ABSTRACT
Direct carotid-cavernous fistula (CCF) refers to direct communication between the cavernous portion of the internal carotid artery (ICA) and the cavernous sinus due to rent in the ICA, most commonly secondary to trauma. These are generally high-flow fistula and rarely resolve spontaneously. We report a case of a young male who developed features of direct CCF after trauma, was denied any treatment for 4 years, and then presented with spontaneous thrombosis of the fistula and a residual large pseudoaneurysm of the cavernous segment of the right ICA, which was subsequently managed with parent vessel occlusion.
ABSTRACT
A 14-year-old girl visited our hospital with pyrexia of unknown origin. In view of suspicion of tuberculosis, various haematological and radiological investigations were done. Further examinations revealed titres positive for lupus anticoagulant syndrome. Contrast-enhanced computed tomography [CT] of the chest and abdomen was also advised for further evaluation, which revealed type II superior vena cava obstruction. Contrast-enhanced CT of the abdomen revealed an interesting observation in the left lobe of the liver, which is known as the hot spot sign. CT quadrate lobe hot spot sign' was first described by Ishikawa in 1983. It manifests as an area of intense focal wedge-shaped enhancement of the quadrate lobe [functionally a part of the left lobe of the liver and designated segment IVb in the Bismuth-Couinaud classification system] of the liver in the arterial and venous phase [figure 1].1 This hot spot sign was initially observed on 99mTc sulphur colloid scan of the liver as a focal area of increased radiopharmaceutical uptake and was diagnostic of superior vena cava syndrome.2 Hot spot sign is caused by portosystemic venous shunting between the superior vena cava and the left portal vein via the internal mammary and paraumbilical veins along the ligamentum teres, secondary to superior vena cava obstruction
ABSTRACT
Bladder cancer is the second most common neoplasm of the urinary tract worldwide. Dynamic contrast-enhanced and diffusion-weighted MRI has been introduced in clinical MRI protocols of bladder cancer because of its accuracy in staging and grading. To evaluate and compare accuracy of Dynamic contrast enhanced [DCE] and Diffusion weighted [DW] MRI for preoperative T staging of urinary bladder cancer and find correlation between apparent diffusion coefficient [ADC] and maximum enhancement with histological grade. Sixty patients with bladder cancer were included in study. All patients underwent Magnetic Resonance Imaging [MRI] on a 1.5-T scanner with a phased-array pelvic coil. MR images were evaluated and assigned a stage which was compared with the histolopathological staging. ADC value and maximum enhancement curve were used based on previous studies. Subsequently histological grade was compared with MR characteristics. The extent of agreement between the radiologic staging and histopathological staging was relatively greater with the DW-MRI [?=0.669] than DCE-MRI [?=0.619]. The sensitivity, specificity, and accuracy are maximum and similar for stage T4 tumors in both DCEMRI [100.0, 96.2 and 96.7] and DW-MRI [100.0, 96.2 and 96.7] while minimum for stage T2 tumors - DCEMRI [83.3, 72.2, and 76.7] and DWI-MRI [91.7, 72.2, and 80]. MRI is an effective tool for determining T stage and histological grade of urinary bladder cancers. Stage T2a and T2b can be differentiated only by DCE-MRI. Results were more accurate when both ADC and DCE-MRI were used together and hence a combined approach is suggested