Measurement of the Distance and Angle Between the Aorta and Superior Mesenteric Artery on CT Scan: Values in Indian Population in Different BMI Categories.

The primary intention of the study was to "prove" that the reduced angle and distance between the superior mesenteric artery (SMA) and aorta significantly correlates with reduced body mass index (BMI). This in turn indicates the strong etiological role of this factor for causation of SMA syndrome. (Most literature till date still mentions sudden depletion of fat pad between the vessels as a "proposed predisposing factor"). The superior mesenteric artery syndrome is characterized by the compression of the third segment of the duodenum by the mesentery at superior mesenteric artery level and a resulting duodenal (±gastric) dilatation. The disease is closely related with the depletion of the fat pad between the vessels narrowing the angle and reducing the distance between the vessels. A prospective study of 100 patients (58 males and 42 females) in the age range 15-85 years (mean age 50 years) who had undergone CT scan for various other complaints. CT scan had been performed with routine protocol comprising plain phase followed by arterial and venous phase by measuring the angle between the aorta and superior mesenteric artery, and also BMI was calculated. Mean values for distance and angle were obtained with standard deviation and 95 % confidence intervals. Pearson coefficients were also calculated and results tabulated. A strong positive correlation exists between BMI and the angle between the aorta and SMA. With increment in BMI, the angle also increases so less chance of developing superior mesenteric artery syndrome.

Pancreaticopleural fistula complicating chronic pancreatitis.

Pancreaticopleural fistula is an extremely rare complication of chronic pancreatitis with characteristic feature that it may appear in the absence of changes of acute pancreatitis. We present a case of a 32-year-old man whose CT scan showed multiple pseudocysts along the body and tail of the pancreas, left crus of diaphragm and in the posterior mediastinum with associated splenoportal thrombosis. MR cholangiopancreatography imaging diagnosed the case as a pancreatico-pleural fistula, with the fistulous tract connecting distal body and tail of the pancreas to the posterior mediastinum through a diaphragmatic hiatus with right-sided mild-to-moderate pleural effusion. Meanwhile the patient was treated conservatively for his acute symptoms that included pleural tap also. Finally, endoscopic retrograde cholangiopancreatography was done and minor papilla papillotomy was performed and a stent was placed. Knowledge about such cases would help one to be aware of such a rare but dangerous complication, so that timely and correct diagnosis and management can be undertaken.

Extra cranial invasive meningioma of fronto-temporo-parietal region of the skull vault.

Meningioma is the benign, unencapsulated neoplasm arising from meningo-epithelial arachnoid cells of cerebellopontine angle-internal auditory canal dura but extracranial meningiomas are very rare. In making the diagnosis of invasive meningioma, both changes of benign meningioma and invasive growth should be present. A case of the neglected invasive meningioma is described here which invaded approximately half of the fronto-temporo-parietal skull vault. The diagnosis was established and confirmed by the histopathology and immunohistochemistry, the cells were positive for epithelial membrane antigen, vimetin and progesterone receptors. The patient underwent surgical resection.