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Extrahepatic duplication of the common bile duct (CBD) is an extremely rare anatomic variation seen in the biliary tract. It represents failure of regression of the primitive duplicated biliary ductal system, resulting in five different subtypes of the duplicated CBD as described by Choi et al. To date, only few such cases have been reported in the literature. Associated variation in branching of intrahepatic bile ducts presenting as combined dual ductal anomaly is even rarer phenomena to be seen. We report a case of a 67-year-old man with chronic kidney disease and obstructive jaundice resulting from choledocholithiasis. Evaluation revealed type IIIa branching of intrahepatic bile ducts with type Va duplication of the CBD.

With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive “one-stop” modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist”s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.

The COVID-19 pandemic has caused multi-dimensional global crisis in the recent times. There is an increasing necessity of understanding and developing a strategy for optimal utilization of healthcare resources in this time of crisis. Radiology department remains the backbone for diagnosis and for appropriate management of orthopaedic ailments. Amidst COVID-19 pandemic, there is a need to change in imaging algorithm, for various clinical conditions taking care of the exposure risk to patients and healthcare workers and to handle the volume of diagnostic and intervention work. Radiology preparedness is to set the workflow protocols and policies applicable to radiology investigations for different clinical conditions, which will help to attain these objectives. Radiologists are in best position to decide the most appropriate imaging investigation and protocol making it vital to have a frequent Orthopaedic surgeon–Radiologist interaction, which is one of the most important steps in patient management pathway.

Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on July 7, 2021.

Hysterosalpingography (HSG) has become an important initial investigation in patients who present with infertility or other endometrial/tubal problems. This chapter predominantly deals with HSG as the initial screening procedure for an intrauterine adhesion or Asherman’s workup with emphasis on procedural details and image interpretation. The correct procedural technique and image interpretation of HSG play an important role in efficient patient management. It also briefly addresses the ultrasound extension of HSG–sono HSG and its advantages over HSG.

Objectives This prospective study was conducted to evaluate the site-specific incidence of extra-cranial cysticercosis and to study the imaging spectrum of cysticercosis at extra-cranial locations. Material/Methods The study included a total of 57 sites of involvement in 55 patients over a period of two years. All the patients with imaging-based diagnosis of cysticercosis at extra-cranial locations were studied to determine the imaging patterns. Results These extra-cranial locations included orbit (8.7% of all sites), extra-orbital skeletal muscles (19.44%), skin & subcutaneous tissue (5.2%), parotid gland (3.5%), and miscellaneous (1.75%). Visualization of a cyst with an eccentric nodule was present in 37.2%, while cyst without any definite eccentric nodule was seen at 62.8% extra-cranial sites. Rounded cyst morphology was seen at 24.4% sites, while 75.6% sites showed deformed cysts in extra-cranial cysticercosis. Discussion Cysticercosis is commonly seen at extra-cranial locations and often manifest with several common and uncommon patterns. Typical imaging morphology of cysticercosis is less common at extra-cranial locations, as compared to intra-cranial sites and probably account for diagnostic delays.

Cirrhosis of liver is often a silent disease and need early diagnosis for effective treatment strategy. The present article aims to describe new imaging signs for early diagnosis of cirrhosis on routine CT. These are ‘hepato-diaphragmatic fat interposition’ (HDFI) and ‘increased right hemi-diaphragmatic thickness’ (increased r-DT sign). This was a retrospective study based on the presence or absence of cirrhosis of liver (n = 100). ‘HDFI sign’ was labeled as positive if F is more than 50% of D; where F is the medio-lateral extent of the intra-abdominal fat along the postero-medial margin of liver and D is the distance from the lateral vertebral margin to the medial margin of the outer-most rib in the same axial image. Increased ‘r-DT sign’ is labeled when the dimension on right side exceeds left side by at least 0.2 cm. Pearson χ2 was performed to calculate the p value. A p value of

Congenital brain tumors (CBTs) are extremely rare and account for only 0.5%-1.9% of all pediatric brain tumors. Medulloepithelioma is one of the rare tumors with an incidence of about 1% among all CBTs with a very dismal prognosis and typically diagnosed at the median age of 24 months. The objective is reporting medulloepithelioma presenting in the intrauterine period with very few prior cases being reported in the prenatal period, and to add to the limited existing literature on medulloepithelioma. We present a rare case of medulloepithelioma referred to us in the antenatal period at 27 weeks and subsequently causing intrauterine fetal demise. Prenatal MRI of the fetal brain and postnatal histopathological findings on autopsy were suggestive of intracranial medulloepithelioma.

Background: The objective was to validate the hypothesis and evaluate whether the presence or absence of accessory renal artery can be predicted on the basis of volumetric parameters of kidney and diameter of the main renal artery (mRA). Methods: This retrospective analysis was performed in a total of 60 kidneys in 30 patients, who had computed tomographic (CT) angiography. The kidneys were segregated into control and study groups depending on the absence or presence of accessory renal artery. The total renal volumes were measured using renal length, breadth, and height in mm3. The renal artery diameters were also measured in mm, in the postostial segment. Renal volume/renal artery diameter (V/d) was measured for each kidney in two groups, and the difference in mean V/d values (in mm2) in two groups was measured for statistical significance. Results: The mean V/d value in the study group with presence of the accessory renal artery was found to be 23,444.7 mm2 (range: 16,229.1–32,490.0). The V/d value in the control group with the absence of accessory renal artery was found to be 19,717.15 mm2 (range: 13,704.6–28,000.0). The mean values in the two groups showed a statistically significant difference in the V/d with a P value of 0.001 (P < 0.05). Conclusion: The study suggests that the possibility of the presence of the accessory renal artery is directly proportional to the total renal volume and inversely proportional to the diameter of mRA. The use of integrated volumetric parameter (V/d) is therefore likely to play a key role in the prediction of the presence of accessory renal artery on imaging studies. Renal volumetry on CT angiography may help predict the presence of accessory renal artery and thus may have implications on renal Doppler studies.

Pancreatic inflammation limited to the area between the wall of the duodenum and common bile duct is referred to as groove pancreatitis. The condition is often associated with cystic dystrophy in the medial wall of the duodenum. These patients can present with features of either pancreatitis or pancreatic malignancy. CA19.9 levels are usually normal and serum amylase and lipase may be slightly elevated. Diagnosis is confirmed with either computerized tomography abdomen or endoscopic ultrasound. Management consists of conservative management and endoscopic shincterotomy. Pancreatico-duodenectomy may be required in some cases. In our case, a pancreatico-duodenectomy was required as the patient was suffering from gastric outlet obstruction and severe episodes of recurrent acute pancreatitis.

Purpose To evaluate whether shear-wave sonoelastography can help differentiate stable renal allograft from acute allograft dysfunction and chronic allograft dysfunction and to correlate shear-wave sonoelastography measurements with resistive index (RI), serum creatinine level, estimated glomerular filtration rate (eGFR) obtained with the Nankivell equation, and biopsy findings. Materials and Methods A prospective study of 60 patients who had undergone renal transplantation was conducted between October 2014 and March 2016. Patients were classified as having stable allograft, acute allograft dysfunction, or chronic allograft dysfunction on the basis of clinical parameters. Mean parenchymal stiffness was compared. The Banff score was used wherever applicable. Receiver operating characteristic curves were drawn to evaluate the feasibility of differentiation. Results Thirty patients had graft dysfunction (acute in 19 patients and chronic in 11). Mean parenchymal stiffness values in stable allograft, acute allograft dysfunction, and chronic allograft dysfunction were 8.51 kPa ± 2.44, 11.06 kPa ± 2.91, and 24.50 kPa ± 4.49, respectively (stable vs acute dysfunction, P = .010; stable vs chronic dysfunction, P.001; acute sysfunction vs chronic dysfunction, P.001). The allograft parenchymal stiffness values for patients with Banff grade I (mild interstitial fibrosis and tubular atrophy) differed significantly from those with Banff grade II (moderate interstitial fibrosis and tubular atrophy) (P = .02). Parenchymal stiffness showed a negative correlation with eGFR (r = -0.725; P.001) and a positive correlation with RI (r = 0.562; P.001) and serum creatinine level (r = 0.714; P.001). The sensitivity was 73.68% and specificity was 80% in the differentiation of stable graft from acute graft dysfunction (threshold value, 10.11 kPa). Conclusion Shear-wave sonoelastographic evaluation of renal parenchymal stiffness may help differentiate stable allograft from acute and chronic allograft dysfunction. The inverse correlation of parenchymal stiffness with eGFR and positive correlation with RI and serum creatinine level show that shear-wave sonoelastography may reflect functional status of the renal allograft.

Pelvic peritoneal adhesions constitute an important cause of concern which affects the life of millions of people worldwide due to complications like abdominal pain, bowel obstruction and infertility along with challenges in surgical exploration. Precise pre-operative diagnosis of the presence and extent of peritoneal adhesions is of great clinical and surgical importance. Diagnostic laparoscopy to detect peritoneal adhesions may itself lead to formation of adhesions. Routine CT and MRI studies are therefore useful non-invasive modalities to achieve this objective. This review article provides a brief background about the causation and patho-physiology of peritoneal adhesions. The article also addresses the range of clinical presentations in these patients, mainly from the gynecologic perspective. This article provides an illustrative review of CT and MRI findings with laparoscopic correlation. A new ′imaging-based grading system′ for pre-operative quantification of the burden of peritoneal adhesions is also proposed. Despite practical challenges in accurate pre-operative diagnosis of peritoneal adhesions on imaging, detection of peritoneal adhesions is certainly feasible on routine CT and MRI scans and should be an integral part of image interpretation.

To compare the transrectal (TR) spectral Doppler findings between benign prostatic hyperplasia group and prostate cancer group.All the patients were assessed for adequate preparation, and informed consent was obtained prior to the procedure. The control group (n = 33) comprised patients who were negative for malignancy on biopsy. The study group (n = 22) were positive for malignancy and were also divided into three groups on the basis of the Gleason score. Study parameters included mean values for resistive index (RI), pulsatality index (PI), systolic/diastolic ratio (S/D) and peak systolic velocity (PSV). These were separately measured for bilateral capsular and urethral branches and compared between groups. In patients with unilateral tumour, these were compared between the tumour and non-tumour sides. Finally, the parameters were compared with patient's age. Mann-Whitney U test was used to evaluate the statistical significance.The mean values of RI, PI, S/D and PSV were found to be 0.84/1.03, 1.8/1.99, 3.93/4.45 and 15.52/16.15 cm s(-1), respectively, in the control and study groups which were not statistically significant. In patients with unilateral malignancy (n = 16), there was no significant difference from the non-tumour side. Doppler parameters showed statistically significant relationships with age. The mean of minimum RI was found to be 0.60 in patients less than 60 years of age and 0.76 in patients more than or equal to 60 years of age in the benign category (p-value = 0.014). The PI and S/D also showed significant difference in the benign category.TR spectral Doppler parameters did not reveal any significant difference in patients with or without prostatic malignancy, irrespective of the Gleason grade. Doppler parameters, however, showed significant correlation with age and were lower in younger patients.TR spectral Doppler is unlikely to emerge as a diagnostic and prognostic tool for prostate carcinoma.

Renal transplant complications are categorized as those related to the transplant vasculature, collecting system, perinephric space, renal parenchyma, and miscellaneous complications including posttransplant lymphoproliferative disorder. Many of these renal transplant complications are diagnosed with imaging. Medical complications including rejection, acute tubular necrosis, and drug toxicity also can impair renal function. These medical complications are typically indistinguishable at imaging, and biopsy may be performed to establish a diagnosis. Normal transplant anatomy, imaging techniques, and the appearances of renal transplant complications at ultrasound, computed tomography, and MR imaging are reviewed.

By definition, antenatal MRI is the MR imaging during state of gestation without causing any significant risk to ongoing pregnancy and the fetus. MRI is in a unique advantageous position during antenatal period where ultrasound often provides limited information and CT is usually avoided due to radiation-related risks. The indications of antenatal MRI can be sub-divided into fetal indications, maternal obstetric indications and maternal non-obstetric indications. Antenatal MRI offers better anticipation of prognosis and facilitates parental counseling by accurate characterization of disease process and detection of concomitant anomalies. Ultrasound will however, remain the primary fetal imaging modality and MRI is not likely to replace its role in fetal imaging because of the proven utility, widespread availability and relatively low cost of ultrasound. But under specific clinical conditions, where Ultrasound does not provide adequate information, MRI is bliss and is a useful adjunct to ultrasound. The specific clinical indications where MRI proved to be more useful include fetal anomaly screening in high risk/precious pregnancy, oligohydramnios / maternal obesity, fetal CNS assessment, characterization of fetal mass, assessment of fetal spine, delineation of fetal alimentary tract and other abdominal viscera, conjoint twin assessment, prior to antenatal intra-uterine fetal surgery or ex-utero intrapartum procedure. MRI indications which are presently at relatively experimental stage include non-invasive MR spectroscopy to detect antenatal fetal hypoxia and lung maturity status. Apart from this, the role of Diffusion-weighted MRI in antenatal imaging of placenta and fetal kidneys/lungs is also likely to emerge in near future. In addition, antenatal MRI also evaluates the maternal pelvis and provides vital information about fetal-pelvic disproportion. By virtue of recent advances in MR technology and the need to practice evidence-based medicine, antenatal MRI is now rapidly moving from the realms of select academic medical centers into community practice in India. The article provides a brief update on antenatal MRI in routine clinical practice.

Chest physicians need to be aware about MinIP images, as these are increasingly being used for the evaluation of a wide range of lung diseases in HRCT study of lungs. MinIP images highlight the areas with reduced CT attenuation in the lung parenchyma. This allows prompt and early diagnosis of cystic lung diseases or airway, vascular or parenchymal disorders, which manifest with hypoattenuation, mosaic attenuation or air trapping. MiniP images are therefore useful for accurate pre-operative planning and disease monitoring.

Thoracic endometriosis syndrome is a rare disorder characterized by the presence of functioning endometrial tissue in the pleura, the lung parenchyma, or the airways. The diagnosis of thoracic endometriosis syndrome is usually based on the temporal relationship of the patient’s symptoms with menses

NOTICE: THIS ARTICLE HAS BEEN RETRACTED Salmonella typhi infection presents most commonly as typhoid fever and infrequently as extraintestinal localized infections of bone, joints, soft tissues, spleen, endocarditis, pulmonary, hepatobiliary, genital and urinary systems. Urinary tract infection (UTI) is rare and clinical presentation is indistinguishable from UTIs due to other etiological agents or may even be asymptomatic. We report two cases of patients with chronic kidney disease with UTI due to Salmonella typhi . Renal cyst, nephrolithiasis and urethral strictures were the concomitant findings in one case and renal tubular acidosis with nephrocalcinosis in the other. In patients with relapses and a chronic course with coexisting functional or structural abnormalities of the urinary tract system, the suspicion of salmonella as one of the probable causative agents should be kept in mind so as to ensure appropriate and adequate therapy. Also in the presence of long-standing hypokalemia, one must investigate for renal abnormalities and vice versa. World J Nephrol Urol. 2017;6(3-4):32-34 doi: https://doi.org/10.14740/wjnu310w

As Laparoscopic Donor Nephrectomy (LDN) offers several advantages for the donor such as lesser post-operative pain, fewer cosmetic concerns and faster recovery time, there is growing global trend towards LDN as compared to open nephrectomy. Comprehensive pre-LDN donor evaluation includes assessment of renal morphology including pelvi-calyceal and vascular system. Apart from donor selection, evaluation of the regional anatomy allows precise surgical planning. Due to limited visualization during laparoscopic renal harvesting, detailed pre-transplant evaluation of regional anatomy, including the renal venous anatomy is of utmost importance. MDCT is the modality of choice for pre-LDN evaluation of potential renal donors. Apart from appropriate scan protocol and post-processing methods, detailed understanding of surgical techniques is essential for the Radiologist for accurate image interpretation during pre-LDN MDCT evaluation of potential renal donors. This review article describes MDCT evaluation of potential living renal donor, prior to LDN with emphasis on scan protocol, post-processing methods and image interpretation. The article laid special emphasis on surgical perspectives of pre-LDN MDCT evaluation and addresses important points which transplant surgeons want to know.

Received August 14, 2008, from the Diwan Chand Imaging Research Center, New Delhi, India. Revision requested August 20, 2008. Revised manuscript accepted for publication August 28, 2008. Address correspondence to Nitin P. Ghonge, MD, DNB, Diwan Chand Imaging Research Center, 10B, K. G. Marg, New Delhi-110 001, India. E-mail: nitin_ghonge@yahoo.com 15-year-old girl underwent abdominal sonography for evaluation of continuous dull-aching upper abdominal pain in the epigastric region of 1-year duration with recurrent episodes of emesis. The pain did not have any definite aggravating or relieving factors. There was a clinical history of intermittent abdominal pain in the past for at least 4 to 5 years. The girl lived in India in a suburban locality of the national capital region of Delhi and belonged to the poor socioeconomic strata of the society. Sonography done elsewhere in the past yielded normal findings. No definite clinical history of tuberculosis, diabetes, or hypertension was suggested. Laboratory test results, including the white blood cell count and urinalysis, were within normal limits. A stool examination for parasites was not done before the patient was referred to the radiology department. However, she did not notice any worms in her vomitus or stools in the past. Supine and upright radiographs of the abdomen did not reveal any definite evidence of intestinal obstruction. Sonography of the abdomen was advised to look for the cause of abdominal pain. Sonography of the abdomen showed the stomach distended with fluid because the patient had a glass of water just before the examination. The sonographic examination of the stomach was performed with a 2.5-MHz curvilinear transducer with the patient in the supine position. Because the gastric lumen was grossly distended with fluid, the tissue harmonic mode was used for imaging. The gastric lumen showed a long tubular tortuous echogenic structure in the dependent part (Figure 1). The lumen of the lesion appeared hypoechoic and measured approximately 7 mm in thickness. A faint thin echogenic line was also noted in the central part of the lumen

Learning Point for Clinicians Cysticercosis is now seen as a global disease affecting the whole world, and clinicians should be aware of the typical clinical presentations and imaging findings of rice-like or starry sky appearance in order to avoid misdiagnosis and thereby instituting appropriate treatment. A 28-year-old man without significant medical history presented to our hospital for premarital health checkup. On clinical examination, several lumps were palpated in the skin of the entire body, with arms and legs predominance. No other clinical abnormalities were found, with normal neurological and opthalmological examinations. Past history revealed occasional eating of several kinds of raw meat during his stay in the rural mountainous region. Blood tests revealed normal hematocrit profile and WBC count. Radiographs were performed which revealed numerous rice-like ovoid calcified lesions resembling starry sky appearance in the abdomen and lower extremities with lower limb predominance (Figure 1, Panel A). Considering high suspicion for parasitic infestation, magnetic resonance imaging (MRI) of the lower extremities was performed for better …

The present article reports a case of a 21 years male that was diagnosed to have isolated intramuscular hydatid cyst of the biceps brachii on Ultrasound and MRI. The ‘Scroll appearance’ of the ruptured endocyst in this case is likely to be an intervening transient stage in evolution of the disease and also indicates recent rupture of the endocyst.

In this study, we evaluated the role and relevance of multidetector computed tomography (MDCT) "surface map" of the appendix in demonstrating the variations in the location of the appendicular base with reference to McBurney's point and its likely clinical implications during an open appendicectomy.This prospective study included a total of 74 patients who underwent an MDCT study of the abdomen for various clinical indications. Post-processing of the data was performed and a "surface map" of the appendicular base was reconstructed with a superimposed measurement grid. The variation in the appendicular base location with reference to McBurney's point was analyzed along the cranio-caudal and medio-lateral axes.The maximum deviation in the location of the appendicular base was +10.0 cm along the cranio-caudal axis and -4.2 cm along the medio-lateral axis. The average cranio-caudal deviation was +2.79 cm, while the average medio-lateral deviation was +0.146 cm. In the subgroup of 16 patients who had appendicular inflammation, the maximum deviation was +8.8 cm along the cranio-caudal axis and +3.0 cm along the medio-lateral axis. The average cranio-caudal deviation in this subgroup of patients was +2.77 cm; the average medio-lateral deviation was +0.77 cm.The MDCT "surface map" of the appendix is an effective tool that can convey precise information regarding appendix location to the operating surgeon. There are significant variations in the location of the appendicular base with reference to McBurney's point. These variations are more pronounced along the cranio-caudal axis than the medio-lateral axis. Accurate preoperative localization of the appendicular base with MDCT will help surgeons optimize the initial incision for an open appendicectomy, thus, minimize extension-related incision risks.

Multi-detector computed tomography has become a first-line imaging modality for the evaluation of small bowel disease. Its high speed and resolution ensure excellent imaging of the small bowel with simultaneous evaluation of the lumen and wall, adjoining mesentery, and extraluminal structures in the abdominal cavity. Optimal luminal distension is an important prerequisite. Computed tomography enterography (CTE) is a dedicated adaptation for the study of the small bowel. This review discusses CTE with emphasis on procedural technique and image interpretation.

Clinical symptoms and signs of ovarian torsion are often nonspecific, and imaging studies have a crucial role in making an accurate timely diagnosis. Ultrasound with color Doppler is often the initial investigation. However, as illustrated in our case, a normal Doppler study cannot exclude the diagnosis of ovarian torsion, and MRI should be performed if a high degree of concern for ovarian torsion persists. We report a case of a case of an 18-year-old female who was diagnosed with ovarian torsion on MRI. To the best of our knowledge, "whirlpool sign on MRI" has not been reported previously. If this sign is present, a specific diagnosis of ovarian torsion can be made.

A 45-year-old male presented with a clinical history of vague upper abdominal pain. There was no significant medical illness or any history of renal disease in the past. Clinical examination and laboratory parameters were unremarkable. A serum creatinine value of 0.83 mg/dL, serum sodium of 139 mEq/L and serum potassium of 4.2 mEq/L were reported. Contrast-enhanced CT study of the abdomen revealed a ‘horseshoe’ configuration of the kidneys with a thick pre-aortic parenchymal isthmus (Figure ​(Figure1).1). The kidneys also showed multiple parenchymal cysts of varying sizes (Panels A and B). These cysts were seen to involve the cortical as well as medullary regions. The renal parenchymal enhancement and contrast excretion were preserved. No definite hydroureteronephrosis, calculus or mass lesion was identified. Multiple small parenchymal cysts were also seen in the liver. No definite cysts were seen in pancreas or seminal vesicles. The diagnosis of polycystic horseshoe kidney was made, which was in fact an incidental detection, as the abdominal pain was ascribed to cholelithiasis and the renal functions were preserved. Fig. 1. Coronal (left panel) and axial (right panel) contrast-enhanced CT images showing a horseshoe configuration of the kidneys, which also shows multiple parenchymal cysts of varying sizes (arrows in both panels). The liver also shows multiple parenchymal ... Polycystic horseshoe kidney is a combination of two distinct renal disorders. Horseshoe kidney is a renal fusion anomaly during embryogenesis while autosomal-dominant polycystic kidney disease (ADPKD) is a hereditary disorder due to gene mutations. Horseshoe kidney is the most common of all renal fusion anomalies and is often asymptomatic. ADPKD is the third most common cause of end-stage renal disease. Polycystic horseshoe kidney is, however, extremely rare with only 20 cases reported in the literature. Concomitant presence of renal polycystic disease and horseshoe anomaly is likely to lower the age of renal failure and therefore warrants closer surveillance of these patients, despite the incidental diagnosis.

Ortner′s syndrome (left recurrent laryngeal nerve palsy caused by cardiovascular pathology) is described in literature as occurring secondary to a variety of conditions. Spontaneous aneurysm of ductus arteriosus is a rare cause of this condition. We present a case where an adult patient with an aneurysm of the ductus arteriosus presented for the first time at the age of 62 years with hoarseness of voice secondary to left recurrent laryngeal nerve palsy.

We report two adult patients with varied urologic symptoms who were found to have inflammatory pseudotumor on histopathology. The first patient had a large, solid, enhancing retroperitoneal mass lesion and presented with increased frequency of urination and recurrent urinary tract infections. The second patient had an obstructing left distal ureteric stricture and presented with painless hematuria. Though preoperative radiological diagnosis of this entity is not feasible, the present article illustrates the imaging findings in this unusual disease entity with review of the relevant literature.

A 15-year-old boy presented with lifelong neck swellings that had been gradually increasing in size. He was otherwise asymptomatic. Physical examination was notable for a larger nodule in the infrahyoid area (Panel A, white arrow) and a smaller nodule in the suprahyoid area (Panel A, black arrow). Laboratory tests revealed evidence of subclinical hypothyroidism, with elevated thyrotropin levels (12.6 μIU per milliliter; normal range, 2 to 11), accompanied by normal levels of triiodothyronine (92 ng per deciliter [1.4 nmol per liter]) and thyroxine (6.1 μg per deciliter [78.5 nmol per liter]). After the administration of contrast material, computed tomographic scans . . .