Radiological features of multifocal embryonal rhabdomyosarcoma affecting the vagina and the urinary bladder in a pediatric patient.

Rhabdomyosarcomas are the most common soft-tissue sarcomas, found usually in the younger age group. Histologically, they are subdivided into embryonal, alveolar, pleomorphic and not otherwise specified. They have a heterogenous appearance on imaging with few additional characteristic features based on the subtype. Botryoid variant of embryonal rhabdomyosarcoma commonly involves the genitourinary and the biliary system. They can be multifocal. Most of these lesions have a heterogenous appearance on imaging with areas of necrosis and haemorrhage. On ultrasound, they are polypoidal with cystic areas and are vascular. The lesions are hyperintense on T2 sequences, isointense to the skeletal muscle on T1 sequences and show heterogenous enhancement. Surgery is the mainstay of treatment along with radiotherapy or chemotherapy depending on the site and the stage of the tumour. We report a case of botryoid variant of rhabdomyosarcoma involving the vagina and the urinary bladder.

Imaging of coronavirus disease (COVID-19): a pictorial review.

Coronavirus disease (COVID-19), caused by a highly contagious novel coronavirus, has seen a rapid surge of cases over the past 6 months spreading to more than 215 countries and posing a global threat to mankind. Reverse transcriptase-polymerase chain reaction (RT-PCR) from pharyngeal swabs is considered the gold standard for diagnosis of this disease. Portable chest radiography (CXR), point of care ultrasound, and computed tomography (CT) are crucial modalities in diagnosis and follow-up. Portable CXR can help in patients who are clinically unstable, and also to prevent the cumbersome process of steriliastion after every CT scan. However, chest CT is useful as a problem-solving tool, to look for progression and complications associated with the disease. In a few cases, in our experience (as has also been documented by others), RT-PCR was negative in early disease, and CT chest was able to detect the radiologi-cal findings raising suspicion of COVID-19. With this pictorial review, we aim to describe and illustrate the typical, and a few atypical, radiological findings of this disease.

Determining the normal effective diameter of thoracic aorta in pediatric population of India.

BACKGROUND: It is imperative to establish normative ranges of aortic diameter to diagnose various aortic pathologies. There have been very few studies establishing the normal aortic diameter on cross-sectional imaging, and none pertaining to the Indian pediatric population. The objective of this study was, therefore, to establish the normal effective diameter of thoracic aorta at multiple levels using computed tomographic data, calculate z-scores, and plot reference curves. SUBJECTS AND METHODS: The effective thoracic aorta diameters (average of anteroposterior and lateral diameters) were measured at predefined levels (aortic root, ascending aorta at the level of right pulmonary artery, aortic arch, proximal descending aorta, and aorta at the level of diaphragmatic hiatus) on double-oblique reconstructed computed tomography (CT) images perpendicular to the direction of the vessel. Multiple functional forms relating the effective diameter to subjects' age were evaluated with least square regression methods, and further R2 was used to ascertain the best model. Age-based formulas to derive normal aorta diameters and mean squared errors (MSEs) were established. RESULTS: Two hundred and seven contrast-enhanced CT (CECT) thorax studies of children without known cardiovascular disease were studied. The polynomial regression model relating the effective diameter that included linear, quadratic, and cubic age terms as independent variables were found to the best statistical model. The z scores were calculated, and normative curves were plotted. CONCLUSIONS: We have established normative effective diameters of the thoracic aorta at multiple levels in Indian children of different age groups. Measurements outside of the normal ranges are indicators of ectasia, aneurysm, hypoplasia, or stenosis.

Sinonasal paraganglioma and Cushing's syndrome: A rare association.

In general, paragangliomas are symptomatic tumors, which may be clinically taken for other tumors, benign or malignant lesions. Paragangliomas of the nasal cavity and paranasal sinuses are an extremely rare entity and what is even rarer is its association with ectopic adrenocorticotropic hormone production. We report this very rare case to highlight the rare association of Cushing's syndrome with nasal paraganglioma and the importance of total surgical resection in its treatment.

Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia.

BACKGROUND: Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. CASE REPORT: We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. CONCLUSIONS: Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis.

Spontaneous ovarian hyperstimulation syndrome - understanding the dilemma.

Ovarian hyper-stimulation syndrome (OHSS) is an uncommon identity due to variable number of causes, gestation and gestational disease being more common than thyroiditis and other causes. The role of radiology and biochemical markers are of utmost importance in not only diagnosing spontaneous ovarian hyper-stimulation syndrome (sOHSS) but also ruling out other cystic ovarian diseases and to determine the underlying aetiology and course of the disease. Understanding its pathophysiology and genetics holds the key to unravel the mysteries of this condition.