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Unusual site metastasis as presenting complaint of renal cell carcinoma (RCC) has been reported previously in literature. RCC is a notorious tumor with unpredictable behavior. We present a case of RCC who presented with scrotal mass and on subsequent investigation was found to have metastasis to scrotum and spermatic cord. Both testes were normal with no evidence of metastasis.

Secondary pneumothorax is a very common medical emergency. At times it is associated with pneumomediastinum, which could be fatal at times if not identified. We present a case of a 11 years old sputum positive child who presented with both these conditions and was diagnosed on chest x ray.

Introduction: Acute abdomen can sometimes be life-threatening and requires an exact diagnosis and appropriate management to avoid mortality among patients. Multi-detector Computed Tomography (MDCT) provides a specific diagnosis and the whole picture of pathology, especially in patients with inconclusive diagnoses. Aim: To evaluate the accuracy of MDCT in diagnosing non-traumatic acute abdominal and pelvic emergencies. Materials and Methods: A cross-sectional study was conducted on 100 patients who presented with acute abdomen and had inconclusive diagnoses based on clinical examination, laboratory investigations, and other imaging modalities. MDCT was performed with a specific protocol depending on the clinical diagnosis. The MDCT results were compared with intraoperative findings, clinical recovery, and Histopathological Examinations (HPE). Data was entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Results: The MDCT diagnosis was concordant in 95% of patients and discordant in 5% of patients. Acute appendicitis was the most common cause of acute abdomen (20%). Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of MDCT in diagnosing the aetiology of acute abdomen were 96.49% (CI 87.89% to 99.57%), 97.67% (CI 87.71% to 99.94%), 98.21% (CI 90.45% to 99.95%), 95.45% (CI 84.53% to 99.44%), and 97%, respectively. Conclusion: Since the clinical findings overlap in patients with acute abdomen, making an accurate clinical diagnosis is challenging. In these cases, MDCT provides a diagnosis with high accuracy and specificity in a short duration of time; hence, MDCT should be performed in acute abdominal emergencies for appropriate patient management.

Context: Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). As it is a novel coronavirus infection, its acute as well as long-term pulmonary alterations in terms of radiological imaging and pathology need to be explored. Aim: To analyze the risk factors associated with the development of pulmonary fibrosis in post-COVID-19 patients. Settings and Design: A retrospective study in a tertiary center in a hilly state of North India. Methods and Material: A retrospective study was carried out in a hilly state of North India during the second wave of the COVID-19 pandemic. A baseline computed tomography (CT) within 1 month and a follow-up CT within 3–6 months of the onset of patients’ symptoms was done. The patients were assigned two groups based on the presence of fibrosis [reticular pattern (inter/intralobular septal thickening), parenchymal bands, bronchiectasis, and/ or honeycombing] on follow-up CT. The patients’ demographic profiles, clinical records, blood laboratory findings, treatment given, baseline CT, and follow-up CT findings were compared between the fibrosis and non-fibrosis groups. Statistical analysis used: The data entry was done in the Microsoft EXCEL spreadsheet, and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, ver 25.0. Results: Of the total 72 patients, two had no abnormality on baseline CT. Forty (57.14%) out of 70 patients already had fibrosis on baseline CT, which increased to involve 47 (67.14%) patients on follow-up CT. It was analyzed that old age, smoking, comorbid status, low SpO2, longer hospitalization, lymphopenia, and increased severity of COVID-19 disease were independent risk factors for the development of pulmonary fibrosis in post-COVID-19 pneumonia. Conclusions: A better understanding of the underlying mechanism and pathogenesis can help in filling up of gaps in risk stratification of COVID-19.

Introduction: Coronary Artery Disease (CAD) is a major cause of morbidity and mortality worldwide; therefore, early diagnosis plays a crucial role in managing patients with CAD. Multidetector Computed Tomography (MDCT) allows non invasive visualisation of coronary arteries but has limited availability, involves radiation, and is costly. Carotid artery atherosclerosis can be assessed by Ultrasound (USG) in terms of Carotid Intima-media Thickness (CIMT) and carotid plaque assessment. These carotid USG parameters are associated with CAD and can be used to predict CAD in high-risk patients. Aim: To study the association and correlation between carotid artery atherosclerosis USG parameters (CIMT and carotid plaque) and CAD, using Computed Tomography Coronary Angiography (CTCA) as a reference. Materials and Methods: A cross-sectional study was conducted from January 2020 to October 2021 in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In the present study, 31 patients with suspected CAD were enrolled. All patients underwent CTCA followed by carotid artery USG within two weeks. The association and correlation between carotid artery atherosclerosis on USG and CAD on CTCA were examined. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated using CTCA as the reference standard. Categorical data were analysed using the Chi-square test, with a p-value of

Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterised by the deposition of calcium phosphate microliths in the alveoli. PAM has been reported in all continents and there is often a familial history. There is clinical-radiological dissociation as there is often a paucity of symptoms in contrast to the imaging findings. Patients often remain asymptomatic until the third or fourth decade of life, and dyspnea is the most common symptom. PAM is caused by a mutation within the solute carrier family 34 member 2 gene (the SLC34A2 gene) located on chromosome 4p15.2, which encodes a sodium/phosphate co-transporter. The imaging appearance of the disease is quite pathognomic with the high-resolution computed tomography (HRCT) demonstrating a diffuse micronodular appearance. Transbronchial lung biopsy also confirms the diagnosis. There is no effective therapy at present except lung transplantation. We herein, present a case of PAM along with clinical history, imaging study, histopathological study and genetic study of a 43-year-old female adult patient along with genetic analysis.

Scrotal arteriovenous malformation (AVM) is an unusual entity with its own important clinical implications. Described only as a few case reports in medical literature, it not only can cause life-threatening haemorrhage because of its superficial location in the scrotum but also can result in infertility. We report the case of a 35-year-old man who had a progressively increasing scrotal swelling for almost 20 years and now presented for infertility workup. He had oligospermia on semen analysis with a normal testosterone level and no history of testicular infection or scrotal surgery. On scrotal sonography and computed tomography angiography, he was diagnosed to have bilateral scrotal AVMs which may have resulted in his oligospermia. Pre-operative embolisation and surgery was offered as a treatment option which the patient declined and was lost to follow-up. However, this case describes scrotal AVM as an important and possibly correctable cause of infertility. Usually diagnosed as scrotal lymphedema clinically, the case has been reported so that the clinician should be aware of this entity as a plausible cause of male infertility and the treatment could be refined and accelerated.

ObjectiveTransient tachypnea of newborn (TTN) and respiratory distress syndrome (RDS) are the most common causes of respiratory distress among preterm neonates. The aim of this study was to evaluate the accuracy of lung ultrasonography (LUS) for diagnosing and differentiating TTN and RDS in preterm neonates. MethodsThis was a prospective single center study. From January 2020 to June 2021 a total of 114 preterm neonates who were admitted to neonatal intensive care unit (NICU) with symptoms of respiratory distress within 6 hours of birth were subjected to clinical examination, laboratory testing, chest x-ray (AP and lateral view’s) and LUS. Their clinical course was closely monitored. On the basis of final diagnosis made on day three of admission they were divided into two groups, 37 diagnosed with TTN and 61 with RDS. Patients diagnosed with other conditions including neonatal pneumonia, meconium aspiration syndrome etc. were excluded from analysis. LUS findings in RDS and TTN were analyzed and compared to each other. Results Pulmonary edema manifesting as alveolo-interstitial syndrome, double lung point and less commonly as white out lungs in absence of consolidation had a 100% sensitivity and specificity in diagnosing TTN. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has a 100% sensitivity and specificity for diagnosing RDS. Double lung point was seen only in infants suffering from TTN while consolidation with air or fluid bronchograms was only seen in cases of RDS. ConclusionLung ultrasound can accurately diagnose and reliably differentiate TTN and RDS in preterm neonates. Hence LUS can become an initial screening tool in NICU.

To evaluate the accuracy of lung ultrasound in diagnosing and differentiating transient tachypnea of the newborn and respiratory distress syndrome in preterm neonates.

To correlate sonographic renal parameters (mean renal cortical thickness, length and volume) with renal functions in patients with newly diagnosed chronic kidney disease. To predict the best renal parameter correlating with renal functions in patients with newly diagnosed chronic kidney disease.

Introduction: Prostate cancer ranks second among all cancers affecting men. Common diagnostic tests like Transrectal Ultrasound (TRUS) and Prostate-Specific Antigen (PSA) are suboptimal for diagnostic purpose. Magnetic Resonance Imaging (MRI) has a promising role in detection, guidance for targeted biopsy and staging of prostate cancer. Aim: To evaluate the role of TRUS and MRI in the detection of prostate cancer and to ascertain if any functional parameter or union of parameters is of any utility in detection of prostate cancer. Materials and Methods: A prospective study was conducted which included fifty patients who underwent TRUS and 1.5-T MRI before being subjected toTRUS-guided biopsy. Imaging was compared with histopathological results. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio for each of the investigation was calculated. Results: The accuracy of the model combining all the imaging variables {T2-weighted imaging (T2WI), MR spectroscopy (MRS), Diffusion-Weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC) and Dynamic Contrast-Enhanced (DCE) MRI} in predicting prostate cancer was 94%, which was higher than the diagnostic accuracy of each variable considered alone (DWI, 92%; ADC, 92%; MRS, 88.0%; DCE-MRI, 92%; and T2WI, 72%). TRUS had a diagnostic accuracy of 80%, sensitivity of 100.0%, specificity of 67.7%, PPV of 65.5% and NPV of 100.0%. Conclusion: TRUS had a high sensitivity and negative predictive value but a low specificity. MRI had both high sensitivity and specificity especially when the combination of functional sequences was used. But, the addition of a third functional technique does not further improve detection. Thus, a limited number of functional sequences are needed in every MRI study for prostatic cancer. However, DWI being the most valuable should be included as one of the sequences.

Introduction: Blunt abdominal trauma is a major cause of morbidity and mortality in young people. Abdominal Ultrasonography (USG) can detect organ injury and free intraabdominal fluid which provides indirect evidence of injury. Multidetector Computed Tomography (MDCT) is the modality of choice in haemodynamically stable patients as it can accurately diagnose and ascertain the severity of injuries. It can also evaluate retroperitoneum and detect arterial contrast extravasation or pseudoaneurysm which predicts the need for surgery or angioembolisation. Aim: To study the spectrum of abdomino-pelvic injuries on MDCT and to compare the MDCT findings with operative findings wherever possible. Materials and Methods: The prospective cohort study was conducted in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from the period 1st June 2019 to 31st May 2020. Patients with history of Road Traffic Accidents, fall, or assault or other causes where clinically blunt trauma of abdomen was suspected and referred for MDCT abdomen and pelvis were included. The blunt abdominal patients who were Focused Assessment with Sonography for Trauma (FAST) positive or had clinical suspicion of abdomino-pelvic injury were evaluated with MDCT. The present study was conducted on 64 slice MDCT scanner light speed Volume Computed Tomography Xte General Electrics (VCT Xte GE) medical systems. All patients underwent CECT abdomen and pelvis in arterial (30 seconds) and porto-venous phase (60 seconds). The MDCT findings were compared with operative findings and clinical follow-up was done after three months. Data were entered into Microsoft Excel sheet and Statistical Package for the Social Sciences (SPSS) software 20.0 version was used for analysing data. Results: Thirty five haemodynamically stable patients with blunt abdominal trauma were included in the study with mean age of 28.5±8.8 years with male predominance. Road traffic accident was the most common mechanism of injury. Visceral injury or free fluid was seen in all the 35 patients on MDCT of abdomen and pelvis. Twenty eight patients were managed conservatively while seven patients were operated. Solid organ injury was seen in 28 patients. Amongst solid organ injury, spleen was the most common organ injured followed by liver. On comparing MDCT and operative findings, pancreatic transection was found in three patients. Sigmoid perforation, renal injury and UB perforation were confirmed in one patient each. On comparing with surgical findings, MDCT had a sensitivity of 100%, specificity of 100% for detecting solid organ injury and the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 100%, respectively. Amongst hollow visceral injury, jejunal perforation was seen in two patients while ileal perforation and Urinary Bladder (UB) perforation was seen in one patient each. However, one case of sigmoid perforation was missed on MDCT. On comparing with surgical findings, MDCT has a sensitivity of 66.66%, specificity of 100% for detecting hollow visceral injury and the PPV and NPV were 100% and 80%, respectively. Conclusion: The MDCT is helpful in detecting solid organ injuries. The MDCT plays a major role in the management of blunt abdominal trauma and helps in making decision regarding operative and non operative treatment. Therefore, MDCT is the investigation of choice in patients with blunt abdominal trauma.

The term “gossypiboma” denotes a mass of cotton that is retained in the body following surgery. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 46-year-old female who presented with vague upper abdominal pain associated with postprandial fullness and occasional vomiting. She had a history of open cholecystectomy 16 years ago. Abdominal X-ray and ultrasonogram examination of the abdomen were inconclusive. Her contrast-enhanced computed tomography of the abdomen revealed thickening of the wall of the pyloric antrum with air containing thick-walled structure in relation to the pyloric antrum and the first part of the duodenum possibility of the duodenal diverticulum with inflammatory/neoplastic thickening was suggested. Her esophagogastroduodenoscopy revealed large cotton sponge embedded in the anterior wall of the first part of the duodenum. On exploratory laparotomy, she was found to have a large gossypiboma embedded in the first part of the duodenum with dense adhesions to surrounding structures. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain even years after the operation.

Introduction: Coronary Artery Disease (CAD) is a major cause of morbidity and mortality worldwide; therefore, early diagnosis plays a crucial role in managing patients with CAD. Multidetector Computed Tomography (MDCT) allows non invasive visualisation of coronary arteries but has limited availability, involves radiation, and is costly. Carotid artery atherosclerosis can be assessed by Ultrasound (USG) in terms of Carotid Intima-media Thickness (CIMT) and carotid plaque assessment. These carotid USG parameters are associated with CAD and can be used to predict CAD in high-risk patients. Aim: To study the association and correlation between carotid artery atherosclerosis USG parameters (CIMT and carotid plaque) and CAD, using Computed Tomography Coronary Angiography (CTCA) as a reference. Materials and Methods: A cross-sectional study was conducted from January 2020 to October 2021 in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In the present study, 31 patients with suspected CAD were enrolled. All patients underwent CTCA followed by carotid artery USG within two weeks. The association and correlation between carotid artery atherosclerosis on USG and CAD on CTCA were examined. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated using CTCA as the reference standard. Categorical data were analysed using the Chi-square test, with a p-value of <0.05 considered statistically significant. Results: The mean age of the patients was 54.06±10.79 years. The CAD was observed in 14 (45.1%) cases, of which 13 (92.8%) had significant CAD. Nine patients had raised CIMT, of which eight had CAD. Raised CIMT and CAD showed a significant association with sensitivity, specificity, PPV, NPV, and accuracy of 57.14%, 94.12%, 88.89%, 72.73%, and 77.42%, respectively. A positive correlation was found between CIMT values and the number of vessels with significant CAD (r= +0.67). A total of 7 patients (22.5%) had the presence of carotid plaque, of which 6 (88.57%) had significant CAD. A significant association was found between CAD and the presence of carotid plaque. Carotid plaque had sensitivity, specificity, PPV, NPV, and accuracy of 50%, 100%, 100%, 70.83%, and 77.42%, respectively, in predicting CAD. A positive correlation was observed between carotid plaque burden and the number of vessels with significant CAD (r= +0.56). Conclusion: There is a significant association between carotid ultrasonography parameters (i.e., CIMT, carotid plaque) and CAD. CIMT is a more sensitive parameter than carotid plaque in predicting CAD. However, carotid plaque is more specific for predicting CAD. Carotid artery ultrasonography can be used as a screening tool for predicting CAD and should be included in the work-up of patients with suspected CAD. [ABSTRACT FROM AUTHOR]

Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

Situs inversus is a rare autosomal recessive condition, with incidence that varies from 1 in 5000 to 1 in 20,000 live births. Because of the atypical “mirror-image” anatomy associated with situs inversus, diagnosis of gallstone disease in these patients is difficult, especially in those with an unknown history of this condition. We report a case of a young female suspected to have situs inversus on esophagogastroduodenoscopy. Subsequently, she was confirmed to have situs inversus totalis with symptomatic cholelithiasis. She was managed successfully with single-incision laparoscopic cholecystectomy by a right-handed surgeon.

Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a well-defined globular mass attached to the anterolateral papillary muscle. The mass was hyperintense on T1 and T2 weighted images with suppression of signal on fat saturated and short tau inversion recovery (STIR) images. This imaging established the diagnosis of cardiac lipoma attached to the anterolateral papillary muscle, Papillary muscle is a very rare location of lipoma, which is rarely reported in the literature. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.

The morphogenesis of the pancreas is a complex process having a very low frequency of anatomic variation. The congenital anomalies are rare. Complete pancreatic and ventral pancreatic agenesis are incompatible with life. Dorsal pancreatic agenesis is exceedingly rare with less than 100 cases reported in the world literature. Patients with this anomaly may be asymptomatic or may present with abdominal pain, hyperglycemia, diabetes mellitus, and acute or chronic pancreatitis. Such anomalies are rarely reported; therefore, clinical awareness of agenesis of the dorsal pancreas as a cause of these symptoms can expand the differential diagnosis and improve patient management.

Caroli’s disease is autosomal recessive, non-obstructive dilatation of intrahepatic biliary ducts. The exact etiology is unclear. Two variants of Caroli’s disease are well known-simple; in which bile ducts are dilated without hepatic fibrosis and the second type which is associated with congenital hepatic fibrosis along with its sequelae, also known as Caroli’s syndrome. Simple Caroli’s disease without hepatic fibrosis is quite rare. The importance of recognizing this disease as a cause of biliary stasis is its frequent association with lithiasis, recurrent cholangitis, liver abscesses, cirrhosis and cholangiocarcinoma.

Aim: The purpose of the study was to describe the enhancement patterns of focal liver lesions (FLLs) on contrast enhanced sonography (CEUS), assessing the potential of this technique for characterizing the lesions and to compare its diagnostic accuracy with conventional baseline sonography including color Doppler. Materials and methods: Between August 2009 and July 2010, 50 patients with FLLs underwent gray scale sonography, color Doppler and CEUS. The enhancement patterns of these FLL’s were analyzed throughout the arterial phase, the portal venous phase and the extended portal venous phase (the late parenchymal phase). The final diagnosis was established on the basis of histopathologic examination or CT/MRI imaging. Results: Out of these 50 FLLs, 33 were malignant (4 hepatocellular carcinoma and 29 metastasis) and 17 were benign (5 hemangioma, 5 abscess, 2 cyst and 1 each of FNH, focal fat sparing area, focal fatty infiltration, adenoma and benign/granulomatous lesion). The enhancement patterns after injecting microbubble contrast agent allowed characterization of FLLs. The malignant lesions showed intratumoral and/or peritumoral vascularity during the arterial phase and perfusion defect during the late parenchymal phase. Contrast enhanced sonography improved sensitivity in detecting malignancy (CEUS vs. baseline sonography, 100% vs. 81.8%). Conclusion: CEUS improves detection and characterization of FLLs. It should be used as problem solving tool in cases where conventional gray scale and color Doppler sonography are non-diagnostic.