A Series of Ocular Tuberculosis Cases from A Rural Tertiary Care Center in West Bengal

Tuberculosis in Eye can have diverse presentations leads to diagnostic difficulty. If no extra-ocular tubercular lesions are found then it becomes a challenge to diagnose & treat. Here authors present 6 cases of Ocular Tuberculosis without any associated extra-ocular tubercular lesions. One case of tubercular anterior uveitis, eales disease, solitary Choroidal Tuberculoma, bilateral multiple Choroidal Tuberculoma, multifocal & serpiginous like Choroiditis are presented here. All of them were resolved with first line anti-tubercular regimen and corticosteroids. Authors recommend initial visual assessment for all Tuberculosis cases to diagnose & treat hidden cases of Ocular Tuberculosis which may be sight threatening.

A rare case of complicated malaria presenting as warm autoimmune hemolytic anemia

Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.

Primary leiomyosarcoma of ovary: A rare malignancy as an incidental finding

Primary leiomyosarcoma (PLMS) of the ovary is extremely rare tumors comprising 1% of ovarian tumors. About 3% of all ovarian malignancies are primary ovarian sarcomas. Only 72 cases have been reported till date. A 57-year-old postmenopausal female presented with abdominal pain for the last 6 months. Ultrasonography and MRI revealed a heterogeneously enhancing solid lobulated mass in the left adnexa abutting the fundus of the uterus and bowel loops. The endometrial cavity was normal. Ovarian markers CA 125, CEA, CA 19.9, and all hematological parameters were within normal limits. LDH was near normal (284 IU/ml). The specimen was sent for frozen section and a diagnosis of malignant spindle cell lesion of ovary was rendered. Histopathology of the ovarian mass revealed intersecting fascicles of tumor cells consisting of ovoid to spindle-shaped cells having a moderate amount of cytoplasm. Bizarre and atypical cells were seen singly dispersed and in small aggregates along with the brisk mitotic activity. Focal areas of necrosis and hemorrhage were also noted. Immunohistochemistry showed strong positivity for smooth muscle actin and Caldesmon while focal positivity for Desmin and Epithelial Membrane Antigen (EMA) was noted. The lesion was negative for Inhibin, Calretinin, and CD 117 and S100. The final diagnosis of primary ovarian Leiomyosarcoma was given based on histopathology and Immunohistochemistry. PLMS of the ovary are rare incidental findings in postmenopausal women. These are highly malignant tumors and carry a poor prognosis. Hence, early diagnosis and surgical treatment with cytoreduction improve patient survival.

Histological Variants of Leiomyoma: A Great Impersonator posing a Diagnostic Challenge - Three year Study in Delhi NCR

Background: Objectives: Uterine smooth muscle tumours are diagnostically challenging as well as scientifically intriguing with leiomyoma being the most common. On review of literature there are numerous studies on audit of hysterectomy specimens worldwide, however, studies focusing on detailed histopathologi cal analysis of leiomyomas are limited. Thereby, this study was conducted to identify the secondary changes as well as histological variants of leiomyoma, their frequency of occurrence and other associated clinicopathological factors Methods: A retrospecti ve audit of all the hysterectomy and myomectomy specimens was conducted over a period of 3 years (Jan 2016 to Dec 2018) comprising of a total of 155 cases with 388 leiomyomas (LM). The clinical details were retrieved, and histopathological slides reviewed for cellularity, mitosis, atypia, necrosis, any secondary changes or specific variants. Results: On histopathology, 19.1% LM showed degenerative changes and histologic variants were observed in 6.18% LM. Hyaline change was the most frequent degenerative ph enomenon in 82.43% (60/74) while cellular leiomyoma was the most common variant in 37.5% (9/24) LM. Conclusion: Certain histological variants make the differentiation from malignant tumors challenging. A thorough tissue sampling and strict adherence to histologic criteria coupled with a ncillary techniques like immunohistochemistry can help in excluding malignancy in most of the cases. Awareness regarding these is very important amongst youn g pathologists to avoid misdiagnosis and overtreatment leading to unwarranted stress to the patient.

The ocular surface after simple limbal epithelial transplant (SLET): A high-resolution OCT study of the early postoperative period

Simple limbal epithelial transplantation (SLET) is an emerging technique for treating unilateral limbal stem cell deficiency. We report the high-resolution, anterior segment optical coherence tomography (OCT) features of the first 2 weeks of a patient undergoing SLET for an old acid injury of the right eye, repeatedly from postoperative day 1 through day 14. Three out of 11 explants with the subjacent human amniotic membrane (hAM) and the overlaid bandage contact lens were imaged. The hAM was intact and of the same thickness throughout the study period; the sub-hAM space increased from day 3 to 9 and disappeared by day 10; the explants started thinning from day 3 with the fibrin around them starting to decrease from day 2 and completely disappeared by day 4. Epithelialization occurred between day 8 and 14 and proceeded more rapidly towards the limbus than centrally. There was no change of the corneal stromal thickness or reflectivity. This case report uses high-definition, spectral-domain OCT to document the events on the ocular surface after a successful SLET surgery and opens up an avenue to study epithelialization in a convenient and noninvasive manner.

Effects of applied cadmium on its accumulation, dry matter production and net photosynthesis in okra and amelioration of cadmium toxicity through lime application

Aim: Vegetables grown in cadmium contaminated soils accumulate cadmium in their tissues and are risky for consumption. The aim of the study was to get an insight into the effect of different levels of cadmium in soil, on accumulation in different plant parts of okra and its effect on overall growth, biomass production and photosynthesis rate so that suitable management option is explored to produce safe vegetable in cadmium contaminated soils. Methodology: The study was conducted in replicated pots with three soil pH (5.46, 6.54 and 7.45) attained through addition of CaCO3 as main treatment and four Cd levels viz., 0, 3, 6 and 9 mg kg-1 of soil as sub-treatment. Okra (Abelmoschus esculentus) was taken as the test crop. The experiment was conducted in a net house. Results: The Cd concentrations were minimum in fruits (0.54, 0.31 and 0.14 mg kg-1) and higher in leaves at acidic pH (5.5), while in soil limed to slightly acidic (6.5) and alkaline pH (7.5) roots retained maximum Cd among plant parts. Net photosynthesis and biomass production decreased significantly with higher Cd doses at acidic pH (5.5). The rate of decline in net photosynthesis was lesser at higher soil pH. The transfer factors decreased with increase in soil pH. The DTPA extractable soil Cd decreased from 8.5 to 2% when soil pH increased rendering the Cd less available for plant uptake. Interpretation: Liming can be an effective ameliorative measure to mitigate Cd toxicity in acidic soils and can ensure safe consumption. Lowest accumulation of cadmium in fruit part suggests okra to be a potential vegetable crop for Cd polluted soils.

Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission?

Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.

Diagnostic utility of gray scale ultrasound and elastography in solitary thyroid nodules

Background: A firm and hard thyroid nodule on palpation is associated with an increased risk of malignancy .Palpation is subjective. Elastography has been introduced to evaluate the tissue hardness objectively and to augment the diagnostic accuracy of gray-scale ultrasonography (US). Aim and objectives: To evaluate the diagnostic utility of gray-scale ultrasonography (US) and elastography in differentiating benign and malignant thyroid nodules. Materials and methods: A retrospective analysis of Gray scale US and Elastography of 70 solid thyroid nodules in 50 patients was done in our Dhiraj General Hospital over a 6 month period. Diagnostic performances of gray scale US, Elastography with Rago and Asteria criteria, and Odd’s ratios (ORs) with 95% confidence intervals for predicting thyroid malignancy were compared with gold standard FNAC using generalized estimating equation. Results: 70 solid thyroid nodules in 50 patients were evaluated. 21 were malignant and 49 were benign. Sensitivity, negative predictive value (NPV), and Odd’s ratio(OR) of gray-scale US for the 70 nodules were 91.6%, 94.5% and 22.2 respectively, and these values were higher than the 15.6% and 65.3% sensitivity, 71.6% and 79.2% NPV and 3.6 and 2.7 ORs found for elastography with Rago and Asteria criteria, respectively. Conclusion: Elastography alone as well as the combination of elastography and gray-scale US showed inferior performance in the differentiation of malignant and benign thyroid nodules compared with gray-scale US features. Hence elastography is not a useful tool in recommending FNAC.

Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation

Background: Thyroid gland is afflicted by various pathologies ranging from diffuse enlargement (goitre) to nodular lesions, thyroiditis, and malignancy. Presently high resolution ultrasound with color Doppler is the primary imaging modality of choice in morphological evaluation of thyroid gland. It is used to define the nature of the lesion, whether solid or cystic, to differentiate thyroid from extra thyroidal masses, to assess the size of nodule in patients who are under observation or therapy, to monitor patient who are at increased risk of thyroid malignancy especially those with radiation exposure or having a family history, to detect recurrence of thyroid malignancy after surgery and in interventional procedure like guiding in FNAC. Materials and methods: Study was carried out using standard 5-12 MHz frequency probe with grey scale and color Doppler spectrum to evaluate and analysis of different thyroid nodules and taking Ultrasound guided fine needle aspiration cytology and correlate histopathologically. Results: Majority of patients belonged to middle age group between 21-60 years with mean age of 38.2 years. Colloid goitre was most common presentation on ultrasound and it showed wide spectrum of appearance, majority being nodular with anechoic echotexture. Malignant lesions of thyroid were usually hypoechoic, though all hypoechoic lesions were not malignant. (Sensitivity of 75%, specificity of 81.48%, PPV of 37.5% and NPV 95.65%). The most sensitive sign for picking up malignancy on USG were Intralesional vascularity; absent halo sign and regional lymph node Siddharth Zala, C. Raychaudhuri. Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation. IAIM, 2019; 6(4): 86-91. Page 87 involvement (sensitivity of 100%) the most specific signs were invasion of adjacent tissue (specificity of 92.59%), Lymphadenopathy (85.18%) and hypoechotexture (81.48%). A combination of signs aid in prediction of malignancy and in guidance for site of FNAC. The most useful combination of sign proved to be Invasion to adjacent tissue, Lymphadenopathy, absent halo, hypoechogenicity, microcalcification and Intralesional vascularity on color flow imaging. Conclusion: The ultrasonographic findings in thyroiditis were usually hetroechogenicity and coarse calcification with diffuse vascularity on color flow imaging. The addition of color flow imaging to gray scale ultrasound had increased the overall sensitivity for diagnosis of thyroiditis (96.87%) and was also highly specific (89.70%)

Role of USG and CT scan in evaluating ovarian lesions

Introduction: Ultrasound helps by detecting lesions, give idea about its internal structure and also give opportunity to evaluate other abdominal organs. However evaluation by CT scan can give additional information, which can modify the course of treatment and prognosis of patient. Materials and methods: Study comprise of 84 patients who were evaluated with ultrasonography and CT scan of abdomen and pelvis. Ovarian pathologies were categorized with benign, malignant and metastasis and compared with histopathological diagnosis or conservative treatment follow up. Results: 84 patients were evaluated; CT scan and sonography are excellent noninvasive modality to differentiate ovarian masses from benign and malignant lesions and both imaging techniques seem to be comparable in differentiation of malignant from benign ovarian tumors. CT scan was more sensitive than ultrasonography, but sonography is more specific than CT scan in diagnosis of malignant lesions. Ultrasonography has high positive predictive value as compare to CT scan to diagnose malignant lesions. Conclusion: Ultrasound by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is investigation of choice in ovarian pathology and it can easily detect solid to cystic lesions and characterize the size, shape and extent of lesion. Computerized Tomography is particularly useful to know the enhancement pattern of the lesion, density and extent and staging of malignancies.

Role of CT imaging to evaluate solitary pulmonary nodule with extrapulmonary neoplasms

Background: A solitary pulmonary nodule is defined as a discrete, well - marginated, rounded opacity less than or equal to 3 cm in diameter that is completely surrounded by lung parenchyma, does not touch the hilum or mediastinum, and is not associated with adenopathy, atelectasis or pleural effusion. Aim and objectives: To determine the frequency of single lung metastasis, primary lung cancer and benign lesions in patients with solitary lung nodule and a primary extrapulmonary neoplasm, to evaluate the Chest Radiographs and CT characteristics of solitary lung nodule with a primary extrapulmonary neoplasm, to develop a statistical model to guide clinicians regarding choice of patient for diagnostic biopsy. Materials and methods: A retrospective analysis of CT and Chest Radiographs of 50 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule, done in our Dhiraj General Hospital over a 6 – month period. Results: 50 patients of Extrapulmonary neoplasms were evaluated; out of these patients were diagnosed and evaluated for Primary Bronchogenic Carcinoma, lung metastases, benign nodule. Conclusion: Solitary lung nodule in patients with extrapulmonary malignancies showed a variety of patterns on CT. Nearly half of the non – calcified solitary pulmonary nodules identified in this series were malignant. The likelihood of a spread depends on the histological Anand Vachhani, Shashvat Modia, Varun Garasia, Deepak Bhimani, C. Raychaudhuri. Role of CT imaging to evaluate solitary pulmonary nodule with extrapulmonary neoplasms. IAIM, 2018; 5(8): 86-92. Page 87 characteristics of the extrapulmonary neoplasm and the patient's smoking history. Lung cancer was more common than metastatic disease.

Pulmonary Sarcoidosis – Radiological Evaluation

Background: Sarcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes. Sarcoidosis is manifested by the presence of noncaseating granulomas (NCGs) in affected organ tissues. It is characterized by a seemingly exaggerated immune response against a difficult–to-discern antigen. Materials and methods: All patients were known case of pulmonary sarcoidosis. All patients for this study had undergone X-ray and CT scan after taking informed consent. Results: In our study, we found that 17 (68%) patients with sarcoidosis have a characteristic radiologic appearance consisting of enlarged hilar and paratracheal lymph nodes, 24% of cases shows nonspecific or atypical findings, and in 4% of patients the radiograph is normal. Conclusion: Radiologists can play an essential role in the diagnosis and management of sarcoidosis. It is essential to recognize both the typical and the atypical manifestations of the disease and use information obtained from the correlation of imaging features with pathologic findings to help achieve an early diagnosis and reduce associated morbidity and mortality

Renal cell carcinoma – A spectrum of radiological findings

Background: Renal cell carcinomas (RCC) are primary malignant adenocarcinomas derived from the renal tubular epithelium and are the most common malignant renal tumor. They usually occur in 50- 70-year-old patients. Aim: Radiological evaluation of patients of renal cell carcinoma by modalities like USG, CT-Scan and MRI. Materials and methods: All the patients were cases of renal cell carcinoma that had come to Department of Radiology in Dhiraj Hospital. They were evaluated by different modalities like USG, CT-Scan and MRI after taking consent when and where needed. Results: Renal cell carcinoma followed age and sex trends which means 72% patients were males and 28% patients were females and most of the patients were above 50 years of age. Conclusion: CECT is the modality of choice for evaluation of renal cell carcinoma patients as it gives the information not only about the localization but also the distant spread of tumor. MRI can be used as an alternative and also to know about the renal vein and IVC invasion by the tumor. USG as is a cheap and easily available method can be used to screen the patients with a palpable flank mass and those with hematuria.

A radiological perspective of assessing neonatal respiratory distress syndrome

Background: The causes of respiratory distress in the neonatal period can be classified into abnormalities primarily affecting aeration, circulation or development of the thorax. Conditions of the lungs and cardiovascular system account for the majority but abnormalities of the tracheobronchial tree, chest wall, diaphragm, and a variety of neuromuscular diseases must also be considered in the differential diagnosis. Chest radiography is the most valuable imaging modality in the investigation of neonatal respiratory disorders. Within 48 – 72 hours, the most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X-ray. Materials and methods: This was a prospective observational study that was conducted in rural tertiary care center. Anteroposterior chest radiograph in supine position of (59) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, in my study 32.20% diagnosed with transient tachyponea; 20.3% diagnosed with hyaline membrane disease; 16.94% diagnosed with congenital neonatal pneumonia; 11.86% diagnosed with meconium aspiration syndrome; 1.96% diagnosed with aspiration syndrome; 5.08% diagnosed with cardiac causes; 3.38 % diagnosed with tracheaoesophageal fistula; 3.38% diagnosed with congenital diaphragmatic hernia; 1.69% diagnosed with idiopathic persistent pulmonary hypertension; 1.69% diagnosed with eventeration of diapghram; 1.69% diagnosed with pneumoperitoneum, presented to radiology department with respiratory distress. Jayesh Shah, Nikhil Parvatkar, C. Raychaudhuri. A radiological perspective of assessing neonatal respiratory distress syndrome. IAIM, 2017; 4(12): 10-15. Page 11 Conclusion: Chest radiography is essential in neonates with acute respiratory distress to exclude structural abnormalities such as congenital diaphragmatic hernia or congenital lobar emphysema. One should remember that any sign of post–natal respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible. Finally chest radiograph should be read by an expert radiologist.

Radiological evaluation of Ovarian Dermoid

Background: Ovarian dermoid cyst is the most common ovarian neoplasm. It accounts for ~15% of all ovarian neoplasms. They tend to be identified in young women, typically around the age of 30 years. These slow-growing tumor contain elements from multiple germ cell layers and are easily detected with ultrasound and much better by CT scan and MRI. Materials and methods: Patients presented to Radiology department with known case of dermoid cysts of ovary or in whom accidental diagnosis of ovarian dermoid cyst was made eventually. Evaluation of ovarian dermoid with Ultrasound machine (Logiq P9 GE), CT scan Siemens (16 slice) and MRI Philips (1.5 Tim + dot system). Results: In our study we found that 25 (100%) patients had ovarian dermoid, 20 (80%) patients were of age group 21years to 40 years, 4 (16%) patients were of 41-60 years and 1 (4%) patients were of 0- 20 year age group. In diagnosis of ovarian dermoid our results showed that CT scan was more sensitive (96%) than USG (92% sensitivity). Conclusion: Detection and morphological characterization of ovarian dermoid can be easily done on ultrasound. MRI and CT scan are useful adjunct to USG in its characterization and detection of associated pathology. In USG, when ovary shows heterogeneously hyperechoic lesion with fat fluid level without any vascularity highly suggestive of ovarian dermoid.

Role of MRI in acute disseminated encephalomyelitis

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

Role of MRI spine in evaluation of cases of neurotrophic arthropathy

Introduction: A neurotrophic joint (also known as a Charcot joint) refers to a progressive degenerative/ destructive joint disorder in patients with abnormal pain sensation and proprioception. A substantial number of neurotrophic joints are caused secondary to lesions of the spine. Many a times the patient does not give any history indicating a spine lesion. Hence MRI scan of Spine should be made a part of the investigations in every case of neurotrophic joint. Aims and objectives: To study the incidence of Spinal lesions as a primary causative factor behind a neurotrophic joint and to study the efficacy of MRI spine exam in correctly diagnosing Spinal lesions in patients presenting with a neurotrophic joint. Materials and methods: This study was conducted in the Radiology department of Dhiraj general Hospital. 20 patients presenting with neurotrophic joint/joints but giving no history suggestive of an underlying spinal pathology were evaluated by MRI spine. Results: Out of 20 patients presenting with neurotrophic joint who were evaluated by MRI spine, only 12 scans revealed a spinal pathology secondary to which the patient had developed neuropathic change of the affected joint. Conclusion: Onset of joint neuropathy is usually insidious. If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or super infection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity and for that early diagnosis of any underlying pathology is important. MRI spine is a sensitive tool to detect any lesion of the spine. It helps to accurately diagnose a variety of spinal lesions and tells about its exact size, extent and severity and thereby contributes immensely in the management of a neurotrophic joint.

Radiological investigations of imperforate anus

Introduction: Imperforate anus is a defect that is present from birth (congenital) in which the opening to the anus is missing or blocked. In female infants, imperforate anus is typically characterized by the rectum, bladder and vagina sharing one large opening called a cloaca. The condition develops in utero during the 5th to 7th weeks of pregnancy. This condition often happens in conjunction with other defects of the rectum. Incidence is 1 in 5000. It is more common in males. Diagnosis is usually made shortly after birth. Aims and objectives: To study the presentation of imperforate anus using various radiological modalities. Materials and methods: 10 cases of either strong suspicion or symptoms related to imperforate anus were evaluated who came to Dhiraj hospital with different radiological modalities like plain radiograph lateral invertogram, cross table lateral radiograph, erect radiograph and contrast studies (MCUG). Results: Out of total number of 10 patients who were diagnosed and evaluated for imperforate anus 3 i.e. 33.3 % were diagnosed with plain radiograph lateral invertogram, 2 i.e. 20 % were diagnosed with prone cross table lateral radiograph, 2 i.e. 20 % were diagnosed with abdominal erect radiograph and 2 were found to have recto-vesical fistula with the help of micturating cystourethrogram. Conclusion: It was concluded that plain radiograph lateral invertogram proves to be the most important modality in diagnosing imperforate anus. It is followed by prone cross table lateral radiograph and abdominal erect radiograph. Micturating cystourethrogram proves to be important in diagnosing associated anomalies such as recto-vesical fistula.

Rhinotillexomania – A rare case report of chronic nose picking

Nasal septal lesions are relatively common. Although most manifest with symptoms of nasal destruction, some are incidentally found. Acquired septal lesions may appear due to chronic inflammation and relative ischemia induced by repeated trauma due to nose picking. Because their imaging features often are nonspecific, the diagnosis usually is based also on the clinical history. Rhinotillexomania is a common and generally benign habit in adolescents and adults and only rarely leads to mutilating self-injury. Chronic self-mutilation with resultant loss of body parts occurs most often in schizophrenic and severely obsessive-compulsive patients. The most common symptoms produced by such lesions include nasal obstruction, nasal discharge, epistaxis, facial swelling, and pain. If a physical examination confirms the presence of a trauma, both MR imaging and CT may be used to characterize the finding.

Imaging in neurofibromatosis type 1: An original research article with focus on spinal lesions

Background: Neurocutaneous syndromes encompass a group of disorders that affect the embryonic ectodermal plate, which includes the central and peripheral nervous systems, as well as the overlying skin. Materials and methods: All patients were known case of neurofibromatosis type 1. All patients for this study had undergone MRI whole spine with brain screening. Conventional radiographs were also taken when and where needed after taking informed consent. Results: In our study we found that 15 (60%) patients having lumbar neurofibromas, 7 (28%) patients having cervical neurofibromas, 2 (8%) patients having thoracic neurofibromas and 1 (4%) patients having sacral neurofibromas. Conclusion: MRI allows non-invasive detection of spinal neurofibromas and helps determine intrdural or extradural origin and their relationship to the neural foramina, spinal canal, and thecal sac and spinal cord. The target sign (bright on T2, with dark collagen centrally) is highly suggestive of a peripheral neurofibroma on MRI.