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Background Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitation The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusion Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes.

Objective: The objective of this study was to compare the safety of BAK-preserved latanoprost versus travoprost BAK-free ophthalmic solution in the primary open-angle glaucoma (POAG). Methods: Prospective, open-labeled, and randomized comparative study conducted in tertiary care hospital. Forty patients were enrolled and divided into 20 patients in each group: Group A topical latanoprost (0.005%) with BAK and Group B topical BAK-free travoprost (0.004%). Safety assessment was done by following parameters – Schrimer test (ST), tear break-up time (TBUT), and ocular surface disease index (OSDI). Results: ST and TBUT were calculated at baseline, 1 month, 2 months, 3 months, and 4 months and OSDI scores were calculated at baseline, 2 months and 4 months. Group A and B were compared using ST, TBUT, and OSDI scores. Group B showed statistically significant results (p

TO report the corneal manifestations in patients with COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM).This study was a retrospective, observational, and record-based analysis of patients of ROCM with corneal involvement.A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty-two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID-19 infection, and injudicious use of systemic steroids. Twenty-nine patients were known diabetics, 32 had recent COVID-19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round-oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals.Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.

Introduction: Serum ferritin correlates with hepatic iron deposition in patients with Non Alcoholic Fatty Liver Disease (NAFLD). Iron removal improves insulin sensitivity thereby delaying the onset of type 2 diabetes mellitus, improves liver function and NAFLD histology. Objectives: This study was done to assess the iron status in NAFLD patients and its association with fibrosis and metabolic syndrome in NAFLD. Material and Method: The study was conducted in the Department of Medicine, GTB Hospital, Delhi from November 2017 - October 2019. It was an Analytical, comparative study. Forty patients with NAFLD were selected in the study group and forty healthy subjects with no evidence of fatty liver on ultrasound were selected in the control group. The level of iron parameters recorded in NAFLD patients and the control group were compared using independent t test and p value of

Introduction Detection of subclinical neuropathy can aid in triage, timely intervention and dedicated care to reduce disease progression and morbidity. High resolution sonography has emerged as a promising technique for evaluation of peripheral nerves. The aim of the present study was to assess the utility of high resolution sonography in screening diabetic patients for subclinical neuropathy. Methods A total of 70 adult patients with type 2 diabetes mellitus and 30 controls were enrolled; those with clinical features of neuropathy constituted the diabetic polyneuropathy group and those without symptoms/normal nerve conduction the non-diabetic polyneuropathy group. After institutional ethical committee approval and informed consent, high resolution sonography was performed by two musculoskeletal radiologists. Nerves studied were median (elbow and wrist), ulnar (cubital tunnel and Guyon’s canal), common peroneal (fibular head) and posterior tibial nerve (medial malleolus).The size (cross sectional area), shape, echogenicity and morphology of nerve were assessed and compared between the groups. Results The mean cross sectional area of all nerves was significantly higher both in diabetic polyneuropathy and non-diabetic polyneuropathy group compared to controls (p value 2 had the highest sensitivity (93%) and specificity (86%) for detecting nerve changes in the non-diabetic polyneuropathy group. The nerves were more rounded, hypoechoic and had an altered morphology in both study groups. Conclusion Presence of sonographic nerve changes in asymptomatic diabetics depicted that morphological alterations in nerves precede clinical symptoms. High resolution sonography detected nerve changes with a good accuracy, and thus, can be a potential screening tool for detection of subclinical diabetic polyneuropathy.

Meckel-Gruber syndrome in one twin of a naturally conceived dizygotic twin pregnancy is largely unknown and has not been reported till date. This report illustrates the sonographic features in a case of 20-week twin pregnancy where one twin had an occipital encephalocele, bilateral enlarged and cystic kidneys, hepatic cyst and oligohydramnios but the other twin was normal. The affected twin succumbed within few days after normal vaginal delivery while the normal twin survived and is healthy.

To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia.30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P 0.05 was considered significant.Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively.Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.

Conventionally used Schatzker and AO/OTA classification, do not identify posterior column injuries in tibial plateau fractures. CT based Four quadrant classification, has been proposed to identify fractures of tibial plateau and help in surgical planning of treatment. However, to assess its validity, there is scanty literature about its reliability (inter and intra-observer variation) and comparison of its reliability with that of the more popular Schatzker classification in classifying tibial plateau fracture.X-rays and CT scans of 35 patients (18-65 years) of closed tibial plateau fractures were assessed by 5 Orthopaedic surgeons and classified by both Schatzker's and Four Quadrant Classification. A similar observation was recorded after 2 months. All observers were blinded for the demographic and clinical details of the patients. Their responses were noted and interobserver and Intraobserver variation was calculated. Kappa Test of Cohen was used to determine the level of agreement, as per Landis and Koch's criteria. The reliability of four quadrant classification was also compared with that of Schatzker's classification.There was a moderate agreement in interobserver variation in observations for Schatzker's classification (on X-rays) which improved to substantial agreement when the observations were recorded after showing both CT and X-rays. The intraobserver variation had substantial agreement. On the other hand, there was a perfect agreement in both intra- and interobserver variation for Four Quadrant Classification. This difference between the reliability of both classifications was statistically significantFour Quadrant classification is a more reliable classification having a better agreement on interobserver and intraobserver variation.

The most common cause of congenital torticollis is sternocleidomastoid contracture. Torticollis due to a unilateral absence of sternocleidomastoid is very rare. Association of an ipsilateral absence of sternocleidomastoid and trapezius with cerebellar hypoplasia is even rarer. We describe a combination of these rarities in an 11-year-old patient with congenital torticollis.

The COVID19 pandemic since its beginning in March 2020, continues to wreak havoc causing great morbidity and mortality with each passing day. Ample literature is now available describing the imaging features of COVID19 infection; however, there is still a paucity of knowledge on the various causes of pulmonary cavitation and cystic lesions which can be associated with the virus albeit uncommonly. Cavitation in a COVID19 positive patient could be a consequence of the infection itself or a manifestation of sinister etiologies like coinfection with bacterial, fungal or mycobacterial pathogens, or incidental malignancy/metastasis. It could also be a result of multiple cavitating pulmonary nodules as a manifestation of septic emboli and infarct, Granulomatosis with polyangiitis or rheumatoid arthritis creating a diagnostic dilemma. Similarly, the causes of cystic air spaces on chest CT in COVID19 patient can be varied, either primarily due to the infection itself or secondary to coexistent cystic bronchiectasis, emphysema, interstitial lung disease or mechanical ventilation-associated barotrauma as well as complicated pulmonary cysts. Through this pictorial review, we aim to highlight these uncommon imaging manifestations of COVID19 and educate the reader regarding the various causes, MDCT features and differentials to be considered while approaching a cavity/cystic lesion amidst this pandemic.

Pathologies of the male urethra are mostly obstructive in nature and require imaging to delineate the lesion type, site, extent and associated abnormality of the urinary bladder. Contrast urethrography (CU) is the gold standard investigation for urethral assessment but has many limitations. Cross-sectional imaging is infrequently used for the evaluation of the urethra but has been gaining importance recently. Multidetector computed tomographic urethrography (MDCTU) has the capability of evaluating the entire length of a male urethra in a single setting and overcomes many technical and patient limitations of CU. Being a novel technique, most radiologists are not familiar with MDCTU and the imaging spectrum of various urethral and bladder pathologies. This pictorial review attempts to present the imaging appearance of the normal male urethra and spectrum of pathological findings, with highlights on its advantages over the CU technique.

Skeletal tubercular infections that do not involve the spine or large joints are rarely encountered. This case series aims to highlight the importance of imaging in diagnosing skeletal tuberculosis (TB) at uncommon sites in clinically unsuspected patients by demonstrating specific imaging findings. We present the clinical details and imaging findings of seven pathologically confirmed cases of extraspinal skeletal TB. A multimodality imaging approach including radiography, ultrasonography (USG) and computed tomography (CT) scan was used in most cases. The imaging studies revealed an infective soft tissue collection over different sites including the sternoclavicular joint, acromion process, chest wall and temporo-mandibular joint, along with destruction and erosion of the underlying or adjacent bones. In tubercular endemic countries, strong clinical suspicion should be entertained in cases presenting with a soft tissue collection, even around unusual skeletal sites.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.

PURPOSE OF THE STUDY: To estimate and to compare the levels of cervical phIGFBP-1 among primigravida with prolonged pregnancy, with and without successful induction of labor (IOL). METHODS: A diagnostic study (cross-sectional study design) was conducted in our institution from November 2016 to April 2018 on 84 primigravida at ≥ 41 weeks with uncomplicated singleton pregnancy. The results were analyzed using SPSS software and receiver operating characteristics curves to determine the best cutoff using Youden Index. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive (+ LR) and negative likelihood ratio (− LR) were calculated. P value 7.8 µg/l) were 0.87, 0.87, 0.89, 0.85, 6.76 and 0.15, respectively. Using logistic regression analysis, phIGFBP-1 was found to be the best predictor of successful IOL (OR 44.200; 95% CI 12.378–157.831, p

OBJECTIVE: Impingement syndrome is the most common differential in a patient presenting to an orthopaedic OPD with shoulder pain. Impingement syndrome is often managed with subacromial corticosteroid injection, which can be instilled using either landmark guided (LMG) approach or with the assistance of ultrasound (US). This study was envisaged to enquire whether ultrasound assistance improves the accuracy, efficacy or safety profile of the injection. METHODS: 60 patients of rotator cuff syndrome underwent diagnostic ultrasound. They were randomly assigned to receive subacromial injection of 2 ml (40 mg/ml) methylprenisolone and 2 ml of 1% lignocaine combination either by US assistance (n = 30) or using LMG assistance (n = 30). The patients were evaluated before injection and on follow up visits at day 5, week 3, week 6 and 3rd month by a single assessor. The assessor was blinded of the treatment group to which patient belonged. Clinical assessment included demographic and clinical data, accuracy of injection, VAS (0–100) for pain, Constant score with goniometer evaluation of range of motion, patient’s self assessment proforma and post injection side effects if any. RESULTS: Initial demographic, clinical and US findings in the groups exhibited no significant differences. The accuracy of US guided injections (100%) was more when compared from LMG injection (93.3%). Both VAS and Constant score showed significant improvement following steroid injection up to 3 months of follow up. However the differences in the two groups were not significant suggesting comparable efficacy of the two approaches. (Mean VAS score decrease: 27.23 for US and 25.16 for LMG, p

The purpose of this study was to determine the predictive value of sonography in identifying the receptor status of breast cancer. Sonograms were performed on 73 patients with breast cancer by two experienced sonologists, and the sonographic features such as tumor size, shape, margins, vascularity, posterior acoustic features, and architectural distortion of surrounding tissues were studied. These were then correlated with the receptor status, that is, triple negative versus non-triple negative. Triple-negative breast cancer was associated with large size, circumscribed margins, posterior acoustic enhancement, high vascularity, and lack of architectural distortion. Non-triple-negative breast cancer tumors revealed smaller sizes with spiculated margins, posterior shadowing, lower vascularity, and architectural distortion of surrounding tissues. Sonography revealed a high sensitivity and specificity (84.0% and 81.2%, respectively) on multivariate analysis for identifying receptor status prospectively. Interobserver agreement was also good. In conclusion, sonography may play a valuable role in prospectively predicting the receptor status in breast cancer and can serve as a potential tool for detecting triple-negative cancer.

Summary Background Venous thromboembolism is a known but rare complication associated with Mycobacterium tuberculosis infection. The reported incidence of venous thromboembolism is 1.5–3.4% of infected patients, and it occurs due to a hypercoagulable state induced by the associated inflammation. Case Report A young woman with pulmonary tuberculosis was found to have disseminated tuberculosis and a clinically unsuspected partial thrombus in the splenic vein on imaging. Ultrasound demonstrated hepato-splenomegaly with multiple granulomas as well as ascites and a left-sided pleural effusion. An increased calibre of the splenic vein with a hyperechogenicity within it raised the suspicion of a thrombus, which was confirmed on a contrast-enhanced CT examination. CECT of the abdomen also showed a small peripheral splenic infarct, while CECT of the chest revealed bilateral miliary lesions in the lungs along with necrotic mediastinal lymphadenopathy. The final imaging diagnosis was disseminated tuberculosis complicated by splenic vein thrombosis. A timely institution of anti-coagulant and anti-tubercular treatment led to a complete resolution of the splenic vein thrombosis. Conclusions Contrast-enhanced CT serves as a useful imaging tool for the detection of venous thrombosis and for the estimation of a complete burden of the disease. This condition should be kept in mind by both clinicians and radiologists and looked for in order to prevent life-threatening complications.

Urethral stricture in a woman is a difficult diagnosis to establish due to its rarity and clinical resemblance to bladder outlet obstruction. Imaging is used to differentiate between the various bladder, urethral, and extrinsic causes of obstruction with the standard voiding cystourethrographic examination but with little success in female patients. The following case presents complete urethral stricture in a woman, which was detected with transvaginal sonography. Transvaginal sonography is not a common modality used to assess female urethral anatomy. The urinary bladder is comfortably distended, unlike in transvaginal sonography for gynecologic indications. Urethral evaluations can be carried out while the patient strains in an attempt to void the urinary bladder. As the normal proximal urethra distends with the antegrade flow of urine during straining, the urethral caliber and wall can be evaluated to assess the level, cause, and severity of obstruction. Sonography provides the unique ability to capture a dynamic assessment of the urethra for a reasonable length of time, without the use of ionizing radiation.

Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.I paragangliomi vagali sono rari tumori benigni e rappresentano solo il 3% dei paragangliomi del distretto testa-collo; originano dai gangli vagali e più frequentemente dal ganglio nodoso localizzato all’interno della guaina carotidea. L’imaging svolge un ruolo importante nella sua diagnosi, nella differenziazione dalle lesioni più comuni che possono trovarsi nello spazio carotideo e, nella sua gestione, una volta identificato. La RM è tuttavia l’indagine di scelta; tuttavia il tipico aspetto “sale e pepe” in T1 pesate pur essendo ben noto non è specifico per i paragangliomi. Pertanto la dimostrazione della continuità della lesione con il nervo vago con la RM è fondamentale per la diagnosi di glomo carotideo. La TC con mdc, può suggerirne la diagnosi, ma è limitata nel dimostrarne la sua origine neurale. Pertanto l’ecografia è considerata solo come un’indagine preliminare in questi pazienti e TC con mdc e/o RM del collo vengono effettuate prima di pianificare il trattamento. In questo caso viene mostrato come la diagnosi di Tumore del glomo carotideo sia stata effettuata con esame ecografico. Un pz maschio di mezza età presentatosi con tumefazione del collo, grazie all’esame ecografico che dimostrava la presenza di una massa riccamente vascolarizzata al color-Doppler e in continuità con il nervo vago veniva inviato col sospetto di tumore glomivo, a esame di II livello e quindi a intervento chirurgico che ne confermavano, grazie all’esame istologico, la diagnosi. L’aspetto ecografico, le caratteristiche Doppler e di imaging del tumore del glomo vagale è di seguito discusso nei dettagli.I paragangliomi vagali sono rari tumori benigni e rappresentano solo il 3% dei paragangliomi del distretto testa-collo; originano dai gangli vagali e più frequentemente dal ganglio nodoso localizzato all’interno della guaina carotidea. L’imaging svolge un ruolo importante nella sua diagnosi, nella differenziazione dalle lesioni più comuni che possono trovarsi nello spazio carotideo e, nella sua gestione, una volta identificato. La RM è tuttavia l’indagine di scelta; tuttavia il tipico aspetto “sale e pepe” in T1 pesate pur essendo ben noto non è specifico per i paragangliomi. Pertanto la dimostrazione della continuità della lesione con il nervo vago con la RM è fondamentale per la diagnosi di glomo carotideo. La TC con mdc, può suggerirne la diagnosi, ma è limitata nel dimostrarne la sua origine neurale. Pertanto l’ecografia è considerata solo come un’indagine preliminare in questi pazienti e TC con mdc e/o RM del collo vengono effettuate prima di pianificare il trattamento. In questo caso viene mostrato come la diagnosi di Tumore del glomo carotideo sia stata effettuata con esame ecografico. Un pz maschio di mezza età presentatosi con tumefazione del collo, grazie all’esame ecografico che dimostrava la presenza di una massa riccamente vascolarizzata al color-Doppler e in continuità con il nervo vago veniva inviato col sospetto di tumore glomivo, a esame di II livello e quindi a intervento chirurgico che ne confermavano, grazie all’esame istologico, la diagnosi. L’aspetto ecografico, le caratteristiche Doppler e di imaging del tumore del glomo vagale è di seguito discusso nei dettagli.

Superior Mesenteric Artery Syndrome (SMAS) is a rare clinical entity presenting as acute or chronic upper gastrointestinal obstruction. It occurs due to compression of third part of duodenum between abdominal aorta and overlying superior mesenteric artery caused by a decrease in angle between the two vessels. Rapid loss of retroperitoneal fat, in conditions leading to severe weight loss is the main factor responsible for this disorder. Superior mesenteric artery syndrome in association with abdominal tuberculosis has not been reported earlier to the best of our knowledge. Therefore, an unknown cause (SMAS) of upper gastrointestinal obstruction in a patient of abdominal tuberculosis is being presented for the first time through this case report. An imaging diagnosis of SMAS was made on contrast enhanced CT abdomen which also confirmed the clinical suspicion of abdominal tuberculosis in the patient. The patient was managed conservatively and recovered without requiring any surgical intervention for the obstructive symptoms.

Summary Gastrointestinal tuberculosis (GI TB) is an important manifestation of abdominal tuberculosis (TB), an extra-pulmonary form of the disease. GI TB commonly affects the small bowel but is difficult to diagnose due to the challenge of evaluating the entire length of overlapping small bowel loops with traditional diagnostic methods like Barium meal follow through, abdominal computed tomography (CT), and endoscopy. New techniques of CT/MR enteroclysis/enterography are now available which specifically image the small bowel. MDCT enterography (MDCTE) is a non-invasive, simple to perform, modified abdominal CT imaging technique permitting reasonably accurate evaluation of the small bowel lumen, wall, perienteric tissues, and solid organs within the abdomen. As GI TB can cause morphological alterations in and around the small bowel, MDCTE seems to be an attractive modality for patients suspected of abdominal or GI TB. As scarce literature is available on MDCTE on tuberculosis, we present a pictorial review on MDCTE findings in patients with GI tuberculosis proved on FNAC and clinical and/or imaging follow-up.

Segmental hypoplasia of the right lobe of liver is a very rare congenital abnormality which is usually asymptomatic and detected incidentally on cross sectional imaging like Computed tomography (CT) and Magnetic resonance imaging (MRI). It is usually associated with various other hepato-biliary anomalies. The radiologic identification of these anatomical variations has significant surgical and interventional implications. We report a case of segmental hypoplasia of posterior segments of right lobe of liver found incidentally on contrast enhanced CT (CECT) abdomen done to determine the cause of sub acute intestinal obstruction in a young adult male patient. Keywords: HepaticSegments, Hypoplasia, Liver, CT

Well differentiated papillary carcinoma of thyroid frequently metastasizes to regional lymph nodes and the patients usually present with cervical or mediastinal lymphadenopathy. In this article, we report a case of papillary thyroid carcinoma with hepatic metastasis presenting as liver mass in absence of lymph nodal metastasis, a presentation not previously reported to the best of our knowledge.

Ocular emergencies contribute to a large proportion of ocular pathologies. These may even be organ-threatening diseases such as central retinal artery and vein occlusion or globe rupture. Conventional physical examination may not always be feasible in emergency situations but decision-making in time is critical in the interest of patient in few of these conditions. Sonography in this setting plays an important role, allowing real-time, quick and dynamic evaluation. Common acute ocular pathologies such as retinal detachment, lens dislocation and globe rupture can be easily diagnosed by ultrasound. Vascular lesions can be identified using Doppler. This article illustrates the sonographic appearance in traumatic and non-traumatic acute ocular pathologies.

Infertility affects 15–20% of the reproductive age range population; the male factor accounts for up to 40–60% of these. With female factor infertility catching most of the limelight in research, diagnosis and treatment, the other half of the problem has not been duly addressed. Imaging has an important role to play in the evaluation of male infertility, especially to identify correctible (obstructive) causes. We review the scrotal, trans-rectal sonographic and Doppler findings in infertile men to aid in the accurate diagnosis and proper management of such patients.

Lipoma of the pancreas is a rare benign tumor which is usually discovered incidentally on imaging Being innocuous in nature it does not require surgical removal and therefore needs to be differentiated from various pancreatic masses Unlike other pancreatic tumors it can be confirmed on CT or MRI imaging and does not require invasive histopathological examination to establish a definite diagnosis We present a case of pancreatic lipoma in a year old female detected incidentally on ultrasound and confirmed on Computed Tomography by demonstrating the characteristic imaging features of lipoma and thus no further histopathological confirmation was required This case report presents a brief review of literature re emphasizing the importance of imaging in distinguishing lipoma from other fat containing lesions of the pancreas and thus re enforcing the ldquo masterly inactivity rdquo policy for these lesions A confident imaging diagnosis of a pancreatic mass being a lipoma would obviate the anxiety of the patient as well as the clinician regarding the need for further management

Adhesive capsulitis (AC) of the shoulder has been a diagnosis of exclusion on sonography due to lack of specific diagnostic criteria. This study prospectively assesses the efficacy of sonography using multiple static and dynamic parameters for diagnosis of AC.Shoulder sonography was performed independently by two musculoskeletal radiologists on 90 subjects (60 symptomatic and 30 controls). All symptomatic subjects were subjected to an MRI. Based on clinical and MRI diagnosis, three groups were made: AC (Sonographic visualisation of CHL (96.7%) and its mean thickness (1.2 mm) were highest in the AC group (Sonography revealed a high accuracy for diagnosing AC of the shoulder and in differentiating it from other causes of painful shoulder. It, thus, has the potential to be adopted as a preferred imaging modality.La capsulite adesiva (AC) della spalla è una diagnosi ecografica di esclusione, per la mancanza di criteri diagnostici specifici. Questo studio valuta prospetticamente l’efficacia dell’ecografia, utilizzando multipli parametri statici e dinamici, per la diagnosi di capsulite adesiva.L’ecografia della spalla é stata effettuata indipendentemente da due radiologi muscoloscheletrici su 90 soggetti (60 sintomatici e 30 di controllo). Tutti i soggetti sintomatici sono stati sottoposti a risonanza magnetica (RM). Sulla base della diagnosi clinica e RM sono stati suddivisi tre gruppi: pazienti con capsulite adesiva (AC) (n = 30), con spalla dolorosa (PS) (n = 30) e gruppo di controllo (CL) (n = 30). I parametri ecografici studiati sono stati: lo spessore del legamento coracoomerale (CHL), l’aumento di tessuto molle nell’intervallo dei rotatori (parametri statici) e la diminuzione di abduzione e rotazione esterna nelle scansioni dinamiche. I risultati sono stati confrontati all’interno dei tre gruppi ed è stata calcolata l’accuratezza di ogni parametro, singolarmente e in combinazione per la diagnosi di AC.La visualizzazione ecografica del CHL (96,7%) e il suo spessore medio (1,2 mm) erano più alti nel gruppo AC (P 0.01). Il valore di cutoff di 0,7 millimetri è stato considerato accurato (sensibilità del 93,1% e specificità del 94.4%) per la diagnosi di AC. L’aumento del tessuto molle nell’intervallo dei rotatori é stato osservato nel gruppo AC e aveva elevata sensibilità (86,2%) e specificità (92,8%). Con scansioni dinamiche, la limitazione della rotazione esterna era significativa (sensibilità 86,2%, specificità 92,8%), mentre la limitazione dell’’abduzione non lo era (specificità 6,7%). L’accordo inter-osservatori, nella visualizzazione del CHL è stato notevole (kappa 0,66). Utilizzando più parametri, nel complesso, l’ecografia ha rivelato elevata sensibilità e specificità (100% e 87% rispettivamente) nella diagnosi di capsulite adesiva della spalla.L’ecografia ha rivelato un’elevata precisione nella diagnosi di capsulite adesiva della spalla, nonché nel differenziarla dalle altre cause di spalla dolorosa, pertanto ha le potenzialità per essere adottata come modalità di scelta tra le metodiche di imaging.

Background: The current recommendation for evaluation of axilla in patients with early breast cancers is Sentinel Lymph Node Dissection. Axilllary node sampling (ANS) has been validated as an alternative, but its reliance on palpation for localization of axillary nodes limits its precision. Pre-operative ultrasound guided localization can be combined with ANS to overcome this limitation. We conducted this study to find the accuracy of Ultrasound Guided Axillary Node Sampling (UGANS) in predicting the status of the axilla in patients with breast cancer.Methods: Forty patients of carcinoma breast with clinically negative axilla underwent pre-operative ultrasonography to identify axillary nodes with suspicion of metastatic involvement. Identified nodes were marked on the skin by a permanent marker and depth from the surface was recorded. The patients underwent mastectomy/breast conservation surgery with axillary dissection. The pre-operatively marked nodes were first dissected out under guidance of the skin markings and subsequently complete axillary lymph node dissection (ALND) was performed. Based on histopathological correlation, accuracy of UGANS was calculated taking ALND as the gold standard.Results: Thirty eight (95%) patients had successful marking of axillary nodes by ultrasonography (USG) (Mean 3.89 nodes). Thirty four (85%) patients had successful sampling of marked nodes (Mean-3.76 nodes). There was a higher rate of sampling failure in patients with negative axilla ( 3/17, 17.6%) than those with axillary metastasis ( 1/21, 4 .76% ). Patients in whom marked nodes could not be localized were mostly young (mean age 39 years), had significantly higher body mass index (BMI) score ( mean 31.38 Kg/m2 versus 24.84 kg/m2 , p = 0.006), and smaller size of marked nodes ( mean 0.99 cm in failure group versus 1.03 cm in successful group). The nodes sampled with USG guidance reflected the status of axilla with accuracy of 100%Conclusion: The present study establishes the feasibility and accuracy of UGANS as a potential cost effective axillary staging modality in low resource settings. However, more studies with a larger sample size are required to validate these initial results.

Purpose: To assess the best method to prescribe spectacles in children.Source of Data: References have been collected from a MEDLINE search from 1975 to 2014. Older articles deemed not to be very contributory and those with foreign languages without any translation were omitted. The search was done using the words – spectacles, children, glasses, and prescription. Study Selection: To help and decide a proper prescription of glasses in children.Data Extraction: Internet for indexed PubMed articles.Conclusions: Children have visual needs that differ from adults, and therefore, the prescription of glasses has to be given with utmost care. They are interested in their near world and the eyes are going through a process of emmetropization. A cycloplegic refraction cannot be avoided. Many guidelines have been given based on the experience of pediatric ophthalmologists/optometrists. The basic principles, however, remain the same and should be adhered to the treatment of myopia, hypermetropia, astigmatism, and anisometropia. It is equally important to look at the spectacle frame and lenses to ensure that the prescription is used by the child.Keywords: Astigmatism, children, hypermetropia, myopia, prescription, spectacles

Acute swelling and discoloration of scrotum in new born can have many localized causes like testicular torsion, inguinal hernia, scrotal or testicular edema, hydrocele, or even remote causes like adrenal hemorrhage. We report a neonate of adrenal hemorrhage presenting clinically as acute scrotum misguiding the clinician to rule out a local scrotal pathology. As the local clinical examination is not reliable in a newborn, it definitely requires an imaging evaluation to establish the diagnosis. This case report emphasizes being aware of the clinical association of acute adrenal hemorrhage and an acute scrotum and the role of ultrasonography in the evaluation of the various differential diagnoses leading to an acute scrotum. An optimum sonographic examination helps in suspecting an abdominal pathology as a cause of acute scrotum and in establishing the specific diagnosis of adrenal hemorrhage to avoid an unnecessary surgical exploration.La tumefazione acuta con pallore dello scroto nel neonato può avere molteplici cause come la torsione testicolare, l’ernia inguinale, l’edema scrotale o testicolare, l’idrocele e anche cause remote come l’emorragia surrenalica. Riportiamo il caso di emorragia surrenalica di un neonato che si presenta clinicamente come scroto acuto, portando il medico al dubbio di una patologia scrotale locale. Poiché l’esame clinico nel neonato è difficile, si richiede necessariamente una valutazione di imaging per formulare la diagnosi. Il caso riportato vuole sottolineare la possibilità di una associazione di emorragia surrenalica acuta con scroto acuto, nonché il ruolo dell’ecografia nella valutazione delle varie diagnosi differenziali dello scroto acuto. Un esame ecografico ottimale aiuta nell’identificare il sospetto di patologia addominale come causa di scroto acuto e a stabilire la diagnosi specifica dell’emorragia surrenalica al fine di evitare un’inutile esplorazione chirurgica.

Multifocal skeletal tuberculosis accounts for less than 1% of all tuberculous lesions in children. A 3-year-old unimmunised child presented with painless symmetrical swelling of both arms, pallor and hepatosplenomegaly. A skeletal survey demonstrated lytic lesions of the metadiaphysis of both humeri, a rib and the sacrum. The possibility of Langerhans cell histiocytosis or multifocal fibrous dysplasia was considered; however, acid-fast bacilli were detected in the biopsy specimen and real-time polymerase chain reaction confirmed Mycobacterium tuberculosis infection. Culture for M. tuberculosis was negative. The patient responded to anti-tuberculous therapy.

Iridocorneal Endothelial syndrome (ICE) is a rare ocular disorder characterized by abnormal endothelization of angle structure and iris producing characteristic manifestations including secondary angle closure glaucoma. We describe the clinical course of three patients with secondary glaucoma due to ICE syndrome who underwent trabeculectomy with mitomycin-C. At last follow-up, all patients had controlled IOP (

Background: Congenital talipes equinovarus is a common foot deformity afflicting children with reported incidence varying from 0.9/1000 to 7/1000 in various populations. The success reported with Ponseti method when started at an early age requires an imaging modality to quantitate the deformity. Sonography being a radiation free, easily available non-invasive imaging has been investigated for this purpose. Various studies have described the sonographic anatomy of normal neonatal foot and clubfoot and correlated the degree of severity with trends in sonographic measurements. However, none of these studies have correlated clinical, radiographic and sonographic parameters of all the component deformities in clubfoot. The present study aims to compare the radiographic and sonographic parameters in various grades of clubfoot. Materials and Methods: Thirty-one children with unilateral clubfoot were examined clinically and graded according to the Demeglio system of classification of clubfoot severity. Antero-posterior (AP) and lateral radiographs of both normal and affected feet were obtained in maximum correction and AP talo-calcaneal (T-C), AP talo-first metatarsal (TMT) and lateral T-C angles were measured. Sonographic examination was done in medial, lateral, dorsal and posterior projections of both feet in static neutral position and after Ponseti manouever in the position of maximum correctability in dynamic sonography. Normal foot was taken as control in all cases. The sonographic parameters measured were as follows : Medial malleolar- navicular distance (MMN) and medial soft tissue thickness (STT) on medial projection, calcaneo-cuboid (C-C) distance, calcaneo-cuboid (C-C) angle and maximum length of calcaneus on lateral projection, length of talus on dorsal projection; and tibiocalcaneal (T-C) distance, posterior soft tissue thickness and length of tendoachilles on posterior projection. Also, medial displacement of navicular relative to talus, mobility of talonavicular joint (medial view); reducibility of C-C mal alignment (lateral view); talonavicular relation with respect to dorsal/ ventral displacement of navicular (dorsal view) and reduction of talus within the ankle mortise (posterior view) were subjectively assessed while performing dynamic sonography. Various radiographic and sonographic parameters were correlated with clinical grades. Results: MMN distance and STT measured on medial view, C-C distance and C-C angle measured on lateral view and tibiocalcaneal distance measured on posterior view showed statistically significant difference between cases and controls. A significant correlation was evident between sonographic parameters and clinical grades of relevant components of clubfoot. All radiographic angles except AP T-C angle were significantly different between cases and controls. However, they did not show correlation with clinical degree of severity. Conclusion: All radiographic angles except AP T-C angle and sonographic parameters varied significantly between cases and controls. However, radiographic parameters did not correlate well with clubfoot severity. In contrast, sonography not only assessed all components of clubfoot comprehensively but also the sonographic parameters correlated well with the severity of these components. Thus, we conclude that sonography is a superior, radiation free imaging modality for clubfoot.