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Sharma J, Yadav U, Tej V, Malik R, Sarawagi R, Rahman N, Kumar A, Patel A, Bhagat AC. Infantile fetiform abdominal mass: Teratoma or fetus in fetu? A case report with insights into radiological diagnosis and surgical management. Radiol Case Rep 2024; 19:1304-1308. [PMID: 38292806 PMCID: PMC10825550 DOI: 10.1016/j.radcr.2023.12.031] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
Fetus-in-fetu (FIF) is a rare congenital anomaly in which a malformed parasitic twin develops within the body of a live fetus or child. Abdominal teratoma, a type of germ cell tumor, can be a great imaging mimicker of FIF and vice-versa, as they both can present as a heterogeneous mass with calcifications and a fat component. Radiological differentiation of these 2 entities should be made because of the difference in surgical planning and treatment options. Features such as visualization of distinct bony vertebral elements and encysted cystic components are the specific features of Fetus in fetu [1]. In contrast, the presence of elevated serum markers can help diagnose teratoma. Here, we report a case of a 5-month-old girl presented with progressive distension of the upper abdomen for the last 2 months, noticed by her mother. Her initial imaging with abdominal X-ray and ultrasonography showed the presence of a large heterogenous solid-cystic mass in the upper abdomen with large elongated calcifications. A provisional diagnosis of teratoma vs FIF was considered. CECT abdomen showed clear identification of osseous structures of the axial and appendicular skeleton within a fat density mass, along with an encapsulated cystic component, strongly suggestive of FIF. Her serum tumor markers were within normal limits. The final diagnosis of FIF was confirmed on Laparotomy and postoperative specimens.
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Affiliation(s)
- Jitendra Sharma
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Upasna Yadav
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Varun Tej
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Rajesh Malik
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Radha Sarawagi
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Nadeem Rahman
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Aman Kumar
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Ankur Patel
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
| | - Abhinav C. Bhagat
- Department of Radiodiagnosis, AIIMS Bhopal, Bhopal, Madhya Pradesh, India
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Aggarwal P, Malik R, Sarawagi R, Kumar A. Comparing the Efficacy of a Combination of Diffusion-Weighted Imaging and T2-STIR (Short Tau Inversion Recovery) Imaging With Contrast-Enhanced MRI in the Evaluation of Perianal Fistula. Cureus 2024; 16:e53485. [PMID: 38440010 PMCID: PMC10910302 DOI: 10.7759/cureus.53485] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Perianal fistula is clinically diagnosed and commonly characterized using magnetic resonance imaging (MRI). Diffusion-weighted imaging (DWI) and T2-weighted imaging are emerging techniques that can obviate the need for contrast injection in cases where contrast administration is not feasible or contraindicated. The main objective of our study was to compare the efficacy of the combination of DWI and T2 STIR (short tau inversion recovery) imaging with contrast-enhanced MRI for the diagnosis and characterization of perianal fistula. METHODS Sixty-nine patients with clinical perianal fistula with at least one external opening were evaluated with DWI, T2 STIR, and contrast MRI. A comparative cross-sectional study was conducted in the Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India. The chi-square test was done to find the association between categorical variables. The Kappa test was done to estimate the agreement between two different tests in measuring the outcome. The validity of tests was measured using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS The combination of DWI and T2 STIR is equivalent to contrast-enhanced MRI in the evaluation of primary and complicated perianal fistula. The combination of DWI and T2 STIR is superior to DWI alone in the classification and characterization of perianal fistula. However, DWI is superior to T2 STIR in differentiating perianal inflammation with abscess from perianal inflammation without abscess and can be used as an alternative to post-contrast fat-suppressed T1-WI in the detection of perianal abscesses and disease activity. CONCLUSION DWI can be used as an adjunct to T2 STIR, and the combination of DWI and T2 STIR can replace the post-contrast fat-suppressed T1 MRI sequence in the classification and characterization of perianal fistula.
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Affiliation(s)
- Pooja Aggarwal
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rajesh Malik
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Aman Kumar
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
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Patil V, Malik R, Sarawagi R. Comparative study between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labelling perfusion in differentiating low-grade from high-grade brain tumours. Pol J Radiol 2023; 88:e521-e528. [PMID: 38125817 PMCID: PMC10731442 DOI: 10.5114/pjr.2023.132889] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Our aim was to distinguish between low-grade and high-grade brain tumours on the basis of dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion and arterial spin labelling (ASL) perfusion and to compare DSC and ASL techniques. Material and methods Forty-one patients with brain tumours were evaluated by 3-Tesla MRI. Conventional and perfusion MRI imaging with a 3D pseudo-continuous ASL (PCASL) and DSC perfusion maps were evaluated. Three ROIs were placed to obtain cerebral blood value (CBV) and cerebral blood flow (CBF) in areas of maximum perfusion in brain tumour and normal grey matter. Histopathological diagnosis was considered as the reference. ROC analysis was performed to compare the diagnostic performance and to obtain a feasible cut-off value of perfusion parameters to differentiate low-grade and high-grade brain tumours. Results Normalised perfusion parameters with grey matter (rCBF or rCBV lesion/NGM) of malignant lesions were significantly higher than those of benign lesions in both DSC (normalised rCBF of 2.16 and normalised rCBV of 2.63) and ASL (normalised rCBF of 2.22) perfusion imaging. The normalised cut-off values of DSC (rCBF of 1.1 and rCBV of 1.4) and ASL (rCBF of 1.3) showed similar specificity and near similar sensitivity in distinguishing low-grade and high-grade brain tumours. Conclusions Quantitative analysis of perfusion parameters obtained by both DSC and ASL perfusion techniques can be reliably used to distinguish low-grade and high-grade brain tumours. Normalisation of these values by grey matter gives us more reliable parameters, eliminating the different technical parameters involved in both the techniques.
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Affiliation(s)
- Vaibhav Patil
- All India Institute of Medical Sciences, Bhopal, India
| | - Rajesh Malik
- All India Institute of Medical Sciences, Bhopal, India
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Jha P, Sarawagi R, Malik R, Kumar A, Pushpalatha K. Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification. Cureus 2023; 15:e44915. [PMID: 37814774 PMCID: PMC10560544 DOI: 10.7759/cureus.44915] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. METHODS A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. RESULTS Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. CONCLUSION POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.
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Affiliation(s)
- Pallavi Jha
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Rajesh Malik
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - Aman Kumar
- Radiology, All India Institute of Medical Sciences, Bhopal, IND
| | - K Pushpalatha
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhopal, IND
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Patel S, Dadheech M, Maurya AK, Singh J, Purwar S, Rai N, Sarawagi R, Joshi A, Khadanga S. Assessment of the Diagnostic Utility of GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) Assay in the Suspected Cases of Tuberculous Meningitis. Cureus 2023; 15:e37761. [PMID: 37213979 PMCID: PMC10193876 DOI: 10.7759/cureus.37761] [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] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Tuberculous meningitis (TBM) is a manifestation of extrapulmonary tuberculosis (EPTB) caused by Mycobacterium tuberculosis (MTB). The central nervous system is involved in about 1%-2% of all current tuberculosis (TB) cases and about 7%-8% of all EPTB. if not treated early, TBM leads to a high rate of neurological sequelae and mortality. OBJECTIVE This study aimed to assess the diagnostic performance of the GeneXpert MTB/rifampicin (RIF) assay in patients with TBM. METHODS A total of 100 suspected TBM cases were enrolled from various departments at tertiary care hospital, Bhopal, Madhya Pradesh, India, and classified as definite, possible, or probable TBM. The clinical samples were tested for microbiological and other cerebrospinal fluid (CSF) testing. RESULTS Out of 100 cases, 14 (14%) were classified as definite TBM, 15 (15%) were having probable TBM, and 71 (71%) were having possible TBM. Out of a total of 100 participants, all were negative for acid-fast bacilli (AFB) staining. Of the 100 cases, 11 (11%) were positive by mycobacterium growth indicator tube (MGIT) culture, of which only four (36.36%) were positive by GeneXpert MTB/RIF. GeneXpert MTB/RIF detected three (3%) cases that were negative by MGIT culture. Ten (90.9%) of the 11 MGIT-positive culture isolates were found to be RIF sensitive while one (9.1%) was found to be RIF resistant. Three cases tested positive/sensitive by the GeneXpert MTB/RIF but negative by MGIT culture. Six (85%) of the seven GeneXpert MTB/RIF positive cases were RIF sensitive while one (15%) was RIF resistant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 36.36% (95% Confidence Interval (CI) (10.93% to 69.21%)), 96.63% (95% CI (90.46% to 99.30%)), 57.14% (95% CI (25.50% to 83.85%)), 92.47% (95% CI (88.70% to 95.06%)) and 90% (95% CI (82.38% to 95.10%)) for GeneXpert MTB/RIF assay, compared with MGIT culture as the reference standard. CONCLUSION Our study found that the sensitivity is lower when compared to culture, so using GeneXpert MTB/RIF alone is not recommended. Overall performance of GeneXpert MTB/RIF assay is noteworthy. The GeneXpert MTB/RIF assay is a potentially accepted test for obtaining an earlier diagnosis, and if it tested positive, the treatment should begin immediately. However, culture must be performed in GeneXpert MTB/RIF negative cases.
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Affiliation(s)
- Sakshi Patel
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Malti Dadheech
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Anand K Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jitendra Singh
- Department of Translational Medicine Center, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Radha Sarawagi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sagar Khadanga
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Kothiya PK, Gupta V, Sarawagi R, Jayashankar E, Sharma J, Wani H, Balaji K, Roshny J. Isolated primary hydatid cyst of the pancreas: Management challenges of a cystic masquerade. Ann Hepatobiliary Pancreat Surg 2022; 26:401-406. [PMID: 35995585 PMCID: PMC9721249 DOI: 10.14701/ahbps.22-031] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
Abdominal hydatid cyst disease mostly involves the liver. Involvement of the pancreas as an isolated primary organ is rare accounting for < 2% of all systemic echinococcosis cases. It mostly involves the head of the pancreas. Symptoms depend on the location, size, and associated complications; therefore, it can have varied presentations including acute pancreatitis. On imaging, it can mimic other common pancreatic cystic lesions like pseudocyst or cystic neoplasm. Accurate preoperative diagnosis is usually difficult and requires a very high index of suspicion even in endemic areas. Herein, a case of primary isolated hydatid cyst of the pancreas that was initially diagnosed and managed as acute pancreatic pseudocyst is reported.
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Affiliation(s)
- Pradeep Kumar Kothiya
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Vishal Gupta
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India,Corresponding author: Vishal Gupta, MS, MCh Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh 462020, India Tel: +917552834086, E-mail: ORCID: https://orcid.org/0000-0003-3574-1805
| | - Radha Sarawagi
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Erukkambattu Jayashankar
- Departments of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Jitendra Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Hamza Wani
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Karunagaran Balaji
- Departments of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - J. Roshny
- Departments of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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Shaji N, Singhai A, Sarawagi R, Pakhare AP, Mishra VN, Joshi R. Assessment of Liver Fibrosis Using Non-invasive Screening Tools in Individuals With Diabetes Mellitus and Metabolic Syndrome. Cureus 2022; 14:e22682. [PMID: 35386158 PMCID: PMC8967074 DOI: 10.7759/cureus.22682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
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Abstract
Mycetoma is a chronic granulomatous disease that is more common in tropical regions with predominant involvement of foot. Spinal mycetoma presenting as lumbar canal stenosis is extremely rare. We hereby present a case of fungal eumycetoma of vertebral column in a 42-year-old male who presented with chronic progressive low back pain and features of lumbar canal stenosis without any skin swelling or discharging sinuses. The “dot-in-circle” sign, a highly specific magnetic resonance imaging (MRI) and ultrasonography (USG) sign of mycetoma has been described in the literature as a pathognomonic feature of mycetoma involving the musculoskeletal system. We describe the importance of characteristic imaging features with dot in circle sign in the diagnosis of eumycetoma of lumbar spine.
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Affiliation(s)
- Radha Sarawagi
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jitendra Sharma
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajesh Malik
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Aman Kumar
- Department of Radio Diagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Lachungpa T, Sarawagi R, Chakkalakkombil SV. Comparison of MR Hysterography and Sonohysterography in Women with Abnormal Uterine Bleeding: An Interventional Study. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/46357.14870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Abnormal Uterine Bleeding (AUB) is very common and major public health issue. AUB along with its sub-group often affects 14.25% women of reproductive age and have major impact on their physical, social, emotional and material quality of life. It not only has direct impact on the woman and her family, but also on both economy and health services. Aim: To compare Magnetic Resonance (MR) hysterography and Sonohysterography (SSHG) for detection of uterine pathologies in women with AUB. Materials and Methods: An interventional cross-sectional study was conducted over a period from July 2019 to July 2020, among 30 patients with severe AUB. SSHG and MR hysterography were used to assess endometrial pathology, and endometrial pathology was assessed by both the diagnostic modality and considering histopathology as gold standard. We calculate sensitivity, specificity, positive predictive value and negative predictive value for both the diagnostic modalities. Results: Very good agreement was noted in case of the cervical carcinoma whilst fibroid and endometrial hyperplasia showed good and fair agreement respectively by both the diagnostic modality. Sensitivity of fibroid and cervical carcinoma was 100%, polyp was 33.33%, and endometrial hyperplasia was 87.50%. Whereas specificity of fibroid was 91.67%, endometrial hyperplasia was 86.30% and cervical carcinoma was 100%. Polyp and submucosal fibroid both showed 96.30% specificity. For pathology like cervical carcinoma, endometrial hyperplasia, fibroid had very high agreement with kappa value 1, 0.684 and 0.814 respectively, whereas agreement for two tests for pathology like submucous fibroid, dual pathology was less. Conclusion: MR Hysterography and Sonohysterography were having almost equal sensitivity and specificity for abnormal uterine bleeding and can be used as per patient preference, patient discomfort, and availability of investigation.
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Saxena H, Takkar B, Kumar A, Sarawagi R. A case of occult bilateral optic nerve aplasia with pituitary dysfunction: hidden anomaly missed on ultrasound. BMJ Case Rep 2020; 13:13/2/e232839. [DOI: 10.1136/bcr-2019-232839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of ‘occult’ bilateral optic nerve aplasia (ONA) where pituitary dysfunction was discovered subsequently. The initial ultrasonography had missed ONA in a child with bilateral microcornea, small non-dilating pupils and roving eye movements. Due to presence of relevant clinical signs in this case, ONA was re-evaluated with MRI, and was subsequently discovered to be associated with life-endangering hypopituitarism. This case raises the possible underestimation of ONA, and hence also the risk of missing life-threatening endocrine disorders.
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Gupta P, Takkar B, Sarawagi R, Obedulla H. Miosis in a case of congenital fibrosis of extraocular muscles: a rare presentation of a rare disease. BMJ Case Rep 2019; 12:12/3/e229680. [PMID: 30898947 DOI: 10.1136/bcr-2019-229680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Payal Gupta
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Brijesh Takkar
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | | | - Hameed Obedulla
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
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Tiwari V, Behera P, Sarawagi R, Rafi BM, Sahu S, Raj H, Rajpoot M. Atypical Presentation of Fibrodysplasia Ossificans Progressiva: A Case Report and Review of Literature. Cureus 2018; 10:e2955. [PMID: 30214843 PMCID: PMC6132596 DOI: 10.7759/cureus.2955] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by widespread areas of abnormal bone formation in muscles, ligaments, tendons and joint capsules. Typically, the symptoms begin in the first decade of life with episodes of painful inflammatory soft tissue swellings. Gradually, there occurs restriction of motion at various joints, severely limiting the activities of daily living and the quality of life of such patients by the third decade of life. There is no definite cure available for the disease and the current treatment options target symptomatic and palliative management. We describe the case of a 10-year-old child who presented to our institute with a severe disability of upper limbs due to joint contractures along with several bony masses at various locations of the body but without having any prior complaints of painful soft tissue lesions or the characteristic flare-ups of the disease ever. Identification of typical soft tissue ossified masses in the specific anatomic pattern, along with the presence of short and malformed great toes helped us in reaching the diagnosis. Surgical procedures including biopsies should be strictly avoided in such patients to prevent triggering the development of more lesions, which occurred in our patient after inadvertent removal of the first swelling by an orthopaedic specialist.
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Affiliation(s)
- Vivek Tiwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Radha Sarawagi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, IND
| | - Babu Mohammed Rafi
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Saurabh Sahu
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Bhopal, IND
| | - Hemanth Raj
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Manish Rajpoot
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
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Sarawagi R, Sundar S, Raghuvanshi S, Gupta SK, Jayaraman G. Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication. Pol J Radiol 2016; 81:250-5. [PMID: 27298653 PMCID: PMC4886616 DOI: 10.12659/pjr.895827] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/07/2015] [Indexed: 12/19/2022] Open
Abstract
Background Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. Material/Methods This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. Results The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. Conclusions Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries.
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Affiliation(s)
- Radha Sarawagi
- Department of Radiodiagnosis, People's College of Medical Sciences and Research Center, Bhopal, India
| | - Shyam Sundar
- Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Sameer Raghuvanshi
- Department of Radiodiagnosis, People's College of Medical Sciences and Research Center, Bhopal, India
| | - Sanjeev Kumar Gupta
- Department of Community Medicine, RKDF Medical College Hospital and Research Centre, Bhopal, India
| | - Gopal Jayaraman
- Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Sarawagi R, Kankanala S, Gupta S. Detection of numeric and morphological variation at lumbosacral junction: Role of whole spine magnetic resonance imaging. West Afr J Radiol 2016. [DOI: 10.4103/1115-3474.179254] [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: 11/04/2022]
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15
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Rai GS, Sarawagi R, Sharma S, Apte A. An infant with nasal regurgitation since birth and failure to thrive. J Clin Diagn Res 2015; 9:TD03-4. [PMID: 26023621 DOI: 10.7860/jcdr/2015/12711.5819] [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] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/19/2015] [Indexed: 11/24/2022]
Abstract
The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3(rd) of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive 'bird beak sign'. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller's Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.
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Affiliation(s)
- Garjesh Singh Rai
- Associate Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, India
| | - Radha Sarawagi
- Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, India
| | - Sakshi Sharma
- Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, India
| | - Ashwin Apte
- Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, India
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Sivalingam J, Sarawagi R, Raghuwanshi S, Yadav PK. Sinonasal Neoplasia - Clinicopathological Profile And Importance of Computed Tomography. J Clin Diagn Res 2015; 9:TC01-4. [PMID: 26266182 DOI: 10.7860/jcdr/2015/13514.6026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 02/13/2015] [Accepted: 03/16/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nasal cavity and Paranasal sinus malignancies are very rare, in which maxillary sinus is the commonest, followed by ethmoid, frontal and sphenoid sinus. Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) play a key role in diagnosis, staging and management of paranasal sinuses and nasal pathologies. Multiplanar imaging in CT helps better imaging of critical anatomical areas. Aim of our study was to study the incidence, clinical features, CT features and its importance in the management of sinonasal neoplasms. MATERIALS AND METHODS This prospective study was carried out in a tertiary care hospital of MP, India. Consecutive 40 histologically proven cases of sinonasal neoplasia who visited the Department of Otorhinolaryngology and Radiotherapy are included in our study. Demography and clinical features were recorded. Cases of nasal and paranasal sinus masses diagnosed on CT attending ENT and Radiotherapy OPD or admitted in the Radiotherapy ward forms the material of this study. This included patients of both sexes and all ages. Histopathological examination was asked to confirm the diagnosis made on CT. RESULTS There were total 40 cases of sinonasal neoplasia among which 24 were benign. Almost all the benign cases were seen in the age group <40 y with mean age of 20 y and most of the malignant cases were seen in the age group above 40 y with mean age of 55 y. In our study we found male preponderance with male female ratio of 4:1 in both benign and malignant conditions. The commonest presenting symptoms of the patients with sinonasal masses in our study was nasal obstruction (75%) and nasal discharge (67.5%) followed by nasal mass (65%), epistaxis (62.5%) and headache (60%). Angiofibroma and papilloma were the commonest benign lesions. Commonest malignant lesion was squamous cell carcinoma. Of the malignant Sinonasal tumours studied in our series, maxillary sinus was involved in 13, ethmoid sinuses and nasal cavity in 10 cases each, and frontal sinuses in 2 cases. CONCLUSION Contrast enhanced computed tomography with multiplanar reconstruction is an excellent modality for imaging sinonasal masses. CT can define the character of the sinonasal mass, thus differentiating benign from malignant. CT helps better imaging of critical anatomical areas and helpful in planning treatment procedures such as surgery and radiotherapy.
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Affiliation(s)
| | - Radha Sarawagi
- Professor, Department of Radiodiagnosis, Peoples College of Medical Sciences and Research Institute , Bhopal, MP, India
| | - Sameer Raghuwanshi
- Assistant Professor, Department of Radiodiagnosis, Peoples College of Medical Sciences and Research Institute , Bhopal, MP, India
| | - Pankaj Kumar Yadav
- Associate Professor, Department of Radiodiagnosis, Gajra Raja Medical College , Gwalior, MP, India
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17
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Abstract
Hypertrophic olivary degeneration (HOD) is seen following lesions in the Guillain–Mollaret triangle. This is unique because the inferior olivary nucleus hypertrophies following degeneration unlike the typical atrophy seen in other structures. We report two cases of HOD in two different clinical scenarios.
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Affiliation(s)
- Radha Sarawagi
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Aravind Murugesan
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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18
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Govindarajan A, Sarawagi R, Prakash ML, Govindarajalou R. CT pleurogram for diagnosing an occult diaphragmatic tear. BMJ Case Rep 2015; 2015:bcr-2014-208608. [PMID: 25694642 DOI: 10.1136/bcr-2014-208608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old man road traffic accident victim, in his initial CT, showed fractures in left lower ribs, pleural effusion and splenic and pancreatic lacerations. The left pleural effusion, drained with an intercostal tube, did not show any significant reduction in size and pleural fluid amylase was abnormally high. A diaphragmatic tear was suspected. Contrast was injected through the intercostal tube and a CT was performed, which revealed a small diaphragmatic tear and communication of the pleural space with peritoneum and the pancreatic laceration site.
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Affiliation(s)
- Arunkumar Govindarajan
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, Pondicherry, India
| | - Radha Sarawagi
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, Pondicherry, India
| | - Manikka Lakshmanan Prakash
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, Pondicherry, India
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19
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Abstract
Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of self-inflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment.
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Affiliation(s)
- Garjesh Singh Rai
- Associate Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, Madhya Pradesh, India
| | - Rakesh Roshan
- Post Graduate Student, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, Madhya Pradesh, India
| | - Radha Sarawagi
- Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, Madhya Pradesh, India
| | - Mahendra Mohan Vyas
- Assistant Professor, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, Madhya Pradesh, India
| | - Deepak Goel
- Post Graduate Student, Department of Radiodiagnosis, Peoples College of Medical Science and Research Centre Bhopal, Madhya Pradesh, India
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20
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Dhanasekaran J, Reddy AK, Sarawagi R, Lakshmanan PM. Imaging features of macrodystrophia lipomatosa: an unusual cause of a brawny arm. BMJ Case Rep 2014; 2014:bcr-2014-204899. [PMID: 25406225 DOI: 10.1136/bcr-2014-204899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Macrodystrophia lipomatosa (MDL), a rare non-hereditary congenital disorder of localised gigantism, is characterised by progressive proliferation of all mesenchymal elements, with a disproportionate increase in fibroadipose tissue. We report a case of a 19-year-old man who presented with a history of painless enlargement of the left upper limb since childhood, which was gradually increasing in size and predominantly involving the radial aspect of the upper limb with relative sparing of the ulnar aspect. The patient was imaged with X-ray and MRI. Imaging and clinical features were classical of MDL. The patient underwent stage 1 reduction plasty of the left forearm; preoperative and histopathological findings confirmed the preoperative diagnosis.
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Affiliation(s)
- Jagadeesan Dhanasekaran
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, Puducherry, India
| | - Ajit Kumar Reddy
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, Puducherry, India
| | - Radha Sarawagi
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, Puducherry, India
| | - Prakash Manikka Lakshmanan
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Puducherry, Puducherry, India
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21
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Sarawagi R, Narayanan S, Lakshmanan PM, Chakkalakkoombil SV. Hirayama disease: imaging profile of three cases emphasizing the role of flexion MRI. J Clin Diagn Res 2014; 8:RD03-4. [PMID: 25300741 DOI: 10.7860/jcdr/2014/8433.4716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/10/2014] [Accepted: 04/16/2014] [Indexed: 11/24/2022]
Abstract
We report three cases of Hirayama disease, cervical flexion myelopathy presenting as unilateral or bilateral asymmetric muscular atrophy of forearm and hand involving C7 - T1 myotomes in young males. MRI revealed asymmetric cord atrophy, altered signal intensity of cord, posterior dural detachment and enlarged posterior epidural space with multiple flow voids. This article emphasizes the role of Flexion MRI in diagnosing Hirayama disease.
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Affiliation(s)
- Radha Sarawagi
- Associate Professor, Department of Radiodiagnosis, Mahatma Gandhi Medical College & Research Institute , Pillaiyarkuppam, Pondicherry, India
| | - Sathya Narayanan
- Post Graduate Trainee, Department of Radiodiagnosis, Mahatma Gandhi Medical College & Research Institute , Pillaiyarkuppam, Pondicherry, India
| | - Prakash Manikka Lakshmanan
- Professor & Head of Department, Department of Radiodiagnosis, Mahatma Gandhi Medical College & Research Institute , Pillaiyarkuppam, Pondicherry, India
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22
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Affiliation(s)
- Sathya Narayanan
- From the Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
| | - Radha Sarawagi
- From the Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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23
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Abstract
Hyperparathyroidism can be primary, secondary or tertiary depending on its aetiology. Parathyroid adenoma accounts for 80% of cases of primary hyperparathyroidism. We report a case of a 41-year-old female patient presented with severe osteoporosis and pathological fracture of right acetabulum and left intertrochanteric region. The patient had diffuse osteoporosis and multiple well-defined lytic lesions. A diagnosis of hyperparathyroidism apart from multiple myeloma and metastasis was made based on the findings of diffuse osteoporotic changes with multiple lytic lesions. A skeletal survey was performed in view of the pathological fracture of the femur; findings of the skeletal survey favoured the diagnosis of hyperparathyroidism. An ultrasound of the neck was performed to look for the cause and a parathyroid adenoma was picked up in the inferior aspect of the left lobe of the thyroid gland. CT of the neck was also performed for preoperative localisation of the lesion. Based on these findings diagnosis of primary hyperparathyroidism due to parathyroid adenoma was made. The patient underwent parathyroidectomy and perioperative and histopathological findings confirmed the preoperative diagnosis.
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Affiliation(s)
- Tsella Lachungpa
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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24
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Affiliation(s)
- Radha Sarawagi
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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25
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Abstract
A 14-year-old boy presented with upper backache and a painful swelling in the right paraspinal region for 7 days. He had no history of trauma. MRI showed a non-specific ill-defined heterogeneous lesion, which showed intense postcontrast enhancement. Ultrasonogram showed a peripheral sheet of calcification around the lesion. A CT scan showed a faint rim of calcification, which increased in thickness over weeks, confirming the diagnosis as myositis ossificans. We present our approach to the case and also review the imaging features of different stages of the disease process and their differentials.
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Affiliation(s)
- Arunkumar Govindarajan
- Department of Radiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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26
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Gupta SK, Pal DK, Tiwari R, Garg R, Shrivastava AK, Sarawagi R, Patil R, Agarwal L, Gupta P, Lahariya C. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India. J Health Popul Nutr 2012; 30:464-71. [PMID: 23304913 PMCID: PMC3763618 DOI: 10.3329/jhpn.v30i4.13416] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.
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Affiliation(s)
- Sanjeev K. Gupta
- Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road, Pillayarkuppam, Pondicherry, India
| | - Dinesh K. Pal
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Rajesh Tiwari
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Rajesh Garg
- Department of Community Medicine, VCSG Medical Sciences & Research Institute, Srikot-Ganganali, Pauri Garhwal, Uttarakhand, India
| | - Ashish K. Shrivastava
- Department of Community Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Radha Sarawagi
- Department of Radiology, Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road, Pillayarkuppam, Pondicherry, India
| | - Rajkumar Patil
- Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road, Pillayarkuppam, Pondicherry, India
| | - Lokesh Agarwal
- Department of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road, Pillayarkuppam, Pondicherry, India
| | | | - Chandrakant Lahariya
- Department of Community Medicine, GR Medical College, Gwalior, Madhya Pradesh, India
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Mani B, Sarawagi R, Cherian RA. Review of the dimensions of the median nerve and carpal tunnel using sonography in asymptomatic adults. J Med Imaging Radiat Oncol 2011; 55:126-31. [PMID: 21501400 DOI: 10.1111/j.1754-9485.2010.02225.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aims to establish the normal range of all sonologic measurements of carpal tunnel (CT) structures in an asymptomatic population. METHODS Sonological evaluation of 150 wrists in 75 asymptomatic adults was performed. The cross-sectional area (CSA) of the median nerve at four levels, the flattening ratio (FR) at three levels, the antero-posterior (AP) diameter of the CT and the distance of the transverse carpal ligament (TCL) from the trapezium-hamate (TmH) line were measured. RESULTS The mean (standard deviation (SD)) CSA of the median nerve at the distal forearm, CT inlet, mid and outlet were 6.8 (1.3), 7.4 (1.1), 7.5 (1.0), 7.1 (1.0) mm(2) , respectively. The mean (SD) FR at the CT inlet, mid and outlet were 2.66 (0.54), 2.55 (0.54), 3.69 (0.82), respectively. The mean (SD) AP diameter of the CT was 10.4 mm (1.1). Volar bowing of the retinaculum was seen in 7.3% of normal wrists. CONCLUSIONS The normal range at two SDs of the CSA of the median nerve at the inlet was 5.2-9.6 mm(2) . The upper limit of volar bowing of the flexor retinaculum was 0.8 mm. The FR overlaps with values obtained in other studies of patients with carpal tunnel syndrome. The mean AP diameter of the CT was 10.4 mm (SD 1.1). To the best of our knowledge, this is the largest study performed in an asymptomatic population assessing the different sonological parameters related to the CT.
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Affiliation(s)
- Betty Mani
- Christian Medical College, Vellore, Tamil Nadu, India.
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28
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Sarawagi R, Keshava SN, Surendrababu NRS, Zachariah UG, Eapen EC. Budd-Chiari Syndrome Complicating Hydatid Cyst of the Liver Managed by Venoplasty and Stenting. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S202-5. [DOI: 10.1007/s00270-010-9833-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 02/18/2010] [Indexed: 12/01/2022]
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Sureka J, Sarawagi R, Eapen A, Keshava SN, Vedantam R. Skull base hydatid cyst with intracranial extension presenting as vocal cord palsy: a case report. Br J Radiol 2010; 83:e67-9. [PMID: 20197432 DOI: 10.1259/bjr/21853098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
Hydatid disease of the skull base is extremely rare, and intracranial extension of hydatid cysts through the skull base is even rarer. We report an interesting case of a 42-year-old man who presented with features of right vocal cord palsy. The diagnosis of hydatid cyst was made based on his history and on pre-operative MRI and was confirmed by surgery and histopathological examination.
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Affiliation(s)
- J Sureka
- Christian Medical College, Vellore, Tamilnadu, India.
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30
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Rehman TA, Gibikote S, Ilango N, Thaj J, Sarawagi R, Gupta A. Bifid mandibular condyle with associated temporomandibular joint ankylosis: a computed tomography study of the patterns and morphological variations. Dentomaxillofac Radiol 2009; 38:239-44. [PMID: 19372112 DOI: 10.1259/dmfr/12945701] [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: 11/05/2022] Open
Abstract
OBJECTIVES Bifid mandibular condyle (BMC) with associated temporomandibular joint ankylosis (TMJA) is extremely rare with only four cases reported. We present the first case series of BMC with TMJA in an attempt to elucidate the morphological pattern in this rare condition. METHODS Retrospective examination of CTs over a period of 6 years revealed 37 patients with TMJA, of whom 10 had BMC. Clinical and CT features of these were analysed. Patients were grouped according to sides of involvement and orientation of condyles. RESULTS The male:female ratio was 1:1. Nine were post-traumatic and one post-infectious. The aetiology was sustained in childhood in all patients. Six patients had unilateral BMCs and four had bilateral. One patient had bilateral BMCs with bilateral TMJA. This was anteroposterior (AP) in orientation. Three patients had bilateral BMCs with unilateral TMJA, among which one was AP and two mediolateral (ML). Six patients had unilateral BMC with ipsilateral TMJA; all of the ML anterior condylar process was ankylosed in joints with AP BMC and TMJA. Lateral condylar process was ankylosed in post-traumatic ML BMC with TMJA, while the medial condylar process ankylosed in the post-infectious patient. In general, ankylosed heads were found to be larger, sclerotic and often mushroom shaped compared with non-ankylosed heads. CONCLUSIONS This series attempts to elucidate patterns of ankylosis and CT morphology in BMC with associated TMJA. Also included are hitherto unreported cases such as bilateral AP BMC with TMJA and post-infectious BMC with TMJA.
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Affiliation(s)
- T A Rehman
- Department of Radiology, Christian Medical College, Vellore, India.
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Sarawagi R, Anderson GA, Cherian R. Fibrolipomatous hamartoma of the median nerve presenting with carpal tunnel syndrome. Neurol India 2009; 57:361-2. [DOI: 10.4103/0028-3886.53264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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