Aggressive Vertebral Body Hemangioma Causing Compressive Myelopathy - Two Case Reports.

INTRODUCTION: Hemangiomas are benign tumors characterized by proliferation of blood vessels. A few hemangiomas are aggressive, characterized by bone expansion and extraosseous extension. These benign tumors may be mistaken for metatasis resulting in unnecessary biopsies, which have a high risk of hemorrhage. These hemangiomas can spread not just into the paraspinal soft tissues but also into the epidural region of the spinal canal causing cord compression and paraparesis. These clinical symptoms can be relieved by surgical decompression of the posterior elements, embolization or radiotherapy. CASE REPORT: In this case report the authors describe the imaging features of two aggressive vertebral body hemangiomas in two patients with back pain. One patient had isolated motor deficit while the other patient had both sensory and motor deficit. On imaging this benign tumor was seen involving both the vertebral body and its posterior elements with paraspinal and epidural extension causing compressive myelopathy. CONCLUSION: Thus, these case reports help identify the characteristic imaging features of an aggressive vertebral body hemangioma, preventing unnecessary and often risky biopsy. The clinical symptoms of the patient can be relieved by surgical decompression of the posterior elements or by radiotherapy. Use of onyx for intraarterial embolization is now believed to be the safest and most efficacious method for treatment of aggressive vertebral body hemangiomas. However, in the absence of definite guidelines, a multicentric study is warranted to prove that embolization with onyx is better than surgery with post-operative radiotherapy.

A case report of renal papillary necrosis due to tuberculosis-CT urogram and static MR urogram findings.

The urinary tract is a common site of tuberculosis, which causes significant morbidity in the form of chronic renal disease. T uberculosis is not only common in developing countries but with the spurt in the number of immune-suppressed patients and the increasing incidence of drug -resistant strains, an increase in the number of patients suffering from genitourinary tuberculosis is expected even in developed countries. Genitourinary tuberculosis occurs owing to haematogenous dissemination of tubercular bacilli. Urinary tract tuberculosis can result in complications such as ureteric stricture, chronic pyelonephritis and papillary necrosis, resulting in compromised renal function. This renal compromise makes it prudent to avoid contrast- enhanced studies if other alternatives are available. There is a dearth of-cases of papillary necrosis reported on static MR urogram. The authors report a case of tuberculosis complicated by papillary necrosis on both CT urogram and static MR urogram.

Ureteral Reflux into an Ectopic Upper Moeity of a Duplex Kidney from the Bladder Neck with Distal Ureteral Pseudodiverticulum Formation.

Urinary incontinence is a condition causing significant psychological trauma and affects the quality of life of the affected individual. Though common causes of urinary incontinence of non-traumatic aetiology in young adults include detrusor instability and congenital conditions like meningomyelocoele, an ectopic ureter is an important surgically correctable cause of urinary incontinence. The cause of incontinence in an ectopic ureter is insertion of the ureter distal to the internal urethral sphincter. The authors describe a case report of an ectopic ureter arising from a duplex moiety with poor renal function using multiple modalities. This highlights the utility of multiple modalities in arriving at an accurate diagnosis, with adequate clinically useful information. In this case, the formation of a pseudo-diverticulum resulted in diagnostic confusion.

Multiple Enchondromatosis: Olliers Disease- A Case Report.

Olliers disease is a rare disease characterized by widespread enchondromas with a unilateral predominance, in early childhood. The diagnosis is based on clinical and conventional radiological evaluations. The prognosis for olliers disease is difficult to assess. Enchondromas in olliers disease present a risk of malignant transformation into chondrosarcomas. Due to its rarity literature focusing on olliers disease is limited. This case report discusses the case of a 12-year-old female who presented with difficulty in walking, leg pain and multiple painless swellings in hands and legs for a period of 2 years.

Cervical lymph node metastases in head & neck malignancy - A Clinical /ultrasonographic/ Histopathological comparative study.

A study was conducted on the value of Ultrasound (US) in the detection of cervical lymph node metastases in cases of Head and Neck malignancy; and its usefulness in planning surgical management. The clinical, ullrasonographic and histopathological examination (HPE) findings were compared in 20 patients as a preliminary assessment of this ongoing study. Clinically and ultrasonogiaphically, patients were assessed for presence of nodes, their size, shape, mobility and overall positivity for malignancy. All patients then underwent neck dissection, and individual nodes from the specimens were assessed by HPE.It was found that US, when compared with clinical examination had a sensitivity of 47.62% versus 43.75%, specificity of 77.78% versus 25.0% and an accuracy of 61.54% as opposed to 38.9%. US proved valuable in detecting sub-clinical nodes, central necrosis, extra-capsular spread, pressure on large vessels - all indicators of metastatic spread. Hence, US was found to be efficient and cost-effective pre-operatively, in planning surgical management.