Mesenteric ischemia: a radiologic perspective.

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.

Added value of strain elastography in the characterisation of breast lesions: A prospective study.

BACKGROUND: Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. PURPOSE: To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). METHODS: In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. RESULTS: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. CONCLUSION: Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.

Fibrosing mediastinitis mimicking as chronic pulmonary thromboembolism.

Fibrosing mediastinitis is an uncommon, benign, progressive disorder caused by proliferation of fibrous tissue within mediastinum resulting in encasement of vital mediastinal broncho-vascular structures. Due to its rarity and variable clinical presentation, it is often misdiagnosed. We are presenting a case of fibrosing mediastinitis in an Ethiopian origin young male presenting with pulmonary hypertension due to simultaneous occlusion of pulmonary vein and arteries, clinically misdiagnosed as chronic pulmonary thromboembolism.

Can strain elastography be used in reclassification of indeterminate breast lesions in BIRADS lexicon?: A prospective study.

PURPOSE: To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions. METHODS: 113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC). RESULTS: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US: 0.98 vs 0.90 (Difference = 0.08, P = 0.02). Elastography parameters were more specific as compared to US (ES-94.5 & SR-93.2% vs 63%, P < 0.05) with high NPV. SE performed better in BIRADS 4 category lesions. On the basis of elastography parameters, 85% of BIRADS 4 category lesions were correctly predicted as benign with overall sensitivity, specificity and diagnostic accuracy of elastography being 97%, 84.6% and 91.9%. Among BIRADS 3 category lesions, 97% were correctly predicted as benign and 50% lesions were correctly predicted as malignant with a sensitivity of 50%, specificity of 97.8% and diagnostic accuracy of 94%. CONCLUSION: Strain elastography is a useful adjunct to conventional ultrasonography for the assessment of indeterminate breast lesions and may help in avoiding unnecessary follow ups and biopsies. Elastography score is a better parameter as compared to strain ratio.

Hepatic arterial communicating arcades-Case series and review of literature.

This case series describes the hepatic arterial communicating arcades and their importance in the endovascular management of hepatic artery pseudoaneurysm, pediatric post liver transplant lobar arterial occlusion, and lobar arterial stenosis due to gall bladder carcinoma. We describe new types of arterial communicating arcades which have not been described earlier.

Intracranially protruded bilateral posterior and superior SCCs with multiple dehiscences in a patient with positional vertigo: CT and MR imaging findings and review of literature.

We report a rare case of intracranially protruded posterior and superior semicircular canals beyond the margins of temporal bone with bony roof dehiscence in bilateral posterior and left superior semicircular canals in a patient with benign paroxysmal positional vertigo (BPPV).

Stretched bowel sign in combined transmesocolic and transomental internal hernia: A case report and review of literature.

Transomental and transmesenteric hernias are rare types of internal hernia, with a reported frequency of upto 4% and 8%, respectively. Combined transomental and transmesocolic hernia is even rare. Only in a few types of internal hernia, the dilated small bowel loops will be seen extending from the antero-superior aspect of the distal stomach and cause stretching effect over the adjacent bowel loops with increase in the size of the herniated bowel segment or intestinal obstruction. We report a rare case of idiopathic combined transomental (across the lesser omentum) and transmesocolic internal hernia with "stretched bowel sign," its diagrammatic representations, and review of literature.

Fibrochondrogenesis, an antenatal and postnatal correlation.

Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped) and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.

Imaging features of extra cranial parapharyngeal space meningioma: case report.

Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].

Ellis van creveld syndrome with synpolydactyly, an antenatal diagnosis with postnatal correlation.

Ellis Van Creveld syndrome (EVC), also known as chondroectodermal dysplasia, presents at birth with short limbs accompanied by postaxial polydactyly, nail dysplasia, and dental anomalies. Other manifestations of EVC include atrial septum defects and other congenital heart diseases. We report a case of the EVC syndrome with postaxial polydactyly (Synpolydactyly with seven fingers on the right side and hexadactyly on the left side) and a partial atrioventricular canal defect diagnosed antenatally. This variation of EVS has not been reported in English literature till date.