims: The focus of computed tomography (CT) examination in patients with suspected traumatic brain injury (TBI) is to assess the damage to cranial structures as a result of trauma; however, sometimes findings unrelated to the chief complaint and not pertinent to the immediate patient care are discovered. These findings are classified as "incidental findings." The aim of the study is to determine the prevalence of incidental findings discovered during CT examinations in patients with suspected TBI in our environment. Materials and Methods: A retrospective study of 551 patients with TBI, referred for CT examination at the Radiology Department of the University of Ilorin Teaching Hospital (UITH), Ilorin from January 2009-2013. Any non-traumatic findings on CT scan or findings that were not related to the chief complaint were considered "incidental findings." Results: Incidental findings were seen in 19 (3.4%) patients, 12 (2.2%) males and 7 (1.2%) females. Enlarged cisterna magna was the commonest finding occurring in 5 (0.9%) patients. Meningiomas were the commonest incidental brain tumor found in 3 (0.54%) patients. Other incidental lesions include lacunar infarcts, arachnoid cyst, neuroglial cyst, and osseous lesions. Conclusion: Clinically serious incidental findings were mainly brain tumors. Visual abnormalities resulting from an incidental suprasellar meningioma may actually predispose to TBI as the patient was found to be responsible for the road traffic accident in which the head injury was sustained. However, larger studies involving many centers may be needed to correlate the role of serious incidental findings vis a vis predisposition to road traffic accidents.
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Computed tomographic assessment in deep space infections of odontogenic origin
Sankalp Verma, Ravi Prakash Sasankoti Mohan, Anchal Singh, Udita Singh, Neha Agarwal
July-December 2014, 21(2):64-67
DOI:10.4103/1115-1474.134607  
Background/Aim: The objective of the article is to investigate the pathways of spread of odontogenic infection in the facial and neck spaces and to determine the accuracy of contrast enhanced computed tomography (CT) in diagnosing deep neck space infections. Study Design/Materials and Methods: Contrast enhanced CT scans of 27 patients with extensive spread of odontogenic infection into the facial and neck spaces were analyzed to document the pathways of spread. Results: The results of the study indicated that the masseter space was the most commonly involved space followed by the pterygoids (both lateral and medial) and a different spread (other than medial pterygoids) to the parapharyngeal space has been proposed. Odontogenic infections from the mandible spread in two different ways. It first spreads upward, into the masseter and/or medial pterygoid muscles in the masticator space, and downward, into the sublingual and/or submandibular spaces, and then spreads into the spaces or muscles adjacent to one or more of these locations. Infections from the masseter muscle spreads into the parotid space to involve the temporalis and lateral pterygoid muscles. Infections from the medial pterygoid muscle spread into the parapharyngeal space to involve the lateral pterygoid muscle. Infections in the maxilla do not spread downward; instead, they tend to spread upward and superficially into the buccal space. Conclusion: CT is useful in depicting the exact site and extent of infection and in planning the treatment of extensive odontogenic infection, which can be life threatening when therapy is ineffective.
  2,308 29 -
Pre-HSG microbial isolates from endocervical swabs in infertile women in Ilorin, Nigeria
Adewale E Oguntoyinbo, Kikelomo T Adesina, Adebunmi O Olarinoye, Abiodun P Aboyeji, Waheed I Olanrewaju, Muritala Oniyangi
July-December 2014, 21(2):59-63
DOI:10.4103/1115-1474.134604  
Background: Genital infections contribute significantly to infertility by causing tubal disease in our environment. This can be worsened by any instrumentation of the genital tract such as hysterosalpingography (HSG), which is the most common and affordable investigation by infertile couples for tubal factor. Materials and Methods: A prospective study of 53 women who presented for HSG on account of infertility was done in a radio-diagnostic centre In Ilorin, Nigeria. Endo-cervical swabs were taken aseptically prior to standardized HSG in all clients. The swabs were sent for microscopy, culture, and antibiotic sensitivity and the HSG findings of patients were documented. Results: The age ranged between 25 and 52 years with a mean of 34.26 + 5.762 years. Both fallopian tubes were patent in 10 patients and blocked in 14 cases. There were 14 cases of unilateral hydrosalpinx and 10 (18.9) bilateral hydrosalpinges. Either pelvic or cervico-uterine cavity adhesions were observed in 35 (66.0%) of the cases. Mild to heavy growth occurred in 67.9% of the cases. Gram stain was positive in 54.7% of cases. The most common organism was Staphylococcus spp (28.3%). Forty-five percent of yields were sensitive to more than two antimicrobials. There was statistical significant relationship between the presence of pathogens in the endo-cervix and the frequency of tubal disease (x 2 = 2.71, P ≤ 0.05). Conclusion: There was a positive or significant statistical relationship between presence of pathogens in the cervix and tubal disease. Pre-HSG endo-cervical swab for microscopy, culture and sensitivity is advisable to prevent genital infections after HSG.
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Feasibility of computed tomography angiography as an essential prerequisite tool in cases of massive hemoptysis requiring embolization in a tuberculosis prevalent South Indian population: Case series
Santosh PV Rai, Vishak Acharya, M Chakrapani
July-December 2014, 21(2):53-58
DOI:10.4103/1115-1474.134601  
Aims: The objective of this study is to assess the cases of massive hemoptysis suited for bronchial artery embolization (BAE). The useful role of computed tomography angiography (CTA) in assessing the arteries responsible for the hemoptysis, prior to endovascular imaging and intervention is assessed. Materials and Methods: CTA was performed with a 16 slice multi-detector row computed tomography scanner on all cases of massive hemoptysis provisionally posted for BAE (12 cases) in a 9 month period. Results: Out of the 12 patients, 10 were completely symptom free after 6 months (83% success rate). Out of the 12 cases, 1 was judged as suboptimal detection on the CTA as compared with the conventional angiography. In 11 cases, CTA appropriately demonstrated the hypertrophied bronchials, which were confirmed on conventional angiography and subsequently embolized (sensitivity 92%). All the 11 cases, which demonstrated the bronchial arterial (BA) and non-bronchial arterial feeders were also detected on conventional angiography (specificity 92%). Conclusions: CTA is helpful in identifying the precise origin of the BAs from the aorta, which enhances the success of the procedure and clinical results. We recommend CTA before conventional angiography and attempting BAE.
  2,115 27 -
CASE REPORTS
Cerebral aspergilloma mimicking tumoral mass: A diagnostic dilemma
Jyoti Valecha, Vivek Gupta, Nitin Garg
July-December 2014, 21(2):87-90
DOI:10.4103/1115-1474.134620  
Intracranial aspergillosis infection is very rare in immunocompetent patients. Among its varied presentations a solitary intracranial mass is very uncommon. It is usually misdiagnosed as tumor or abscess. A high index of clinical suspicion coupled with an early diagnosis can potentially be life saving. Because of its rarity in the immunocompetent patient and difficultly in preoperative diagnosis we illustrate this case.
  2,097 16 -
Progressive hemiparesis following scorpion sting in a female with uncontrolled hypertension
Srinivas Malliboina, Vidavaluru Mahesh, Amit Agrawal
July-December 2014, 21(2):85-86
DOI:10.4103/1115-1474.134619  
Scorpion sting is a potentially life-threatening medical emergency. Cerebrovascular manifestations (e.g. intracerebral hemorrhage) with focal deficits are uncommon presentations of scorpion sting. We present a case of a 42-year-old female with uncontrolled hypertension, who developed hemiplegia after scorpion sting. In the present case, the patient had a previous history of uncontrolled hypertension.
  1,649 17 1
Repeated local recurrence of dermatofibrosarcoma protuberans in the anterior chest wall of a child
Francis Osita Okpala
July-December 2014, 21(2):91-93
DOI:10.4103/1115-1474.134621  
Dermatofibrosarcoma protuberans (DFSP) is a very rare, low-intermediate-grade sarcoma of the dermis layer of the skin; it has a marked propensity for local recurrence after excision. It is typically diagnosed during early adult life at a tumoral stage and it occurs rarely in children. This report is a case of childhood DFSP that had recurred five times within a period of eight years, each following surgical excision. This tumor also showed an uncommon myxoid change: Appearing as larger multi-nodular cutaneous plaque that arose at the site of excision of previous tumors some years earlier. The rarity of this tumor, and the fact that it is even rarer in children, prompted the report of this case.
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LETTER TO EDITOR
Calcifying epithelial odontogenic cyst of the maxillary sinus
Yadavalli Guruprasad, Dinesh Singh Chauhan
July-December 2014, 21(2):105-106
DOI:10.4103/1115-1474.134627  
  1,402 18 -
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