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Yegurla J, Qamar S, Gopi S, Madhusudhan KS, Agarwal S, Sati HC, Mani K, Tandon N, Gunjan D, Saraya A. Opportunistic screening for osteopathy with routine abdominal computed tomography scan in chronic pancreatitis. Pancreatology 2024; 24:41-47. [PMID: 38072684 DOI: 10.1016/j.pan.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND AIMS Lumbar vertebral bone attenuation, measured in Hounsfield units (HU) can indirectly indicate the bone mineral density (BMD). The aim of this study is to determine the optimal HU threshold on abdominal computed tomography (CT) scans to detect osteopathy in patients with chronic pancreatitis (CP). METHODS This cross-sectional study included patients with CP who underwent CT scans to measure HU at L1 to L4 vertebrae. The mean lumbar vertebral attenuation of female renal transplant donors, aged 20-30 years was utilized to calculate the T-scoreHU of all patients at each vertebral level. Receiver operator characteristic analysis was used to determine the HU and T-scoreHU for diagnosis of osteopathy in patients with CP. Dual-energy X-ray absorptiometry value was used to categorize osteopenia and osteoporosis. RESULTS A total of 175 patients (mean age, 34.5 ± 10.9 years; 72 % males) and 33 female renal transplant donors (mean age, 28 ± 2.4 years) were included. A threshold HU value 212 or T scoreHU of -1.80 at L1 vertebra was found to have a 78 % sensitivity and 70 % specificity for differentiating between osteoporosis and non-osteoporosis (osteopenia and normal BMD). Similarly, a threshold HU value of 254 or a T-scoreHU of -0.46 at L1 vertebra had 78 % sensitivity and 71 % specificity for distinguishing between normal and low BMD (osteoporosis and osteopenia). CONCLUSION Abdominal CT images, which are routinely performed in chronic pancreatitis, can be used for opportunistic screening of osteoporosis and osteopenia without additional cost or radiation exposure.
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Affiliation(s)
- Jatin Yegurla
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sumaira Qamar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanth Gopi
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - K S Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
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Maji P, Malik R, Madhusudhan KS, Sharma S. Utility and Safety of Transjugular Liver Biopsy in Children. Indian J Pediatr 2021; 88:709-711. [PMID: 33533007 DOI: 10.1007/s12098-020-03650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Transjugular liver biopsy (TJLB) is widely used in adults when percutaneous liver biopsy (PLB) is contraindicated. The authors evaluated the safety, efficacy and utility of TJLB in pediatric patients with contraindications to PLB. Twenty-three children and adolescents (13 male) underwent 24 (one patient had two separate biopsies) consecutive biopsies (TJLB) under general anaesthesia (18) or intravenous sedation (6). PLB was contraindicated because of elevated prothrombin time (PT)/international normalized ratio (INR) (˃ 15.5/1.5) in 19 (79.2%) and thrombocytopenia (< 60,000/dL) in 15 (62.5%) procedures. Derangement in both INR and platelet count were found in 12 (50%) cases. Significant ascites was present in 10 (41.7%) procedures. Technical success rate with adequate biopsy sample was 95.8% (23/24) with no major complications. A new diagnosis was established in 9 (37.5%) cases. Another 14 (58.34%) biopsies confirmed the initial diagnoses. Four cases also revealed additional information guiding overall management and prognosis. Thus, TJLB is a safe and useful procedure in children.
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Affiliation(s)
- Prabir Maji
- Division of Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohan Malik
- Division of Gastroenterology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - K S Madhusudhan
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Sharma
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Nakra T, Das P, Gupta B, Yadav R, Singh AN, Dash NR, Madhusudhan KS, Ramteke P. Primary Multifocal Hepatic PEComa: A Rarely Encountered Diagnostic Dilemma. J Gastrointest Cancer 2021; 51:667-672. [PMID: 31919784 DOI: 10.1007/s12029-019-00352-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tripti Nakra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Brijnandan Gupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Anand N Singh
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar R Dash
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - K S Madhusudhan
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Ramteke
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Sonai MK, Rastogi S, Madhusudhan KS, Gupta SD, Das P. Clear cell sarcoma like tumor of gastrointestinal tract: Experience of three cases and review of literature. INDIAN J PATHOL MICR 2020; 63:90-95. [PMID: 32031130 DOI: 10.4103/ijpm.ijpm_195_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSGT) is a rare, aggressive tumor with many histological mimickers. Herein, we have documented our experience of three cases of CCSGT and reviewed the literature. The index cases were identified in male patients in their twenties, one in jejunum and two in the distal colon. Histomorphological examination revealed the characteristic heterogeneous histomorphology with patchy immunohistochemical positivity with S100 protein and negative melanocytic markers. The fluorescence in-situ hybridization test showed translocation of the EWSR1 (22q12) gene in >80% tumor cells. While one of our patients died after 2 years with lung metastasis, the other two patients are still alive on 1.5 years and 3 months follow up, respectively. CCSGT is a rare malignant tumor of the gastrointestinal tract. Although characteristic morphology, use of a judicial panel of immunohistochemical stains, and translocation study for EWSR1 gene can establish the diagnosis, experience in adjuvant therapy is still limited.
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Affiliation(s)
- Mukin Kumar Sonai
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - K S Madhusudhan
- Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha D Gupta
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Das P, Sharma P, Nakra T, Ghosh S, Yadav R, Gupta B, Khanna G, Madhusudhan KS, Panwar R, Anoop MK, Kilambi R, Singh AN, Dash NR, Pal S, Gupta SD. Spectrum of hepatobiliary cystic lesions: A 7-year experience at a tertiary care referral center in North India and review of literature. INDIAN J PATHOL MICR 2018; 60:487-500. [PMID: 29323060 DOI: 10.4103/ijpm.ijpm_691_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Cysts arising from the hepatobiliary tree are a group of heterogeneous lesions with regard to pathogenesis, clinical presentation, and radiological finding. They can be intrahepatic or extrahepatic, developmental, secondary to infective/inflammatory etiologies, as well as neoplastic. This study was conducted to determine the spectrum of hepatobiliary cysts in surgically intervened cases, with regard to their prevalence, histological spectrum, and clinicoradiological correlation, wherever possible. METHODS In this retrospective observational study, hematoxylin and eosin stained slides of all cases of hepatobiliary cystic lesions, operated between 2009 and 2016 were reviewed. Special stains as reticulin, Masson's trichrome, and periodic acid Schiff were done wherever necessary. Overall prevalence, age-sex distribution, clinical presentation and histopathological patterns were studied. Relevant imaging findings were correlated wherever possible. RESULTS A total of 312 cases of hepatobiliary cysts were identified, the majority in females. Choledochal cysts (CCs) were the most common type (n = 198,63.5%), followed by hydatid cysts (n = 73,23.3%), simple hepatic cysts (n = 10,3.2%), congenital hepatic fibrosis (n = 10,3.2%), biliary cystadenomas (n = 4,1.2%) hepatic mesenchymal hamartomas (n = 7,2.2%), and cavernous hemangiomas (n = 3,0.9%). Fibropolycystic liver disease (n = 2,0.6%), Caroli's disease (n = 1, 0.3%), liver abscess (n = 2, 0.6%), infantile hemangioendothelioma (n = 1,0.3%), and biliary cystadenocarcinomas (n = 1,0.3%) were rare. Lesions noted mostly in 1st decade of life were: CCs, fibrocystic liver disease, Caroli's syndrome, cystic mesenchymal hamartoma, and infantile hemangioendotheliomas. CONCLUSION In our cohort of surgically intervened cases of hepatobiliary cystic lesions from a tertiary care hospital in North India, the CCs, followed by hydatid cyst were the most common lesions. Histology can play vital role in characterization, as often clinical findings and radiology can overlap.
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Affiliation(s)
| | | | - Tripti Nakra
- Department of Pathology, AIIMS, New Delhi, India
| | | | - Rajni Yadav
- Department of Pathology, AIIMS, New Delhi, India
| | | | | | | | | | - M K Anoop
- Department of Radiology, AIIMS, New Delhi, India
| | | | | | - Nihar R Dash
- Department of GI Surgery, AIIMS, New Delhi, India
| | - Sujoy Pal
- Department of GI Surgery, AIIMS, New Delhi, India
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Kilambi R, Singh AN, Madhusudhan KS, Das P, Pal S. Choledochal cyst of the proximal cystic duct: a taxonomical and therapeutic conundrum. Ann R Coll Surg Engl 2017; 100:e34-e37. [PMID: 29181996 DOI: 10.1308/rcsann.2017.0201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Isolated choledochal cysts involving the cystic duct are rare. We present a case of a choledochal cyst involving only the proximal cystic duct, and discuss the taxonomic and therapeutic challenges. There is a need for a clearly defined classification system for these cysts as they may be categorised as either type II or type VI cysts. The optimal treatment remains debatable, with some authors recommending a bilioenteric reconstruction owing to the wide cystic duct-bile duct junction. However, we suggest that a cholecystectomy should be performed with examination of the specimen and frozen section in case of any abnormality rather than upfront bile duct excision. In addition, given the rarity of this condition and the paucity of long-term data, we recommend meticulous follow-up for development of any malignancy.
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Affiliation(s)
- R Kilambi
- All India Institute of Medical Sciences , New Delhi , India
| | - A N Singh
- All India Institute of Medical Sciences , New Delhi , India
| | | | - P Das
- All India Institute of Medical Sciences , New Delhi , India
| | - S Pal
- All India Institute of Medical Sciences , New Delhi , India
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Khanna G, Sharma P, Madhusudhan KS, Barwad A, Ranjan P, Mishra B, Das P. Intrahepatic biliary cystadenoma with ciliary metaplasia: Report of a rare morphological variant. INDIAN J PATHOL MICR 2017. [PMID: 28631647 DOI: 10.4103/0377-4929.208394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Histological diagnosis of biliary cystadenoma is based on the type of epithelial cells lining the cyst and radiological features. The cyst-lining cells are not usually ciliated. We herein report a very rare example of an intrahepatic biliary cystadenoma with ciliated epithelial lining, which had taken us away from this diagnosis toward an intrahepatic foregut duplication cyst. Radiologically, also the lesion was deceptive, and a possibility of hydatid cyst was considered. However, immunohistochemical workup finally led us to this diagnosis. This report would document this rare morphological variant, which may pose diagnostic difficulty.
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Affiliation(s)
- Gaurav Khanna
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pragya Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K S Madhusudhan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endoscopy demonstrated a large, friable mass along the duodenal wall and biopsy was suggestive of malignant melanoma. A detailed physical examination and whole body imaging (positron emission tomography and computed tomography) did not reveal any other lesion. The patient underwent a pancreaticoduodenectomy with segmental resection and anastomosis of the superior mesenteric vein as well as a segmental colectomy. His postoperative recovery was uneventful. The histopathology of the operative specimen showed a malignant amelanotic melanoma arising from the duodenum with lymph nodal involvement. He received oral temozolomide. However, he developed liver metastasis at six months and again at ten months, which was managed with radiofrequency ablation both times. He is doing well at 32 months of follow-up review. Multimodality treatment including surgery, adjuvant chemotherapy and salvage therapy appears to be a promising tool for achieving long-term survival in such patients.
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Affiliation(s)
- R Kilambi
- All India Institute of Medical Sciences , New Delhi , India
| | - A N Singh
- All India Institute of Medical Sciences , New Delhi , India
| | - N R Dash
- All India Institute of Medical Sciences , New Delhi , India
| | | | - P Das
- All India Institute of Medical Sciences , New Delhi , India
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9
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Gahlot GPS, Roy M, Jain H, Dash NR, Madhusudhan KS, Suri V, Yadav R, Das P. Primary extraskeletal osteosarcoma of gall bladder. ACTA ACUST UNITED AC 2016; 36:277-80. [PMID: 27509713 DOI: 10.7869/tg.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Metha R, Gahlot GPS, Das P, Jindal G, Mouli VP, Madhusudhan KS, Sharma R, Pal S, Ahuja V, DattaGupta S. Sclerosing mesenteric panniculitis in a young patient : common cause of diagnostic dilemma and treatment refractoriness. Acta Gastroenterol Belg 2016; 79:254-256. [PMID: 27382948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sclerosing mesenteric panniculitis (SMP) is an idiopathic chronic fibroinflammatory disorder of the intra-abdominal fat. CASE PRESENTATION Herin, we report a case of SMP, involving the omentum, mesentery and peri-colic fat in a 18 year old male, who presented with significant and recurrent abdominal distension for 4.5 years. Computed tomogram revealed ascites, with nodular and irregular omental thickening and foci of calcification. Non-specific radiological and histological features made an accurate diagnosis extremely difficult. After a thorough work up and exclusion of other differentials, diagnosis of a nodular SMP (Weber Christian disease) was given. After showing resistance to chemotherapeutic agents, slow response was noted with cyclophosphamide, followed by rapid symptomatic improvement with mesenterectomy. CONCLUSION SMP is an uncommon benign mesenteric/ omental inflammation, and is a diagnosis of exclusion. As treatment refractoriness is common, management should be individualized and continued for along period. Surgical omentectomy may be helpful.
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Abstract
Vascular complications after percutaneous renal biopsy are uncommon and may require interventional management. In most of these cases, the pathology is a renal arterial pseudoaneurysm (PsA) or an arterio-venous fistula. Injury to other vessels like aorta, lumbar arteries or mesenteric arteries is rare with only one case of left colic artery PsA reported in literature. We report a case of a 60-year-old female, who developed left colic artery PsA after renal biopsy, which was successfully embolized through endovascular route using microcoils.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Prasad TV, Madhusudhan KS, Srivastava DN, Dash NR, Gupta AK. Transarterial chemoembolization for liver metastases from solid pseudopapillary epithelial neoplasm of pancreas: A case report. World J Radiol 2015; 7:61-65. [PMID: 25825635 PMCID: PMC4374090 DOI: 10.4329/wjr.v7.i3.61] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/23/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
Solid pseudo-papillary epithelial neoplasm (SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented with extensive liver metastasis from SPEN of pancreatic body for which she was operated four years ago. Due to the extensive nature of metastatic disease she was offered Transarterial chemoembolisation (TACE) using gemcitabine as chemotherapeutic agent. Short term follow up after a month of TACE with multiphase computed tomography showed > 90% resolution in the viable tumor with significant clinical improvement. TACE ensures targeted delivery of chemotherapeutic drugs in higher doses with least systemic toxicity and is more effective and safe than systemic chemotherapy. TACE with gemcitabine was found to be very effective in our patient with numerous liver metastasis.
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Agrawal N, Pal S, Dash NR, Madhusudhan KS, Srivastava DN. Asymptomatic transhiatal pancreatic herniation after oesophagectomy. J Clin Diagn Res 2014; 8:ND24-5. [PMID: 25478403 PMCID: PMC4253221 DOI: 10.7860/jcdr/2014/9881.5017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022]
Abstract
Transhiatal herniation of abdominal organs after oesophageal resection and reconstruction is rare and sparsely described in the literature. The commonest organ to herniate is the colon. Pancreatic herniation has been reported twice before. We report a case of postoesophagectomy transhiatal pancreatic herniation in an asymptomatic patient.
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Affiliation(s)
- Nikhil Agrawal
- Assistant Professor, Department of HPB Surgery, Institute of Liver and Biliary Sciences, D1, Vasant Kunj, New Delhi, India
| | - Sujoy Pal
- Additional Professor, Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Additional Professor, Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - KS Madhusudhan
- Assistant Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Benign mediastinal teratomas are commonly asymptomatic and seldom cause complications. Spontaneous rupture into the pleura is rare and cross-sectional imaging is crucial in its early detection and planning a proper surgical approach. We report two cases of spontaneous pulmonary and pleural rupture of benign mediastinal teratoma and discuss the imaging appearances.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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15
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Madhusudhan KS, Madan R, Shad PS. Gossypiboma causing intestinal obstruction. Clin Res Hepatol Gastroenterol 2012; 36:400-1. [PMID: 22504155 DOI: 10.1016/j.clinre.2012.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/19/2012] [Accepted: 03/05/2012] [Indexed: 02/04/2023]
Affiliation(s)
- K S Madhusudhan
- Mahajan Imaging Centre, Dr BL Kapur Memorial Hospital, Pusa Road, 110005 New Delhi, India.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiology, Ganesh Diagnostic and Imaging Centre, New Delhi, India
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Madhusudhan KS, Shad PS, Sharma S, Goel A, Mahajan H. Metastatic pulmonary calcification in chronic renal failure. Int Urol Nephrol 2011; 44:1285-7. [PMID: 21779916 DOI: 10.1007/s11255-011-0035-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 07/01/2011] [Indexed: 10/18/2022]
Abstract
Metastatic pulmonary calcification can be caused by a number of diseases, most common being end-stage renal disease. Most of the patients are asymptomatic, and imaging with computed tomography is useful in making a diagnosis. Demonstration of pulmonary and chest wall vessel calcification is characteristic. We report a case of a 60-year-old patient with chronic renal failure on dialysis, presenting with gradual onset dyspnea, who showed metastatic pulmonary calcification on chest imaging.
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Affiliation(s)
- K S Madhusudhan
- Mahajan Imaging Centre, Dr. BL Kapur Memorial Hospital, Pusa Road, New Delhi 110005, India.
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Abstract
Lichen planus is a rare cause of esophagitis and esophageal stricture. It is invariably associated with oral mucosal involvement and the diagnosis has to be considered in these patients who present with dysphagia. We present a case of esophageal stricture secondary to lichen planus.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Chitranjan, Kandpal H, Madhusudhan KS. Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. Br J Radiol 2010; 83:e65-6. [PMID: 20197431 DOI: 10.1259/bjr/47866965] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented.
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Affiliation(s)
- Chitranjan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
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Madhusudhan KS, Srivastava DN, Gamanagatti S. Giant hemangioma of liver presenting as deep vein thrombosis of the lower limbs. J Postgrad Med 2010; 55:290-1. [PMID: 20083882 DOI: 10.4103/0022-3859.58939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis,All India Institute of Medical Sciences, New Delhi, India
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Madhusudhan KS, Sharma R, Kandpal H, Kumar A, Gamanagatti S, Jain V, Chumber S. A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances. Br J Radiol 2009; 82:e219-24. [PMID: 19890114 DOI: 10.1259/bjr/88504406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arteriovenous malformations are uncommon congenital lesions of the hand. Although present at birth, they usually manifest later in life. Ultrasonography, MRI and digital subtraction angiography play an important role in the diagnosis of these lesions. We report the imaging appearances of an unusual case of combined soft-tissue and intraosseous arteriovenous malformation (AVM) of the hand with marked periosteal elevation in a 12-year-old child. Although associated skeletal changes are common, diffuse periosteal elevation owing to direct communication of the AVM with the subperiosteal space has not, to the best of our knowledge, been reported previously.
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Affiliation(s)
- K S Madhusudhan
- Departments of Radiodiagnosis Surgery, All India Institute of Medical Sciences, New Delhi - 110029, India
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Madhusudhan KS, Srivastava DN, Dash NR, Gupta C, Gupta SD. Case report. Schwannoma of both intrahepatic and extrahepatic bile ducts: a rare case. Br J Radiol 2009; 82:e212-5. [PMID: 19759209 DOI: 10.1259/bjr/63746798] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Schwannoma of the biliary tree is extremely uncommon, with only a few cases having been reported so far. They commonly present with obstructive jaundice. Although involvement of the extrahepatic duct is common, occurrence in the intrahepatic ducts has not been reported. We report a case of combined intrahepatic and extrahepatic schwannoma in a 46-year-old man presenting with obstructive jaundice.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Madhusudhan KS, Das CJ, Dutta R, Kumar A, Bhalla AS. Endovascular embolization of pulmonary sequestration in an adult. J Vasc Interv Radiol 2009; 20:1640-2. [PMID: 19875305 DOI: 10.1016/j.jvir.2009.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 08/30/2009] [Accepted: 09/02/2009] [Indexed: 11/26/2022] Open
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Madhusudhan KS, Sharma S, Srivastava DN, Thulkar S, Mehta SN, Prasad G, Seenu V, Agarwal S. Comparison of intra-arterial digital subtraction angiography using carbon dioxide by 'home made' delivery system and conventional iodinated contrast media in the evaluation of peripheral arterial occlusive disease of the lower limbs. J Med Imaging Radiat Oncol 2009; 53:40-9. [PMID: 19453527 DOI: 10.1111/j.1754-9485.2009.02035.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO(2)) digital subtraction angiography (DSA) using a 'home made' delivery system with iodinated contrast medium (ICM) DSA in the evaluation of peripheral arterial occlusive diseases (PAOD) of lower limbs. Twenty-one patients (27 limbs; all men; mean age, 47.6 years) who presented with PAOD of lower limbs underwent DSA using both intra-arterial CO(2) and ICM. Conventional ICM DSA was performed first and used as gold standard. Carbon dioxide was then injected by hand using a locally improvised home made plastic bag delivery system. Patient tolerance was assessed subjectively. Arteries from aortic bifurcation to the ankle were independently evaluated by two radiologists and graded for stenosis using a five-point scale. For each patient, the quality of CO(2) DSA images were compared with the corresponding images of ICM DSA and an overall grade of 'good', 'acceptable' or 'poor' was assigned. Cohen's kappa coefficient was used to determine inter-observer agreement. Carbon dioxide opacified 86.2% (188/195) of major arteries and depicted stenosis adequately in 84.5% (191/226) of arterial segments. A good or acceptable image quality of CO(2) DSA was obtained in over 95% of patients. Infrapopliteal arteries were inadequately visualized. Mild pain was seen in six (28.6%) patients with both contrast agents; one patient developed severe pain during CO(2) DSA. Inter-observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO(2) into lower limb arteries is well tolerated. Carbon dioxide DSA using the locally improvised home made delivery system is a feasible and safe alternative to ICM DSA in the evaluation of PAOD. It provides adequate imaging of arteries of lower extremities except infrapopliteal segments.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Dehli, India
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Madhusudhan KS, Seith A, Khadgawat R, Das P, Mathur S. Tuberculosis of the thyroid gland: magnetic resonance imaging appearances. Singapore Med J 2009; 50:e235-e238. [PMID: 19644607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Tuberculosis involving the thyroid gland is a rare occurrence. We report a case of cytologically-diagnosed thyroid gland tuberculosis in a 21-year-old man who presented with thyroid swelling of short duration, and describe the magnetic resonance (MR) imaging appearances of the lesion, which to our knowledge, has not been previously described. We also report a rare complication of abscess formation in the track of the fine needle aspiration. The intermediate signal intensity of the lesions on both T1- and T2-weighted MR images may provide a clue about tuberculosis, as clinical suspicion is low due to the rarity of the disease.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Kandpal H, Ahuja J, Madhusudhan KS. Cavernous sinus thrombophlebitis causing reversible narrowing of internal carotid artery. Neurol India 2009; 57:102-3. [DOI: 10.4103/0028-3886.48792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Madhusudhan KS, Das CJ. Creutzfeldt-Jakob disease: Importance of early magnetic resonance imaging. Ann Indian Acad Neurol 2009; 12:52-3. [PMID: 20151013 PMCID: PMC2811982 DOI: 10.4103/0972-2327.48859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 06/19/2008] [Accepted: 06/29/2008] [Indexed: 11/04/2022] Open
Affiliation(s)
- K. S. Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi – 110 029, India,For correspondence: Dr. Madhusudhan KS, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi – 110 029, India. E-mail:
| | - Chandan Jyoti Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi – 110 029, India
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Madhusudhan KS, Sharma R, Das CJ. Abdominal radiograph: archaic modality or still clinically relevant? Natl Med J India 2008; 21:295-306. [PMID: 19691220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Madhusudhan KS, Gamanagatti S. Primary breast tuberculosis masquerading as carcinoma. Singapore Med J 2008; 49:e3-e5. [PMID: 18204757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although tuberculosis is a very common disease in endemic areas, isolated involvement of the breast is very rare. Any form of tuberculous mastitis may present with features of malignancy. Diagnosis is mainly based on identification of tubercle bacilli. We report a 50-year-old woman with primary tuberculous abscess of the breast which simulated carcinoma on mammography, and describe the importance of ultrasonography in differentiating abscess from malignancy.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India.
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Madhusudhan KS, Gamanagatti S, Seith A, Hari S. Pulmonary infections mimicking cancer: report of four cases. Singapore Med J 2007; 48:e327-e331. [PMID: 18043829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Lung infections infrequently simulate cancer, and their differentiation, based on imaging findings, can sometimes be difficult. The infections may be fungal, mycobacterial, parasitic or, rarely, viral. A biopsy is required to prove the infectious nature of the lesions. A specific diagnosis is necessary for initiation of appropriate therapy. We report four cases of chronic pulmonary infections, which were wrongly diagnosed as bronchogenic carcinoma based on radiological features. We also reviewed the existing literature.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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Das CJ, Paul SB, Madhusudhan KS, Gulati MS. Update in liver imaging. Trop Gastroenterol 2007; 28:149-155. [PMID: 18416343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Over the last decade, liver imaging has experienced a revolution providing a bewildering array of options for detection and characterisation of liver lesions. Cross-sectional imaging modalities like computed tomography and magnetic resonance imaging have improved in speed and resolution, thereby facilitating multiphasic scanning of the liver. The advent of the use of contrast agents for ultrasonography and magnetic resonance imaging has further paved the way for definitive diagnosis in an attempt to obviate the need for invasive diagnosis. This article captures advances made in ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography and brings the specialist up to date with the latest in liver imaging.
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Affiliation(s)
- C J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences New Delhi, India
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Abstract
Esophageal duplication cysts are rare congenital anomalies. Frequently asymptomatic, they may cause respiratory distress and feeding difficulties in infants. Unilateral hyperinflation of the lung due to compression of the bronchus by the cyst is rare. We report a case of a 4-day-old male neonate presenting with respiratory distress who had an esophageal duplication cyst causing obstructive hyperinflation of the right lung. The nature of the cyst was confirmed after surgery.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis and Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Gogia N, Sharma R, Gamangatti S, Seenu V, Madhusudhan KS, Parshad R. Hepatic hydatid cysts with biliary, and peritoneal rupture and transdiaphragmatic migration. Trop Gastroenterol 2006; 27:93-6. [PMID: 17089622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.
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Affiliation(s)
- Nidhi Gogia
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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