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The World Health Organization has declared “with great hope” an end to COVID-19 as a public health emergency. The vaccination drive that started in December 2020 played a crucial role in controlling the pandemic. However, the pace at which COVID-19 vaccines were developed and deployed for general population use led to vaccine hesitancy, largely owing to concerns regarding the safety and efficacy of the vaccines. Radiology has been instrumental in demonstrating the extent of pulmonary involvement and identification of the complications of COVID-19, and the same holds true for vaccine-related complications. This review summarizes the existing body of radiological literature regarding the efficacy, adverse events, and imaging pitfalls that accompany the global rollout of various COVID-19 vaccines.

Subclavian artery pseudoaneurysm is an uncommon entity caused by trauma or iatrogenic arterial injury. Endovascular management is the preferred treatment strategy but can be complicated by endoleaks. We report a case of type I endoleak occurring after endovascular covered stent placement to treat a traumatic pseudoaneurysm of proximal left subclavian artery.

Skeletal radiographs along with dental examination are frequently used for age estimation in medicolegal cases where documentary evidence pertaining to age is not available. Wrist and hand radiographs are the most common skeletal radiograph considered for age estimation. Other parts imaged are elbow, shoulder, knee, and hip according to suspected age categories. Age estimation by wrist radiographs is usually done by the Tanner-Whitehouse method where the maturity level of each bone is categorized into stages and a final total score is calculated that is then transformed into the bone age. Careful assessment and interpretation at multiple joints are needed to minimize the error and categorize into age-group. In this article, we aimed to summarize a suitable radiographic examination and interpretation for bone age estimation in living children, adolescents, young adults, and adults for medicolegal purposes.

Introduction: Hansen's disease (HD) is a major public health problem in developing countries. It causes peripheral neuropathy, and if left untreated, it leads to deformities. It is important to diagnose such cases early, and prompt treatment should be given to patients to preserve nerve function. Materials and Methods: A total of 40 patients with HD who were already on multi-drug therapy (MDT) or treatment-naive were included in this study. These were clinically diagnosed cases of HD as per the Ridley–Jopling classification, and these patients were subjected to high-resolution ultrasonography (HRUS). A total of 19 controls were also included. The patients were clinically evaluated, and HRUS of bilateral ulnar nerves (UNs) was performed in all cases and controls. The other peripheral nerves, if clinically thickened, were evaluated using HRUS. Results: The cross-sectional area (CSA) of the UN in cases was significantly thickened as compared to controls. There was no difference in the CSA of patients on MDT as compared to treatment naïve patients. In two patients with pure neuritic HD, the clinical examination missed the bilateral nerve enlargement, and only unilateral nerve thickening was clinically appreciated. However, bilateral thickening was detected on HRUS. Conclusion: HRUS is a non-invasive and sensitive diagnostic tool that gives significant information on nerve structure and morphology. HRUS adds a new dimension to diagnosing HD, particularly the pure neuritic type, with the assessment of early nerve damage, which can prevent disabilities. HRUS is an objective diagnostic tool that can complement the clinical examination.

Purpose The aim of this study was to evaluate the technical feasibility, complication rate, and efficacy of percutaneously delivered plastic biliary stent, compared with that of internal–external biliary drainage catheter.

Abstract Background Atypical MRI findings of cranial tuberculosis can lead to prolonged delay in diagnosis resulting in high costs to evaluate for alternative diagnoses. The aim of this study was to describe a series of cranial tuberculosis patients with spectrum of MRI features, other than hydrocephalus, parenchymal tuberculomas, and leptomeningeal thickening. The final diagnosis was made based on CSF findings, clinical findings, and/or marked improvement after antitubercular treatment. Results A total of 39 patients met the inclusion criteria and were diagnosed with vasculitis (n = 15), tubercular abscess (n = 5), miliary tuberculosis (n = 3), tubercular cerebritis (n = 9), sellar and parasellar tuberculosis (n = 7), mass forming tuberculosis (n = 1), choroid plexitis (n = 2), and intraventricular tuberculomas (n = 1). Conclusion A significant number of patients of cranial tuberculosis can have variable presentations and may be misdiagnosed. This analysis helps to reinvestigate the spectrum of MRI findings.

Pseudoaneurysm developing from the internal maxillary artery is a rare but potentially fatal condition. We describe a case of iatrogenic pseudoaneurysm of the internal maxillary artery developed during dental extraction and successful endovascular closure of the feeder artery. At 2-month follow-up, the patient remained well with persistent thrombosis of pseudoaneurysm.

Background The Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting format for the categorization of the degree of suspicion for recurrent head and neck malignancies on positron emission tomography/computed tomography.

Aim The aim of this article was to evaluate uterocervical angle (UCA) and cervical length (CL) measured at 16 to 24 weeks of gestation using transvaginal sonography (TVS) as predictors of spontaneous preterm birth. Methods In this prospective study, TVS was performed in 159 primigravidas with a singleton, uncomplicated pregnancy at 16 to 24 weeks of gestation to measure the anterior UCA and CL. All the cases were followed until labor to document gestational age at delivery. Results The risk of spontaneous preterm birth was higher in women with obtuse UCA (>95 degrees) with sensitivity of 86.7%, specificity of 93.0%, positive predictive value of 83.0%, negative predictive value of 94.6%, and p-value of

Background Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans.

Cumulative exposure to multiple early life stressors is expected to affect behavioral development, causing increased susceptibility to neuropsychiatric disorders. The present study was designed to mimic such conditions in a rat model to study behavioral impairments during adolescence and adulthood. Female Wistar rats (n = 32; 140–150 gm) were switched to a low protein (LP; 8% protein) or control (20% protein) diet 15 days prior to conception, and then the diet regime was maintained throughout the experimental period. Pups born to control and LP dams were intraperitoneally injected with deltamethrin (DLT—pyrethroid insecticide; 0.7 mg/kg body weight; PND 1 to 7), lipopolysaccharide (LPS—bacterial endotoxin; 0.3 mg/kg body weight; PND 3 and 5), or DLT+LPS, on designated days forming eight experimental groups (Control, LP, Control+LPS, LP+LPS, Control+DLT, LP+DLT, Control+DLT+LPS and LP+DLT+LPS). Neurobehavioral assessments were performed in F1 rats (1, 3, 6 months) by open field, elevated plus maze, light and dark box, and rotarod tests. LP rats were found to be highly susceptible to either singular or cumulative exposure as compared to their age-matched control counterparts, showing significantly severe behavioral abnormalities, such as hyperactivity, attention deficits and low anxiety, the hallmark symptoms of neuropsychiatric disorders like schizophrenia and ADHD, suggesting thereby that early life multi-hit exposure may predispose individuals to developmental disorders.

Abstract Background There is an increasing concern that a proportion of the survivors of COVID 19 might develop fibrotic and/or other non-reversible lung changes. The aim of this retrospective study was to review the imaging findings of HRCT of lungs in a cohort of COVID 19 survivors, coming for short-term clinical follow-up and to assess the relation of the observed HRCT changes with the presence of dyspnea. Results In total, 40 patients with residual CT findings were included in this study with a mean age of 44.3 years and male: female ratio of 3:2. The presence of residual ground-glass opacities (85%) and reticular opacities (80%) was the most common findings. 25% of the cases had cystic changes in their lung. The presence of dyspnea was significantly associated with male sex and a history of smoking. On HRCT, the presence of cystic changes, involvement of > 10 lung segments, and an HRCT severity score > 7 were significantly associated with dyspnea. Conclusion Survivors of COVID 19 demonstrate persistent changes in the lung on HRCT. We recommend that a follow-up HRCT should be performed in these patients to identify those with post-COVID sequelae.

BACKGROUND: Accurate staging of disease severity and its serial monitoring thus is central to the effective management protocols of interstitial lung disease (ILD). PURPOSE: The aim is to evaluate the effectiveness of semi-quantitative parameters of lung ultrasound (LUS) in patients of ILD as a means of staging disease severity. MATERIALS AND METHODS: LUS of 47 patients of ILD and 20 age-matched controls was performed, and findings such as B-line distance, pleural thickening, subpleural changes, decreased lung sliding, and fragmented pleural lining were charted, and an LUS score was done using these parameters. Findings were compared with the Modified Medical Research Council (MMRC) dyspnea grade and spirometry parameters. RESULTS: The presence of B-lines and fragmented pleural lining were the most common findings observed in patients of ILD. Predicted forced vital capacity (FVC) and predicted forced expiratory volume in 1 s (FEV1) showed a good correlation with all the LUS parameters. B-line distance was the most significant LUS parameter to predict the variability in predicted FEVI, FVC, and MMRC dyspnea score. LUS severity score also showed good negative correlation with predicted FEV1 (r = −0.674, P < 0.001) and predicted FVC (r = −0.65, P < 0.001). LUS severity score of 4 or more predicted MMRC dyspnea score of > 3 with 82% sensitivity and 70% specificity. CONCLUSION: Semi-quantitative LUS score and B-line distance can provide a simple but effective estimate of disease severity in ILD.

Background: Isolated anterior cruciate ligament (ACL) reconstruction is frequently associated with anterolateral ligament injury (ALL) and results in residual instability at follow-up. It was hypothesized that patients who underwent combined ACL and lateral extra-articular tenodesis (LET) reconstruction would exhibit less residual laxity, better clinical outcomes, and better graft incorporation on follow-up magnetic resonance imaging (MRI) as well. Patient and Methods: Sixty-four patients with concomitant ACL and ALL injuries who were operated over a period of 2 years were enrolled between 2016 and 2018. Two groups of patients were evaluated prospectively. Eighteen patients in control Group B underwent anatomical ACL reconstruction alone, and 20 in test Group A underwent ACL reconstruction combined with LET. Exclusions were multiligament injuries, chondral injury, meniscus tear, and ramp lesion. Follow-up by Lysholm and modified Cincinnati knee rating was done and MRI for status of graft at least 1-year postoperative. Results: After excluding dropout or inadequate follow-up, Group A (n = 20) with ACL + LET was compared with Group B (n = 18), with isolated ACL reconstruction, at final median follow-up of 18 months. There were no significant differences between groups regarding gender, age, and duration of injury. Regarding functional outcome scores, patients in the LET group presented better results on both the clinical scoring (P < 0.0001). In addition, patients in the LET group had better graft uptake on MRI and no pivoting at physical examination. Regarding graft failures, the isolated ACL reconstruction group had 5 and the LET group had 1 failure. Conclusion: The combined ACL and LET reconstruction in patients with ACL injury is an effective and safe solution and leads to good functional outcomes with no increase in complications and aids in early return to preinjury activities with a surviving healthy graft.

Protein malnourishment and immune stress are potent perinatal stressors, encountered by children born under poor socioeconomic conditions. Thus, it is necessary to investigate how such stressors synergistically contribute towards developing neurological disorders in affected individuals. Pups from Wistar females, maintained on normal (high-protein, HP:20%) and low-protein (LP:8%) diets were used. Single and combined exposures of Poly I:C (viral mimetic: 5 mg/kg body weight) and Lipopolysaccharide (LPS; bacterial endotoxin: 0.3 mg/kg body weight) were injected to both HP and LP pups at postnatal days (PND) 3 and 9 respectively, creating eight groups: HP (control); HP+Poly I:C; HP+LPS; HP+Poly I:C+LPS; LP; LP+Poly I:C; LP+LPS; LP+Poly I:C+LPS (multi-hit). The effects of stressors on hippocampal cytoarchitecture and behavioral abilities were studied at PND 180. LP animals were found to be more vulnerable to immune stressors than HP animals and symptoms like neuronal damage, spine loss, downregulation of Egr 1 and Arc proteins, gliosis and behavioral deficits were maximum in the multi-hit group. Thus, from these findings it is outlined that cellular and behavioral changes that occur following multi-hit exposure may predispose individuals to developing Schizophrenia-like pathologies during adulthood.

Background: Mural lesions of gallbladder on ultrasound (US) are often difficult to characterize as benign or malignant. Purpose: The aim of the study was to evaluate the role of contrast-enhanced US (CEUS) in characterization of gallbladder (GB) wall lesions and making distinction between benign wall thickening and GB adenocarcinoma, utilizing both quantitative and qualitative parameters. Methods: A total of 26 patients with GB wall lesions detected on sonography underwent CEUS. Lesions were evaluated on the basis of morphological imaging features, enhancement pattern, dynamic real-time contrast uptake, and intralesional vascularity. Results: Overall, 19 patients had final diagnosis of GB adenocarcinoma, whereas seven patients had benign etiology. CEUS has enabled the differentiation of nonenhancing tumefactive sludge from enhancing mural lesions, thus improving the accuracy of morphological assessment of lesions. The intactness of outer wall was better assessed on CEUS. The dynamic postcontrast assessment showed that carcinoma showed early washout of contrast compared to benign thickening (P = 0.002). Nonlayered mural enhancement or thick enhancing inner layer with nonenhancing thin outer layer was associated with adenocarcinoma. The classification of intralesional vascularity on CEUS was not helpful in distinguishing benign lesions and adenocarcinoma. Conclusion: CEUS can increase the diagnostic confidence in differentiation between benign mural lesions and adenocarcinoma of GB.

India is a land of spices and medicinal plants. Ayurvedic medications and methods are commonly practised in India for curing several ailments. Lepidium sativum (garden cress) is an important herb that belongs to Brassicaceae family. It is believed that the plant has its origin in Ethiopia but is now cultivated throughout the world. The plant is well-known in Ayurveda for its beneficial properties it holds. The present study describes the fracture healing property of the methanolic and aqueous extract of Lepidium sativum seeds. For the study, 21 Charles foster rats were used. They were grouped into three groups each containing seven rats: control, methanolic, and aqueous group. Rats were anesthetized using ether vapors and fractures were induced in each rat from all the three groups using hand held three-point bending technique. The broken bone fragments were then stabilized using splints. The control group was administered with normal saline, along with food and water, post-fracture. The methanolic group was administered with the methanolic extract of Lepidium sativum seeds at dose of 400 mg/kg given orally, post-fracture along with food and water. The third group received aqueous extract of the seeds in doses of 550 mg/kg orally, along with daily food and water intake for a period of 8 weeks. The results were evaluated both radiologically and biochemically. X-rays were done on day 0, 2nd week, and 4th week post-fractures to look for the callus formation and serum levels for calcium, phosphorus, and alkaline phosphatases were evaluated on 0 day, 1 week, 2nd week, 4th week, 6th week, 8th week, and 10th week post-injury. It was observed at the end of the study period that the methanolic group had significant callus formation starting at the 2nd week itself post-fracture. The serum levels of calcium, phosphorus, and alkaline phosphatases at 4th, 6th, and 8th weeks had significant P values in the methanolic group rats.

Abstract Background We present a series of three cases of Klippel-Trenaunay syndrome (KTS) presenting with unilateral lower limb involvement demonstrating a wide range of radiological findings. Case presentation Case 1: A 61-year-old male presented with varicosities in the right lower limb, which was atrophic with a complete absence of deep venous system in the right limb. Case 2: A 23-year-old woman presented with hypertrophied left lower limb with multiple varicosities showing unusual distribution and intraosseous extension into the distal femur, patella, and tibia. Case 3: A 14-year-old male presented with hypertrophy of the right lower limb overlying macular cutaneous lesions. Capillary malformation was seen underneath the cutaneous lesion and multiple subcutaneous and intramuscular venous malformations were seen. Also noted was persistent embryological vein, i.e., lateral marginal vein of Servelle. Conclusion The three cases in our series demonstrate common and unusual findings of KTS and highlight the role of CT and MR venography in addition to color Doppler sonography to identify the complete extent of the involvement.

Introduction Takayasu’s arteritis, a chronic, idiopathic, inflammatory panarteritis, is the major cause of Aortoarteritis in pediatric age group. The purpose of this study is to analyze the patterns of involvement and imaging findings of pediatric Takayasu’s arteritis. Materials and Methods We retrospectively reviewed the CT angiographic images of 11 pediatric cases reported as “Takayasu’s arteritis” or “nonspecific arteritis” over the period of last 3 years. Results Mural thickening with luminal stenosis was the most common findings. Aneurysmal dilatation of the descending thoracic aorta was observed in one case. Vessel stenoses without mural thickening, thrombosis and collateral vessel formation were the other findings. Pattern of involvement ranged from variable involvement of thoracic and abdominal aorta and their branches. Conclusion Awareness of its CT angiographic appearances and distribution pattern can help the clinicians and radiologists to have high index of suspicion in aiding early diagnosis and better management of this disease.

Background: Cardiac iron deposition in transfusion-dependent thalassemia patients is patchy in distribution. Purpose: The purpose of this study is to assess the correlation between T2* matrices of membranous interventricular septum (MIVS) and T2* values of muscular interventricular septum (IVS) on magnetic resonance imaging (MRI) and to evaluate the relationship of myocardial T2* at these two locations with MRI-estimated liver iron concentrations (LIC) and electrocardiographic (ECG) parameters. Material and Methods: MRI of heart and liver was performed in 16 consecutive pediatric patients of transfusion-dependent thalassemia major to calculate liver iron concentration and T2* time of membranous and muscular IVS. ECG parameters of these patients were charted and correlated with MRI parameters. Results: No significant correlation between T2* values of muscular IVS and MIVS was observed. Mean T2* of MIVS (9.8 ms) was significantly lower than that of muscular IVS (26.9 ms). T2* of MIVS correlated strongly with LIC where as a weak correlation was observed between T2* of IVS and LIC. Significantly higher mean QTc (corrected QT interval) value (439.86 ms) was seen in patients with T2* IVS

Objectives: Spinal fusion is an effective treatment for degenerative lumbar spine; however, conflicting results exist regarding the best procedure. This study compares the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) versus instrumented posterolateral fusion (PLF) in patients of degenerative lumbar spine disorders. Methods: Of the total 37 patients, 16 patients were operated with TLIF and 21 were operated with instrumented PLF with bone grafting. Duration of the study was from June 2017 to June 2019. Patients fulfilling the inclusion criteria were included in the study. Inclusion criteria were (1) age of patient ranging from 18 years to 70 years, (2) involvement of single level, (3) diagnosis of degenerative spine disease, and (4) minimum follow-up of 1 year. Radiographic parameters such as slippage of vertebrae, anterior and posterior disc heights, local disc lordosis, T12–S1 angle were measured, and fusion were assessed; comparison between preoperative and postoperative parameters was also done. Clinical outcome score was obtained using visual analog scale (VAS) and Oswestry disability index (ODI). Statistical analysis was done using SPSS software. Results: No significant difference was found in ODI and VAS between TLIF and PLF. Restoration of disc height and improvement of local disc lordosis was better in the TLIF group than in the PLF group. The fusion rate was 87.5% in the TLIF group and 81% in the instrumented PLF group. Amount of blood loss was slightly higher in the TLIF group (319.69 ± 53.8 mL) than in the instrumented PLF group (261.19 ± 34.9 mL). Operating time was also slightly higher in TLIF (133 ± 6.02 min) than in instrumented PLF (90.71 ± 6.3 min). Conclusion: TLIF is superior to instrumented PLF in terms of restoration of anterior and posterior disc heights and improvement in local disc lordosis and higher fusion rate, however it requires greater surgical expertise and more experience. Because of anterior cage support, early weight-bearing mobilization can be allowed in the TLIF group compared to the PLF group. Surgical time and blood loss were slightly higher in cases of TLIF than instrumented PLF.

Perinatal protein malnourishment (LP) is a leading cause for mental and physical retardation in children from poor socioeconomic conditions. Such malnourished children are vulnerable to additional stressors that may synergistically act to cause neurological disorders in adulthood. In this study, the above mentioned condition was mimicked via a multi-hit rat model in which pups born to LP mothers were co-injected with polyinosinic:polycytidylic acid (Poly I:C; viral mimetic) at postnatal day (PND) 3 and lipopolysaccharide (LPS; bacterial mimetic) at PND 9. Individual exposure of Poly I:C and LPS was also given to LP pups to correlate chronicity of stress. Similar treatments were also given to control pups. Hippocampal cellular apoptosis, β III tubulin catastrophe, altered neuronal profiling and spatial memory impairments were assessed at PND 180, using specific immunohistochemical markers (active caspase 3, β III tubulin, doublecortin), golgi studies and cognitive mazes (Morris water maze and T maze). Increase in cellular apoptosis, loss of dendritic arborization and spatial memory impairments were higher in the multi-hit group, than the single-hit groups. Such impairments observed due to multi-hit stress mimicked conditions similar to many neurological disorders and hence, it is hypothesized that later life neurological disorders might be an outcome of multiple early life hits. This article has an associated First Person interview with the first author of the paper.

Background: The dynamic contrast enhanced magnetic resonance imaging (DCE MRI) has currently become the most utilized technique for the detection of pituitary microadenoma. However, owing to differential enhancement of normal pituitary, high rate of false positivity remains a concern in its interpretation. Purpose: Our aim was to assess the utility of precontrast T1 signal intensity ratio (SIR) of the lesions suspected on DCE MRI, in prediction of presence of microadenoma. Materials and Methods: We retrospectively reviewed MRI of 23 patients referred for DCE MRI of pituitary (group 1, 15 patients with diagnosis of pituitary microadenoma; and group 2, patients not clinically labeled as microadenoma). STC were plotted and T1-SIR at t = 0 s was obtained at the suspicious zone of differential enhancement (SIR T) and normal pituitary (SIR P). SIR difference (SIR P − SIR T) and relative SIR difference (SIR P − SIR T/SIR P) were calculated for each patient and was compared between the two groups. Results: Mean T1 SIR is lower in patients with microadenoma than those without (P = 0.065). SIR difference and relative SIR difference was higher in patients with microadenoma (P = 0.003 and 0.005, respectively). Receiver-operated characteristic curve analysis demonstrated that a cut-off of 26 and 0.107 for SIR difference and relative SIR difference, respectively, could diagnose microadenoma with 100% specificity and reasonable sensitivities. Conclusion: The baseline precontrast T1 SIR evaluation of the lesion suspected to be microadenoma on DCE MRI, derived through STC curve, can increase diagnostic confidence in diagnosis of microadenoma.

Objective: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with that of ultrasonography (USG) for the measurement of lower segment cesarean scar during trial of labor after cesarean (TOLAC). Materials and Methods: This was a prospective case-control observational study conducted with a cohort of 30 participants being considered for TOLAC but eventually proceeding to lower segment cesarean section (LSCS) at a university-based teaching institute over a period of 2 years. Measurement of scar thicknesses were done by MRI and USG preoperatively and validated by surgical findings. Comparison of diagnostic accuracy as well as the cut-off values (to differentiate a normal scar from an abnormal scar) was done between the two modalities. Results: Insignificant systematic error between the measurements obtained by the two modalities was noted by a Bland–Altmann analysis. The diagnostic accuracy of USG for differentiating a normal from an abnormal uterine scar was 96.7% while that of MRI was at a slightly lower level of 90%. A strong level of agreement between the two modalities was observed. Conclusion: MRI offers no advantage in diagnostic accuracy for the measurement of LSCS scar thickness during consideration of TOLAC. Advances in Knowledge: Measurement of uterine scar by MRI has a good correlation with that done on USG in the setting of post-cesarean pregnancy. The results hold good both for normal (grades 1 and 2) and abnormal (grades 3) scars. MRI, however, does not offer any added advantage over sonographic scar thickness measurement for the differentiation of a normal (grades 1 and 2) from an abnormal (grade 3) scar.

Background: Both emphysematous destruction of lung parenchyma and airway remodeling is thought to contribute to airflow limitation in cases of chronic obstructive pulmonary disease (COPD). Objective: To evaluate the value of quantitative computed tomography (QCT) parameters of emphysema and airway disease with disease severity in patients with COPD. Materials and Methods: We prospectively studied 50 patients with COPD, which included nonsmokers and patients with different degrees of cumulative smoking exposure. Three QCT parameters namely LAA% (low attenuation area percentage), WA% (Wall area percentage), and pi10 were calculated as per the standard technique. Forced expiratory volume in 1 s (FEV1), BODE score, and MMRC dyspnea scale were used as measures of disease severity. Results: FEV1 was inversely and significantly associated with all three QCT parameters. Receiver operated characteristic curves in prediction of GOLD class 3 COPD yielded cut-off values of 12.2, 61.45, and 3.5 for LAA%, WA%, and pi10, respectively, with high sensitivities and specificities. In multiple linear regression model, however, only LAA% proved to be significantly associated with FEV1, BODE, and dyspnea. Conclusion: QCT indices of both emphysema and airway disease influence FEV1, dyspnea, and BODE score in patients with COPD. Emphysema, however, appears to be more closely related to disease severity.

Aim: To identify and to assess imaging and clinical features of Posterior urethral diverticula (PUD) in a single-centre series and include a brief review of literature. Materials and method: Post operative MRI of 140 children from north India were retrospectively reviewed who underwent surgical repair for anorectal malformation (ARM) along with the Hospital records. Results: Ten cases had MRI features of posterior urethral diverticulum. All of these patients had undergone primary abdominoperineal pull through (APPT) procedure. The lesions ranged between 6 mm and 38 mm in size. Two of these lesions were missed in the post operative MRI report. Only one of these patients was symptomatic and presented with dribbling of urine and gross bilateral vesicoureteric reflux in which the diverticulum was excised surgically. Conclusion: PUD is an under-recognised entity and can be identified in preclinical stage on MRI. Careful assessment of urethra and periurethral structures should be a mandatory step in MRI evaluation of post repair ARM cases. An observational conservative approach in selected asymptomatic patients can be an effective management strategy. Keywords: Posterior urethral diverticulum, MRI, Anorectal malformation

Right isomerism, also known as Ivemark syndrome, is an unusual degree of symmetry of some of the abdominothoracic viscera reflecting bilateral right-sidedness. We report an exceedingly rare occurrence of anomalous drainage of the left hepatic vein to the left-sided atrium in a patient of right isomerism. With this case report, we further endorse that the isomerism of atrium might extend beyond the appendages, a view that has been long dismissed by the existing literature.

Rhabdomyosarcoma (RMS) is a malignant mesenchymal tumor arising from the embryonal muscle cells (rhabdomyoblasts), and is the most common soft tissue sarcoma in children and young adults accounting for 4–6% of all malignancies in this age group. Though rare overall, embryonal rhabdomyosarcoma is the most common malignancy arising in the pediatric female genitourinary tract with sarcoma botryoides being the most common variant of the tumor. In young and adolescent individuals, the cervix and uterus are affected; whereas in infants, vaginal lesions are more common. Imaging plays a crucial role not only in the initial diagnosis but also in long-term follow-up of genital RMS. We describe a rare case of embryonal rhabdomyosarcoma of the vagina occurring in a 23-year-old female who presented with abnormal vaginal bleeding ever since she was a child.

Dermoidcysts of the ovary represent the most common form of benign ovarian tumors. Their site, size and clinical presentations are extremely variablecausing confusion with various medical and surgical entities. Uncomplicated dermoid cysts are often asymptomatic andare relatively easy to diagnose on imaging. Symptomatic complicated dermoids may lead to diagnostic dilemmas. Of the various complications of ovarian dermoid, spontaneous rupture into theadjacent viscera is the least common. We report a case of a 55-year-old patient presenting with abdominal pain and passage of hair-like and cheesy material in stools, in which contrast enhanced CT scan demonstrated bilateral ovarian dermoids with the right oneruptured into asmall bowel loop. Keywords: Ovarian dermoid, Cystic teratoma, Bowel infiltration, Fistula, Computed tomography

We report two infants presenting with unilateral congenital facial palsy since birth. Magnetic resonance imaging (MRI) in both the cases revealed complete unilateral aplasia of facial nerve. To our knowledge, this is the first reported MR depiction of nonsyndromic isolated facial nerve aplasia. Imaging features and the pertinent anatomy is discussed along with a brief review of literature.

Genitourinary involvement of neurofibromatosis is uncommon and genital neurofibromatosis is even rarer. Involvement of clitoris by neurofibroma can lead to clitoromegaly masquerading as a male penis. We report such a case of ambiguous genitalia in a 7-year-old female child presenting with clitoromegaly since birth, in which magnetic resonance imaging (MRI) revealed the presence of extensive neurofibromatosis in the clitoris and lumbosacral regions. We emphasize the central role of MRI in evaluation of hormonal and non-hormonal causes of ambiguous genitalia. We further discuss the merits of including MR neurography in the imaging protocol for comprehensive delineation of neurofibromatosis.