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Mahal S, Yadav T, Panda S, Garg PK, Khera PS, Tiwari S. Multimodality imaging in cerebral venous thrombosis: a synopsis for emergency radiologist. Jpn J Radiol 2024; 42:437-449. [PMID: 38212513 DOI: 10.1007/s11604-023-01522-y] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/02/2023] [Indexed: 01/13/2024]
Abstract
Cerebral venous thrombosis (CVT) is an uncommon but potentially fatal condition which presents with a wide range of symptoms. Some of these presenting features are vague thus contributing to the delay in diagnosis. A prompt diagnosis and initiation of appropriate therapy are therefore of paramount importance. In this pictorial, we have tried to illustrate the direct and indirect imaging features of CVT in detail on multiple imaging modalities, along with the potential pitfalls of imaging.
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Affiliation(s)
- Sayani Mahal
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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Sharma S, Sureka B, Varshney V, Soni S, Yadav T, Garg PK, Khera PS. MDCT evaluation of Dorsal Pancreatic Artery and Intrapancreatic arcade anatomy. Surg Radiol Anat 2023; 45:1471-1476. [PMID: 37638995 DOI: 10.1007/s00276-023-03235-3] [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: 12/29/2022] [Accepted: 08/12/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE The purpose of the study was to analyze the anatomy and variations in the origin of the dorsal pancreatic artery, greater pancreatic artery and to study the various types of arterial arcades supplying the pancreas on multidetector CT (MDCT). METHODS A retrospective analysis of 747 MDCT scans was performed in patients who underwent triple phase or dual phase CT abdomen between December 2020 and October 2022. Variations in origin of Dorsal pancreatic artery (DPA), greater pancreatic artery (GPA), uncinate process branch were studied. Intrapancreatic arcade anatomy was classified according to Roman Ramos et al. into 4 types-small arcades (type I), small and large arcades (type II), large arcades (type III) and straight branches (type IV). RESULTS The DPA was visualized in 65.3% (n = 488) of cases. The most common origin was from the splenic artery in 58.2% (n = 284) cases. The mean calibre of DPA was 2.05 mm (1.0-4.8 mm). The uncinate branch was seen in 21.7% (n = 106) with an average diameter of 1.3 mm. The greater pancreatic artery was seen in 57.3% (n = 428) predominantly seen arising from the splenic artery. The most common arcade anatomy was of Type II in 52.1% (n = 63) cases. CONCLUSION Pancreatic arterial variations are not very uncommon in daily practice. Knowledge of these variations before pancreatic surgery and endovascular intervention procedure is important for surgeons and interventional radiologist.
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Affiliation(s)
- Shaurya Sharma
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.
| | | | - Subhash Soni
- Department of Surgical Gastroenterology, AIIMS, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Pawan Kumar Garg
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
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Gupta P, Madhusudhan KS, Padmanabhan A, Khera PS. Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis. Indian J Radiol Imaging 2022; 32:339-354. [PMID: 36177275 PMCID: PMC9514912 DOI: 10.1055/s-0042-1754313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AbstractAcute pancreatitis (AP) is one of the common gastrointestinal conditions presenting as medical emergency. Clinically, the severity of AP ranges from mild to severe. Mild AP has a favorable outcome. Patients with moderately severe and severe AP, on the other hand, require hospitalization and considerable utilization of health care resources. These patients require a multidisciplinary management. Pancreatic fluid collections (PFCs) and arterial bleeding are the most important local complications of pancreatitis. PFCs may require drainage when infected or symptomatic. PFCs are drained endoscopically or percutaneously, based on the timing and the location of collection. Both the techniques are complementary, and many patients may undergo dual modality treatment. Percutaneous catheter drainage (PCD) remains the most extensively utilized method for drainage in patients with AP and necrotic PFCs. Besides being effective as a standalone treatment in a significant proportion of these patients, PCD also provides an access for percutaneous endoscopic necrosectomy and minimally invasive necrosectomy. Endovascular embolization is the mainstay of management of arterial complications in patients with AP and chronic pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the percutaneous management of complications of pancreatitis.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aswin Padmanabhan
- Division of Clinical Radiology, Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sureka B, George T, Garg MK, Banerjee M, Deora S, Sukhla R, Goel A, Garg PK, Yadav T, Khera PS. Cutoff values of body fat composition to predict metabolic risk factors with normal waist circumference in Asian Indian population. Eur Radiol 2022; 33:711-719. [DOI: 10.1007/s00330-022-09009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
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Deora S, Sharma SK, Choudhary R, Kaushik A, Garg PK, Khera PS, Singh K, Shah S, Patel TM. Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization. Indian Heart J 2022; 74:322-326. [PMID: 35728657 PMCID: PMC9453060 DOI: 10.1016/j.ihj.2022.06.007] [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: 03/25/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background The distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery. Methods Total of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization. Results The mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p < 0.001). Females had significantly smaller radial artery diameter as compared to males at right conventional access site (2.42 ± 0.36 mm vs 2.60 ± 0.34 mm; p < 0.001) and distal access site (2.09 ± 0.38 mm vs 2.27 ± 0.39 mm; p < 0.001). The diameter of the right dRA was not significantly correlated with age (r2 linear = 0.002, p = 0.0475) but was positively correlated with height and weight (r2 linear = 0.076, p = <0.001 and r2 linear = 0.005, p = <0.001) and negatively correlated with BMI (r2 linear = 0.076, p = 0.519). Conclusions This study has shown the size of right dRA 2.27 + 0.39 mm in males and 2.09 + 0.38 mm in females. Diabetes, hypertension, height and weight are important predictors of dRA diameter.
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Affiliation(s)
- Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Shubham Kumar Sharma
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Choudhary
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Atul Kaushik
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjay Shah
- Department of Cardiology, Smt NHL Medical College & Apex Heart Institute, Ahmedabad, Gujarat, India
| | - Tejas M Patel
- Department of Cardiology, Smt NHL Medical College & Apex Heart Institute, Ahmedabad, Gujarat, India
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Khera PS, Garg PK, Yadav T, Tiwari S, Ghosh TS, Sureka B, Rajagopal R. Emergency Uterine Bleeding: A Pictorial Essay of Imaging and Endovascular Management. Curr Probl Diagn Radiol 2022; 51:858-867. [DOI: 10.1067/j.cpradiol.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022]
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Saxena S, Tiwari S, Khera PS, Midha NK. Bright Tongue Sign in Amyotrophic Lateral Sclerosis. Neurol India 2022; 70:824-825. [PMID: 35532680 DOI: 10.4103/0028-3886.344609] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Suvinay Saxena
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naresh K Midha
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Biswas S, Sureka B, Kaushal D, Elhence P, Goyal A, Yadav T, Goel A, Khera PS. American college of radiology thyroid imaging reporting and data system score has high diagnostic value in the diagnosis of malignant thyroid nodules: A prospective single-center cross-sectional study. Ann Afr Med 2022; 21:377-382. [PMID: 36412338 PMCID: PMC9850886 DOI: 10.4103/aam.aam_123_21] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction A palpable thyroid swelling is a very common finding and is seen in almost 12% of Asian Indian population. Thyroid imaging reporting and data system (TI-RADS) can be used as a risk stratification system to determine malignant or benign thyroid nodules and necessity of further intervention. Objective The objective of this study was to determine the positive predictive value (PPV) of TI-RADS category/ultrasound using TI-RADS categories in the diagnosis of malignancy in clinically suspected thyroid nodule and necessity for further intervention in the case of malignant thyroid nodules. Materials and Methods We conducted a prospective study evaluating 110 patients (140 thyroid nodules) from March 2018 to April 2020 including patients with thyroid swelling. Ultrasound was performed by a radiologist on the patients, and targeted fine-needle aspiration cytology from thyroid nodules was interpreted by an experienced pathologist. Ultrasound features and TI-RADS category were compared with cytology and surgical histopathology. Sensitivity, specificity, PPV, and positive likelihood ratio in different categories of TI-RADS nodules were calculated. Results A total of 113 thyroid nodules were assessed. Out of 113 nodules (right lobe - 64, isthmus - 6, and left lobe - 43), 84 nodules were benign and 29 nodules were malignant. Eleven (10%) patients were found to have metastatic cervical lymphadenopathy. There was no significant difference in the occurrence of malignant nodules according to gender, location of the nodule, or size of the nodule. The mean anteroposterior and transverse diameter of benign nodule was 14.1 ± 6.9 mm and 20.9 ± 9.9 mm, respectively, whereas in the case of malignant nodules, it was 15.6 ± 7.1 mm and 19.5 ± 9.0 mm, respectively. A TI-RADS score of ≥4 had 84% PPV for malignancy. The PPV for malignancy was 32.2%, 49.1%, and 100% for TI-RADS 2, 3, and 5 categories. Conclusion TI-RADS is a simple, practical, and cost-effective tool for assessing the malignancy rates of thyroid nodules. TI-RADS categories 4 and 5 have high PPV for malignancy in thyroid nodules.
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Affiliation(s)
- Souvik Biswas
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Binit Sureka, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan, India. E-mail:
| | - Darwin Kaushal
- Department of E.N.T. Otorhinolaryngology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Amit Goyal
- Department of E.N.T. Otorhinolaryngology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Akhil Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
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Yadav T, Tiwari S, Gupta A, Garg PK, Khera PS, Rajagopal R, Goyal A, Soni K, Chugh A, Jain V, Sureka B, Elhence P, Misra S. Magnetic Resonance Imaging in Coronavirus Disease - 2019 Associated Rhino-Orbital-Cerebral Mucormycosis (CA-ROCM) - Imaging Analysis of 50 Consecutive Patients. Curr Probl Diagn Radiol 2022; 51:112-120. [PMID: 34802841 PMCID: PMC8564981 DOI: 10.1067/j.cpradiol.2021.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/02/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19. High clinical suspicion and prompt imaging are crucial for early diagnosis and management. Our study evaluates imaging characteristics of patients with COVID-19 associated Rhino-orbital-cerebral Mucormycosis (CA-ROCM) in a tertiary care hospital in India. MATERIALS AND METHODS A retrospective analysis of clinical and imaging data of patients with CA-ROCM who presented between December 2020 to June 2021 was performed. All patients had microbiologically or histologically proven sino-nasal mucormycosis along with documented SARS-CoV-2 positive RT-PCR test and/or classical lung imaging features of COVID-19 infection. The extent of sinus involvement, bony erosions, extra-sinus soft tissue extension, orbital-intracranial invasion, perineural spread, and vascular complications were assessed. RESULTS Fifty patients were included for the final analysis. Diabetes was the most common associated comorbidity. Seven patients presented with stage I disease, 18 patients with stage II, and 25 patients with stage III disease. The stage of disease showed a positive statistical correlation with HbA1c levels using Pearson's correlation. The common imaging features were "Black turbinate sign" and nonenhancing sino-nasal mucosa (82%), orbital involvement (76%), and diffusion restriction in the optic nerve (24%). Intracranial involvement was seen as perineural extension into the brain (42%), cerebritis (30%), and internal carotid artery involvement (16%). CONCLUSIONS CA-ROCM is an acute invasive fungal sinusitis with an aggressive clinical course. Black-turbinate sign and peri-antral soft tissue infiltration are early features, whereas extra-nasal tissue infarction, optic nerve diffusion restriction, and vascular invasion are seen with advanced disease.
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Affiliation(s)
- Taruna Yadav
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Reprint requests: Dr. Sarbesh Tiwari MD., DM, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences-Jodhpur, Rajasthan 342008
| | - Aanchal Gupta
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rengarajan Rajagopal
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amit Goyal
- Department of E.N.T.-Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kapil Soni
- Department of E.N.T.-Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Professor Department of Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Islam GMN, Yadav T, Khera PS, Sureka B, Garg PK, Elhence P, Puranik A, Singh K, Singh S. Abbreviated MRI in patients with suspected acute appendicitis in emergency: a prospective study. Abdom Radiol (NY) 2021; 46:5114-5124. [PMID: 34379149 DOI: 10.1007/s00261-021-03222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the diagnostic performance of an abbreviated non-contrast MRI protocol in diagnosing acute appendicitis. METHODS Prospectively, a total of 67 consenting consecutive patients with clinical suspicion of acute appendicitis (Alvarado score ≥ 5) were evaluated with an abbreviated three-sequence non-contrast MRI protocol (axial T2WI, coronal T2WI, axial DWI) at a single tertiary care center. MRI was interpreted by two radiologists blinded to the clinical details, other investigations, and outcome of the patients. Diagnostic performance of MRI was determined using either histopathological examination (HPE) results as the reference standard in surgical cases (n = 39), or final clinical diagnosis at discharge and 3-months follow-up in non-operatively managed cases (n = 28). RESULTS Sixty-seven patients comprising 42 males, 25 females including 1 pregnant patient were enrolled (median age 24 years; age range 6-70 years). The median acquisition duration of the MRI protocol was 12.5 min. In the analysis of the complete cohort including both surgical and non-operatively managed cases (n = 67), MRI showed sensitivity of 93.3% (95% CI 81.7-98.6%), specificity of 86.4% (95% CI 65.1-97.1%), and diagnostic accuracy of 91.0% (95% CI 81.5-96.6%) (p < 0.001). In the subset of surgical cases with HPE as the reference standard (n = 39), MRI showed sensitivity of 97.1% (95% CI 84.7-99.9%), specificity of 100% (95% CI 47.8-100%), and diagnostic accuracy of 98% (95% CI 87.5-100%) (p < 0.001). CONCLUSION MRI may be performed to diagnose acute appendicitis or alternative causes of right iliac fossa pain. An abbreviated MRI protocol consisting of only three sequences without IV contrast, patient preparation, or antiperistaltic agents could shorten the examination duration while retaining diagnostic accuracy.
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Abstract
Introduction: Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management. Materials and Methods: The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India. It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients. Results: The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28–57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant. Conclusion: This study recommends the trans-sacro-coccygeal “needle inside needle” technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.
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Affiliation(s)
- Nitesh Gonnade
- Department of Physical Medicine and Rehabilitation, AIIMS, Jodhpur, Rajasthan, India
| | - Neeraj Mehta
- Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Dewesh Kumar
- Department of Community and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Rengarajan Rajagopal
- Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
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Abstract
OBJECTIVES Evaluation of remdesivir, an RNA polymerase inhibitor, for effectiveness in adults with COVID-19. DATA SOURCES Electronic search for eligible articles of PubMed, Cochrane Central and clinicaltrials.gov was performed on 20 September 2020. PARTICIPANTS AND STUDY ELIGIBILITY CRITERIA Only randomised controlled trials (RCTs) evaluating efficacy of remdesivir in COVID-19 were included for meta-analysis. INTERVENTIONS Remdesivir was compared with standard of care. PRIMARY AND SECONDARY OUTCOMES Primary outcome was mortality and secondary outcomes were time to clinical improvement and safety outcomes like serious adverse events, respiratory failure. STUDY APPRAISAL AND SYNTHESIS METHODS Data synthesis was done with Cochrane review manager 5 (RevMan) V.5.3. Cochrane risk of bias V.2.0 tool was used for methodological quality assessment. The GRADE pro GDT was applied for overall quality of evidence. RESULTS 52 RCTs were screened and 4 studies were included in analysis, with total of 7324 patients. No mortality benefit was observed with remdesivir versus control group (OR=0.92 (95% CI 0.79 to 1.07), p=0.30, moderate quality evidence). Significantly higher rates of clinical improvement (OR=1.52 (95% CI 1.24 to 1.87), p<0.0001, low quality) and faster time to clinical improvement (HR=1.28 (95% CI 1.12 to 1.46), p=0.0002, very low quality) was observed with remdesivir versus control group. Significant decrease was found in the risk of serious adverse events (RR=0.75 (95% CI 0.62 to 0.90), p=0.0003, low quality); however, no difference was found in the risk of respiratory failure (RR=0.85 (95% CI 0.41 to 1.77), p=0.67, very low quality evidence) with remdesivir. CONCLUSIONS As per the evidence from current review, remdesivir has shown no mortality benefit (moderate quality evidence) in the treatment of COVID-19. From a cost-benefit perspective, it is our personal opinion that it should not be recommended for use, especially in low and lower middle income countries. TRIAL REGISTRATION NUMBER PROSPERO registration number: CRD42020189517.
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Affiliation(s)
- Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences, New Delhi, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Kumar Chugh
- Department of Dentistry, All India Institute of Medical Sciences, New Delhi, India
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Sureka B, Tiwari S, Garg PK, Yadav T, Khera PS, Tak V, Misra S. COVID-19 pandemic: Cleaning and disinfection - What should the radiologist know? Indian J Radiol Imaging 2021; 31:S207-S211. [PMID: 33814786 PMCID: PMC7996686 DOI: 10.4103/ijri.ijri_334_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
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Sureka B, Jha S, Yadav A, Varshney V, Soni S, Vishnoi JR, Yadav T, Garg PK, Khera PS, Misra S. MDCT evaluation of pancreatic contour variations in head, neck, body and tail: surgical and radiological significance. Surg Radiol Anat 2021; 43:1405-1412. [PMID: 33738524 DOI: 10.1007/s00276-021-02735-4] [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: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. METHODS A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head-neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body-tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. RESULTS The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%). CONCLUSION Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.
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Affiliation(s)
- Binit Sureka
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.
| | - Satya Jha
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Arushi Yadav
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.,Department of Radiodiagnosis, GMC Chandigarh, Chandigarh, India
| | | | - Subhash Soni
- Department of Surgical Gastroenterology, AIIMS, Jodhpur, India
| | | | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Pawan Kumar Garg
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | | | - Sanjeev Misra
- Department of Surgical Oncology, AIIMS, Jodhpur, India
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Affiliation(s)
- T S Ghosh
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - S Tiwari
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P K Garg
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P S Khera
- Department of Diagnostic and Interventional RadiologyAll India Institute of Medical Sciences, JodhpurRajasthan, India
| | - P Elhence
- Department of PathologyAll India Institute of Medical Sciences, Jodhpur Rajasthan, India
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Yadav K, Sureka B, Elhence P, Choudhary GR, Pandey H, Garg PK, Yadav T, Khera PS. Can combined multiparametric magnetic resonance imaging of the prostate and prostate-specific antigen density improve the detection of clinically significant prostate cancer: A prospective single-center cross-sectional study. J Cancer Res Ther 2021; 17:372-378. [PMID: 34121679 DOI: 10.4103/jcrt.jcrt_216_20] [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] [Indexed: 11/04/2022]
Abstract
Objective The objective of the study was to validate PIRADS v2 on 3T MRI with secondary assessment if combination of the PIRADS v2 and PSA density improves detection of clinically significant prostate cancer. Materials and Methods We conducted a prospective study evaluating 58 patients with PSA value of >4 ng/ml from July 2017 to December 2019. Transrectal ultrasonography (TRUS) guided targeted biopsy was performed via cognitive targeting followed by systemic 12 core biopsy. Two cognitive fusion-targeted biopsy cores were added for each lesion in patients who had suspicious or equivocal lesions on mpMRI. The PI-RADS scoring system version 2.0 (PI-RADS v2) was used to describe the MRI findings. Results Total of 112 lesions of 58 patients were assessed via mpMRI followed by TRUS guided biopsy. A PI-RADS v2 score of ≥4 irrespective of PSA density categories and a PI-RADS v2 score of 3 with PSA density of ≥0.15 ng/mL/cc, yielded the highest overall prostate cancer and clinically significant prostate cancer detection rate. Contrary to, a PI-RADS v2 score of ≤3 and a PSA densitay of <0.15 ng/ mL/mL(low risk group), which yielded no clinically significant prostate cancer. Conclusion Both PIRADS v2 score and PSA density are eminently sensitive and specific in the detection of clinically significant prostate cancers individually. However the combination of PIRADS v2 and PSA density significantly improved the accuracy of clinically significant prostate cancer detection. Patients with combination of PIRADS v2 score 33 and PSA density 30.15 ng/ml/cc should undergo prostate biopsy.
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Affiliation(s)
- Kuldeep Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sureka B, Garg PK, Khera PS, Sinha A, Misra S. Rationalizing personal protective equipment (PPE) in radiology in the time of COVID-19. Indian J Radiol Imaging 2021; 31:S204-S206. [PMID: 33814785 PMCID: PMC7996676 DOI: 10.4103/ijri.ijri_443_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/29/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- Department of Professor Pediatric Surgery and Medical Superintendent, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Department of Professor Surgical Oncology, Director and CEO, All India Institute of Medical Sciences, Basni, Jodhpur, Rajasthan, India
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Tiwari S, Yadav T, Pamnani J, Shukla K, Rao M, Gosal JS, Garg P, Khera PS. Primary Spinal Epidural Extraosseous Ewing's Sarcoma with Brachial Plexus Infiltration. Asian J Neurosurg 2020; 15:1068-1071. [PMID: 33708691 PMCID: PMC7869268 DOI: 10.4103/ajns.ajns_138_20] [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: 04/05/2020] [Revised: 07/01/2020] [Accepted: 09/03/2020] [Indexed: 11/11/2022] Open
Abstract
The Ewing's sarcoma family of tumors are aggressive malignant small round blue cell tumors of undifferentiated mesenchymal origin. Skeletal Ewing's sarcoma is a common entity that classically involves the diaphysis of the long bones, pelvis, ribs, and sacrum. Extraosseous Ewing's sarcoma (EES) is rare, most commonly presenting as a paravertebral mass lesion. Its manifestation as an anterior epidural mass lesion with extension along brachial plexus is an even rarer phenomenon. A 25-year-old male presented with neck stiffness and progressive weakness of the bilateral upper and lower limbs. Magnetic resonance imaging of the cervical spine revealed an anterior epidural mass lesion compressing the cervical cord and extending along the right brachial plexus, suggesting imaging differentials of EES and lymphoma. The patient underwent laminectomy with gross tumor resection, and histopathology confirmed a diagnosis of EES. EES should be kept in the differential diagnosis of anterior epidural mass lesions in young adults, specifically when the lesion shows extension along multiple neural foramina and nerve plexus.
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Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaya Pamnani
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kartikeya Shukla
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Garg PK, Patel S, Sharma AK, Khera PS. Retrograde radial arteriovenous fistula, post coronary artery intervention. J Card Surg 2020; 35:2350-2352. [PMID: 32667071 DOI: 10.1111/jocs.14869] [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: 06/11/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Radial arteriovenous fistula (AVF) post coronary artery intervention is rare. METHODS AND CONCLUSION Here we describe an extremely rare case of radial AVF with retrograde filling through the deep palmar arch and presenting as early ischemic changes.
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Affiliation(s)
- Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surendra Patel
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Alok Kumar Sharma
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tiwari S, Garg PK, Khera PS, K.B SB, Yadav T, Sureka B. Delayed Spontaneous Thrombosis of Neglected Direct Carotid-Cavernous Fistula: A Case Report. Neurointervention 2020; 15:96-100. [PMID: 32550712 PMCID: PMC7412658 DOI: 10.5469/neuroint.2020.00094] [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: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022] Open
Abstract
Direct carotid-cavernous fistula (CCF) refers to direct communication between the cavernous portion of the internal carotid artery (ICA) and the cavernous sinus due to rent in the ICA, most commonly secondary to trauma. These are generally high-flow fistula and rarely resolve spontaneously. We report a case of a young male who developed features of direct CCF after trauma, was denied any treatment for 4 years, and then presented with spontaneous thrombosis of the fistula and a residual large pseudoaneurysm of the cavernous segment of the right ICA, which was subsequently managed with parent vessel occlusion.
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Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India,Correspondence to: Pawan Kumar Garg, MD Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan-342008, India Tel: +91-8003995327 E-mail:
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Santosh Babu K.B
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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Sharma S, Dixit SG, Khera PS, Nayyar AK, Ghatak S. Morphometric evaluation of Anterior Cerebral Artery (on Digital Subtraction Angiography)-Potential implications. Morphologie 2020; 104:109-116. [PMID: 31351808 DOI: 10.1016/j.morpho.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of the present study was to perform a morphometric analysis of ACA and to establish significant differences, if any, with sex and age via Digital Subtraction Angiography (DSA). METHODS This cross-sectional study was conducted on 70 patients (>20 years) for the evaluation of ACA by Digital Subtraction Angiography done on a Philips biplane system clarity (Allura FD20/20). Length and diameter of ACA were taken manually on the DSA console using auto-calibration. Statistical analysis was done. RESULT Mean diameter and length of ACA was found to be greater in female. The f-ratio value for diameter and length of the same was 1.43 and 0.92 respectively. The length of ACA was found to be statistically significant for different age groups. The mean length of ACA followed a decreasing trend with age, whereas mean diameter of ACA was nearly the same in all the age groups. CONCLUSION The results of our study show that the length of ACA was found to be statistically significant for different age groups.
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Affiliation(s)
- S Sharma
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - S G Dixit
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India.
| | - P S Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - A K Nayyar
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
| | - S Ghatak
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India
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Ahmed S, Tiwari S, Yadav T, Khera PS, Garg P, Sureka B, Budania A, Singh S. Parry Romberg syndrome: Imaging features in 4 consecutive cases and review of literature. J Clin Neurosci 2020; 76:249-253. [PMID: 32317188 DOI: 10.1016/j.jocn.2020.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/30/2020] [Accepted: 04/05/2020] [Indexed: 02/07/2023]
Abstract
Parry Romberg syndrome (PRS) is a distinct sporadic self-limiting entity comprising progressive hemi- atrophy of the face with predisposition to affect the skin, subcutaneous tissue and in some cases deeper extension to the cartilage, osseous structures and musculature (Wong et al., 2015; Aydın et al., 2015; Sharma et al., 2012) [1-3]. Neurologic and ocular involvement is variable as is the progression of this entity. With a multitude of aetiologies ranging from autoimmune to infectious this syndrome is a diagnosis of exclusion, with a highly variable prognosis, drawing the amusement of radiologists and clinicians. Radiological assessment and subsequent diagnosis of this entity can aid in alleviating the lifestyle hampering progression of this disease process. We hereby report 4 cases of this syndrome and aim to describe the varied radiological presentations of this entity with concise review of literature.
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Affiliation(s)
- Sabha Ahmed
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India.
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Binit Sureka
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Anil Budania
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
| | - Saurabh Singh
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur 342008, Rajasthan, India
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Tiwari S, Garg PK, Patavardhan P, Chauhan NK, Bhaskar S, Khera PS. Pseudo-subarachnoid Hemorrhage in a Patient with Acute on Chronic Respiratory Failure. Ann Indian Acad Neurol 2020; 23:706-708. [PMID: 33623278 PMCID: PMC7887467 DOI: 10.4103/aian.aian_257_20] [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: 04/05/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Pawan Kumar Garg, Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India. E-mail:
| | - Preetham Patavardhan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Yadav T, Mirza G, Khera PS, Garg P. Macrodystrophia lipomatosa with fibrolipomatous hamartoma of medial plantar nerve and lipomatosis of thigh. Sudan J Paediatr 2020; 20:62-67. [PMID: 32528203 PMCID: PMC7282426 DOI: 10.24911/sjp.106-1570297771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/06/2019] [Accepted: 02/17/2020] [Indexed: 12/27/2023]
Abstract
Macrodystrophia lipomatosa (MDL) is a rare congenital non-hereditary condition characterised by an abnormal overgrowth of mesenchymal tissue of a digit or an extremity. Although MDL is interchangeably described by terms such as macrodactyly and macrosomia, the entity has to be differentiated from other acquired and hereditary causes of macrodactyly. Rare association with osteochondromas and lipomas in other parts of the body has also been reported. We present a case with gradual progressive swellings of the right great toe and right thigh, which was diagnosed to be a case of MDL of the great toe with fibrolipomatous hamartoma of medial plantar nerve and lipomatosis of the thigh based on characteristic imaging findings.
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Affiliation(s)
- Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur-342008, Rajasthan, India
| | - Galib Mirza
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur-342008, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur-342008, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur-342008, Rajasthan, India
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Khera PS, Kumar Garg P, Pandey H, Chaurasia K. Post-traumatic high-flow priapism: uncommon presentation with endovascular management. BMJ Case Rep 2019; 12:12/10/e229299. [PMID: 31645391 DOI: 10.1136/bcr-2019-229299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pushpinder Singh Khera
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Pawan Kumar Garg
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Himanshu Pandey
- Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Kavish Chaurasia
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, India
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Khera D, Elhence P, Khera PS. An unusual cause of lymphadenopathy in a child. BMJ Case Rep 2019; 12:12/7/e230436. [PMID: 31326910 DOI: 10.1136/bcr-2019-230436] [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)
- Daisy Khera
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sureka B, Sharma N, Khera PS, Garg PK, Yadav T. Hepatic vein variations in 500 patients: surgical and radiological significance. Br J Radiol 2019; 92:20190487. [PMID: 31271536 DOI: 10.1259/bjr.20190487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations. METHODS A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al. RESULTS Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%). CONCLUSION Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. ADVANCES IN KNOWLEDGE Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.
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Affiliation(s)
- Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Neelmani Sharma
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Pushpinder Singh Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Pawan Kumar Garg
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
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Meena V, Sureka B, Elhence P, Gautam M, Garg P, Khera PS. Pseudoprogression in Rectal Gastrointestinal Stromal Tumor. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_148_17] [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: 11/04/2022] Open
Abstract
AbstractAlthough gastrointestinal stromal tumors (GISTs) are common mesenchymal intestinal neoplasms, rectal GISTs are rare mesenchymal tumors of the GI tract. We describe a case of rectal GIST in a 63-year-old male. The patient was given imatinib monotherapy and was further followed up by contrast-enhanced computed tomography abdomen for response assessment. We conclude that although rectal GISTs are extremely uncommon, it should be considered as a differential when any rectal mass is incidentally detected. Oncologists and radiologists should also be aware of pseudoprogression phenomena of GISTs in evaluating tumor response.
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Affiliation(s)
- Virendra Meena
- Departments of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Binit Sureka
- Departments of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Departments of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mayuresh Gautam
- Departments of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Departments of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Departments of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Sureka B, Elhence P, Khera PS, Choudhary GR, Pandey H, Garg PK, Yadav K, Goel A. Quantitative contrast-enhanced perfusion kinetics in multiparametric MRI in differentiating prostate cancer from chronic prostatitis: results from a pilot study. Br J Radiol 2019; 92:20190181. [PMID: 31184934 DOI: 10.1259/bjr.20190181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The objectives of the study were to analyze the apparent diffusion coefficient (ADC), ktrans, kep metrics in dynamic contrast-enhanced multiparametric MRI (DCE-mpMRI) in biopsy proven cases of prostate cancer (PCa) and prostatitis and to establish "cut-off" values for various pharmacokinetic parameters that may distinguish PCa from chronic prostatitis. METHODS A retrospective review of all cases of PCa and chronic prostatitis patients, who underwent DCE-mpMRI in our institute was done from July 2017 to January 2019. Mean ADC, ktrans , kep for lesion "L" (ADCL, ktrans L , kepL) and normal prostate tissue "N" (ADCN, ktrans N , kepN ,) were calculated for each region of interest. Different ratios ADC ratio (defined as ADCL/ ADCN), ktrans ratio (ktrans L/ ktrans N), kepratio (kepL/kepN) were calculated to differentiate PCa from chronic prostatitis. RESULTS Total of biopsy proven 14 cases of PCa and 18 cases of chronic prostatitis were included in the study. For ktrans ratio, the optimal cut-off was at 1.49 units where sensitivity was 85.7%, specificity was 61.1 % and Youden's index was 0.468 %. Similarly, optimal cut-offs determined for kep lesion was 0.86 (sensitivity 85.7%, specificity 66.7%, J = 0.524) and for kep ratio was 1.34 units (sensitivity 78.6%, specificity 66.7%, J = 0.543). CONCLUSION DCE-mpMRI metrics could differentiate between PCa and chronic prostatitis with good specificity and sensitivity, while ProstateImaging Reporting and Data System v. 2 alone, did not differentiate between these patterns. ADVANCES IN KNOWLEDGE ktrans ratio, kep lesion and kep ratio can differentiate PCa from chronic prostatitis.
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Affiliation(s)
- Binit Sureka
- 1 Departments of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Poonam Elhence
- 2 Departments of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Pushpinder Singh Khera
- 1 Departments of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Gautam Ram Choudhary
- 3 Departments of Urology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Himanshu Pandey
- 3 Departments of Urology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Pawan Kumar Garg
- 1 Departments of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Kuldeep Yadav
- 1 Departments of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
| | - Akhil Goel
- 4 Departments of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Basni, Jodhpur, Rajasthan 342005, India
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Sureka B, Yadav K, Garg PK, Khera PS. Moustache sign. Abdom Radiol (NY) 2019; 44:1629-1630. [PMID: 30498922 DOI: 10.1007/s00261-018-1856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sureka B, Meena V, Ganakumar VM, Khera PS. An intriguing cause of male infertility. Journal of Clinical Urology 2018. [DOI: 10.1177/2051415818792450] [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: 11/16/2022]
Abstract
We would like to submit an interesting radiology image of a case of ejaculatory duct calculus leading to male infertility proven by MRI. Level of evidence: Level 5
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Affiliation(s)
- Binit Sureka
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), India
| | - Virendra Meena
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), India
| | - Vijay Mallayya Ganakumar
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), India
| | - Pushpinder Singh Khera
- Department of Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), India
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Abstract
We would like to submit an interesting image of ureteric steinstrasse post lithotripsy procedure resembling a cobble stone street.
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Affiliation(s)
- Aditi Sullere
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.
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Affiliation(s)
- Binit Sureka
- Assistant Professor, Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, India
| | - Aditi Sullere
- Senior Resident, Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, India
| | - Pushpinder Singh Khera
- Additional Professor & Head, Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, India
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Sureka B, Meena V, Choudhary GR, Khera PS. Beaded pulmonary artery sign. Lung India 2018; 35:363-364. [PMID: 29970785 PMCID: PMC6034366 DOI: 10.4103/lungindia.lungindia_285_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Binit Sureka
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
| | - Virendra Meena
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India E-mail:
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Garg PK, Khera PS, Tarafdar S, Sureka B, Deora S. Duplicated RCA with Anomalous Origin of Left Circumflex Artery: A Rare Case Report. J Clin Diagn Res 2018. [DOI: 10.7860/jcdr/2018/32142.11321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Leiyomyosarcoma of vascular origin is uncommonly seen but mostly occurring in the inferior vena cava. We report a case of young male who presented with giant retroperitoneal leiyomyosarcoma which extended into the right atrium along Inferior vena cava.
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Affiliation(s)
- Sonal Saran
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh; Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Parul Gautam
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Abstract
Arteriovenous fistulas (AVF) are an entity most commonly seen in the head and neck region. An AVF is a direct connection between the arterial feeders and the draining veins without intervening capillary beds (unlike an arteriovenous malformation in which a nidus intervenes between the arteries and veins). We describe a case of traumatic AVF in a child aged 9 years, who presented with a pulsatile scalp swelling following blunt trauma to the head. It turned out to be an AVF between the superficial temporal artery and vein. Correct diagnosis of an AVF involves Doppler examination with digital subtraction angiography providing a good roadmap for treatment, which can be either endovascular or surgical.
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Affiliation(s)
- Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Singh Khera
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeraj Mehta
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Khera PS, Moses V, Ahmed M, Kakde S. Superior thyroid artery pseudoaneurysm and arteriovenous fistula following attempted internal jugular venous access and its management. Indian J Radiol Imaging 2015; 25:15-7. [PMID: 25709159 PMCID: PMC4329680 DOI: 10.4103/0971-3026.150131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/02/2023] Open
Abstract
Vascular injury during common jugular venous (IJV) access is a rare complication, usually involving injury to the common carotid artery. We describe a previously unreported complication of iatrogenic injury of IJV access involving a branch of the superior thyroid artery, and its endovascular management.
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Affiliation(s)
| | - Vinu Moses
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Munawwar Ahmed
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shailesh Kakde
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
AbstractTolosa-Hunt syndrome (THS) is a painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We present a case of THS disease evaluated on a 1.5 Tesla MR scanner.
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