Sonography in the diagnosis and assessment of dengue Fever.

OBJECTIVE: The objective of the following study is to determine the use of ultrasound as an important adjunct to clinical and laboratory profile in diagnosing dengue fever and in predicting the severity of the disease by correlating imaging features with platelet count. The variation in sonographic features seen in patients from different age groups was also studied. MATERIALS AND METHODS: This is a retrospective study. 96 patients who were serologically diagnosed as having dengue fever between April and August 2012 were referred for ultrasound scanning of the abdomen and thorax and the imaging findings were analyzed. RESULTS: Out of 96 sero-positive dengue cases, 64 (66.7%) patients showed edematous gallbladder (GB) wall thickening, 62 (64.5%) patients showed ascites, 48 (50%) patients had pleural effusion, 17 (17.7%) patients had hepatomegaly, 16 (16.7%) patients had splenomegaly and in 17 (17.7%) patients ultrasound findings were normal. Edematous GB wall thickening, ascites and pleural effusion were the most common combination of findings in all age groups. Edematous GB wall thickening was seen in 97.8% of patients with platelet count of less than 40,000 along with ascites (86.9%) and pleural effusion (58.6%). In patients with platelet count between 40,000 and 80,000 ascites was more common than edematous GB wall thickening. Significantly no abnormal sonographic finding was detected in patient with platelet count more than 150,000. CONCLUSION: Sonographic features of thickened GB wall, pleural effusion (bilateral or right side), ascites, hepatomegaly and splenomegaly should strongly favor the diagnosis of dengue fever in patients presenting with fever and associated symptoms, particularly during an epidemic. The degree of thrombocytopenia showed a significant direct relationship to abnormal ultrasound features.

Susceptibility weighted magnetic resonance imaging of brain: A multifaceted powerful sequence that adds to understanding of acute stroke.

CONTEXT: To evaluate the additional information that susceptibility weighted sequences and datasets would provide in acute stroke. AIMS: The aim of this study were to assess the value addition of susceptibility weighted magnetic resonance imaging (SWI) of brain in patients with acute arterial infarct. MATERIALS AND METHODS: All patients referred for a complete brain magnetic resonance imaging (MRI) between March 2010 and March 2011 at our institution had SWI as part of routine MRI (T1, T2, and diffusion imaging). Retrospective study of 62 consecutive patients with acute arterial infarct was evaluated for the presence of macroscopic hemorrhage, petechial micro-bleeds, dark middle cerebral artery (MCA) sign and prominent vessels in the vicinity of infarct. RESULTS: SWI was found to detect hemorrhage not seen on other routine MRI sequences in 22 patients. Out of 62 patients, 17 (10 petechial) had hemorrhage less than 50% and 5 patients had greater than 50% area of hemorrhage. A "dark artery sign" due to thrombus within the artery was seen in 8 out of 62 patients. Prominent cortical and intraparenchymal veins were seen in 14 out of 62 patients. CONCLUSIONS: SWI has been previously shown to be sensitive in detecting hemorrhage; however is not routinely used in stroke evaluation. Our study shows that SWI, by virtue of identifying unsuspected hemorrhage, central occluded vessel, and venous congestion is additive in value to the routine MR exam and should be part of a routine MR brain in patients suspected of having an acute infarct.

Value of preoperative sonographic vascular evaluation of haemodialysis access in upperlimb.

OBJECTIVE: To know the value of preoperative Dopplerultrasonography vascular mapping of upper limb for hemodialysis access placement. MATERIALS AND METHODS: Prospective ultrasonographic assess- ment of upper extremity vessels was performed in 60 patients prior to hemodialysis access placement and potential access sites were selected (based on the standard criteria). The findings were correlated with the operative findings. Discrepancies found between ultrasonographic and operative findings were analysed. RESULTS: All the 60 patients who underwent vascular mapping had vascular access placed. 80% of them had native arteriovenous fistulae (AVF) placed. In 95% of patients, at the selected sites, the vascular parameters as determined by ultrasonography matched with the operative findings. In 5% of patients there were discrepancies between the ultrasonography findings and operative findings. There was no negative surgical exploration. There was strong correlation between the diameters measured by ultrasonography and surgery. CONCLUSION: Preoperative ultrasonography vascular mapping prior to hemodialysis access placement has facilitated definite selection of potential sites in difficult patient population in whom evaluation by physical examination was inconclusive. It also helped in maximizing the native AVFs and decreasing the negative surgical exploration rates.

A radiological study on the trabecular pattern in the upper end of the femur in post-menopausal women.

OBJECTIVE: Anatomically, the upper end of the femur is a common site for osteoporosis. Therefore, The trabecular pattern in the upper end of femur is analyzed on the basis of the presence or absence, the relative number and density of the trabeculae, trabecular group and also by the grading of trabeculae. The present study was undertaken to identify the trabecular pattern in the upper end of the femur radiographically in postmenopausal women and to establish that the changes in the trabecular pattern can be used for the diagnosis and the grading of osteoporosis. While osteoporosis is observed in both elderly men and women, its prevalence is much higher in post-menopausal women. The validated data from this study will be of use to all the clinicians to recognize the trabecular patterns and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages. METHOD: Two hundred frontal projection pelvis radiographs of women who were between 18-100 years of age were studied during 2006-2007. In this study, an attempt was made to test the presence, pattern and the grading of the trabecular pattern in pre and post-menopausal females and to find out the influence of the post menopausal age on the trabecular patterns. All the readings were tabulated and subjected to analysis. RESULTS: The distribution of the grading of the trabecular pattern in the upper end of the femur on the left and right sides for the severity of osteoporosis showed that as the number of years increased after menopause, the grading progressed from Grade N (Normal) to Grade A to Grade B to Grade C. CONCLUSION: This study will be useful for anatomists, radiologists and clinicians for recognizing the trabecular pattern and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages.