Trousseau's sign in the left internal jugular vein in gastric cancer

A 24-year-old woman came with complaints of upper abdominal swelling for the last 6 months, early satiety associated with loss of appetite and weight for 3 months, abdominal pain for the last 1 month, and vomiting for the last 4 days. Abdominal examination revealed a centrally placed solid swelling in the epigastric region with mild tenderness. Abdominal ultrasound and contrast-enhanced computed tomography (CECT) abdomen showed multiple liver secondaries and diffuse circumferential gastric wall thickening and enlarged peripancreatic and periportal nodes [Figure 1]. Ultrasound of neck and Doppler and CECT neck showed partial thrombus in the left internal jugular vein thrombosis (IJVT) proximal to its origin for a length of about 1.7 cm [Figure 2]a and [Figure 2]b. Upper gastrointestinal scopy showed ulceroproliferative growth in the body, antrum, and pylorus region with features of infiltrating adenocarcinoma of poorly differentiated diffuse type on biopsy.

Role of Anatomical Landmarks in Identifying Normal and Transitional Vertebra in Lumbar Spine Magnetic Resonance Imaging

STUDY DESIGN: Retrospective study. PURPOSE: Identification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae. OVERVIEW OF LITERATURE: Many studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results. METHODS: We studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department. RESULTS: In our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12–L1 in most patients in the normal and sacralization groups. CONCLUSIONS: CF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.

Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India

STUDY DESIGN: A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population. PURPOSE: There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population. OVERVIEW OF LITERATURE: Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations. METHODS: A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type. RESULTS: Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females. CONCLUSIONS: Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.