Persistent fifth aortic arch (PFAA), also known as congenital double-lumen aortic arch, is a rare developmental anomaly of the aortic arch. A 5-month-old baby who presented with congestive cardiac failure was diagnosed to have a large patent ductus arteriosus with PFAA. Although this arch anomaly had no hemodynamic relevance in this case, preoperative diagnosis prevented surprises "on table."
A 20-year-old man presented with left-sided headache and seizures of three years duration. Conglomerate ring-enhancing lesions were seen in the first magnetic resonance imaging study. He was initially treated with anticonvulsants for two years. Because the symptoms and the lesions were persisting, antitubercular treatment was added. He was asymptomatic after antitubercular treatment despite persisting lesion. Lesion showed exuberant ring enhancement with increased perfusion. Because the lesion was persisting even after 24 months of antitubercular treatment, excision was considered. Lesionectomy was done and histopathology reported meningoencephalitis secondary to neurocysticercosis. The case report highlights the difficulty in differentiating cysticercosis from tuberculoma in patients from countries where both the conditions are endemic.
Background:Renal transplantation is the definitive therapy for the end stage renal disease. This study was undertaken to assess the role of MDCT (64-slice) in the preoperative evaluation of living potential renal transplantation donors for transplantation.Methods: This prospective one year study included 31 potential living renal donors aged between 22-69 years, sent to the department of radio diagnosis for MDCT using 64-slice CT scanner. Nonionic IV contrast material (130-150mL) was given at a rate of 4-5 mL/sec. Arterial images were acquired by smart prep technique followed by venous phase after 20-25 second delay. Finally, excretory phase was taken after 8 minutes from the start of injection. KV of 120, mAs of 250-790 and collimations of 0.625 mm were used. CT data included determination of renal size, assessment of renal parenchyma (cyst, calculus, mass etc); depiction of renal arterial, venous, and urographic anatomy and identification of important vascular variants. Image processing included three-dimensional volume renderings, maximum intensity projections and multiplanar reformations.Results:We identified surgically important vascular variants and renal parenchymal abnormalities. Of the 31 subjects evaluated, 4(12.9%) subjects were excluded on the basis of CT findings, due to vascular variants in 3 cases (9.7%) subjects and bilateral microliths in 1(3.2%). The surgical decision of right nephrectomy was taken in 2 (6.4%) cases due to complex vascular anatomy on left side depicted on CT.Conclusions:Triple phase MDCT provided comprehensive parenchymal and vascular preoperative evaluation of potential living donors for renal transplantation, thus had an impact in deciding the suitability of donor and side of kidney to be harvested for nephrectomy. It provided a road map to the surgeons which helped them in surgical planning to reduce surgical complications.
In patients with obesity, intramuscular injections may be deposited subcutaneously due to an increase in gluteal fat. We aimed to use abdominal CT done in our institute for gluteal fat thickness to test our hypothesis.After IRB approval, CT scans of the abdomen and pelvis of the past 6 months were analyzed. The thickness of gluteal region subcutaneous fat was measured in a standardized manner.Out of 700 CT scans, studied, 476 were males and 224 were females. The average gluteal fat thickness was 2.34 cm +/- 1 cm. The average fat thickness in males was 1.98 cm +/- 0.98 cm whereas in females was 3.0 cm +/- 1.2 cm. Subcutaneous granulomas were seen in 17 cases and one injection granuloma in the intramuscular plane.A significant number of female patients had increased gluteal fat thickness beyond the reach of routinely used needles. The medications in these patients will thus be unintentionally injected to subcutaneous plane, possibly altering the pharmacokinetics.
Abstract Vesicovaginal reflux is a common cause of urinary incontinence in girls. A micturating cystourethrogram, which is the diagnostic investigation of choice, can demonstrate retrograde filling of the vagina during micturition and the complete emptying of the vagina at the end of micturition. Vesicovaginal reflux is a rare cause of gross hydrocolpos occurring without any anatomical obstruction. The condition may be associated with functional voiding disturbances.
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