Multidetector Computed Tomography (MDCT) Angiography Evaluation of Total Anomalous Pulmonary Venous Connection.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiovascular malformation in which all four pulmonary veins anomalously drain into the right atrium (RA) either directly or indirectly. There are four main types based on the site of connection. Any type of TAPVC may be associated with obstruction and presents early in the neonatal period with cyanosis, tachycardia, or respiratory distress. We present four cases of all types of TAPVC and its imaging findings in multidetector computed tomography (MDCT) angiography. Cardiac CT and magnetic resonance imaging (MRI) are very useful in delineating the anatomy and drainage pathway of anomalous pulmonary veins. MDCT angiography is noninvasive and easily available, and rapid image acquisition is possible with high spatial resolution. Since early diagnosis and surgical correction are necessary for the survival of these neonates, rapid image acquisition using MDCT angiography can be preferred over MRI.

Doppler resistive index to reflect risk of acute kidney injury after major abdominal surgery: A prospective observational trial.

BACKGROUND AND AIMS: Doppler renal resistive index (RI) has been studied to find its association with postoperative acute kidney injury (AKI). This study was conducted to evaluate the usefulness of preoperative RI, postoperative RI and RI variation before and after surgery expressed as a percentage (% RI) for early AKI detection in major abdominal surgery. METHODS: This was a single-centre, prospective observational trial performed in the critical care unit of an academic hospital. Eligible patients posted for major abdominal surgery under general anaesthesia using intraperitoneal approach with at least two predefined risk factors for AKI were included in the study. Renal RI was measured preoperatively and on postoperative day zero. Statistical comparisons were performed for various parameters between the AKI and the non-AKI groups. Pre- and postoperative RI receiver operating characteristics (ROC) curves were drawn and areas under the curves computed. Positive and negative predictive values, sensitivity, specificity and positive and negative likelihood ratios were calculated. RESULTS: A total of 69 subjects were enrolled, of which 14 developed AKI in the postoperative period. The mean resistive indices measured were 0.65 ± 0.09 and 0.74 ± 0.09 in the pre- and postoperative periods, respectively. The area under the ROC curve in the postoperative RI was 0.732 with 95% confidence intervals of 0.592-0.871. This most accurate cut-off value to detect postoperative AKI with sensitivity 57.1% and specificity of 85.5% was 0.77. CONCLUSION: Postoperative RI can detect early AKI after major abdominal surgery.

Chronic hypoxemia in a child: thinking outside the box.

BACKGROUND: Chronic hypoxemia is generally attributed to primary cardiac or pulmonary entities. CASE CHARACTERISTICS: A 9-year-old boy presenting with cyanosis, clubbing and hypoxemia, without icterus or hepatosplenomegaly. Cardiovascular and respiratory system examinations were normal. OUTCOME: He was diagnosed as type IB Abernethy malformation, a rare cause of hepatopulmonary syndrome. MESSAGE: Pediatricians should consider hepatopulmonary syndrome in the differential diagnosis of chronic hypoxemia, even in the absence of jaundice or hepatosplenomegaly.

An Unusual Content in a Congenital Hernia - Complete Spleno -gonadal Fusion Band.

Six years old boy underwent elective inguinal exploration for left congenital hernia. Per- operatively, an elongated, purplish-red, fleshy band of tissue was found inside the sac, adherent to the upper pole of testis. Biopsy was taken and the wound closed. An MRI done after 4 weeks proved the origin of the band from spleen. Laparotomy and excision of the band was done. The histo-pathology of the specimen was reported as normal splenic tissue. The above features are consistent with a diagnosis of spleno - gonadal fusion (SGF).

Tuberculoma of the Cavernous Sinus and Meckel's Cave in a Child.

Tuberculous infection of the cavernous sinus and Meckel's cave is extremely rare. In this report, we describe a patient with tuberculoma of the cavernous sinus and Meckel's cave, extending to the petrous apex. The patient underwent microsurgical excision of the lesion and antitubercular chemotherapy resulting in a good outcome. We describe the diagnostic difficulties and review the relevant literature.