Evaluation of Bilateral Ureteral Urinary Jet Flows for Patency of Uretero- Vesical Junctions by Color Flow Imaging

Background: Ureters are meant to transport urine from the pelvis to the urinary bladder in the form of urinary jet. This is continuous process with intermittent release of urine at uretero-vesical junction. This is regulated by autonomous nervous system. The urine coming to urinary bladder can be seen by color flow imaging (CFI) .This also reflects the patency of the ureter without any obstruction in the pathway. Methods: The size of the population was 30 patients (20 males and 10 females). In this study, the Color Doppler ultrasound was used to evaluate the ureteral jets flow in 10 healthy patients and 20 patients with obstructive uropathy. A probability sampling method was employed while collecting samples. Results: In the right ureteral-vesical junction there was complete absence of detectable jets in 5 patients, 6 patients had weak flow of jet and 19 patients had normal flow of jet. Similarly, in the left ureteral-vesical junction there was complete absence of detectable jet in 3 patients, 12 patients had weak flow and 15 patients had normal flow. Conclusions: The color Doppler evaluation of the ureteral jets is a valid method of evaluating ureteral and renal calculi obstruction and could be a first line of investigation to detect ureteric obstruction in patients with obstructive uropathy.

Developmental and Morphological Variations of Frontal Sinus in Pediatric Age Group in Gurugram Region of Haryana – A Study

Background: The aim is to know gender wise development and morphological variation of the frontal sinus in the pediatric age group of Gurugram district of Haryana. The development and pneumatisation of the frontal sinus is the predictor of skeletal growth pattern. The craniofacial structures grow proportionately with the normal development of the body structures. Methods: In this prospective study, a total of 36 subjects were studied. The study was conducted in the Department of Radiodiagnosis of SGT Medical College, Budhera (Gurugram) Haryana from January 2019 to March 2019. This included 12 females and 24 males falling in the age group of 8-18 years. The frontal sinuses were evaluated on various morphological features. Plain X-Ray of paranasal sinus was evaluated by Caldwell’s view. The sinuses were evaluated for width, height, number of scallops, septations and supraorbital cells. Results: Average width and height of left frontal sinuses were 23.8 mm with the range of 5.5 – 43 mm and 28.4 mm with the range of 13-45 mm respectively. Average width and height of right frontal sinuses were 20.4 mm with the range of 9.8 – 39 mm and 20 mm with the range of 13-38 mm respectively. The average number of scalloping on right and left were 1.9 and 2.19 respectively. The septations were noticed in 13 (36.11%) on left and in 16 (44.44%) on right side. Supraorbital cells were found in 16 (44.44%) on left side and 17 (47.22%) on right side. Conclusion: There is a lot of variation in the appearance and development of the frontal sinus in pediatric age group. The dimensions had been found smaller on right side as compared to left side. Scalloping and supraorbital cells had been found more on right side than on the left side. Septations were more on left side as compared to right side.

MRI Spectrum of Symptomatic and Non –Symptomatic Tarlov Cyst: Series of Seven Cases in Orthopaedic Management Point of View

Tarlov cysts are perineural cysts and are usually found in sacral region. The dorsal nerve root is encased in this type of the cyst. These may or may not be with any of the symptomatology. The entity is infrequently found as an incidental finding. These are cerebrospinal fluid (CSF) filled sacs which are diagnosed on cross sectional imaging modalities especially in magnetic resonance imaging (MRI). Tarlov cysts can cause different type of myelopathies as per their location and size. Methods: We present a series of seven cases where these perineural cysts were found during the routine imaging of lumbosacral spine. All these patients had undergone Magnetic Resonance Imaging (MRI) of lumbosacral spine for backache or some other pelvic complaints. In one case Computerized Tomography (CT) Myelography also helped in diagnosis and related bone remodeling.MR myelography adds to the delineation of CSF wrapping around the spinal cord. Results: Three patients were found to be symptomatic and the intensity of complaints corresponded to the size and location of the cysts. In our three cases, the etiopathogenesis also corresponded to the underlying development of these entities. Four patients were asymptomatic as the size of these cysts were small and not contributing to the complaints of the patient. Conclusion: MRI is the best modality to diagnose these perineural cysts which are responsible for different types of myelopathies .T2WI sequences in non contrast MRI studies are the best in delineating the size, shape, outline and location of these cysts. This also further elaborates their extension to the surrounding regions.MR myelography is adjuvant to more morphological features of these cysts.

Importance of Hoffa’s Pad Sign in MRI evaluation of various knee pathologies: a study conducted at SGT Hospital of SGT University of Gurugram Haryana

Hoffa’s fat pad is intracapsular and extra synovial structure present behind the patella and Infrapatellar tendon. This is delineated nicely in magnetic resonance imaging(MRI) by which it has become a modality of choice for its evaluation .The evaluation is by disruption of the outline of this region due to injury or other underlying pathologies .The indirect signs of this fat pad corresponds to the grading of associated trauma or underlying disease. Methods: We had conducted the MRI knee studies of fifty three patients which included both the genders from March 2018 to July 2018 .They all were having complaints of knee pain because of different aetiologies This cross sectional study included from 7-70 years of age group and patients were evaluated for the characteristics of Hoffa’s pad in MRI .The morphological characters of the region were studied and correlated in relation to the corresponding pathology. Results: There was excellent delineation and intensity relationship of HFP in various MRI sequences. The most vulnerable group to the changes was in 21- 30 years age group .The trivial trauma was the most common cause. The left knee was affected more than the right. Conclusion: Hoffa’s fat pad sign is an excellent indicator in various knee pathologies during MR evaluation. This also helps to know the involvement of the associated surrounding structures .MRI evaluation is very helpful in the decision making for the line of management.

Evaluation of Ossification of Iliac Crest in Children as Per Risser’s Sign in Gurugram Region of Haryana

Background: Risser’s sign is a good indicator of skeletal maturity in pediatric age group. The observations drawn from this can be well documented for the age verification and in relation to some pathologies. Ossification centers are evaluated with their further fusion. Methods: We carried out the evaluation by this sign in judging the exact skeletal maturity. Twenty one individual group comprising of eight females and thirteen males were included in this study. All children underwent pelvic radiography with antero-posterior view. Their iliac crest ossification and fusion was evaluated. Results: Grading of ossification of ileal cartilage was done as per the percentage extent of the ossification from Grade I to V. Conclusion: It was observed that there is delay of skeletal maturity in females as compared to males of the same age group in Gurugram region of Haryana which is contrary to the earlier studies conducted in general.

Adenoma Malignum of Cervix – How Useful is Clinico- Radiological Diagnosis.

Adenoma malignum (AM) is a rare type of variant of cervical cancer. The entity remains silent because of common complaints of erratic menstrual cycles and leucorrhea in peri-menopausal age group of females. The imaging modalities play a great role in clinching the diagnosis before the final confirmation by histopathological examination. We present 60- years old post menopausal woman who reported to gynecology outpatient department with complaints of per vaginum bleeding and watery discharge of six months duration .She was evaluated by cross imaging modalities of ultrasound (US) ,color flow imaging(CFI) and magnetic resonance imaging (MRI) with working diagnosis of adenoma malignum of cervix..This was subsequently confirmed in histopathological examination. The importance of the case lies because of the early diagnosis by clinic-radiological evaluation in the light of poor prognosis and early dissemination of this entity.

Normal Functioning Pelvic Lump Kidney: Isolated Anomaly - Radiological Evaluation.

There is wide spectrum of Mullerian dysgenesis presenting in different ways. Routine ultrasound done of a child for pain abdomen discovered a pelvic mass supero-posterior to the urinary bladder. This was diagnosed as fused pelvic kidneys by various cross sectional imaging modalities like Computerized tomography (CT) and Magnetic resonance imaging (MRI).We present a 4-years male child who was diagnosed as a case of “lump kidneys” by plain sonography coupled with color flow imaging (CFI). The entity usually falls in the common group of VATER (vertebral, anorectal malformation, esophageal and renal) anomalies. But our present case was having isolated anomaly and this entity is of a great rarity as seen in literature.

Bilateral primary Non-Obstructive and Non-Refluxing Megaureter in Child: Diagnosis by Non-Radiation Imaging Modalities.

Bilateral megaureters can present as asymptomatic or symptomatic pathology in the form of flank pain or urinary tract infection. The entity can also be diagnosed in antenatal ultrasound scan. We present 12-year old male child who presented with both flank vague pain and was subjected to ultrasonography (US) and Magnetic Resonance Urography (MRU). There was no evidence of any reflux or obstruction noticed as uretero-vasical junctions were normal on both sides. He was diagnosed as a case of bilateral primary non obstructive megaureters. Base line study was carried out by non radiation modalities in our institute for further follow up.

Choroidal Fissure Cysts in Children - Pediatrician Dilemma for Follow-up.

Background: Choroidal fissure cyst is a small cyst present in the choroidal fissure and this is a developmental variant. These are location based cysts and can either be of neuroglial or neuroepithelial, or of arachnoid in nature. These are seen as incidental finding in routine radiological cross sectional imaging studies. There is dilemma in follow up of these cysts because of their asymptomatic nature or of some vague complaints and invites a lot of debate on their follow-up. Methods: Five children of age group 10-16 years who reported to the outpatient department with vague headache, vertigo or unexplained seizures were subjected to non contrast computerized tomography (NCCT) or magnetic resonance imaging (MRI) of the head to rule out any intracranial pathology. Results: Three cases were having pure cysts in the brain while other two were found to be having various sizes and types of tuberculomas resembling with that of cystic appearances. One of the brain cyst cases was 14 years old female where NCCT head findings revealed a small cyst in the right choroid fissure location. This was subsequently confirmed as choroidal fissure cyst on multiplanar and multisectional plain MRI study. The other two cystic pathologies were vesicular stage of cysticercosis and posterior fossa arachnoid cyst. Rest of the two were tuberculomas with ring enhancement, which were confirmed on MR spectroscopy. Conclusion: The case with choroidal fissure cyst required special attention because of the concern of patient as well as clinician for the follow up. We reviewed the literature for the fate and follow up of these types of cases.

Atypical iliac unicameral bone cyst – An incidental finding in MRI.

is no expansion of the bone with unicameral bone cysts but in our present case there was expansion making it atypical presentation. We present a 22-year male who underwent MRI for Lumbosacral spine for his vague low backache symptoms. There was incidental finding of bony lesion in left iliac bone which turned out to be simple bone cyst. The study of Lumbosacral spine was unremarkable.

Split Cord Syndrome (Type 1 Diastematomyelia): A Case Report.

Spinal dysraphism can present in various ways in the form of severity. Split cord is one of the presentations where two hemi cords are separated either by a fibrous septum or calcific spur. This may be accompanied with different other vertebral anomalies like block vertebra, hemi vertebra or spina bifida. We present a 8-years old girl who presented with weakness and gait disturbances since she started walking. She also had a tuft of hair on the back in the lumbar region. She underwent computerized tomography (CT) and magnetic resonance imaging (MRI) and was diagnosed as diastematomyelia with other associated anomalies.

Importance of Conventional Radiography in Diagnosis and Management of Giant Cell Tumour at an unusual location.

Giant cell tumour (GCT) or osteoclastoma of the bone is mostly benign but locally aggressive primary tumour of unknown origin occurring at epiphysis. It is a tumour of long bones and rarely seen in bones of hand and foot. The cases are reported in tarsal and carpal bone but involvement of metatarsal bone is very rare. We present a case of twenty years old female patient with GCT of second metatarsal of left foot. The patient underwent aggressive curettage and filling with bone chips and is on regular follow up.

Clinico-radiological correlation of Primary Multifocal Osseous NHL.

Multifocal skeletal involvement in primary non-Hodgkin’s Lymphoma (NHL) is very rare as compared to the focal one. These findings of multifocal nature are more common in children than in adults. We present 52 years old male patient who presented with slow growing multiple tender swellings on the left side of mandible and on the medial end of right first rib. We present the clinico-radiological aspects of the disease which lead to suspicion of the NHL and later proved to be primary non- Hodgkin’s Lymphoma on fine needle aspiration cytology.

Hyperphosphaturic Mesenchymal Tumor induced Osteomalacia– A Case Report.

Hyperphosphaturic Mesenchymal Tumor (HMT) is a very rare benign tumor of the soft tissue or bone which produces tumor induced osteomalacia, also called as oncogenic osteomalacia. This activity can only be stopped by the surgical removal of the tumor. We present a 23 years old man who presented with long standing bony pains without any relief by a variety of medications. The clue to the diagnosis was taken from pelvis skiagram, Magnetic Resonance Imaging (MRI) of the body, PET scan and the blood chemistry.

Radiological Spectrum of von Hippel-Lindau disease – A Case Report.

Von Hippel-Lindau (VHL) disease is an autosomal dominant genetic disorder resulting from inactivation of tumor suppression genes located at the chromosome 3p 25.5. VHL comprises of many benign and malignant tumors along affecting various systems of the body with variable manifestations. A wide variation in radiological spectrum is seen as per the involvement of particular system or organ. The imaging modalities like Ultrasonogrphy (USG), Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in diagnosing and treating the affected individuals. These also play equally important role in the screening and follow up of such cases. We present a case of an 18 year old female, who was diagnosed with VHL at the age of 10 years, where imaging modalities helped her management and follow up.

Mayer-Rokitansky-Kuster-Hauser Type I Syndrome - A Case Report.

Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome is not uncommon as this is a part of the Mullerian agenesis. This is usually diagnosed during adolescent period when signs and symptoms of the ongoing changes in female body type are delayed. We present 17 years old adolescent female who presented with primary amenorrhoea as the normal menstruation did not start at puberty. She was diagnosed as MRKH Type I Syndrome on the basis of radiological investigations.

Radiological diagnosis of Cysticercosis of Breast - An unusual presentation.

Breast cysticercosis manifestation is usually uncommon and only a few cases have been reported in the literature. This manifests in the form of signs and symptoms which normally do not point towards the diagnosis. The radiological modalities always narrow down the gap between the complaints and the diagnosis. We present a case with cysticercus cysts in breast parenchyma as well as in both pectoral muscles which was suspected on ultrasonography (USG) and diagnosed on Magnetic Resonance Imaging (MRI). The patient responded to the medical treatment conservatively thus avoiding excisional biopsy. Follow up and repeat MRI has confirmed the cure of the complaints as well as the disease.

Neonatal Aerophagia Dilemma – A Gastrointestinal Functional Disorder: Role of Imaging Studies.

Aerophagia is excessive swallowing of air which goes to stomach through oesophagus and causes abdominal distention. This may alert the parents of pediatric age group especially neonates and causes anxiety. Although it’s a functional condition, the clinical presentation can suggest malabsorption or obstruction, leading to unnecessary tests and investigations. We present a 15 days -old neonate who was brought to the pediatric surgical emergency with one such condition and was managed conservatively after imaging studies ruled out any underlying pathology. The case was discharged without any surgical intervention.

Primary pioglitazone failure in Asian Indian diabetics is not related to common Pro12Ala polymorph of ppar- γ gene.

To determine the various factors influencing glycemic response to pioglitazone mono therapy in newly diagnosed Asian Indian T2DM patients. Thirty T2DM patients (age 53.23±8.067 yrs, M : F ratio 14:16) were treated with pioglitazone for at least 14 weeks. Relationship between its glucose lowering effect and following patient parameters was studied: BMI, W:H ratio, HOMA-R, HOMA-β and Pro12Ala polymorph of PPAR-γ gene. Glycemic targets could be achieved in 20 (66.67%) subjects. All the parameters were comparable among responders and non-responders at the start of therapy. All the participants were homozygous for Pro allele of Pro12Ala polymorph of PPAR-γ gene. There was a significant positive association between glycemic response to pioglitazone and W: H ratio (beta = 0.426, P = 0.034) and HOMA-R (beta = 0.563, P = 0.008). Primary pioglitazone failure cannot be explained on the basis of body fat and its distribution, insulin resistance and secretory function and Pro12Ala polymorph of PPAR-γ gene. Among responders central obesity and high insulin resistance were associated with better glycemic response.