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A woman aged 28 years presented with a history of voiding difficulty with straining on micturition for 2 months. She was completely asymptomatic and had no symptoms of voiding difficulty prior to this. On physical examination, she was found to have a firm tender mass measuring 2.5×2 cm, involving the posterior periurethral region. The urethral orifice could not be separately identified. Uroflowmetry was performed and was within the normal limit. Transperineal ultrasound revealed a well-defined homogeneously hypoechoic solid lesion anterior to the vagina. The posterior urethral wall could not be separately delineated from the lesion. On colour Doppler interrogation, the lesion showed significant internal vascularity (figure 1). There was no significant postvoid residue. MRI was performed for further characterisation of the lesion and its relation to adjacent structures. Axial, coronal and sagittal T2-weighted, short tau inversion recovery (STIR) and precontrast and postcontrast T1-weighted images were acquired. A well-defined focal lesion measuring 2.8×2.5×2.3 cm was noted below the level of pubic symphysis arising from the posterior wall of the distal urethra displacing the urethral meatus anteriorly. This lesion was anterior to the vagina with preserved intervening fat planes. The lesion showed intermediate signal intensity and was isointense …

Tuberculosis involving the central nervous system, a source of considerable morbidity and mortality, forms 5-10% of the disease burden associated with tuberculosis. Central nervous system tuberculosis may present as meningitis, tuberculoma, abscesses, cerebritis or miliary tuberculosis. The most common site of tuberculoma has been reported to be at the grey-white matter junction and the periventricular region. They may even be found in the epidural, subdural and subarachnoid spaces, and the brain stem, with the rarer sites of involvement being the cavernous sinus, sella turcica, hypophysis, hypothalamus, sphenoid sinus and the mastoid air cells. Although tuberculosis is very common in developing countries, with the increasing prevalence of immunosuppression owing to human immunodeficiency virus and patients surviving chemotherapy or organ transplantation, the incidence of tubercular infections has been rising in developed countries. The authors report a case of intracranial tuberculosis in a human immunodeficiency virus-negative patient, who underwent incomplete treatment for tubercular peritonitis and presented with unilateral ptosis. Tuberculous involvement was noted in a racemose pattern in the subarachnoid space, cavernous sinuses, suprasellar cistern and parasellar region. To the best of our knowledge, the term racemose pattern of tuberculoma has not been described before, while about 10 cases of tuberculoma involving the cavernous sinuses have been reported in the literature. Furthermore, the racemose pattern of tuberculosis in the subarachnoid space, as well as involvement of the cavernous sinus, hypothalamus, pituitary and the cisterns, developed paradoxically after initiation of antitubercular chemotherapy.

Urinary incontinence is a condition causing significant psychological trauma and affects the quality of life of the affected individual. Though common causes of urinary incontinence of non-traumatic aetiology in young adults include detrusor instability and congenital conditions like meningomyelocoele, an ectopic ureter is an important surgically correctable cause of urinary incontinence. The cause of incontinence in an ectopic ureter is insertion of the ureter distal to the internal urethral sphincter. The authors describe a case report of an ectopic ureter arising from a duplex moiety with poor renal function using multiple modalities. This highlights the utility of multiple modalities in arriving at an accurate diagnosis, with adequate clinically useful information. In this case, the formation of a pseudo-diverticulum resulted in diagnostic confusion.