Complete resolution of lumbar disc sequestration with Ayurveda management: A case report.

Lumbar disc herniation (LDH) is the most common spinal disorder among which disc sequestration is a severe type where the herniated disc fragment migrates and is completely separated from the parent disc. A 46-year-old female patient with severe lower back pain radiating to right lower limb, disability, and numbness in the affected extremity came to Panchakarma O.P.D of our hospital. She was a chronic case of disc sequestration where her symptoms were severely aggravated after a sudden jolt felt on her lower back while traveling on a motorcycle. The patient's Oswestry disability index (ODI) score was 90 % which indicates a bed-bound condition and even Schobar's test indicated a severe reduction in lumbar flexion capability. MRI showed postero-central herniation with disc sequestration at L5-S1 caused compression on the subarachnoid space and traversing S1 nerve roots. She was treated according to Ayurveda treatment principles and underwent Panchakarma like medicated enema (Basti) and fomentation of a lumbosacral region with oil (Kati Basti). She also received different oral medications on successive follow-ups. After 6 months of Ayurveda treatment, the patient showed remission in lower back pain (LBP), radiculopathy, and numbness. Her ODI score was reduced to 6 %. The MRI repeated post-treatment showed complete interval resolution of disc sequestration and no neurological compression was observed.

Levoatrial cardinal vein with normal left ventricle: A forgotten cause of pulmonary arterial hypertension.

Levoatrial cardinal vein (LACV) is anomalous connection between left atrium or pulmonary veins and systemic veins such as innominate vein or superior vena cava. This persistence of splanchnic circulation occurs when there is left-sided obstructive cardiac lesions such as hypoplastic left heart or mitral atresia. In this report we present three cases of LACV with well-developed left heart, without any obstructive lesions. All our cases presented with pulmonary arterial hypertension (PAH) and had associated intracardiac shunt such as ventricular/atrial septal defect and supracardiac partial anomalous pulmonary venous connection. Apart from the above shunts, LACV contributed to PAH in these cases. It is important to detect and report LACV as this may require surgical correction along with other defects. If LACV goes undetected during imaging workup, it may cause persistent PAH postoperatively.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part III: Cyanotic Heart Diseases and Complex Congenital Anomalies.

From the stand point of radiographic analysis most of the complex cyanotic congenital heart diseases (CHD), can be divided into those associated with decreased or increased pulmonary vascularity. Combination of a specific cardiac configuration and status of lung vasculature in a clinical context allows plain film diagnosis to be predicted in some CHD. Correlation of the position of the cardiac apex in relation to the visceral situs is an important information that can be obtained from the plain film. This information helps in gathering information about the atrio-ventricular, ventricular arterial concordance or discordance. Categorization of the cyanotic heart disease based on vascularity is presented below. Thorough understanding of cardiac anatomy by different imaging methods is essential in understanding and interpreting complex cardiac disease. Basic anatomical details and background for interpretation are provided in the previous parts of this presentation.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part II: Acyanotic Congenital Heart Disease and Extracardiac Abnormalities.

Acyanotic heart disease constitutes a significant majority of patient who may present with non-cardiac symptoms. Either they are detected incidentally or present with respiratory complaints. Equipped with knowledge of anatomy by echocardiography and radiographic methods described in previous part of this presentation, diagnosis may be confidently attempted. On plain radiography acyanotic congenital heart diseases have variable appearance depending upon severity of disease. Cardiac size, chamber enlargement and pulmonary vascular pattern are key elements. Typically left to right shunts with large volume flow are associated with pulmonary plethora. Plain radiography has an important role in detecting manifestation of pulmonary arterial hypertension. Severe stenosis of pulmonary valve is associated with pulmonary oligemia. Small intra-cardiac shunts and anomalies of coronary arteries generally present with normal cardiac size and pulmonary arterial pattern. Disease spectrum presented in this illustration demands thorough scrutiny of pulmonary, osseous and abdominal abnormalities. This section illustrates some commonly encountered spectrum of acyanotic cardiac disease.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part I: Clinical Perspective, Anatomy and Imaging Techniques.

Rapid evolution in technology in the recent years has lead to availability of multiple options for cardiac imaging. Availability of multiple options of varying capability, poses a challenge for optimal imaging choice. While new imaging choices are added, some of the established methods find their role re-defined. State of the art imaging practices are limited to few specialist cardiac centres, depriving many radiologists and radiologist in-training of optimal exposure to the field. This presentation is aimed at providing a broad idea about complexity of clinical problem, imaging options and a large library of images of congenital heart disease. Some emphasis is made as to the need of proper balance between performing examination with technical excellence in an ideal situation against the need of the majority of patients who are investigated with less optimal resources. Cases of congenital cardiac disease are presented in an illustrative way, showing imaging appearances in multiple modalities, highlighting specific observations in given instance.

Primary extraskeletal myxoid chondrosarcoma of pulmonary arteries: a rare mimic of acute pulmonary thromboembolism.

Primary extraskeletal myxoid chondrosarcoma of the pulmonary arteries is a very rare entity. Multimodality imaging reports on this entity are few. Myxoid chondrosarcoma is characterized by chondroid and neurogenic differentiation in extraskeletal locations. These tumours represent fewer than 2.5% of all soft-tissue sarcomas, and are most commonly found in the lower extremities, limb girdles, distal extremities and trunk. We report an unusual case of a 31-year old man with histopathologically proven extraskeletal myxoid chondrosarcoma of the pulmonary arteries mimicking acute pulmonary thromboembolism.

Susceptibility artifacts in lipomas.

BACKGROUND: Intracranial lipomas are uncommon tumors, which produce susceptibility artifacts on susceptibility weighted images. The cause for the susceptibility artifact on SWI images remains speculative. Our purpose was identifying the possible causes of susceptibility artifacts in lipoma. MATERIALS AND METHODS: We retrospectively reviewed 15 cases harboring 16 lipomas of head region. All the lipomas are evaluated on SWI images for the presence of blooming and types of blooming artifacts. Computed tomography (CT) images were evaluated for presence of calcification. RESULTS: All three pericallosal tubulonodular lipomas showed peripheral rim-like susceptibility artifacts. All the curvilinear lipomas (four cases) showed complete blooming. Five out of eight nodular lipomas showed peripheral susceptibility artifacts, whereas, one showed complete blooming. Two nodular lipomas showed peripheral and central susceptibility artifacts. Scalp and craniovertebral lipomas (four in number) showed peripheral susceptibility artifacts. Specks of calcification were identified in two out of seven cases on CT scan. CONCLUSIONS: Contribution of the macroscopic calcification to susceptibility blooming appears to be insignificant. Microscopic mineralization and chemical shift artifact appears to be a major cause of susceptibility blooming.