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Abnormal uterine bleeding is a common presentation in the emergency department. A spectrum of uterine vascular abnormalities can lead to potentially fatal hemorrhage. Radiology plays a crucial role in the early diagnosis of the cause of bleeding with the role of an interventional radiologist being pivotal in the management of these cases. This article provides a pictorial review of angiographic appearance of various uterine vascular abnormality and their management by endovascular technique.

Left ventricular false tendons are cord like fibromuscular bands seen commonly in the left ventricle and attach septum to free wall. Described as early as in late 1800s, their functional significance is still not well established. We present the imaging findings in a 13-year-old boy who presented with failure to thrive. Echocardiography and cardiac CT showed the presence of aortic valve thickening, sub-aortic membrane, and patent ductus arteriosus with the left ventricular false tendon.

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Double drainage of the confluence of all four pulmonary veins is extremely rare. We present the image findings in a child with double drainage of the pulmonary venous confluence into the coronary sinus and left superior caval vein with co-existent right superior caval venous stenosis.

To review emerging techniques in cardiac magnetic resonance imaging (CMR) and their clinical applications with a special emphasis on new technologies, recent trials, and updated guidelines. The utility of CMR has expanded with the development of new MR sequences, postprocessing techniques, and artificial intelligence-based technologies, which have substantially increased the spectrum, quality, and reliability of information that can be obtained by CMR. The CMR modality has become an irreplaceable tool for diagnosis, treatment guidance and follow-up of patients with ischemic heart disease, myocarditis, and cardiomyopathies. Its role has been further strengthened by recent trials and guidelines. Quantitative mapping techniques are increasingly used for tissue characterization and detection of diffuse myocardial changes including myocardial storage diseases. With state-of-the-art CMR sequences, postprocessing techniques and understanding of their interpretation, CMR makes invaluable contributions to provide state-of-the-art diagnostics and care for cardiac patients in a multidisciplinary team.

Ilio-caval arteriovenous fistula is a rare sequel of lumbar disc surgery or penetrating injury. We report a case of 40-year gentleman presenting with symptoms of congestive heart failure and continuous murmur heard over right iliac fossa. His past history was significant for lumbar disc surgery done twice 1 year back. Computed tomography angiogram confirmed a large fistulous communication between right common iliac artery and inferior vena cava. Open surgical repair was performed as the fistula was not well suited for endovascular repair. We successfully managed this case by open surgical ligation of right common iliac artery proximal and distal to fistula and continuity restored with interposition Dacron graft. He was relieved of symptoms and performing well on follow-up.

BACKGROUND AND PURPOSE : Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India. MATERIALS AND METHODS : A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed. RESULTS : Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were “Black turbinate sign” and non-enhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%). CONCLUSIONS : CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.

Anomalies of origin of coronary arteries are an uncommon occurrence and found in approximately 1-2% of the general population. While a large proportion of these anomalies are clinically silent, a few might be hemodynamically significant and may even result in sudden cardiac death. Comprehensive knowledge of the normal as well as variant anatomies of the coronary artery origin and familiarity with imaging appearances and clinical significance of these anomalies is imperative for precise diagnosis and subsequent planning of treatment, whenever required. Multidetector computed tomography angiography, on account of its non-invasiveness, faster scan times and multiplanar reconstruction capabilities, is increasingly being utilized for characterization of coronary artery origin anomalies and their three-dimensional spatial relations. It shows a superior rate of detection of these anomalies compared to conventional angiography, providing more accurate delineation of the ostium as well as course. With the advent of newer generation CT scanners and use of advanced dose reduction techniques, images can be obtained rapidly having excellent spatial resolution and with minimal radiation dose. In this review article, we present the multidetector CT angiography imaging findings of the spectrum of anomalous coronary artery origin, using a third-generation dual-source CT scanner.

ObjectivesWe sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.MethodsCT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.ResultsThe median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.ConclusionAnomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.

Anatomically, the course of an artery is described as ‘recurrent’ when the artery originates at a distal location and courses proximally to supply an organ (for instance radial recurrent artery). T...

We present the CT angiogram images of a 43 year old lady with an isolated single coronary artery arising from the noncoronary sinus with a narrow slit like orifice and oblique take off.

To review emerging techniques in cardiac magnetic resonance imaging (CMR) and their clinical applications with a special emphasis on new technologies, recent trials, and updated guidelines.The utility of CMR has expanded with the development of new MR sequences, postprocessing techniques, and artificial intelligence-based technologies, which have substantially increased the spectrum, quality, and reliability of information that can be obtained by CMR.The CMR modality has become an irreplaceable tool for diagnosis, treatment guidance and follow-up of patients with ischemic heart disease, myocarditis, and cardiomyopathies. Its role has been further strengthened by recent trials and guidelines. Quantitative mapping techniques are increasingly used for tissue characterization and detection of diffuse myocardial changes including myocardial storage diseases.With state-of-the-art CMR sequences, postprocessing techniques and understanding of their interpretation, CMR makes invaluable contributions to provide state-of-the-art diagnostics and care for cardiac patients in a multidisciplinary team.ZIEL: Überblick über neuere Techniken der kardialen Magnetresonanztomographie (MRT) und ihre klinischen Anwendungen mit besonderem Schwerpunkt auf neuen Technologien, jüngsten Studien und aktualisierten Richtlinien.Der Nutzen der kardialen MRT wurde durch die Entwicklung neuer MR-Sequenzen, Nachbearbeitungstechniken und Technologien auf der Basis künstlicher Intelligenz erweitert. Mit dem technischen Fortschritt haben sich das Spektrum, die Qualität und die Zuverlässigkeit von Informationen, die die kardiale MRT liefert, erheblich verbessert.Die kardiale MRT hat sich zu einem unersetzlichen Instrument für Diagnostik, Behandlungsentscheidungen und Nachsorge bei Patienten mit ischämischer Herzerkrankung, Myokarditis und Kardiomyopathien entwickelt. Ihre Rolle wurde durch jüngste Studien und Leitlinien weiter gestärkt. Quantitative Kartierungstechniken werden zunehmend zur Gewebecharakterisierung und zum Nachweis diffuser Myokardveränderungen einschließlich myokardialer Speicherkrankheiten eingesetzt.Mit modernsten MR-Sequenzen, Nachbearbeitungstechniken und Verständnis ihrer Interpretation leistet die kardiale MRT einen unschätzbaren Beitrag zur zeitgemäßen Diagnostik und Versorgung von Herzpatienten in einem multidisziplinären Team.

A 32-year-old woman, known case of chronic myeloid leukaemia on chemotherapy, presented with acute onset of bilateral foot pain and paraesthesia. On examinations, the pedal pulses were absent bilaterally with reduced cutaneous temperatures over the ankles and feet. Lower limb arterial Doppler

The authors report the case of a 23-year-old man with hemoptysis who had an abnormal retrocardiac opacity in the medial aspect of the left lower lobe on a chest radiograph. Contrast-enhanced computed tomography (CT) revealed anomalous systemic arterial supply to the left lower lobe with absence of pulmonary arterial branches to the involved lung. The patient underwent successful transarterial embolization of the systemic supply without any complications. Follow-up imaging showed persistent complete thrombosis of the artery. He recovered with no symptoms at 6 months.

Neurotoxicity related to intra-arterial use of iodinated contrast agents is a relatively uncommon complication of angiography. The authors describe the case of a 42-year-old patient with type B aortic dissection, who developed contrast-related neurological symptoms.

Persistence of the embryological fifth aortic arch in postnatal life has been a subject of debate for over more than a century. We describe a patient with congenital kyphoscoliosis and variant anatomy in the aortic arch and brachiocephalic trunk which could be possibly explained by the persistence of bilateral fifth aortic arches, a pattern which has never been previously reported in literature.

Pancreatic pseudoaneurysm is a rare but life-threatening complication secondary to pancreatitis, surgery, trauma, or infection. Early treatment is advocated due to high risk of rupture and bleeding. Surgical treatment has traditionally been the first line but is associated with high morbidity. Transarterial embolization or exclusion is the treatment of choice; however, in cases with failure of endovascular treatment, percutaneous thrombin injection can be used successfully. We present a case of a large pancreatic pseudoaneurysm managed successfully with percutaneous ultrasound-guided thrombin injection after failure of transarterial management.

Introduction: Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management. Materials and Methods: The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India.It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients. Results: The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28–57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant. Conclusion: This study recommends the trans-sacro-coccygeal “needle inside needle” technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.

We present the computed tomography angiogram images of a 43-year-old lady with an isolated single coronary artery arising from the nonadjacent sinus of aortic root.

A 2-year-old child, who presented to the emergency room with breathing difficulty, dysphagia and failure to thrive, underwent a cardiac CT angiography (CTA) to look for presence of any vascular ring. Review of CTA images showed situs solitus, levocardia and a left-sided aortic arch. A Kommerell’s