Coronary anomalies and anatomical variants detected by coronary computed tomographic angiography in Kashmir, India

Background: Coronary Artery Anomalies (CAAs) presenting in adulthood are rare and associated with adverse cardiac events, including sudden cardiac death. Coronary artery anomaly is the second most common cause of Sudden Cardiac Death (SCD) in young athletes. Cardiac Computed Tomographic Angiography (CTA) is a readily available non-invasive imaging modality that provides high-resolution anatomical information of the coronary arteries. Multi-detector row CT is superior to conventional angiography in defining the ostial origin and proximal path of anomalous coronary branches.Methods: This was a prospective study included 186 patients who underwent coronary CTA from December 2018 to November 2019 in Government medical College, Srinagar on a 256 slice CT. The indications for coronary CTA were an equivocal, or non-diagnostic stress test, atypical chest pain, suspected anomalous coronary, as well as the evaluation of cardiac cause of syncope.Results: Ramus intermedius was the most common anatomical variant seen in 25 patients (13.4%). The prevalence of coronary anomalies in this study was 5.66% including myocarding bridging. The most common anomaly was high take off of coronary artery from sinotubular junction accounting for 1.6%.Conclusions: Coronary Computed Tomographic angiography is much superior in detecting coronary artery anomalies than invasive coronary angiography because of the absence of soft tissue information like as is needed in myocardial bridging. Proper knowledge of the anomalies and their clinical significance is highly important in planning treatment and easing hardships of cardiologists in dealing with them.

Complications of left and right sided percutaneous transhepatic biliary drainage

Background: Percutaneous Transhepatic Biliary Drainage (PTBD) is performed either via right or left-ductal approach, on the basis of status of primary confluence, secondary confluence and atrophy of liver parenchyma. Our study compares the complications of two approaches in malignant obstruction. The objectives of this study was to assess and compare complications of PTBD.Methods: This study was a prospective hospital based study performed for a period of 2 years from 2016 to 2018.PTBD was performed either via right in 16 patients or left-ductal approach in 15 patients, on the basis of status of primary biliary confluence and atrophy of liver parenchyma.Results: Both minor and major complications were more common in right-sided approach as compared to left-sided approach with most common major and minor complication being cholangitis (16.12%) and fever (12.9%) respectively.Conclusions: PTBD is an excellent palliative procedure to drain the bile ducts in malignant obstruction. Although complications of PTBD are more common in right sided approach but results are statistically insignificant.

Role of MRI defecography in assessment of pelvic floor pathologies

Background: Functional disorders of the pelvic ?oor are a common clinical problem. Diagnosis and treatment of these disorders, which frequently manifest with nonspeci?c symptoms such as constipation or incontinence, remain dif?cult. MR Defecography has emerged over the last decade as a modality which additionally images the pelvic floor function in real time besides combining the advantages of previously used modalities and that of magnetic resonance i.e. multiplanar imaging, good temporal resolution and lack of radiation exposure. Dynamic MRI defecography is a relatively new imaging protocol which can be extremely useful in identification of anatomic and functional pelvic floor dysfunction such as organ prolapse, anismus and fecal incontinence. Excellent demonstration of the perirectal soft tissues allows assessment of spastic pelvic ?oor syndrome and descending perineum syndrome and visualization of enteroceles. The aim of the study was to assess causes of pelvic floor dysfunction.Methods: Authors evaluated 25 patients with cine Magnetic Resonance Defecography at our center between December 2018 and 15th May 2019. MR Defecography was done with help of 3 Tesla Somatom Seimens MRI. Ultrasound jelly was instilled into the rectum of patient via a short flexible tube while the patient lies in the lateral decubitus position on the scanner table before being moved into the gantry and was asked to defecate when instructed. Scanning was done in four phases-resting, straining, squeezing and defecation as per the standard protocol while patient lied supine.Results: Most common complaint encountered was that of constipation. Patients in age group 20-70 years were studied. Maximum patient were of the age group 40-50 years. Most common finding was organ prolapse in total 9 patients with anterior rectocele in 6 patients followed by rectal prolapse.Conclusions: Magnetic resonance defecography is an excellent modality for assessment of pelvic floor disorders. It has very good temporal resolution and high soft tissue contrast, also allows visualization of the pelvic floor function in real-time without any radiation load. Imaging the defecation process in real-time leads to a definitive diagnosis in cases of dysfunctional defecation and a precise diagnostic and pre-operative assessment in cases of organ prolapse.

Assessment of Thoraco-abdominal injury pattern due to blunt trauma in Kashmiri Population by contrast enhanced Computerized Tomography (CECT)

Background: The most common causes of blunt abdominal trauma are motor vehicle collisions, falls from height, assaults, and sports accidents. Computed tomographic (CT) examination of the head, neck, chest, abdomen, and pelvis has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. Although the decision to surgically intervene is usually based on clinical criteria rather than findings from images. CT information often increases diagnostic confidence and decreases rates of unnecessary exploratory laparotomy. Aim and objective: To study the pattern of Thoraco-abdominal injuries due to Blunt Trauma in Kashmiri population. Methods and materials: Study was done in the department of Radiodiagnosis and Imaging, GMC Srinagar. 64 patients with Positive extended FAST (focused assessment with sonography for trauma) done by expert in emergency Radiology were subjected to contrast enhanced CT. Results: According to our Study, Lung was the most commonly injured organ being injured in 67% cases followed by Spleen and Liver, being injured in 59% and 45% cases respectively. Most common pattern of lung injury was Contusion. Grade III was the most common grade of injury followed by Grade IV injury amongst splenic and liver injuries. Rib was the most commonly injured bone. Suhail Rafiq, Ishfaq Kuchay, Sheema, Sajad Dar. Assessment of Thoraco-abdominal injury pattern due to blunt trauma in Kashmiri Population by contrast enhanced Computerized Tomography (CECT). IAIM, 2019; 6(6): 23-31. Page 24 Conclusion: Multidetector CT has very high accuracy for optimal evaluation of the patients with Blunt trauma. CT plays a vital role in deciding mode of treatment whether medical or surgical for patients with blunt trauma. Lung was the most commonly injured organ in our study followed by Spleen and liver.

Role of Magnetic resonance hysterosalpingography in female infertility

Background: Approximately 15 % of couples are affected by infertility, which is defined as the inability to conceive after 12 months of regular unprotected sexual intercourse. Magnetic resonance imaging (MRI) can be used to evaluate congenital Müllerian duct anomalies and to diagnose adenomyosis, leiomyoma and endometriosis. MRI-hysterosalpingography (MR-HSG) in addition to conventional MRI (with/without contrast) is effectively used in diagnosing the tubal and uterine cause of infertilities. Materials and methods: The purpose of study was to evaluate the ability of magnetic resonance hysterosalpingography to evaluate fallopian tube patency and evaluate cause of infertility. Written informed consent was obtained from all subjects. Forty two women with infertility were recruited between 2017 and 2018. Eighteen out of 42 patients had already underwent conventional hysterosalpingography. MRI was performed on a 1.5-T System, using a phased array surface coil. Results: About 32 patients showed bilateral tubal patency. Six patients showed bilateral tubal occlusion on MR HSG. 2 patients had unilateral tubal occlusion. 7 patients had ovarian endometriosis, 6 had leiomyomas, 2 patients had mullerian anomalies, 3 patients had features of polycystic ovarian disease and 5 patients had multifactorial etiology. No cause could be found in 9 patients. Conclusion: MR-HSG is a feasible, useful, innovative and well tolerated tool for the assessment of the uterus, fallopian tubes, ovaries and extra-uterine structures. MR-HSG is a new promising imaging approach to female infertility. MR-HSG scanning can be helpful in demonstrating tubal patency even in patients with documented tubal blockage on conventional HSG.

Isolated psoas schwannoma: A rare retroperitoneal tumor

Retroperitoneal neurogenic tumors are very rare. Isolated or primary psoas schwannoma is one of the rarest tumors of retroperitoneum. The images of such a case are presented in this report.