Polish journal of radiology / Polish Medical Society of Radiology, 2016
Delayed presentation of post-traumatic aortic pseudoaneurysm and its fistulous communication with... more Delayed presentation of post-traumatic aortic pseudoaneurysm and its fistulous communication with the right renal vein is a very rare entity. Most of the cases described in literature are due to abdominal aortic aneurysm (AAA) rupture into the left renal vein. To the best of our knowledge, communication with the right renal vein has not been described in published literature. Our patient also had a circumaortic renal collar, which is a rare renal vein anomaly. Aortic pseudoaneurysm, its fistulous communication with the right renal vein and circumaortic renal collar in a single patient is of extremely rare occurrence. A 29-year-old male presented to the cardiology department with complaints of breathlessness, abdominal pain and hematuria for the last 6 months. On clinical examination there was evidence of audible bruit over the abdomen. He had a past history of a gunshot injury around two years back. CT angiography revealed a large partially calcified pseudoaneurysm arising from the ...
We report an extremely rare case of coarctation of the aorta with associated left pulmonary arter... more We report an extremely rare case of coarctation of the aorta with associated left pulmonary artery stenosis. This violates the traditional fetal flow pattern theory. Two-dimensional echocardiography, although being the initial imaging modality for diagnosing coarctation of the aorta, is limited in the demonstration of branch pulmonary arteries. Retrospective ECG-gated multidetector CT angiography is a non-invasive imaging technique for comprehensive assessment of the site, length and severity of the stenosed aortic segment. It is also helpful in differentiation of an interrupted aortic arch from severe coarctation. Associated pulmonary arterial and venous system anomalies can be evaluated, which dictates the management of aortic coarctation.
Post-pancreatitis pseudoaneurysms are not uncommon. They have a high associated mortality due to ... more Post-pancreatitis pseudoaneurysms are not uncommon. They have a high associated mortality due to a propensity to rupture. Current standards of treatment advocate immediate intravascular interventions. We describe two cases of alcohol-related post-acute pancreatitis pseudoaneurysms arising from the second-order branches of the superior mesenteric artery (SMA) that were endoluminally inaccessible. Both cases were successfully treated with percutaneous thrombin injection into the pseudoaneurysm sac under ultrasound guidance. We suggest that endoluminally inaccessible pseudoaneurysms that are percutaneously accessible can be expeditiously treated with percutaneous thrombin injection. Further, due to the efficaciousness of this procedure, it could be considered as a first-line minimally invasive therapeutic option.
Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dog... more Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dogs and other canines are the definitive hosts; Human beings are common accidental intermediate hosts. Liver is the most common organ to be involved in this condition. Cardiac hydatid, seen in only 0.5 to 2% cases, is a rare entity because of myocardial contractility. Larvae reach the myocardium through coronary circulation. Among various locations of cardiac hydatid, due to its rich coronary arterial supply Left ventricle (LV) myocardium is the most common site of involvement followed by interventricular septum and right ventricle. Rare locations include pericardium, right atrium and left atrium. A 50-year-old woman presented with dyspnoea for 11 months, chest X-ray showed a well defined, homogenous left paracardiac mass, which is not separable from left heart border. Transthoracic echocardiography revealed a complex multicystic mass lesion abutting antero-lateral wall of left ventricle. Contrast enhanced computed tomography showed a well-circumscribed multicystic mass lesion with honeycomb appearance arising from myocardium of anterolateral wall of left ventricle. Indirect haemagglutination test for hydatid disease was positive. At surgery the cyst was seen to arise from LV myocardium. It was incised and grape like contents were evacuated. The cavity was irrigated with scolicidal solution. Thereafter, the cyst was marsupialised. Histopathological examination revealed grape like cyst contents consistent with the diagnosis of hydatid cyst.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2009
Choledochal cysts in adults are more commonly associated with complications such as cystolithiasi... more Choledochal cysts in adults are more commonly associated with complications such as cystolithiasis, recurrent cholangitis, portal hypertension and malignancy, than in the pediatric age group. We report a case of adult choledochal cyst with long-term complication of large stone cast and portal hypertension due to secondary biliary cirrhosis. A 50-year-old patient presented with obstructive jaundice and hepatosplenomegaly. On investigation, she was diagnosed as having a choledochal cyst with large stone cast and portal hypertension. Single stage resection of the choledochal cyst with Roux-en-Y hepaticojejunostomy was done by meticulous dissection and ligation of collaterals. Single stage resection of a choledochal cyst is possible in spite of associated portal hypertension, if the portal vein is patent.
Indian Journal of Thoracic and Cardiovascular Surgery, 1996
Abstract Traumatic pseudoaneurysms represent untreated arterial insult, especially due to penetra... more Abstract Traumatic pseudoaneurysms represent untreated arterial insult, especially due to penetrating or missile injuries. In spite of vast improvements in early detection and surgical management of vascular trauma, these injuries frequently elude diagnosis, leading to the ...
Wilms' tumour (nephroblastoma), the most common abdominal malignancy of childhood, occurs pri... more Wilms' tumour (nephroblastoma), the most common abdominal malignancy of childhood, occurs primarily as a malignant renal tumour. Extrarenal Wilms' tumour is rare with occasional reports from the Indian subcontinent. The various locations of extrarenal Wilms' tumour include retroperitoneum, uterus, skin and thorax. In this report we will discuss the imaging features highlighting the imaging differential diagnosis in a case of retroperitoneal (extrarenal) primary Wilms' tumour.
ABSTRACT Three cases of intraspinal lumbosacral lipoma are reported and the existing English lite... more ABSTRACT Three cases of intraspinal lumbosacral lipoma are reported and the existing English literature is reviewed. Intraspinal lumbosacral lipoma presents a distinct clinical and radiological pat tern. It should be suspected if, in a child, a soft tissue mass in the ...
Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy (HE), ... more Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy (HE), with abnormal neuropsychologic findings. Inflammatory response may be important in the pathogenesis of MHE. On magnetic resonance spectroscopy (MRS), improvement of metabolic ratios after liver transplantation suggests an important role of myoinositol (mI) and choline (cho) in the development of MHE. To investigate arterial ammonia, tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-18, serum endotoxin, and MRS before and after treatment in MHE. Sixty patients of cirrhosis with MHE were randomized to two groups, Gr. MHE-L (n = 30), treated with lactulose for 3 months, and Gr. MHE-NL (n = 30), who did not received lactulose. Arterial ammonia, TNF-α, IL-6, IL-18, serum endotoxin, and MRS were performed in all patients at baseline and at 3 months and 20 patients of cirrhosis without MHE and 20 healthy controls. After 3 months, median arterial ammonia (69.4 vs 52.7 mcg/dL), TNF-α (26.6 vs 22 pg/mL), IL-6 (17.6 vs 12.4 pg/mL), IL-18 (42.5 vs 29 pg/mL), and serum endotoxin (0.68 vs 0.43 EU/mL) significantly decreased in Gr. MHE-L compared with baseline (P < 0.0001), while no change was seen in Gr. MHE-NL patients. On MRS, compared with patients of cirrhosis without MHE, mI and cho were significantly lower (P < 0.001) and glutamine (Glx) was significantly higher in both MHE groups (P < 0.001). After 3 months, mI and cho increased and Glx decreased significantly in Gr. MHE-L (P < 0.001), without changes in Gr. MHE-NL patients. Psychometric hepatic encephalopathic score (PHES) correlated well with arterial ammonia, TNF-α, IL-6, IL-18, serum endotoxin, and metabolic parameters on MRS. Arterial ammonia, inflammatory mediators (TNF-α, IL-6, IL-18), and serum endotoxin reduce and MRS abnormalities improve after treatment with lactulose in patients with MHE.
Polish journal of radiology / Polish Medical Society of Radiology, 2016
Delayed presentation of post-traumatic aortic pseudoaneurysm and its fistulous communication with... more Delayed presentation of post-traumatic aortic pseudoaneurysm and its fistulous communication with the right renal vein is a very rare entity. Most of the cases described in literature are due to abdominal aortic aneurysm (AAA) rupture into the left renal vein. To the best of our knowledge, communication with the right renal vein has not been described in published literature. Our patient also had a circumaortic renal collar, which is a rare renal vein anomaly. Aortic pseudoaneurysm, its fistulous communication with the right renal vein and circumaortic renal collar in a single patient is of extremely rare occurrence. A 29-year-old male presented to the cardiology department with complaints of breathlessness, abdominal pain and hematuria for the last 6 months. On clinical examination there was evidence of audible bruit over the abdomen. He had a past history of a gunshot injury around two years back. CT angiography revealed a large partially calcified pseudoaneurysm arising from the ...
We report an extremely rare case of coarctation of the aorta with associated left pulmonary arter... more We report an extremely rare case of coarctation of the aorta with associated left pulmonary artery stenosis. This violates the traditional fetal flow pattern theory. Two-dimensional echocardiography, although being the initial imaging modality for diagnosing coarctation of the aorta, is limited in the demonstration of branch pulmonary arteries. Retrospective ECG-gated multidetector CT angiography is a non-invasive imaging technique for comprehensive assessment of the site, length and severity of the stenosed aortic segment. It is also helpful in differentiation of an interrupted aortic arch from severe coarctation. Associated pulmonary arterial and venous system anomalies can be evaluated, which dictates the management of aortic coarctation.
Post-pancreatitis pseudoaneurysms are not uncommon. They have a high associated mortality due to ... more Post-pancreatitis pseudoaneurysms are not uncommon. They have a high associated mortality due to a propensity to rupture. Current standards of treatment advocate immediate intravascular interventions. We describe two cases of alcohol-related post-acute pancreatitis pseudoaneurysms arising from the second-order branches of the superior mesenteric artery (SMA) that were endoluminally inaccessible. Both cases were successfully treated with percutaneous thrombin injection into the pseudoaneurysm sac under ultrasound guidance. We suggest that endoluminally inaccessible pseudoaneurysms that are percutaneously accessible can be expeditiously treated with percutaneous thrombin injection. Further, due to the efficaciousness of this procedure, it could be considered as a first-line minimally invasive therapeutic option.
Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dog... more Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dogs and other canines are the definitive hosts; Human beings are common accidental intermediate hosts. Liver is the most common organ to be involved in this condition. Cardiac hydatid, seen in only 0.5 to 2% cases, is a rare entity because of myocardial contractility. Larvae reach the myocardium through coronary circulation. Among various locations of cardiac hydatid, due to its rich coronary arterial supply Left ventricle (LV) myocardium is the most common site of involvement followed by interventricular septum and right ventricle. Rare locations include pericardium, right atrium and left atrium. A 50-year-old woman presented with dyspnoea for 11 months, chest X-ray showed a well defined, homogenous left paracardiac mass, which is not separable from left heart border. Transthoracic echocardiography revealed a complex multicystic mass lesion abutting antero-lateral wall of left ventricle. Contrast enhanced computed tomography showed a well-circumscribed multicystic mass lesion with honeycomb appearance arising from myocardium of anterolateral wall of left ventricle. Indirect haemagglutination test for hydatid disease was positive. At surgery the cyst was seen to arise from LV myocardium. It was incised and grape like contents were evacuated. The cavity was irrigated with scolicidal solution. Thereafter, the cyst was marsupialised. Histopathological examination revealed grape like cyst contents consistent with the diagnosis of hydatid cyst.
Hepatobiliary & pancreatic diseases international : HBPD INT, 2009
Choledochal cysts in adults are more commonly associated with complications such as cystolithiasi... more Choledochal cysts in adults are more commonly associated with complications such as cystolithiasis, recurrent cholangitis, portal hypertension and malignancy, than in the pediatric age group. We report a case of adult choledochal cyst with long-term complication of large stone cast and portal hypertension due to secondary biliary cirrhosis. A 50-year-old patient presented with obstructive jaundice and hepatosplenomegaly. On investigation, she was diagnosed as having a choledochal cyst with large stone cast and portal hypertension. Single stage resection of the choledochal cyst with Roux-en-Y hepaticojejunostomy was done by meticulous dissection and ligation of collaterals. Single stage resection of a choledochal cyst is possible in spite of associated portal hypertension, if the portal vein is patent.
Indian Journal of Thoracic and Cardiovascular Surgery, 1996
Abstract Traumatic pseudoaneurysms represent untreated arterial insult, especially due to penetra... more Abstract Traumatic pseudoaneurysms represent untreated arterial insult, especially due to penetrating or missile injuries. In spite of vast improvements in early detection and surgical management of vascular trauma, these injuries frequently elude diagnosis, leading to the ...
Wilms' tumour (nephroblastoma), the most common abdominal malignancy of childhood, occurs pri... more Wilms' tumour (nephroblastoma), the most common abdominal malignancy of childhood, occurs primarily as a malignant renal tumour. Extrarenal Wilms' tumour is rare with occasional reports from the Indian subcontinent. The various locations of extrarenal Wilms' tumour include retroperitoneum, uterus, skin and thorax. In this report we will discuss the imaging features highlighting the imaging differential diagnosis in a case of retroperitoneal (extrarenal) primary Wilms' tumour.
ABSTRACT Three cases of intraspinal lumbosacral lipoma are reported and the existing English lite... more ABSTRACT Three cases of intraspinal lumbosacral lipoma are reported and the existing English literature is reviewed. Intraspinal lumbosacral lipoma presents a distinct clinical and radiological pat tern. It should be suspected if, in a child, a soft tissue mass in the ...
Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy (HE), ... more Minimal hepatic encephalopathy (MHE) represents the mildest form of hepatic encephalopathy (HE), with abnormal neuropsychologic findings. Inflammatory response may be important in the pathogenesis of MHE. On magnetic resonance spectroscopy (MRS), improvement of metabolic ratios after liver transplantation suggests an important role of myoinositol (mI) and choline (cho) in the development of MHE. To investigate arterial ammonia, tumor necrosis factor alpha (TNF-α), interleukin (IL)-6, IL-18, serum endotoxin, and MRS before and after treatment in MHE. Sixty patients of cirrhosis with MHE were randomized to two groups, Gr. MHE-L (n = 30), treated with lactulose for 3 months, and Gr. MHE-NL (n = 30), who did not received lactulose. Arterial ammonia, TNF-α, IL-6, IL-18, serum endotoxin, and MRS were performed in all patients at baseline and at 3 months and 20 patients of cirrhosis without MHE and 20 healthy controls. After 3 months, median arterial ammonia (69.4 vs 52.7 mcg/dL), TNF-α (26.6 vs 22 pg/mL), IL-6 (17.6 vs 12.4 pg/mL), IL-18 (42.5 vs 29 pg/mL), and serum endotoxin (0.68 vs 0.43 EU/mL) significantly decreased in Gr. MHE-L compared with baseline (P < 0.0001), while no change was seen in Gr. MHE-NL patients. On MRS, compared with patients of cirrhosis without MHE, mI and cho were significantly lower (P < 0.001) and glutamine (Glx) was significantly higher in both MHE groups (P < 0.001). After 3 months, mI and cho increased and Glx decreased significantly in Gr. MHE-L (P < 0.001), without changes in Gr. MHE-NL patients. Psychometric hepatic encephalopathic score (PHES) correlated well with arterial ammonia, TNF-α, IL-6, IL-18, serum endotoxin, and metabolic parameters on MRS. Arterial ammonia, inflammatory mediators (TNF-α, IL-6, IL-18), and serum endotoxin reduce and MRS abnormalities improve after treatment with lactulose in patients with MHE.
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