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Background The traditional coronary calcium score (CCS) is a time-tested tool for the evaluation of coronary atherosclerosis and predictor of future cardiovascular events. Non-traditional tools can also have a value in predicting and detecting subclinical coronary artery disease (CAD). Methods We studied the role of CCS, the traditional CAD risk predictor, and the less-recognized, non-traditional risk factors, i.e. epicardial fat volume (EFV) and thoracic extracoronary calcium (ECC), to assess the degree of subclinical CAD. In this cross-sectional observational study, we included 950 Indian patients (suspected to have CAD). Coronary computed tomography angiography was performed. Estimation of CCS, EFV and thoracic ECC was done. Results A CCS of 0 was seen in 583 patients (61.4%). Of these, 492 patients had normal coronary angiogram but 91 patients had CAD. The median values of EFV were statistically significantly higher in the ‘CAD present and CCS 0’ group compared to the ‘CAD absent and CCS 0’ group (p Conclusion The combined use of traditional CCS along with non-traditional EFV may guide us in better profiling cardiovascular risk and supplement the various traditional cardiovascular risk factors/scores.

Mucormycosis is a fungal infection caused by fungi of order mucorales. It is most commonly seen in patients with an impaired immune system due to any cause. Gastrointestinal mucormycosis is the least frequent type and may be a primary disease or a feature of generalized mucormycosis. Angioinvasion is the hallmark feature of mucormycosis, leading to bowel infarction which is the responsible for the most common clinical complaint of pain, and is also responsible for most of the imaging findings in this disease. The stomach is most commonly involved organ in the gastrointestinal tract and pneumatosis and lack of gastric wall enhancement are the most common imaging findings. Areas of bowel wall thickening and/ or lack of enhancement are seen in small bowel mucor and perforation can occur due to ischemia. Colonic mucor can present with mural thickening, or complete lack of definition or 'disappearance' of bowel wall with associated air containing collections. Mucormycosis affecting the bowel has a high mortality rate and early recognition and intervention may improve patient outcomes significantly. It should be suspected in immunosuppressed patients with imaging findings of unexplained bowel ischemia, infarction and/or pneumatosis without any obvious visible vascular thrombus.

Post-partum haemorrhage (PPH) is the most common cause of maternal mortality in India. Uterine artery embolization (UAE) for treating PPH is a recent developed minimally invasive method. It has high efficacy and low complication rate. Uterine necrosis is a rare and life threatening complication of UAE. Imaging features on ultrasound include distended endometrial cavity with dirty acoustic shadowing and thinning of myometrium. On CT, hypo to non-enhancing myometrium with or without air foci is seen. Contrast enhanced MRI is a key diagnostic imaging which has a high soft tissue resolution. Thinning of myometrium with non-enhancing myometrium is a key feature to the diagnosis of uterine necrosis. We present a rare case report of uterine necrosis post UAE.

In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA’s).

Objectives: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast, which is benign but potentially morbid. Mammographic and sonographic findings have been well characterized, but magnetic resonance imaging (MRI) findings have been less thoroughly documented. The objective of this study was to demonstrate characteristic findings for IGM and its mimics via a retrospective review. Material and Methods: Breast MRI examinations performed at Sir Ganga Ram Hospital in New Delhi, India between 2014 and 2019 were retrospectively reviewed to identify cases in which a pattern suggestive of granulomatous mastitis was seen. Cases of known malignancy were excluded. Any available breast pathology results were then obtained, and cases with presumptive or definitive diagnoses were compiled for analysis. Results: Overall, cases identified with characteristic imaging findings and confirmed diagnosis included seven cases of IGM, four cases of invasive ductal carcinoma, two cases of tuberculous mastitis, one case of non- tuberculous infectious mastitis, one case of foreign body mastitis, and one case of eosinophilc mastitis. One case of IGM with masses rather than of non-mass enhancement was also identified. Conclusion: In our review, cases with clustered ring enhancement were found to have inflammatory, idiopathic, infectious and malignant etiologies. While, these etiologies can only be reliably differentiated on pathology, familiarity with the pattern and an awareness of the differential may lead to decreased morbidity due to delays in diagnosis.

Objective: We studied the correlation of quantified epicardial fat with severity of coronary artery disease in patients [suspected cases of coronary artery disease (CAD)] referred for computed tomography (CT) coronary angiography and established cutoffs for epicardial fat volume (EFV) for the presence of CAD and obstructive CAD. Methods: A prospective cum retrospective cross-sectional observational study was carried out on 950 Indian subjects (suspected cases of CAD) who were referred for coronary CT in the year 2013–2016. EFV was quantified using semiautomatic technique on multidetector coronary CT angiography. The presence of atherosclerotic plaques and degree of stenosis was assessed on coronary CT angiography scans. The correlation between quantified EFV and degree of stenosis was assessed. Multivariate analysis was also performed. Results: A higher quantity of epicardial fat is found in patients with increasing severity of coronary artery stenosis. The EFV cutoff for the presence of CAD and obstructive CAD are 49.75 and 67.69 mL with area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 0.68, 81%, 45.9%,58.24%, 72.2%, and 62.84% and 0.709, 64.9%, 66.4%, 35.84%, 86.55%, and 66%, respectively. EFV correlates with age, weight, and body mass index (BMI). Multivariate analysis revealed EFV to be an independent risk factor for the presence of CAD. Conclusions: Higher quantities of EFV are found in patients with greater degree of coronary artery stenosis. EFV correlates with age, weight, and BMI. EFV is an independent risk factor for CAD. Keywords: Epicardial fat, Epicardial fat volume, Epicardial fat quantification, Regional thoracic fat depots

In post-transplant patients, de novo malignancies such as post-transplant lymphoproliferative disease (PTLD), lung carcinoma, renal cell carcinoma, cutaneous malignancies, and Kaposi sarcoma are now seen. The immunotherapy used to prevent graft failure indirectly increases their risk. We present a rare case of visceral Kaposi sarcoma in a patient with orthotopic liver transplant.

Omental cysts are a rare occurrence. Abdominal distention and a painless abdominal mass are the most common presenting symptoms in patients with omental cysts. Children may present with pain abdomen as a result of intestinal obstruction. The most common finding of an omental cyst on physical examination is a freely movable abdominal mass. The diagnostic procedures include ultrasonography and computed tomography. Complete excision of the cyst is considered to be the treatment of choice. Recurrence and malignant transformation of omental cysts is rare. We report a case of a 4-year-old girl with a giant cystic lymphangioma arising from the greater omentum [omental cyst]. The diagnosis was established on multidetector computed tomography (MDCT) preoperatively and complete excision of the cyst was performed by laparotomy. The diagnosis of cystic lymphangioma was confirmed on histopathological examination.

Ectopic pancreas is a rare entity where the pancreatic tissue has no anatomic and vascular contact with the main body of the pancreas and has its own duct system and vascular supply. A detailed clinical report with contrast-enhanced computed tomography (CT) and endoscopic ultrasonography (EUS) imaging findings of a 40-year-old male came with vague symptoms. CT showed a well-defined homogeneously enhancing mass lesion in the duodenojejunal (DJ) flexure. EUS revealed a well-defined hypoechoic mass lesion in the submucosal layer of the DJ flexure. Surgical resection of the mass was performed, and histopathological examination of specimen confirmed the pancreatic tissues. Here, we have described the CT and EUS imaging features which can help to differentiate the ectopic pancreas from the gastrointestinal submucosal tumours.

Abernethy malformation, also known as congenital extrahepatic portosystemic shunts (CEPS) is a rare clinical entity and manifests with different clinical symptoms. CEPS are abnormalities of vascular development where there is shunting of portal blood into the systemic venous system. Multidetector computed tomography (MDCT) is a fast and effective modality for evaluation of CEPS. CT displays all the information desired by the surgeon as well as the clinician including the anatomy of the splenic and superior mesenteric veins, size and site of the shunt, presence or absence of the portal vein radicles, and helps to plan the therapy and even the follow-up of these patients. Contrast-enhanced magnetic resonance imaging (MRI) has also emerged as a promising tool for the evaluation of liver lesions associated with the malformation. The Radiologist should be aware of the various imaging appearances of this entity including its complications. In this article, we describe the imaging appearances of CEPS, their complications, and their imaging appearances on CT and MRI. We have also described various associated anomalies.

Vascular complications are rare after laparoscopic cholecystectomy, seen in less than 1% of the patients. These cases mostly present as melena, hemobilia or hemoperitoneum. Hepatic artery pseudoaneurysm can become a life threatening complication, so urgent intervention is needed to control the bleed. We present a case of post laparoscopic cholecystectomy cystic artery stump pseudoaneurysm treated with percutaneous embolization.

Pulmonary embolism (PE) is a common and serious condition, and if not diagnosed timely may lead to the death of the patient. Imaging plays a major role in the diagnosis of the PE. Since the past decade multi-detector computed tomographic pulmonary angiography is playing a major role in the diagnosis of PE due to its high accuracy. PE may be acute or chronic. PE may cause complete or partial obstruction of the pulmonary arteries. In acute PE, complete obstruction of the segmental and subsegmental branches of pulmonary artery causes enlargement of the vessel. Completely obstructed segmental and subsegmental vessels are smaller in size in the chronic PE. Chronic PE may also lead to the poststenotic dilatation of the obstructed vessel and development of the systemic collateral vessels. Multi-detector computed tomographic pulmonary angiography may be used to assess the clot resolution and severity of the PE.

Objectives: To assess the patient radiation dose profiles in routine body image acquisitions when using iterative reconstruction (IR) methods and compare them with filtered back projection technique. Material and methods: Iterative dose profiles of 986 patients – Thorax (317), Abdomen/Pelvis (540), Thorax/Abdomen/Pelvis (129) in routine clinical practice have been evaluated and effective patient dose estimated from dose length product (DLP) Values. Within the evaluated samples, distribution of CT Dose Index (CTDI) and DLP values were calculated. Results: In Thorax, average DLP delivered was 286.30 mGy.cm which corresponded to an effective patient dose of 4.008 mSv. In Abdomen/Pelvis group, average value of DLP was 495.5 mGy, estimated dose was 7.43 mSv. In trunk study group average DLP was 570.21 mGy which corresponded to an effective dose of 8.55 mSv. Conclusion: Substantial dose reduction is achieved with iterative techniques. In 986 patients scans evaluated, average dose reduction of 33.2% in Thorax, 32.455% in Abdomen/Pelvis and 49.706% in trunk examinations were estimated.

Coronary artery anomalies occur in less than 1 % of the general population. With the advent of multidetector rows and 3D reconstruction, multidetector computed tomography has emerged as the modality of choice in the delineation of the complex coronary anatomy and diagnosis of coronary artery anomalies, helping in the institution of appropriate therapy. We report a case of coronary cameral fistula of the left anterior descending artery to the right ventricle, which was closed by an Amplatzer vascular plug. Coronary CT angiography was used to evaluate the patient prior to the procedure to locate the placement site for the vascular plug.

Coronary artery anomalies may involve the origin, course, and structure of epicardial coronary arteries and occur in less than 1% of the general population. Clinical presentation ranges from being completely asymptomatic to sudden death. Multi-detector computed tomography has come a long way in the diagnosis of coronary artery anomalies since the introduction of 4 rows of detectors in scanners, considering its non invasive nature and the benefits of 3D reconstruction. Defining the coronary anatomy helps in clinical decision making and timely intervention. Since repeated angiographies may be required, low dose CT is an excellent investigation for diagnosis and post interventional follow up rather than repeated invasive catheter angiographies or high dose CT examination. We report two cases of clinically significant single coronary artery anomalies; a case of single Right coronary artery and another case of single Left coronary artery (Anomaly of origin & course).

For the evaluation of congenital heart diseases (CHDs), echocardiography is the initial diagnostic modality and Catheter angiography is the gold standard for delineation of the anomalies. Though echocardiography is the initial diagnostic modality in CHDs, it has its limitations and Catheter angiography is relatively invasive and should be reserved for therapeutic procedures. Multidetector computed tomography (MDCT) has emerged as an important tool for cardiac imaging owing to constant advancements in computed tomography scanners. With the judicious and innovative use of three-dimensional reconstructions, the depiction of congenital anomalies is more accurate and it is possible to perform a virtual surgery to aid the surgeon in planning the approach to the patient as a one or two step procedure, counseling the parents about the outcome and giving a fair estimate of the cost of treatment. MDCT acts as a one stop shop for a complete evaluation of the cardiac, extra-cardiac, visceral and skeletal anomalies; their combinations and subsequent effects on each other. Excellent delineation of the vascular compressions on the tracheo-bronchial tree, degree of main and branch pulmonary artery stenosis, anomalous drainage of pulmonary and systemic veins, interruptions and narrowing of the aorta, anomalies of origin and course of coronary arteries are unique to MDCT.

Budd Chiari Syndrome is the eponymic designation of symptomatic post sinusoidal venous obstruction, whether or not this is associated with hepatic vein occlusion or vena caval obstruction. Dutta and associates (1) classified the syndrome into two distinct types. Type I involves obstruction to the hepatic veins while Type II pertains to an obstruction in the inferior vena cava above the entry of hepatic veins. We report a case of thoraco-abdominal aortic aneurysm presenting as Type II Budd Chiari Syndrome.