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ABSTRACT: True cardiac arteriovenous malformations are rare anomalies that may be acquired or congenital in origin. These anomalies are well demonstrated by Multi Detector Computed Tomography (MDCT) with much higher clarity and anatomic detail than invasive angiography. We report a case of large complex cardiac vascular malformation in 55 year old male involving feeders from systemic (internal mammary artery, right inferior phrenic artery), coronary (left anterior descending), and pulmonary arterial and venous systems using a 64 slice MDCT scanner. Cardiac AV malformations have previously been described using MDCT, but this case is unique in terms of its large size, extensive involvement of systemic, coronary and pulmonary vascular connections, and mild clinical symptomatology. Our case shows that patients with complex coronary malformation may not always require treatment as natures’ pathways may work well throughout lifetime.

Wandering spleen is a rare entity and can be a great imitator. Varied presentations have been described. We a present a case, the first in our center, with pelvic spleen associated with splenic vein torsion and secondary gastric varices. Presentation of our patient was with haematemesis which settled after splenectomy.

Background: Focal liver lesions have a broad differential diagnosis. MRI with its improved soft tissue characterization and newer sequences can significantly narrow the differentials especially when discriminating benign from malignant lesions. Methods: T1, T1 IN AND OUT OF PHASE, T2, LONG TE T2 AND Diffusion Weighted Imaging was done in 159 patients with USG documented focal liver lesion. Qualitative and quantitative assessment of ADC values and long TE images was done and a threshold for differentiating benign from malignant lesions was obtained. The MRI diagnosis was compared with final diagnosis obtained from histopathology in most cases or follow up and other tests (markers and RBC scan) were histopathology was not available. Sensitivity, specificity and accuracy of MRI sequences in differentiating various focal lesions were obtained. Results: T1 weighted images were useful for identifying fat, hemorrhage and iron within the lesions. T2 weighted imaging was able to correctly classify 82.0% lesions as malignant and 83.7% lesions as benign. Long TE T2 images were highly accurate in distinguishing haemangiomas and cysts from solid lesions. On diffusion-weighted (DW) imaging, 89.5% (i.e. 60 out of 67) lesions were correctly classified as malignant and 88.0% (i.e. 81 out of 92) lesions were correctly classified as benign. Threshold ADC value of 1.37 × 10-3 mm2/s is highly accurate for differentiating malignant from benign lesions. Conclusion: DWI is a sine qua non in liver lesion assessment allowing improved detection and characterization. Long TE T2 weighted imaging can accurately detect haemangiomas and cysts and rule out metastasis.

Introduction: Sheehan syndrome is a common cause of hypopituitarism in developing countries. Among risk factors, in addition to post-partum haemorrhage, a smaller sellar volume is also believed to predispose to pituitary necrosis. Some earlier studies have reported smaller sellar volume in these patients but involved a small number of patients and lacked matched controls. The main of the present study was to study the sellar volume in a large cohort of patients with Sheehan syndrome and compare it with age- and parity-matched controls. Methods: Fifty women with Sheehan syndrome and an equal number of age- and parity-matched controls were studied. Baseline investigations, relevant hormonal assay, and MRI of pituitary were studied in all. Results: Sellar volume was significantly lower in patients with Sheehan syndrome (334.50 ± 129.08 mm3 in patients as against 456.64 ± 169.25 mm3 in controls, P = 0.000). Far more women with Sheehan syndrome than controls had decreased sellar volume (40% vs. 12%). Conclusions: Patients with Sheehan syndrome have a smaller sellar volume that may be a non-modifiable risk factor for the development of post-partum pituitary necrosis. [ABSTRACT FROM AUTHOR]

Background Pneumothorax is the most common complication of computed tomography (CT)-guided lung biopsy. The asymptomatic rate ranges from 17.5 to 72%. The symptomatic rate requiring chest tube insertion is 6 to 18%. Aims This article studies the role of management of postbiopsy pneumothoraces by needle aspiration and pigtail catheter insertion. Methods This was a prospective observational study conducted over 2 years. Postbiopsy and prior to withdrawing the coaxial cannula a CT data set was obtained to detect and quantify pneumothoraces as mild, moderate, and severe. In all asymptomatic cases of mild pneumothorax simple observation was done. In all asymptomatic cases of moderate pneumothorax, immediate needle aspiration was performed. In all symptomatic cases, cases with severe pneumothorax, and cases with progressively enlarging pneumothorax small caliber 6 to 8F pigtail catheters were inserted. Results Ninety-one cases had mild pneumothorax, 42 had moderate pneumothorax, and 18 had severe pneumothorax. In the 91 patients of mild pneumothorax only 1 (1%) patient showed increase in size of pneumothorax on follow-up requiring catheter insertion. In the 42 cases of moderate pneumothorax, which were managed by simple aspiration of pneumothorax, 4 (9.5%) cases showed increase in size of pneumothorax on follow-up. A total 23 cases required pigtail catheter insertion in our study. These constituted 15.2% of pneumothorax cases. The mean duration of catheterization in our study was 3.74 ± 1.09 days. Conclusion Majority of pneumothoraces are benign and do not require any intervention, just observation. Manual aspiration is an effective way of treating moderate pneumothoraces with success rate of 90%, thereby reducing the number of cases requiring catheter insertion; however, close observation is required as few cases may progress to severe pneumothorax and require pigtail insertion. Only a small percentage of biopsy cases (6.4%) require catheter insertion which is a safe and effective treatment. [ABSTRACT FROM AUTHOR]

Objective: Patients with Sheehan syndrome (SS) are predisposed to coronary artery disease (CAD) due to risk factors like abdominal obesity, dyslipidemia and chronic inflammation. In addition to estimate CAD risk enhancers like high sensitive C reactive protein (hsCRP), apolipoprotein B (ApoB) and lipoprotein A [Lp(a)], this study applies Framingham risk score (FRS) and coronary artery calcium (CAC) score to compute a 10‐year probability of cardiovascular (CV) events in SS patients. Design: Case–control study Sixty‐three SS patients, on a stable hormonal replacement treatment except for growth hormone and 65 age, body mass index and parity‐matched controls. Measurements: Measurement of serum hsCRP, ApoB and Lp(a) and estimation of CAC with 16‐row multislice computed tomography scanner. Results: The concentrations of hsCRP, ApoB and Lp(a) were significantly higher in SS patients than in controls (p <.01). After calculating FRS, 95.2% of SS patients were classified as low risk, 4.8% as intermediate risk and all controls were classified as low risk for probable CV events. CAC was detected in 50.7% SS patients and 7.6% controls (p =.006). According to the CAC score, 26.9% SS patients were classified as at risk (CAC > 10) for incident CV events as against 1.6% controls. The mean Multi‐Ethnic Study of Atherosclerosis (MESA) score was significantly higher in patients with SS than controls. CAC corelated significantly with fasting blood glucose (r =.316), ApoB (r =.549), LP(a) (r =.310) and FRS (r =.294). Conclusion: Significant number of asymptomatic SS patients have high coronary artery calcium score and are classified at risk for CAD. [ABSTRACT FROM AUTHOR]

Byline: Mohd. Ilyas, Fahad. Shafi, Naseer. Choh Brunn's cyst in the region of the bladder neck is a rare cause of lower urinary tract obstruction. This case describes the ultrasonographic [...]

The posterior reversible encephalopathy syndrome (PRES) is characterized by patchy cortical and subcortical lesions in the distribution of the posterior circulation. The lesions are classically reversible. This syndrome has multiple etiologies, most of which cause acute hypertension. We present a case of PRES with involvement of the medulla and cervical cord (apart from the typical parieto-occipital lesions)-an extremely rare imaging manifestation of PRES. It is important to recognize the imaging findings of PRES in spinal cord, and avoid misdiagnosis as myelitis by proper clinical correlation. Typically patients with myelitis have a profound neurodeficit, while patients with spinal manifestations of PRES are asymptomatic. Involvement of the cord in PRES has probably been an underrecognized entity as spinal imaging is not routinely performed in posterior reversible encephalopathy syndrome.

Polysplenia, or left isomerism, is a rare heterotaxy syndrome characterized by bilateral bi-lobed lungs, bilateral pulmonary atria, a symmetrical midline liver, and multiple aberrant splenic nodules. We report a case of polysplenia associated with congenital lobar emphysema apart from other typical anomalies. Such an association has not been previously reported. The patient was a young male with progressive exertional breathlessness referred for high resolution CT of the lungs. CT, MRI and echocardiography revealed (in addition to congenital lobar emphysema of right lung) a hemiazygos continuation of the inferior vena cava, a persistent left superior vena cava, multiple splenunculi in the right hypochondrium, midline liver, bilateral bilobed lungs, a large pulmonary artery (suggestive of severe pulmonary artery hypertension) and a large VSD-a typical constellation of findings described in polysplenia syndrome.

Objective: Cabergoline is a potent dopamine receptor agonist commonly used in the treatment of hyperprolactinemia. However, there are scarce data on the imaging characteristics of prolactinomas that could predict the response to treatment. The present study prospectively evaluated the effectiveness of cabergoline in the reduction of tumor volume and serum prolactin levels in treatment-naive cases of prolactinomas besides evaluating the imaging features of tumors on T2-weighted magnetic resonance imaging that could potentially predict the response to treatment. Methods: The present study evaluated 83 prolactinomas (52 micro- and 31 macroprolactinomas) for a 24-month period. The T2-weighted signal characteristics of prolactinomas were evaluated at the start of treatment in addition to the estimation of tumor volumes and prolactin levels. T2-weighted signal characteristics of tumors allowed the categorization of tumors into homogeneous and heterogeneous groups. Patients were started on cabergoline therapy, and thereafter, serial magnetic resonance imagings were performed at 4-, 8-, 12-, 18-, and 24-month intervals to monitor the changes in tumor volume and prolactin levels. Results: A total of 30 (27 micro- and 3 macroadenomas) patients showed complete disappearance of tumor at 24 months. More than a 75% reduction in tumor volume was noted in 82.7% of microadenomas and 78.6% of macroadenomas. More than a 75% reduction in prolactin levels was seen in 88.5% of microadenomas and 77.9% of macroadenomas at 24 months. After 1 year of treatment with cabergoline, 68.6% (35/51) showed normalization of prolactin levels and 64.7% (33/51) showed more than 50% reduction in tumor volume in the homogeneous group. In comparison, only 28.12% (9/32) showed normalization of prolactin levels and 31.25% (11/32) showed >50% tumor volume reduction among the heterogeneous group. Heterogeneous prolactinomas had more number of macroadenomas and were significantly larger and more secreting compared to homogeneous tumors at baseline (all P < .05) Conclusion: Cabergoline administered for 12-24 months induced a significant tumor volume reduction with amelioration of clinical symptoms of prolactin excess and normalization of serum prolactin levels. T2-weighted homogeneous tumors had a more favorable outcome in comparison to the heterogeneous tumors. [ABSTRACT FROM AUTHOR]