A rare case of Mayer–Rokitansky–Kuster–Hauser syndrome with right ectopic kidney diagnosed on MRI

Introduction

Meyer–Rokitansky–Küster–Hauser syndrome is rare congenital abnormality in females with a blind ending vagina. There can be associated hypoplasia of uterus. The syndrome is of sporadic origin and affects the reproductive life. Adequate and early diagnosis can help to rule out other associated anomalies.

Case presentation

We are presenting an interesting case of Mullerian agenesis in a 16-year-old female patient who came to our gynecology department of our hospital with complaints of primary amenorrhea. On imaging, it was found that she was a case of Mayer–Rokitansky–Küster–Hauser syndrome with ectopic kidney. On physical examination, affected individuals appear normal but there was agenesis of uterus which is the common cause of primary amenorrhea. Magnetic resonance imaging findings are discussed in this article. On karyotyping and hormonal evaluation, patient hormones were in range and karyotype was 46, XX.

Conclusion

MRI is mainstay for diagnosis of this condition although other modalities like ultrasound can diagnose hypoplastic uterus and ectopic kidney. A rudimentary uterus hampers the reproductive functioning, and patient needs counseling for the same.

An unusual case report on intracranial hydatid cyst with intraventricular extension

Background

We report an interesting case of a primary isolated intraventricular and intracranial hydatid cyst in 20-year-old female that mimicked bleeding cystic tumor presenting as intraventricular hemorrhage with hydrocephalus.

Case presentation

Patient presented with headache and giddiness for 1 month. On magnetic resonance imaging, there was multiloculated multi-cystic lesion in left lateral ventricle and adjacent left periventricular deep white matter. Lesion was causing compression of the body of the left lateral ventricle with temporal horn dilatation and midline shift of 17–18 mm toward right side. On investigation, it was diagnosed intracranial hydatid cyst with intraventricular extension. Patient underwent complete removal of cerebral hydatid cyst. Follow-up postoperative computed tomography scan done which revealed no residual hydatid cyst.

Conclusion

In this case, larvae of echinococcus might have passed through capillaries of liver and lungs and entered systemic circulation reaching brain. Intracerebral hydatid cysts are rare and hence, dangerous if the diagnosis and treatment is not prompt. Intracerebral hydatid cysts have slow growth rate with late-stage symptoms, morbidity and mortality are high. So, take home message is whenever intracranial cystic lesion are found on magnetic resonance imaging hydatid cyst with possible intracranial extension should be considered in differential diagnosis.

Clinico-radiological evaluation and management of type II radial ray defect in a young female from rural India: case report

Radial Ray Defect (RRD) is a rare disorder, and the etiology of this disorder is still under discussion. RRD is associated with many medical conditions for which prenatal counselling is of paramount importance. Any association with the family history is still unknown. The patient is a 16-year-old female who came to the orthopaedic clinic complaining of tingling and weakness in the right forearm. On examination, there was a gross deformity in the right forearm with radial deviation of the hand. An X-ray revealed radial ray defect type-2. She previously had a history of perinatal infection during early childhood. Surgery was successfully achieved, and positive results were accomplished. Radial Ray Defect can be focal or associated with other clinical manifestations. The timing of antenatal ultrasound for detecting this musculoskeletal anomaly is crucial. When RRD is associated with other syndromes, counselling to the parents about the quality of life and morbidity comes into play. Treatment is primarily surgical.

Multi-Detector Computed Tomography for Evaluating Characteristics, Distribution and Extension of Mediastinal Masses

Background: The area in the thorax between the lungs is Mediastinum which is surrounded above by thoracic inlet, in front by sternum, below by diaphragm, back by vertebral column laterally by pleura of both lungs. Multiple classification systems are used by doctors. Shields classification system is most commonly used, however the conventional Fraser and Paré, Felson, and other categorization are in daily use in radiology. The present schemes used in practice of radiology is more of nonanatomic divisions based primarily on the chest radiograph. So a typical classification based on multi detector CT is demanded to describe mediastinum and make to the purpose differential diagnoses. This study aims to assess characteristics, distribution and extension of Mediastinal masses by MDCT and correlate the histopathological diagnosis to CT scan findings. Methodology: This will be a prospective study conducted at AVBRH, Wardha. Total 100 patients with Mediastinal Masses diagnosed clinically and on Chest X ray will be enrolled in the study. Contrast CT scan of all patients will be done. Histopathology reports of masses (FNAC/Biopsy) will be collected. Results: Significant accuracy of mediastinal CT in diagnosing the mediastinal masses and a significant corelation to FNAC/biopsy reports is expected. Conclusion: MDCT will prove to be an useful evaluation method for diagnosis and classification of mediastinal masses.

Transvaginal Sonoelastography on Benign Masses of Cervix

Cervix is the lowermost portion of the uterus. Benign pathologies of the uterus mostly occur in women falling under the conceptive age profile. Frequently exhibited symptoms are excessive bleeding, menorrhagia and pain during menstruation or coitus. Sonoelastography in comparison to the sonography alone is a rather recent development and is easily affordable and available. This makes it ideal for use as a first – look diagnostic tool to determine the nature of the cervical mass without unnecessary invasive or expensive examinations. There is an urgent need for early differentiation of benign masses from malignant ones as it impacts the type of treatment administered, its efficacy, prognosis, and lifestyle post-treatment. This review aims to evaluate the accuracy of transvaginal sonography in correctly diagnosing benign masses of cervix from malignancy, and thus gives an overview of the evolution of its application in routine clinical practice. As seen in the review, only studies performing strain elastography have been taken into consideration with strain ratio being a focal point as this is a quantifiable unit, used for measurement of tissue elasticity. This gives us comparable results regarding the diagnostic precision of transvaginal elastography in cervical masses. Gold standard is used is histopathological diagnosis.

A case report on aggressive giant cell tumor of greater trochanter: a divergent site

Background

Giant cell tumor is a tumor of benign nature which usually arises in the long bone, but it can also be seen at unusual sites. Only few cases have been reported so far regarding involvement of greater trochanter of the femur as it is a very divergent site for giant cell tumors; our case is one of them. Giant cell tumors are seen in 20–40 years of age in the metaepiphyseal regions of the long bones. If femur has to be involved, it is in the distal end usually.

Case presentation

We present a case of a 45-year-old female with chief complains of swelling and left hip pain since over a month. Magnetic resonance imaging was done where the location and extent of the tumor was found. What makes this case interesting is that on fine needle aspiration cytology the lesion showed multinucleated giant osteoclasts in the background of osseous matrix of spindle cells suggesting Giant cell tumor.

Conclusion

It is sometimes tricky to make a diagnosis of these lesions on imaging as the typical features may not be present, and hence, in such circumstances helping the clinicians with additional information like location, extent, margins is of utmost importance.

MRI Evaluation of Seizures in Pediatric Age Group Patients in a Rural Hospital of Central India

Background: Seizures are a common presenting complaint in pediatric patients. There are many underlying causes which may present as seizures in pediatric population, for example: febrile seizures, hypoxic ischemic encephalopathy, congenital malformations, certain neoplasms etc. Magnetic resonance imaging(MRI) plays a fundamental role in evaluation of these causes and is especially of use in identifying the structural lesions presenting as seizures. Objectives: To assess the role of MRI(1.5 Tesla) in evaluation pediatric seizures and to study spectrum of MRI findings associated with various causes. Methodology: A prospective study will be conducted at “Acharya Vinoba Bhave Rural Hospital, Sawangi”, involving 138 pediatric patients coming to Radiology department. Results: After statistical analysis, we expect to find effectiveness of MRI in evaluation of pediatric seizures. Conclusion: In this study we expect to find usefulness of MRI as a diagnostic tool in assessment of pediatric seizures especially in those with structural lesions.

Atlanta Classification for Acute Pancreatitis- A Study Protocol

Background: Acute pancreatitis is one of the most common abdominal pathologies having variable outcome ranging from self limiting abdominal pain to high mortality and morbidity due to organ failure, over the past five decades, various classification systems have emerged to classify pancreatitis according to its severity , and the associated complications have emerged to classify acute pancreatitis and its various complications, such as Apache Scoring , Ct Severity , Modified Ct Severity ,Ransen  and Atlanta Classification. Objectives: We in our study will be classifying patients suffering from acute pancreatitis according to the revised Atlanta classification to divide them into interstitial edematous pancreatitis and necrotizing pancreatitis. The local complications will be classified according to CT imaging findings into acute necrotic collection, psuedocyst, acute necrotic collection and walled of necrosis. Organ failure will be assessed according to modified marshal scoring system into transient or persistent organ failure. Methodology: We will be carrying forward our study on   Siemens 16 slice computer tomography machine over a sample of 140 patients coming to the outpatient department of our hospital which will be followed by a routine clinical follow up of the patient to find out their prognosis. Results: Will be tabulated at the end of the study using SPSS version 26 software. Conclusion: The revised Atlanta classification for acute pancreatitis, in conjunction with the Modified Marshall Scoring System for organ failure, if found useful, in our series in improving the prognosis of the patients, then it can be incorporated in management.