High presacral collection approached through the perineal route: A novel computed tomography-guided technique.

For a definitive diagnosis of abdomino-pelvic lesions, percutaneous aspiration or biopsy is often necessary; however, finding a safe 'window' for access is challenging. This case report discusses a novel method to approach a deep pelvic collection and also briefly reviews the various approaches to access such lesions. A sample was obtained from a non-resolving presacral collection using a CT-guided percutaneous, trans-perineal approach with repeated sessions of hydro-dissection. Successful aspiration and analysis revealed multi-drug resistant tuberculosis, thus guiding appropriate management.

Rare occurrence of dural arteriovenous fistula in a child: Multi-modality imaging and literature review.

A dural arteriovenous fistula (AVF) is a rare condition in a child and is not evident clinically. It is a type of an acquired cerebral vascular malformation that usually occurs after a thrombotic event of the cerebral venous sinuses. Dural AVF is not suspected clinically and is revealed through imaging done for evaluation of cranial symptoms. Therefore, it is essential to revisit the pathophysiology and the clinical situations leading to intracranial dural AVF. Equally crucial is identifying the imaging findings on computed tomography, or magnetic resonance imaging brain scans done as a preliminary work-up in these patients. However, for optimal management decision and prognostication of dural AVF, a digital subtraction angiography is essential. As the entire burden of establishing the diagnosis rests on the radiologists, we would like to present this rare case report highlighting both the clinical and imaging aspects and the management options available for dural AVFs.

A kaleidoscopic view of male urethral pathologies on 64-slice multidetector computed tomographic urethrography: A novel technique.

Pathologies of the male urethra are mostly obstructive in nature and require imaging to delineate the lesion type, site, extent and associated abnormality of the urinary bladder. Contrast urethrography (CU) is the gold standard investigation for urethral assessment but has many limitations. Cross-sectional imaging is infrequently used for the evaluation of the urethra but has been gaining importance recently. Multidetector computed tomographic urethrography (MDCTU) has the capability of evaluating the entire length of a male urethra in a single setting and overcomes many technical and patient limitations of CU. Being a novel technique, most radiologists are not familiar with MDCTU and the imaging spectrum of various urethral and bladder pathologies. This pictorial review attempts to present the imaging appearance of the normal male urethra and spectrum of pathological findings, with highlights on its advantages over the CU technique.

Tuberculosis, a great masquerader: A case series unveiling rare sites of musculoskeletal involvement through imaging.

Skeletal tubercular infections that do not involve the spine or large joints are rarely encountered. This case series aims to highlight the importance of imaging in diagnosing skeletal tuberculosis (TB) at uncommon sites in clinically unsuspected patients by demonstrating specific imaging findings. We present the clinical details and imaging findings of seven pathologically confirmed cases of extraspinal skeletal TB. A multimodality imaging approach including radiography, ultrasonography (USG) and computed tomography (CT) scan was used in most cases. The imaging studies revealed an infective soft tissue collection over different sites including the sternoclavicular joint, acromion process, chest wall and temporo-mandibular joint, along with destruction and erosion of the underlying or adjacent bones. In tubercular endemic countries, strong clinical suspicion should be entertained in cases presenting with a soft tissue collection, even around unusual skeletal sites.

Bilateral Hutch diverticula in an elderly male: Revelation of an unknown past.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.