Localized renal cystic disease.

Localized renal cystic disease (LRCD) is a rare benign non-hereditary, non-progressive condition which must be differentiated from other renal cystic diseases. Familiarity with this condition and its characteristic imaging features avoids unnecessary surgical intervention. We report a case of LRCD in a 40-year-old male who presented with left loin pain. Computed tomography demonstrated a cluster of simple cysts in the lower pole of the left kidney with normal right kidney and other organs. Diagnosis of LRCD was made on typical imaging characteristics and absence of family history of cystic renal disease.

Cesarean section under epidural anesthesia in a documented case of ruptured aneurysm of the sinus of valsalva.

Ruptured aneurysm of sinus of Valsalva (RSOV) occurring in pregnancy is a rare cardiac anomaly and it may be either congenital or acquired. Congenital sinus of Valsalva aneurysms are commonly associated with other structural defects such as ventricular septal defect (50-55%), aortic regurgitation (AR) (25-35%), bicuspid aortic valve (10-15%) and Marfan's syndrome (10%). RSOV in pregnancy accentuates the hemodynamic stress on maternal cardiovascular system and pose a significant challenge from obstetric anesthesia point of view. We report a case of 35-year-old documented patient of RSOV with mild AR presenting completely asymptomatic at 37 weeks 4 days of gestation. A successful elective lower segment cesarean section was conducted under epidural anesthesia.

Correlation between neurological recovery and magnetic resonance imaging in Pott's paraplegia.

BACKGROUND: Spinal cord/nerve root compression secondary to a tubercular epidural abscess leads to neurological deficit. Depending on the extent and duration of compression, the end result after treatment may vary from complete recovery to permanent deficit. ASIA has been used extensively to correlate between MRI and neurological status due to traumatic spine injuries. MRI has stood as an invaluable diagnostic tool out of the entire range of current imaging modalities. However, inspite of considerable literature on the applications of MRI in spinal tuberculosis, there have been few studies to assess the relationship between the MRI findings and the neurological deficit as assessed by clinical examination. AIMS: The objective of this study was to ascertain whether the findings of magnetic resonance imaging (MRI) correlate well with the actual neurological recovery status using the American Spinal Injury Association impairment scale (ASIA) in patients with spinal compression secondary to tuberculous spondylitis. MATERIALS AND METHODS: 60 patients (mean age 43.6 years) diagnosed as spinal tuberculosis by MRI/cytology/histopathology were examined and classified into ASIA impairment scale A-E based on the ASIA and again reclassified after 6 months of therapy to assess functional recovery. Similarly, they underwent MR imaging at the start and at the completion of 6 months of therapy to assess the structural recovery. The MRI features of recovery were correlated with the actual neurological recovery as ascertained by the ASIA. RESULTS: Before starting treatment 1 patient (2.08%) was in ASIA A, 2 (4.16%) were in ASIA B, 9 (18.75%) were in ASIA C, 36 (75%) were in ASIA D and 12 (20%) were in ASIA E. There was a significant difference in the epidural abscess thickness, thecal compression and cord compression between ambulatory (ASIA D and ASIA E) and non ambulatory patients (ASIA A, ASIA B and ASIA C). After 6 months of therapy 30 (90%) patients in ASIA D and 5 (55.5%) in ASIA C had complete neurological recovery. Both patients from ASIA B improved to ASIA D. Single patient who was in ASIA A before treatment remained non ambulatory (ASIA C) after treatment. Overall 33 (78.5%) patients showed complete recovery at final followup. Out of all the MRI features, only size of epidural abscess was found to be a poor prognostic factor for recovery of neurological deficit. CONCLUSIONS: There are several parameters on MRI which correlate with the severity of neurological impairment according to ASIA score and resolution of those features on treatment is also correlated well with neurological recovery.

A rare case of hemilingual abscess in a 17-year-old girl: the ease of ultrasound and the advantage of MRI.

Abscess of the tongue is rare owing to the rich vascularity and muscularity of the tongue and anti-infective properties of saliva. An abscess limited only to one half of the tongue is even more rare. We report a case of hemilingual abscess in a 17-year-old girl who presented with high-grade fever and a swollen and immobile tongue. Ultrasound (US) through floor of mouth showed inflammatory changes and collection within the right half of the genioglossus muscle. Magnetic resonance imaging (MRI) confirmed this finding, and isolated right-sided involvement was identified. US-guided aspiration of the collection yielded pus that showed gram-positive cocci on microscopy. The patient was managed conservatively, and repeat US showed resolution of the abscess. The importance of US as a quick, inexpensive, and versatile imaging technique and the precision of MRI regarding the extent of abscess of tongue are stressed.

Fetal MRI in the pre-operative diagnosis and assessment of secondary abdominal pregnancy: a rare sequela of a previous caesarean section.

Secondary abdominal pregnancy is a rare type of ectopic pregnancy. Following fertilization, the blastocyst escapes from the uterine cavity and implants in the peritoneal cavity. The early antenatal diagnosis and identification of the site and extent of placental implantation in an abdominal pregnancy are important to prepare for the eventual surgery. We present the case of a 24-year-old patient presenting with loss of fetal movement at 26 weeks of gestation for whom an abdominal pregnancy was suspected on ultrasonography and later confirmed on magnetic resonance imaging (MRI). She had one caesarean section in the past. The MRI findings suggested a scar dehiscence. She was eventually managed surgically, and the unviable fetus was removed. Abdominal pregnancies must be treated as emergencies. They usually present with complications such as fetal death and intra-abdominal hemorrhaging and can be easily missed on routine antenatal ultrasonography. The exact anatomical relationships of the fetus, the placenta, and vital maternal intra-abdominal structures can be accurately delineated with MRI, which greatly aids the management of patients with abdominal pregnancy. A proposed imaging protocol and technical suggestions for improving the diagnostic capability of ultrasonography and MRI in abdominal pregnancies have been provided to aid in the appropriate evaluation of suspect cases.

Right isomerism with complex cardiac anomalies presenting with dysphagia--a case report.

Isomerism or Heterotaxy syndromes are rare multifaceted congenital anomalies with multi-system involvement. Grouped under the broad category of Situs Ambiguous defects, these often pose diagnostic difficulties due to their varied and confusing anatomy. Since patients rarely survive into adulthood due to cardiovascular complications, the etiology and natural history of such conditions are not fully understood. Imaging provides the most accurate non invasive method for diagnosis and thereby, prognosis in such cases. We present a case of right sided Isomerism with complex cardiac anomalies in a 17 year old adolescent, who presented with dysphagia as one of the main complaints. Multi modality imaging demonstrated the intricate abnormalities in vital systems.