ABSTRACT
Hydatidosis is a parasitic disease caused by the larval stage of Echinococcal tapeworm that is endemic in many regions of the world. The subtle and nonspecific nature of the clinical signs frequently results in a delay in diagnosis. Ultrasonography (USG) is the first modality of choice for the diagnosis followed by magnetic resonance imaging (MRI). The detection of a ruptured membrane, observed as low-signal intensity on all pulse sequences, strongly suggests the diagnosis. We report a rare case of a 39-year-old male who presented with fever, pain, and swelling in the right thigh. On further investigations, he was diagnosed to have primary hydatidosis of the thigh involving the vastus lateralis muscle and subcutaneous tissue. The patient underwent en bloc surgical excision of the mass and histopathology confirmed the diagnosis of intramuscular hydatidosis. Understanding the diverse imaging manifestations of primary intramuscular hydatidosis is imperative for accurate preoperative diagnosis, thereby averting potentially fatal outcomes. Timely intervention is paramount as it mitigates both localized and systemic complications that may arise due to cyst maturation. This underscores the criticality of early therapeutic measures to enhance patient outcomes and diminish associated morbidities.
ABSTRACT
Purpose: To assess the utility of diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) maps and T2* mapping in quantitative analysis of nucleus pulposus (NP) and annulus fibrosus (AF) of lumbar intervertebral discs with its correlation with modified Pfirrmann grading (MPG) for lumbar degenerative disc disease (LDDD). Material and methods: One hundred subjects (20-74 years of age) underwent T2-weighted, DWI with ADC and T2* magnetic resonance imaging. MPG was applied to L3-L4, L4-L5, and L5-S1 discs, and ADC and T2* values of NP and AF were calculated in the mid-sagittal plane by segmenting each disc into 5 regions of interest (ROI) (NP-3, AF-2). Mean ADC and T2* values, their correlation, and cut-offs among different grades were calculated at different ROIs across different levels. Results: Out of total 300 discs analysed; 68 were normal (grade I) discs and 232 were degenerated (grade II to VIII) discs, based on MPG. T2* and ADC values in NP, AF, and the entire disc were significantly lower in degenerated discs than in normal discs. There was significant (p < 0.001) negative correlation between ADC and T2* values with MPG. ADC and T2* cut-off values were statistically significant across grades, with area under the curve (AUC) values in moderate to high accuracy range (0.8 to > 0.9) for assessing the degree of LDDD. Conclusions: T2* and ADC value-based grade scales are highly accurate in evaluating the degree of disc degeneration with a high degree of objectivity in comparison to visual assessment-based MPG. Reduced ADC and T2* values of NP could serve as markers of early LDDD.
ABSTRACT
Leiomyosarcoma (LMS) is a smooth muscle-derived malignant mesenchymal tumour. Primary LMS arising from the ovarian vein is uncommon. A 51-year-old female presented with left loin pain and was diagnosed with a LMS arising from the gonadal vein. The patient refused any treatment. Early detection and timely diagnosis of retroperitoneal masses will improve the prognosis and survival rate in these patients. CT imaging plays an important role in diagnosis. Contribution: Retroperitoneal leiomyosarcoma of vascular origin is a rare entity. CT plays crucial role in diagnosing them by demonstrating the extent of the tumor along the gonadal vein. Early detection and timely diagnosis of retroperitoneal masses will improve the prognosis and survival rate in these patients.
