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Subcutaneous zygomycosis is a rare deep fungal infection caused by a group of fungus belonging to the order Entomophtharales. It is a saprophytic fungus and the predominant species causing the infection includes Basidiobolus ranarum and Conidiobolus coronatus. We, hereby, report a case of a 17-month-old female child who presented with a painless, solitary, woody hard enlarging mass which was disfiguring the left side of the face for 6 months. After our complete workup, a diagnosis of subcutaneous zygomycosis was made. The patient was managed on syrup Itraconazole and potassium iodide drops. The patient responded to the trreatment remarkably. We would like to present our take on workup and treatment of a solitary painless enlarging mass on the face in a child.

Linear calcinosis cutis is a very rare disorder; reported in association with lichen sclerosus etatrophicus, scleroderma, after intravenous infusion of calcium and acute monocytic leukemia. In available literature, idiopathic zosteriform calcinosis cutis is yet to be described. An 8-year-old child presented with spontaneous painful, slowly progressive, linear band-like nodules over the right half of the chest and back of the trunk. Histopathology with special stains was done to confirm the diagnosis. The patient was treated with diltiazem and responded well. We report a case of idiopathic zosteriform calcinosis cutis because of unusual presentation and rarity of the disorder.

Context: Amyloidosis is group of rare diseases that are characterized by extracellular deposition of abnormal amyloid proteins either involving multiple organ systems (systemic amyloidosis) or restricted to a single-tissue site, such as skin (localized amyloidosis). In primary cutaneous amyloidosis, there is deposition of amyloid in apparently normal skin. The hyperpigmentation in all the lesions of primary cutaneous macular amyloidosis gives us an insight of a possibility of a connection between amyloid fibrils and melanogenesis. Aims: To compare the melanin content from the lesional skin of upper back and surrounding non-lesional skin of macular amyloidosis. Settings and Design: A hospital based, cross-sectional study conducted over a period of 6 months. Methods and Materials: Forty-two patients (30 females and 12 males) clinically and histopathologically diagnosed as macular amyloidosis were enrolled in the study. A Mexameter MX18 was used to measure the melanin index of the lesions of Macular amyloidosis over upper back and non-affected similar areas (control). Results: The melanin index of the lesional skin of female patients ranged from 552 to 823 (mean = 705.1). The melanin index of the lesional skin of male patients ranged from 621 to 792 (mean = 697.41). In the non-affected surrounding skin of females, the mean melanin index was 357.66, whereas in males, the melanin index of the surrounding normal skin was 296.75. The P value came out to be significant, that is,

Objective: Comparative analysis of expression of lupus erythematosus (LE) in geriatrics versus adults. Materials and Methods: We analyzed and compare the patient's records attending our department between June 2017 and June 2019, diagnosed clinically and immunologically as LE between the two groups. Results: Sixty patients, 30 in each group, met ACRA criteria, were enrolled with mean age of presentation for early-onset was 28 ± 9.8 years and late-onset, 59 ± 4.8 years. Most of the patients were females with decrease in sex ratio with age. The most common presentations were malar rash, photosensitivity, and oral ulcers. Joint complaints, lung and cardiac involvement, and nonscarring alopecia were more common in the elderly. Direct Coombs test positive hemolytic anemia, renal involvement in forms of proteinuria and lupus nephritis, and neurological involvement were seen more commonly in adults. In immunological parameters, antinuclear antibody, anti-double standard DNA antibody (AntiDsDNA), and anti-smith antibody testing were done. AntiDsDNA positivity was more in adults correlate with disease severity. We calculate the systemic LE disease activity index 2000 score was higher in the adult population. Conclusion: Our study illustrated that disease activity and damage are more in adults in comparison to geriatrics. However, geriatrics had more organ damage that may be attributable to associated comorbidities. Although the connective tissue diseases in the elderly needs less aggressive management, it requires more attention for possible organ damage due to associated comorbidities.

Context: Recently, there has been an increase in the number of chronic, recurrent, and recalcitrant dermatophytosis. Many factors implicated are barrier defects, aberrant host immune response, application of steroids or other irrational combination creams, transmission within family, occlusive clothing, poor hygienic conditions, poor compliance, drug resistance and virulence of the infecting strain. Transepidermal water loss (TEWL) is an important index in accessing the barrier function of skin. Aim: To ascertain the role of TEWL from the lesional skin and its effect on the cure rate and relapse in patients of tinea cruris. Materials and Method: A hospital based prospective comparative study was conducted for 1 year. A total of 200 patients of tinea cruris diagnosed clinically and by KOH examination, were included in the study. TEWL was calculated using Tewameter TM300 open chamber probe of Courage and Khazaka, Cologne, Germany. Patients were classified according to the TEWL values into Group A (patients with abnormal TEWL) and Group B (normal TEWL). Both groups were given oral itraconazole and antihistamines for 4 weeks. The cure rates and recurrence rates of both the groups were analyzed and compared. Results: In the Group A, i.e., patients of tinea cruris with abnormal TEWL, only 28% of the patients showed clinical improvement at the end of 1 month. Out of those cured, 78.57% of the cases showed recurrence after 2 months of completion of therapy. In Group B, i.e., patients of tinea cruris with normal TEWL, 69% (n = 69) of the patients showed clinical improvement at the end of 1 month. Out of those cured, only 21.74% of the cases (n = 15) showed recurrence. Conclusion: The cases of tinea cruris with abnormal TEWL show significant decrease in cure rates and significant relapse rates among those initially cured.

Syringoma is a benign adnexal tumor of intraepidermal portion of the eccrine sweat ducts. Eruptive syringoma is a rare clinical variant characterized by small, flesh-colored papules with both follicular and nonfollicular distribution that occur in successive crops on the anterior body surface. We report a case of 35-year-old female with familial eruptive syringoma with predominant acral distribution. We report this case because of the rarity of disorder and acral predominance.

Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT.

Small bowel transplantation, alone or with other organs as multivisceral transplantation, is performed for patients with chronic intestinal failure. With advancing surgical techniques and improved post-surgical management, survival of these patients has increased tremendously in the last two decades. The radiologist has an important role in the preoperative and postoperative management of these patients. Knowledge of surgical techniques and post-surgical complications seen in the transplant recipient is necessary for adequate management of these patients.

Pancreatic transplantation, performed alone or in conjunction with kidney transplantation, is an effective treatment for advanced type I diabetes mellitus and select patients with type II diabetes mellitus. Following advancements in surgical technique, postoperative management, and immunosuppression, pancreatic transplantation has significantly improved the length and quality of life for patients suffering from pancreatic dysfunction. While computed tomography (CT) and magnetic resonance imaging (MRI) have more limited utility, ultrasound is the preferred initial imaging modality to evaluate the transplanted pancreas; gray-scale assesses the parenchyma and fluid collections, while Doppler interrogation assesses vascular flow and viability. Ultrasound is also useful to guide percutaneous interventions for the transplanted pancreas. With knowledge of the surgical anatomy and common complications, the abdominal radiologist plays a central role in the perioperative and postoperative evaluation of the transplanted pancreas.

Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications.

Hepatocellular carcinomas are highly vascular tumors, showing progressive hypervascularity by the process of neoangiogenesis. Tumor angiogenesis is critical for tumor growth as well as metastatic spread therefore, imaging and quantification of tumor neo-angiogenesis is essential for monitoring response to targeted therapies and predicting disease progression. Sorafenib is a molecular targeting agent used for treating hypervascular tumors. This drug is now the standard of care in treatment of patients with advanced hepatocellular carcinoma. Due to its anti-angiogenic and anti-proliferative actions, imaging findings following treatment with Sorafenib are quite distinct when compared to conventional chemotherapeutic agents. Liver MRI is a widely adopted imaging modality for assessing treatment response in hepatocellular carcinoma and imaging features may reflect pathophysiological changes within the tumor. In this mini-review, we will discuss MRI findings after Sorafenib treatment in hepatocellular carcinoma and review the feasibility of MRI as an early biomarker in differentiating responders from non-responders after treatment with molecular targeting agents.

Combined hepatocellular-cholangiocarcinoma is a rare but unique primary hepatic tumor with characteristic histology and tumor biology. Recent development in genetics and molecular biology support the fact that combined hepatocellular-cholangiocarcinoma is closely linked with cholangiocarcinoma, rather than hepatocellular carcinoma. Combined hepatocellular cholangiocarcinoma tends to present with an more aggressive behavior and a poorer prognosis than either hepatocellular carcinoma or cholangiocarcinoma. An accurate preoperative diagnosis and aggressive treatment planning can play crucial roles in appropriate patient management.

Kindler syndrome (KS) is a very rare genodermatosis characterized by acral blistering starting in infancy along with photosensitivity, progressive poikiloderma, cutaneous atrophy, and a variable degree of mucosal involvement. A large number of other cutaneous and extracutaneous features have been described, which aid in diagnosing it. Generally KS has been found to be associated with hypohidrosis/anhidrosis. We herein present a rare case of KS with unique features.

Before the advent of ultrasound, percutaneous pericardiocentesis was associated with relatively high mortality and complication rates (6% and 20–50%, respectively) [1–3]. Ultrasound (US)-guided pericardiocentesis has dramatically decreased the incidence of complications by direct visualization of the heart and other adjacent vital structures. US helps localize the size and location of the pericardial effusion, measure the distance from the chest wall, localize adjacent, vital organs, and determine the optimal access site to the effusion. We report a case of posttraumatic internal mammary artery pseudoaneurysm, a rare complication of pericardiocentesis.

A patient presented with an acute episode of bright red blood in her stool. The incidental liver mass seen in segment 4 was suspected to represent a cholangiocarcinoma due to associated mild intrahepatic biliary ductal dilatation and suspicion for capsular retraction. Pathology confirmed that this lesion represented a sclerosing hemangioma. This case report corroborates prior observations that degenerative changes in hemangiomas—sclerosis, narrowing of vascular channels, thrombosis, infarct, hemorrhage—may produce atypical radiographic findings. Since these atypical radiographic features may suggest a primary or metastatic malignancy, the protean appearance of hemangiomas remains an important consideration in the evaluation of hepatic masses.

Lupus vulgaris is the most common presentation of cutaneous tuberculosis in India and can present as papular, nodular, plaque, ulcerative, vegetating, and tumid forms. Unusual variants include the frambesiform, gangrenous, ulcerovegetating, lichen simplex chronicus, myxomatous, and sporotrichoid types. We describe a rare sporotrichoid presentation of lupus vulgaris on the leg of a 28-year-old female of 12 years duration.

Abstract This PowerPoint presentation was designed to assist radiologists and endocrinologist (both in practice and in training) in their management of thyroid nodules according to American Thyroid Association (ATA) guidelines. Twenty thyroid nodules have been selected and their management according to ATA guidelines is discussed in order to allow for a better practical understanding of these recommendations. We have included relevant information and highlighted important teaching points. As this is a self-learning tool, motivation of the reader is required for learning. It is a brief review of important recommendations and does not include all the details mentioned in the original publication. Those recommendations that are likely to be encountered in a radiology practice are emphasized.

Abstract Introduction Orthotopic liver transplantation is an established treatment for patients with end-stage liver disease or acute liver failure. The procedure is distinct from living related liver transplantation with regard to surgical technique, postoperative anatomy, and some complications. The aim of this imaging curriculum is to educate radiology, surgery, gastroenterology, hepatology, and internal medicine trainees regarding basic anatomy of the post-orthotopic transplant liver, its various complications, and the role of imaging in their diagnosis. Methods This presentation provides an opportunity to learn imaging characteristics of complications of orthotopic liver transplantation in an interactive format. We have included relevant information and highlighted important teaching points in a series of PowerPoint presentations. This presentation is given to our incoming radiology residents to familiarize them with various aspects of imaging of orthotopic liver transplantation. Results Another version of this presentation has been presented in the University of Washington Annual Radiology Review Course for the last 3 years with excellent feedback. Discussion This resource has been designed to focus on imaging findings and includes a brief description of clinical information. Laboratory data and its details are not included as the focus of this resource is on understanding imaging findings. Adding more cases in quiz format at the end of the presentation will help reinforce learning.

Abstract Introduction Retroperitoneal anatomy is very complex. We wanted to create a presentation that would simplify this subject and show examples of illustrations highlighting the multiple retroperitoneal fasciae and planes, as well as their corresponding appearance on cross-sectional CT imaging. Methods This PowerPoint presentation was designed primarily for radiology residents and faculty but can be used by anyone in the medical field who is interested in radiologic imaging and retroperitoneal anatomy. The presentation provides an overview of the complex retroperitoneal anatomy, with multiple illustrations of the retroperitoneal fasciae, spaces, and interfascial planes. It also discusses the pattern of disease spread in the retroperitoneum, provides a broad overview of the different types of retroperitoneal masses, and proposes an algorithmic approach for diagnosis of retroperitoneal masses based on imaging findings. A number of slides are dedicated to illustrating the role of imaging-guided procedures (mainly biopsies) utilized in the diagnosis and treatment of retroperitoneal masses. Finally, the multisystemic syndromes that involve the retroperitoneum are reviewed in a quiz format. The presentation takes from 30 to 60 minutes depending on the user's prior knowledge of retroperitoneal disease. Results This presentation was presented as an educational exhibit at the Radiologic Society of North America meeting in Chicago, Illinois, and as an exhibit at the imaging symposium at the University of Washington and received positive feedback. Many residents recommended that it would be very helpful for the presentation to be accessible online as a general reference and quick refresher for an overview of retroperitoneal disease. Discussion This presentation requires that the user have some basic understanding of radiology and imaging. The retroperitoneal pathology is very wide; in this presentation, we focus mainly on the pathology with interesting radiologic findings.

Abstract Radiologists supervising imaging studies using contrast media should have the necessary knowledge and skills to deal with adverse contrast media reactions and their appropriate management. The aim of this curriculum is to educate practicing radiologists, residents, fellows, non-radiology house staff covering contrast administration after hours, and hospital code teams regarding current recommendations for dealing with contrast media reactions, contrast-induced nephropathy and nephrogenic systemic fibrosis. Various drugs used in the management of these reactions are reviewed in detail and an algorithmic approach to the management of these reactions is provided. We also review the medication regimens that can minimize the risk of these complications. Our curriculum incorporates the current guidelines as recommended by the American College of Radiology in their manual on contrast medium published in 2012. Pretest questions have been provided for self-assessment. We encourage all physicians responsible for contrast media administration and reaction management to review this curriculum on a regular basis, at least biannually. Algorithms provided are also a good resource for placement in radiology suites and hospital crash carts.

Abstract This is a curriculum intended for radiology, endocrinology, and oncology residents, fellows, and faculty to learn the appropriate recommendations for thyroid nodule workup as seen on ultrasound based on the guidelines of Society of Radiologists in Ultrasound. Thyroid nodules are very common, seen in almost 50% of the population. Hence, guidelines are used to decide if a nodule should undergo fine needle aspiration or not. After a brief introduction, the module begins as the five pretest nodules are followed by both a review of guidelines and the key imaging features of thyroid nodules. Twenty thyroid nodules are then presented as test cases with answers covering the breadth of commonly seen situations. After completion of this module, the learner will be able to manage thyroid nodules appropriately. Approximate time required to complete this module is 45 minutes. Feedback from our residents and attendees at the 2010 annual meeting of the Radiological Society of North America was positive regarding its utility and clarity. This resource is also used by radiology and endocrinology residents and body imaging fellows for self-learning. It is a useful resource for faculty members who image the thyroid gland for review of current guidelines. Future plans include a study to ascertain the effectiveness of this self-paced learning option.

Abstract This is an interactive PowerPoint presentation intended to teach radiology, orthopedic surgery, and physical medicine and rehabilitation residents about magnetic resonance imaging (MRI) of the shoulder. At various points in the presentation, the learner is directed via hyperlinks to available online resources that will aid in self-learning. The common patterns of shoulder abnormalities with emphasis on MRI have been illustrated using a case-based approach. This PowerPoint-based resource can be used as a starting point to understand the basic concepts in a simplistic fashion before embarking on more complex imaging of the shoulder. We have used these slides extensively to initiate second-year radiology residents in their initial rotation to MRI of the shoulder. Radiologists with more experience have benefited from this tool by using it for a quick reference and review.