Imaging in Septic Arthritis With Inflammatory Neuritis: Diagnosing a Rare Complication.

After femoral neck fractures, hip septic arthritis and inflammatory neuritis are extremely rare. For the purpose of making an accurate diagnosis and preventing serious joint damage, early clinical examination and imaging are crucial. Very few studies have thoroughly described the intraoperative and radiographic results of these disorders. We present the case of a 36-year-old man who developed right hip pain one month after undergoing surgery for a right femur head fracture. Magnetic resonance imaging and biopsy revealed the presence of septic arthritis and inflammatory neuritis. Following the initiation of conservative treatment, the patient is receiving routine follow-up. This case highlights its distinctive features and challenges of diagnosing this entity, emphasizing the significance of vigilant clinical evaluation and imaging modalities for prompt management and the best possible outcomes for patients.

Giant cell-rich osteosarcoma of the lumbar spine - A rare entity.

Giant cell-rich osteosarcoma (GCRO) is a rare variant of osteosarcoma. A significant diagnostic hurdle is presented by the lesion's uncommon appearance on histopathology. This report presents a case of a 59-year-old female patient diagnosed with GCRO. Contribution: While it is extremely difficult to distinguish GCRO from malignant giant cell tumour, it is important to do so because of the difference in prognosis and management. Distinctive anatomy of the lumbar spine increases the risks associated with surgical excision.

Duplication of Left Anterior Descending Artery: A Case Report on a Rare Abnormality.

Duplication of the left anterior descending coronary artery (LAD) is a benign condition. The formation of a double LAD is a rare phenomenon among coronary artery anomalies. The categorization of the branching pattern of the LAD has been articulated well in numerous studies, owing to the widespread adoption of computed tomography angiography. Anomalous coronaries are a crucial pathological condition that should be examined. Individuals who are suffering from chest pain should be aware that it can potentially lead to myocardial ischemia, arrhythmia, or sudden cardiac death. Here is a unique case study detailing the diagnosis of dual LAD in a 50-year-old female patient.

Readout-Segmented Echoplanar (RESOLVE) Diffusion-Weighted Imaging on 3T MRI in Detection of Cholesteatoma-Our Experience.

Background Several research studies have demonstrated the utility of diffusion-weighted imaging (DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging (non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE), a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition with reduced image distortion compared to the single-shot-EPI DWI technique. Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear cholesteatomas with surgical and histopathological support. Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI. The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological findings. Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI could not detect three cholesteatoma lesions due to their small size and falsely diagnosed one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma. With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity, 96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy in cholesteatoma detection. Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma. However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.

Pericardial agenesis - the wandering heart.

BACKGROUND: Congenital pericardial absence is an uncommon cardiac anomaly that is typically asymptomatic and commonly misdiagnosed due to a lack of symptoms or atypical symptoms. Pericardial agenesis (PA) should be considered one of the differential diagnoses when the patient presents with chest pain. This case shows how the diagnosis of pericardial agenesis is made exclusively using multi-modality imaging, starting from findings in a basic chest radiograph to cardiac MRI, while also demonstrating the classic signs seen in this condition. Magnetic resonance imaging of the heart is the gold standard for determining the absence of pericardium in the prognosis. CASE PRESENTATION: A 32-year-old male who presented with chest discomfort and radiating pain to his back and left shoulder mimicking myocardial infarction with normal ECG and enzyme markers. A chest radiograph (taken 24 h apart) demonstrates the left lateral position of the heart and the bulging contour of the left heart border, a lucent area between the aorta and pulmonary artery. Subsequently, cardiac MRI reveals left pericardial agenesis. CONCLUSIONS: This article provides insight into a rare differential to consider in a young patient presenting with chest discomfort. This case shows how the diagnosis of pericardial agenesis is made exclusively using multi-modality imaging, starting from findings in a basic chest radiograph to cardiac MRI, while also demonstrating the classic signs seen in this condition.

Cervical Spine Magnetic Resonance Imaging Findings in Hirayama Disease.

Background Hirayama disease is an uncommon type of cervical cord myelopathy seen typically in young males due to trauma from flexion movements. This study aims to assess the clinical presentations and classify the extent of various cervical spine MRI findings for the local population. Methodology A retrospective study of 13 patients diagnosed with Hirayama disease on cervical MRI was performed from January 2017 to December 2022 at Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune. Results Of the 13 patients, 12 (92%) were male, and one (8%) was female. Nine (69%) patients were in the 16-25-year age group, two (15%) were in the 26-35-year age group, and one (8%) each was in the 6-15-year and 66-75-year age groups. Upper limb weakness was the most common clinical symptom seen in 12 (92%) patients, followed by distal muscle atrophy in seven (54%) patients. Tremors in the hand were a rare symptom seen in two patients. Claw hand was an atypical symptom seen in one patient. On cervical MRI, all patients showed excessive forward shifting of the posterior dura on flexion, with resultant cord compression due to tightness of the dural sac. One (8%) patient had no signs of myelopathy, while 12 (92%) patients had developed chronic myelomalacia and showed abnormal cord hyperintensity and atrophy in the lower cervical cord. All 13 (100%) patients showed increased laminodural space on flexion; the mean thickness was 4.08 mm, with the minimum and maximum thickness being 2.4 mm and 6.7 mm, respectively. Classifying by length of the anterior bulging dura, one (8%) patient showed involvement of less than two vertebral body segments, eight (62%) patients showed involvement of two to four vertebral body segments, and four (30%) patients showed involvement of more than four vertebral body segments. Crescent-shaped post-contrast enhancement on flexion was seen in all eight (100%) patients who underwent a contrast study. Prominent epidural flow voids on flexion were seen in six (46%) patients. Conclusions Hirayama disease is an uncommon type of cervical myelopathy seen typically in juvenile males. The occult onset of distal upper limb weakness and atrophy during puberty, typical MRI features of lower cervical cord atrophy, and the presence of a crescent-shaped enhancing mass in the posterior epidural space are pathognomonic of the condition. A few atypical cases can also occur. Early diagnosis and treatment are crucial to avoiding serious dysfunction.

Rare Occurrence of Double Outlet Right Ventricle and Cardiomyopathy on Dynamic Contrast-Enhanced Cardiac MRI: A Case Report.

We present a case of a middle-aged man with recent onset of vague chest pain. On dynamic contrast-enhanced cardiac magnetic resonance (CMR) imaging, he was found to have a double outlet right ventricle (DORV) and restrictive/infiltrative cardiomyopathy. These two conditions are not known associations and could be two entirely different entities.

Role of 3 Tesla Magnetic Resonance Imaging in the Assessment of Infiltrative Cardiomyopathies.

BACKGROUND: The aim of the present study was to assess the role of 3 Tesla (3T) magnetic resonance imaging (MRI) in the assessment of infiltrative cardiomyopathy (ICM). METHODS: Cardiac MRI was performed on a 3T MRI machine for 15 patients who had clinical or echocardiographic signs of infiltrative cardiomyopathy. Each scan was assessed on a set of anatomical and functional parameters. The patterns of left ventricular (LV) late gadolinium enhancement (LGE) were also analyzed. RESULTS: Bi-atrial dilatation was noted in 14 patients, consistent with a restrictive phenotype. All 15 patients had diastolic dysfunction with reduced LV diastolic ventricular filling and prolonged peak filling times. Eleven patients had a decreased peak filling rate. Twelve patients had systolic dysfunction with reduced ejection fraction (EF). Ten patients had contractile dysfunction in the form of global LV hypokinesia. On delayed contrast imaging, four patients showed no abnormal LGE. Two patients showed diffuse subendocardial enhancement. Two patients showed patchy subendocardial enhancement. Six patients showed patchy mid-myocardial enhancement. One patient showed diffuse mid-myocardial enhancement. Three patients showed patchy subepicardial enhancement. Two patients showed patchy transmural enhancement. Three patients showed reversed myocardial nulling. All 15 patients received a provisional diagnosis of infiltrative cardiomyopathy on the basis of cardiac MRI findings. Sarcoidosis was given as a probable cause in four patients, amyloidosis in three patients, an infectious cause in two patients, and drug-induced cardiomyopathy in one patient. In five patients, no obvious cause could be identified. CONCLUSION: Infiltrative cardiomyopathies, although relatively uncommon, pose significant challenges in diagnosis and treatment. Cardiac MRI has become the gold standard for non-invasive diagnosis of all infiltrative cardiomyopathies.

Neuroimaging Spectrum of Intracranial Lipomas.

BACKGROUND: Intracranial lipomas are rare congenital malformations at characteristic sites. Though largely asymptomatic, some cause significant morbidity. We are studying this for the local population.  Objectives: The purpose of this article is to analyze the spectrum of intracranial lipomas, determine their distribution at characteristic locations, and assess their associations.  Method: A retrospective study of 21 patients diagnosed with intracranial lipomas detected on CT and MRI performed between September 2017 and May 2022 at Dr. D.Y. Patil Medical College, Hospital & Research Center, Pune. RESULTS: Amongst the 21 patients with intracranial lipomas, the most common location was the pericallosal region seen in 11 patients (n = 11, 52.3%), of which nine were curvilinear type (n = 9), more common than tubular nodular type (n = 2). Other locations (n = 10, 47.7%) were found to be; quadrigeminal cistern in six patients (28.5%), cranial diploic space in two patients (9.5%), one each in interhemispheric falx (4.8%), and cribriform plate (4.8%). Associated anomalies were observed in three patients, which were fronto-ethmoidal encephalocele (n = 1), partial agenesis of the corpus callosum (n = 2), extension with a frontal subcutaneous lipoma (n = 1), and bilateral intraventricular extension (n = 1). Presenting symptoms were headache and dizziness (38.1%), seizures (19%), swelling on the forehead (9.5%), and other non-specific clinical symptoms (33.3%). CONCLUSION: Intracranial lipomas are rare congenital lesions that are usually asymptomatic and discovered incidentally. However, lipomas at interhemispheric locations can cause seizure disorders and some present with headaches and dizziness. Few have associations like communication with extracranial swellings and corpus callosum agenesis.

Imaging of the neurological manifestations of dengue: A case series.

Dengue fever, the most common arboviral tropical disease, has shown a rapid increase in incidence over the last few decades. Increasing evidence of the various neurological manifestations in dengue has been documented in the literature. Patients positive for dengue on serology and with neurological manifestations were analysed and included in the present case series and brief review. The cases reveal a spectrum of neurological findings in dengue infection and include dengue haemorrhagic encephalitis, acute disseminated encephalomyelitis (ADEM), reversible splenial lesion syndrome (RESLES), intracranial haematoma, and posterior reversible encephalopathy syndrome (PRES), with a focus on the relevant imaging features. Contribution: The present case series emphasises the importance of understanding the relevant imaging findings and potential aetiopathogenesis of neurological involvement in dengue infected patients in order to make the correct diagnosis for effective treatment and improved outcome.

MRI Findings in Case of Post-COVID-19 Vaccination Rhabdomyolysis: A Rare Postvaccination Adverse Effect.

In the era of this pandemic, without any proper and efficacious availability of antiviral agents against the novel coronavirus disease 2019 (COVID-19), vaccines have come as a hope for humankind. Although adverse reactions are common after getting the COVID-19 vaccine, serious or life-threatening side effects are very uncommon in these new emergency-approved vaccines. In this case report, we describe an unusual case of adverse reaction in a patient who received the COVID-19 vaccination. The patient who received the COVID-19 vaccination presented with progressive right lower limb pain and swelling, which further progressed to bilateral shoulder pain and swelling. Ultrasonography, Doppler, and magnetic resonance imaging of right lower limb were done for the patient.

Multiple Paragangliomas in the Carotid Body, Adrenal and Extra-Adrenal Retroperitoneal Locations.

Paragangliomas are chromaffin cell tumors that arise from neural crest cells and are extremely rare. Multiple paragangliomas in different locations of the neck and abdomen in the same patient are highly uncommon. We give the instance of a hypertensive male aged 42 years with a history of breathlessness, chest pain, and excessive perspiration for 10 days. Computed tomography of neck and abdomen revealed solid homogenous intensely enhancing masses in the left adrenal of size 64 x 45 x 52 mm [AP x TR x CC (anteroposterior x transverse x craniocaudal)], left paraaortic region of size 41 x 28 x 29 mm [CC x TR x AP (craniocaudal x transverse x anteroposterior)] and at the division of the left common carotid artery of size 17 x 15 x 11 mm (CC x TR x AP). The patient underwent a diagnostic laparotomy and resected tumors were diagnosed as paragangliomas. The possibility of paragangliomas should always be considered when hypervascular masses are encountered in certain locations of the body. Presence of such a lesion must prompt further imaging of the common sites of paragangliomas for the detection of occult synchronous paragangliomas. Routine screening at timely intervals in patients previously diagnosed with paraganglioma may aid in the earlier detection of metachronous tumors.

Role of Neuroimaging in COVID 19 Infection-A Retrospective Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the family of coronaviruses, induces COVID-19 disease which is predominantly a respiratory illness. Several authors have reported neurological manifestations such as acute venous and arterial strokes and rarely acute disseminated encephalomyelitis, hemorrhagic posterior reversible encephalopathy syndrome, and acute inflammatory demyelinating polyneuropathy by studying magnetic resonance imaging of brain parenchymal signal abnormalities in patients with COVID-19. Owing to sparsity of literature on extrapulmonary manifestation of COVID, it is imperative to study the mechanism of neuronal invasion and manifestations of COVID-19. This study aimed to assess and correlate neurological manifestations in patients with COVID using imaging findings on computed tomography and magnetic resonance images. A retrospective observational study was conducted among 80 patients who tested positive for COVID-19 disease via a reverse transcription-polymerase chain reaction (RT-PCR) test in a tertiary care teaching institute in Pimpri, India. Most patients presented with acute arterial and venous strokes. Arterial stroke was the most prevalent finding; nearly 42.50% showed imaging findings consistent with arterial stroke; 25% patients had findings of venous stroke. Meningitis and spontaneous hemorrhage were found in 10% of cases. Rare complications such as acute disseminated encephalomyelitis comprised 7.50%, and encephalitis was found in 5%. This study highlights the need for increased neuroimaging in suspected patients to alert the treating physicians about the neurological complications. As the conventional RT-PCR and serum tests are unremarkable in the early onset of COVID-19, it is important to have a multidisciplinary approach and more neurology consultations in COVID-19 suspected patients with an emphasis on prompt neuroimaging to prevent potential life-threatening complications. To alert the attending physician about neurological involvement in patients with COVID-19, it is vital that nursing staff is aware about the neurological manifestations of COVID-19 so that they can recognize change in patients' neurological status without any undue time delay.

Tracheostomy: Experience at Tertiary Hospital.

An attempt was made to find indications of tracheostomy procedure and its complications in the modern era of medicine with refined surgical techniques at a tertiary hospital. A retrospective study of 240 patients, who had undergone tracheostomy, was done during the period from January 2013 to April 2017 at Govt. Medical College Hospital. Various details of all participants such as age and sex of patients, detailed history of the current disease, and detailed information about tracheostomy and complications were recorded. In the present study, the most common indication for tracheostomy was prolonged ventilation due to Organophosphorus poisoning and Snake bite. The complication rate for tracheostomy procedure was 11.5%. The most common complication was tubal occlusion (7.5%) followed by Granulations around stoma (2.5%), Tracheal stenosis (1.25%), tracheoesophageal fistula (0.4%). No death was occurred during the tracheostomy procedure. The morbidity and mortality due to tracheostomy are reduced definitely. Tracheostomy Complications can be prevented by refined surgical techniques, use of high volume low pressure cuffed tracheostomy tubes and attentive post-operative nursing care. Yet complications of tracheomalacia and tracheal stenosis call for further improvement.

Esophagobronchial fistulae: Diagnosis by MDCT with oral contrast swallow examination of a benign and a malignant cause.

We report two cases of esophagobronchial fistulae diagnosed by Multi-detector computed tomography (MDCT) oral contrast swallow examination. It is helpful to supplement the CT study with an oral contrast swallow as it aids in confirmation of a suspected fistula and also demonstrates the fistula tract better. We present the clinical details and the imaging findings on MDCT of two cases of esophagobronchial fistulae - one secondary to chronic chest tuberculosis and the other secondary to a squamous cell carcinoma of the upper esophagus - followed by discussion of the etiology, pathogenesis, and imaging of these fistulae.