Pseudoaneurysm of Splenic Artery - A Severe Vascular Complication of Pancreatitis

Acute pancreatitis is one of the common abdominal pathologies having an incidence of 10 to 100 cases per 100,000 population worldwide with varying type of presentation ranging from self-limiting abdominal pain to high mortality and morbidity due to organ failure. The major risk factors leading to pancreatitis include gall stones and alcohol consumption, others being trauma, drugs, and infections.1,2 The revised Atlanta classification (2012) has classified acute pancreatitis on the basis of local, systemic complications and organ failure as mild, moderately severe and severe type of pancreatitis. One of the dreaded local complications of pancreatitis are the vascular complications occurring with a frequency of 1.2 - 14 %, with a greater incidence seen in chronic pancreatitis (7 - 10 %) than acute pancreatitis (1 - 6 %). The two main types of vascular complications being splenic vein thrombosis (more common) and pseudo aneurysm of (in order of decreasing frequency) the splenic, gastro duodenal, and pancreaticoduodenal arteries.3,4 The common symptoms of pseudoaneurysm of splenic artery are abdominal pain, hematemesis, melena, flank pain, and chest pain. Haemorrhage from pseudo aneurysm can be found in the pseudo cyst, stomach, pancreatic duct, peritoneal cavity, or retro peritoneum making the patient highly haemodynamically unstable at presentation having high rates of morbidity and mortality.5 The mortality rate due to haemorrhages directly related to the pancreas is up to 50 %.2 Clinical diagnosis in these patients is highly difficult due to varied range of symptoms and hence ultrasound coupled with contrast enhanced CT imaging helps in accurate diagnosing of such an entity.Pancreatitis is one of the common abdominal pathologies having variable type of presentation. Vascular complications are rare, but severe in nature having high mortality and morbidity rates. Ultrasound coupled with computer tomography helps in fast and accurate diagnosis of these vascular complications like pseudo aneurysms, aneurysms and thrombosis of peri pancreatic arteries. We are presenting a case report of pseudoaneurysm of splenic artery.

Fat Necrosis in Axillary Lipoma after FNAC - A Case Report

Lipomas are benign soft tissue tumours having mature adipose tissue. These lesions are the most common soft tissue tumours, accounting for approximately 50 % of all soft tissue tumours.1 Lipomas are mostly located within the superficial soft tissues of the extremities, back, and neck. These lesions are asymptomatic, but due to the superficial location these lesions, they commonly present less than 5 cm in size.2 Lipomas deep to the superficial fascia also occur, but are rare. These lesions may be intramuscular or intermuscular and mostly occur in the lower extremity. Following accidental trauma fat necrosis can be seen, and the patient presents with pain at the site of lipoma with discoloration of skin. It can be confidently diagnosed on ultra-sonography, without further need of any investigation. Here, we are discussing USG, Doppler and Strain Elastography imaging findings in a middle-aged lady having fat necrosis within axillary lipoma. Lipoma are relatively common benign lesions and can arise from anywhere in the body. Fat necrosis is common following accidental trauma.

Importance of Ultrasonography in Inspissated Bile Syndrome in a Neonate - A Case Report

Neonatal cholestasis is the diagnostic dilemma in clinical practice.1 It is a serious condition with the varied aetiological factors. Biliary atresia, hepatitis, choledochal cyst are common causes in neonates. Intrahepatic and extrahepatic causes can be easily differentiated by radiological investigations.2 Inspissated bile syndrome is a rare cause of neonatal jaundice.3,4 Predisposing factors for the development of inspissated bile in neonates include haemolysis, prematurity, parenteral nutrition, sepsis, and diuretic therapy.5 Ultrasonography is valuable in diagnosing the causes of obstructive jaundice especially in neonates where computed tomography scan cannot be done due to radiation exposure and MRI cannot be done due to the motion artefacts. Hepatobiliary scintigraphy single-photon emission computer tomography (HBS SPECT) is the most reliable diagnostic method. Generally, inspissated bile resolves spontaneously, but sometimes patient needs ursodeoxycholic acid. Rarely surgical drainage is also needed.Inspissated bile syndrome is a rare cause of neonatal jaundice. It is extrahepatic obstruction due to sludge of inspissated bile. We present a case of 8 days old child who presented with jaundice. Total bilirubin was raised mainly due to high levels of unconjugated bilirubin.

Focal Post Traumatic Rhabdomyolysis of Thigh Muscle - USG and CT Imaging

Rhabdomyolysis as a term, literally means striated muscle breakdown, where these lysed cells of the muscles produce substances which when released causes severe damage to the body. And to diagnose this medical condition is where the art of imaging comes into picture. And hence, we are presenting a case report on rhabdomyolysis showing distinct ultrasound and CT features.Rhabdomyolysis is the skeletal muscle necrosis with liberation of intracellular substances of the lysed cell into the extracellular fluid and circulation. These substances are electrolytes, purines, enzymes (such as creatine kinase) and myoglobin, which may cause further life-threatening complications.1,2 Diffuse rhabdomyolysis caused due to over-exertion is found in athletes, while focal rhabdomyolysis is rare. Early diagnosis along with its swift management is thus crucial to prevent its complications and Imaging can be a complementary part of the detection and assessment of the extent of rhabdomyolysis. Despite the fact that, the definite diagnosis depends on laboratory tests, imaging studies are usually one of the first modalities used to examine patients. Drugs and other toxic agents, infections, physical exertion, crush injury, and muscle disease are some of the common causes of rhabdomyolysis. And it typically present as muscle fatigue, pain, weakness, and tea-coloured urine. Although in the initial stage of the disease, these clinical symptoms may be subtle and so it is easily missed2. The causes for rhabdomyolysis maybe many, but they often lead to a final common feature, which is muscle tissue breakdown causing myocyte destruction and release of its components into the circulatory system. All these finally lead to muscle ischemia and cell breakdown. Rhabdomyolysis may occur due to traumatic events and the pathophysiology actually takes place once pressure is relieved from the damaged tissue, and the necrotic muscles release their components into circulation.1Muscle ischemia caused by traumatic events interferes with oxygen delivery to the cells, limiting the production of ATP. If oxygen deprivation is maintained for prolonged periods this may result in muscle cell necrosis. Skeletal muscle ischemia may result from either localized or generalized conditions. Localized causes include compression of blood vessels.3

Autosomal Dominant Polycystic Kidney Disease with Liver and Pancreatic Involvement.

Autosomal dominant polycystic kidney disease (adult polycystic kidney disease, Potter Type III disease) is the fourth-most common cause of end-stage renal disease.(1) Polycystic Liver Disease, the most common extrarenal manifestations of Polycystic Kidney Disease is seen in 75-90% of cases, characterized by multiple biliary cystic lesions localized in over 50% of the hepatic parenchyma. In Polycystic kidney disease, hepatic cysts develop later than the renal cysts.(2) It is associated with hypertension in about 70% of cases, cyst in pancreas in 9%, saccular berry aneurysm of cerebral arteries in 3-13%, and mitral valve prolapse.

Ultrasound Evaluation of Uterine Leiomyoma in Perimenopausal Females with Histopathological Correlation.

Abnormal uterine bleeding remains an important health issue in perimenopausal females, often a cause of high morbidity and mortality. Uterine leiomyoma is the major cause of abnormal or irregular bleeding. We wanted to evaluate the role of ultrasound in assessing uterine leiomyomas and determine its sensitivity, specificity and diagnostic accuracy in comparison to histopathological studies.METHODSThis is a cross sectional, observational and analytical study conducted in the Department of Radiodiagnosis at AVBRH, (Sawangi Meghe), a rural tertiary care hospital in central India. The study was carried out over a period of 6 months from January 2019 to June 2019. 50 patients in perimenopausal age group of 40-50 years were selected on the basis of predetermined inclusion and exclusion criteria. All included patients were counselled and asked for informed consent before entry into the study. Statistical analysis was done using descriptive and inferential statistics using sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.RESULTSMost of the uterine leiomyomas were intramural in location and hypoechoic in echotexture. Intramural fibroid was the most common fibroid detected constituting 88%. The sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and diagnostic accuracy of ultrasound in correlation to histopathology was found to be 93.75%, 91.67%, 97.83%, 78.57% and 93.33% respectively.CONCLUSIONSUltrasound has high sensitivity and specificity in diagnosing the uterine leiomyomas. It should be used as primary investigative modality for work up of abnormal uterine bleeding in perimenopausal age group

Role Of Magnetic Resonance Spectroscopy (MRS) In Various Ring Enhancing Lesions In Brain

Aim and objective:To study the role of MR spectroscopy in the evaluation and differential diagnosis of various ring enhancing lesions in the brain with multi-voxel proton MR spectroscopy. Materials and methods: It is the prospective observational study carried out on 42 patients from June 2016 to Aug 2018 at Department of Radiodiagnosis at AVBRH, DMIMS, Sawangi, Wardha. Appropriate MRI sequences with spectroscopy and multiplanar imaging has been performed on patients with intracranial ring enhancing lesions. Result and Conclusion: Total 42 patients were taken. Most common lesions seen were tuberculoma (38%) followed by brain metastasis (34%), neurocysticercosis (16%) and pyogenic brain abscess (12%). On MRS, Tuberculoma was differentiated from NCC by high Cho: Cr ratio > 1.1 and high lipid lactate peak. Special peaks like amino acids, acetate, aspartate and succinate were seen in pyogenic brain abcess while alanine and succinate were present in NCC. High choline peak and high Cho: Cr ratio were seen in brain metastases.