International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical deci... more Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical decision-making. The aim of the study was to compare the diagnostic performance of simple international ovarian tumor analysis (IOTA) rules vs subjective pattern recognition, to discriminate between benign and malignant adnexal mass, and to establish the diagnostic utility of IOTA rules as a standardized examination tool in early diagnosis of ovarian malignancy. Methods: A prospective cohort study was conducted at a tertiary care hospital between November 2017 and March 2019 on 100 women with adnexal masses. All adnexal masses detected on ultrasound were classified according to IOTA rules by the trainee, followed by subjective pattern recognition by experts. These observations were further correlated with histopathology/intraoperative findings/ follow-up examination. Diagnostic efficacy was assessed by comparing sensitivity, specificity, positive predictive value (PPV), negative predictive v...
via cavernous sinus and intracranial propa-gation of periorbital cellulitis. This was not require... more via cavernous sinus and intracranial propa-gation of periorbital cellulitis. This was not required in our case due to probably insti-tution of appropriate antibiotic therapy. It may be of merit in severe or late diagnosed cases. Staphylococcal colonization of na-sopharynx can lead to ethmoiditis in immunocompromized or susceptible child, with rapid progress locally and hematoge-nous seeding as in our case. A variety of or-ganisms other than staphylococcus can cause this infection, which is dangerous be-cause it may be complicated by retrobulbar abscess and cavernous sinus infection and thrombosis. Treatment should be started early with intravenous antibiotics. Also, concomitant staphylococcal foci should be looked for and dealt with surgically if nec-essary. If in any doubt, a contrast enhanced
Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, ... more Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, can cause functional impairment and cosmetic disfiguring. It is further complicated by the difficulty in diagnosis due to complex anatomy and facial developmental process during infancy and childhood. Intraosseous pediatric jaw lesions may vary from odontogenic to nonodontogenic types with nonspecific clinical features in most cases. They deserve careful attention by a systematic approach to provide a relevant diagnosis or differential diagnosis for timely management. Imaging plays a major role in diagnosis with orthopantomograph being the foremost investigation, followed by cross-sectional imaging, essentially computed tomography as a problem-solving tool. This article highlights the imaging spectrum of various jaw lesions in the pediatric population with a pattern-based approach for radiological diagnosis.
Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortal... more Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance.Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section.Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at lea...
Myelolipoma(ML) is an uncommon benign mesenchymal tumor consisting of mature adipocytes and hemop... more Myelolipoma(ML) is an uncommon benign mesenchymal tumor consisting of mature adipocytes and hemopoietic elements mostly found in adrenal glands. Bilateral posterior mediastinal primary myelolipoma presents extremely rarely and only 11 such occurrences have been previously described. With no definite symptoms, pathological evaluation is essential for diagnosis. Here the authors present a case of a 63-year old man diagnosed with bilateral posterior mediastinal primary myelolipoma on basis of radiological findings who underwent surgical resection via video-assisted thoracic surgery (VATS). The aim of this report is to show the diagnosis of an unusual mediastinal lesion and improve understanding of this disease.
Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characteriz... more Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characterized by placentomegaly with multicystic placental lesion on ultrasonography and mesenchymal stem villous hyperplasia on histopathology. Placental mesenchymal dysplasia should be considered in the differential diagnosis of cases of multicystic placental lesion such as molar pregnancy, chorioangioma, subchorionic hematoma, and spontaneous abortion with hydropic placental changes. However, lack of high-velocity signals inside the lesion and a normal karyotype favor a diagnosis of PMD. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ. We report the case of an 18-year-old female at 15 weeks of gestation with sonographic findings suggestive of placental mesenchymal dysplasia. The diagnosis was confirmed on histopathology.
To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (... more To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI), to correlate with clinical outcome measures, and to assess concordance with severity grading, as per the revised Atlanta classification (RAC). In this prospective study approved by the Institutional Review Board (November 2014 to March 2016), sixty patients with AP (as per the RAC definition) underwent contrast-enhanced computed tomography (CECT) 5-11 days (median 6 days) after symptom onset. Two radiologists, blinded to clinical parameters, independently assessed CTSI and MCTSI (differences were resolved by consensus). Clinical outcome parameters included duration of stay in the hospital and intensive care unit (ICU), presence of persistent organ failure (OF), evidence of infection, need for intervention, and mortality. We included 60 cases [36 males, age range 19-65 (mean 37) years]. As per the RAC, 26 patients had mild AP, 12 moderately se...
Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur du... more Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby.
Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising... more Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology.
Cranial ultrasonography was performed on 61 infants with acute bacterial meningitis (ABM). Thirty... more Cranial ultrasonography was performed on 61 infants with acute bacterial meningitis (ABM). Thirty nine, infants (64%) had acute meningitis with no clinical evidence of complications (Group-I) and 22 infants (36%) had clinical evidence of complications of ABM (Group-II). Cranial ultrasound was normal in 20 infants (32.8%). The spectrum of sonographic abnormalities included echogenic sulci (60.6%), sulcal separation (49.8%), abnormal parenchymal echoes (42.6%), ventriculomegaly (34.4%), ventriculitis (19.7%), abscess (3.3%), subdural empyema (1.63%) and hemorrhagic infarct (1.63%). Various abnormal findings were seen in all 22 patients of Group II (100%) and in only 19 out of 39 patients in Group I (31.9%). Cranial sonography was comparable to CT scan done in 10 cases of Group II. Our study suggests that ultrasound is a quick, reliable and effective diagnostic tool in diagnosis and management of infants with or without evidence of complications.
Neurocysticercosis is the most common parasitic infection of the Central Nervous System caused by... more Neurocysticercosis is the most common parasitic infection of the Central Nervous System caused by Taenia solium. Spinal cysticercosis is an uncommon site of cysticercal infestation & intramedullary involvement is even rarer.1 We are reporting a rare case of intramedullary cysticercosis in the cervical region in an 11 year old girl who presented with headache & neck stiffness. CT and MRI of the cervical spine done revealed a cystic lesion with mural nodule (scolex) with cord edema in the cervical region. The child underwent treatment with antihelminthic drugs and showed marked clinico-radiological improvement.DOI: http://dx.doi.org/10.3126/njr.v4i1.11373 Nepalese Journal of Radiology, Vol.4(1) 2014: 63-66
Cavernous hemangioma is the most common benign noninfiltrative neoplasm of the orbit. Most cavern... more Cavernous hemangioma is the most common benign noninfiltrative neoplasm of the orbit. Most cavernous hemangiomas are intraconal and lateral in location. We present a case of a cavernous hemangioma with an unusual extraconal and superomedial location.
We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacr... more We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2-S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing′s sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical deci... more Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical decision-making. The aim of the study was to compare the diagnostic performance of simple international ovarian tumor analysis (IOTA) rules vs subjective pattern recognition, to discriminate between benign and malignant adnexal mass, and to establish the diagnostic utility of IOTA rules as a standardized examination tool in early diagnosis of ovarian malignancy. Methods: A prospective cohort study was conducted at a tertiary care hospital between November 2017 and March 2019 on 100 women with adnexal masses. All adnexal masses detected on ultrasound were classified according to IOTA rules by the trainee, followed by subjective pattern recognition by experts. These observations were further correlated with histopathology/intraoperative findings/ follow-up examination. Diagnostic efficacy was assessed by comparing sensitivity, specificity, positive predictive value (PPV), negative predictive v...
via cavernous sinus and intracranial propa-gation of periorbital cellulitis. This was not require... more via cavernous sinus and intracranial propa-gation of periorbital cellulitis. This was not required in our case due to probably insti-tution of appropriate antibiotic therapy. It may be of merit in severe or late diagnosed cases. Staphylococcal colonization of na-sopharynx can lead to ethmoiditis in immunocompromized or susceptible child, with rapid progress locally and hematoge-nous seeding as in our case. A variety of or-ganisms other than staphylococcus can cause this infection, which is dangerous be-cause it may be complicated by retrobulbar abscess and cavernous sinus infection and thrombosis. Treatment should be started early with intravenous antibiotics. Also, concomitant staphylococcal foci should be looked for and dealt with surgically if nec-essary. If in any doubt, a contrast enhanced
Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, ... more Jaw lesions in the pediatric population, although infrequently encountered in clinical practice, can cause functional impairment and cosmetic disfiguring. It is further complicated by the difficulty in diagnosis due to complex anatomy and facial developmental process during infancy and childhood. Intraosseous pediatric jaw lesions may vary from odontogenic to nonodontogenic types with nonspecific clinical features in most cases. They deserve careful attention by a systematic approach to provide a relevant diagnosis or differential diagnosis for timely management. Imaging plays a major role in diagnosis with orthopantomograph being the foremost investigation, followed by cross-sectional imaging, essentially computed tomography as a problem-solving tool. This article highlights the imaging spectrum of various jaw lesions in the pediatric population with a pattern-based approach for radiological diagnosis.
Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortal... more Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance.Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section.Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at lea...
Myelolipoma(ML) is an uncommon benign mesenchymal tumor consisting of mature adipocytes and hemop... more Myelolipoma(ML) is an uncommon benign mesenchymal tumor consisting of mature adipocytes and hemopoietic elements mostly found in adrenal glands. Bilateral posterior mediastinal primary myelolipoma presents extremely rarely and only 11 such occurrences have been previously described. With no definite symptoms, pathological evaluation is essential for diagnosis. Here the authors present a case of a 63-year old man diagnosed with bilateral posterior mediastinal primary myelolipoma on basis of radiological findings who underwent surgical resection via video-assisted thoracic surgery (VATS). The aim of this report is to show the diagnosis of an unusual mediastinal lesion and improve understanding of this disease.
Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characteriz... more Placental mesenchymal dysplasia (PMD) is an uncommon vascular anomaly of the placenta characterized by placentomegaly with multicystic placental lesion on ultrasonography and mesenchymal stem villous hyperplasia on histopathology. Placental mesenchymal dysplasia should be considered in the differential diagnosis of cases of multicystic placental lesion such as molar pregnancy, chorioangioma, subchorionic hematoma, and spontaneous abortion with hydropic placental changes. However, lack of high-velocity signals inside the lesion and a normal karyotype favor a diagnosis of PMD. PMD must be differentiated from gestational trophoblastic disease because management and outcomes differ. We report the case of an 18-year-old female at 15 weeks of gestation with sonographic findings suggestive of placental mesenchymal dysplasia. The diagnosis was confirmed on histopathology.
To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (... more To assess the severity of acute pancreatitis (AP) using computed tomography (CT) severity index (CTSI) and modified CT severity index (MCTSI), to correlate with clinical outcome measures, and to assess concordance with severity grading, as per the revised Atlanta classification (RAC). In this prospective study approved by the Institutional Review Board (November 2014 to March 2016), sixty patients with AP (as per the RAC definition) underwent contrast-enhanced computed tomography (CECT) 5-11 days (median 6 days) after symptom onset. Two radiologists, blinded to clinical parameters, independently assessed CTSI and MCTSI (differences were resolved by consensus). Clinical outcome parameters included duration of stay in the hospital and intensive care unit (ICU), presence of persistent organ failure (OF), evidence of infection, need for intervention, and mortality. We included 60 cases [36 males, age range 19-65 (mean 37) years]. As per the RAC, 26 patients had mild AP, 12 moderately se...
Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur du... more Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby.
Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising... more Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology.
Cranial ultrasonography was performed on 61 infants with acute bacterial meningitis (ABM). Thirty... more Cranial ultrasonography was performed on 61 infants with acute bacterial meningitis (ABM). Thirty nine, infants (64%) had acute meningitis with no clinical evidence of complications (Group-I) and 22 infants (36%) had clinical evidence of complications of ABM (Group-II). Cranial ultrasound was normal in 20 infants (32.8%). The spectrum of sonographic abnormalities included echogenic sulci (60.6%), sulcal separation (49.8%), abnormal parenchymal echoes (42.6%), ventriculomegaly (34.4%), ventriculitis (19.7%), abscess (3.3%), subdural empyema (1.63%) and hemorrhagic infarct (1.63%). Various abnormal findings were seen in all 22 patients of Group II (100%) and in only 19 out of 39 patients in Group I (31.9%). Cranial sonography was comparable to CT scan done in 10 cases of Group II. Our study suggests that ultrasound is a quick, reliable and effective diagnostic tool in diagnosis and management of infants with or without evidence of complications.
Neurocysticercosis is the most common parasitic infection of the Central Nervous System caused by... more Neurocysticercosis is the most common parasitic infection of the Central Nervous System caused by Taenia solium. Spinal cysticercosis is an uncommon site of cysticercal infestation & intramedullary involvement is even rarer.1 We are reporting a rare case of intramedullary cysticercosis in the cervical region in an 11 year old girl who presented with headache & neck stiffness. CT and MRI of the cervical spine done revealed a cystic lesion with mural nodule (scolex) with cord edema in the cervical region. The child underwent treatment with antihelminthic drugs and showed marked clinico-radiological improvement.DOI: http://dx.doi.org/10.3126/njr.v4i1.11373 Nepalese Journal of Radiology, Vol.4(1) 2014: 63-66
Cavernous hemangioma is the most common benign noninfiltrative neoplasm of the orbit. Most cavern... more Cavernous hemangioma is the most common benign noninfiltrative neoplasm of the orbit. Most cavernous hemangiomas are intraconal and lateral in location. We present a case of a cavernous hemangioma with an unusual extraconal and superomedial location.
We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacr... more We report an unusual case of Ewing′s sarcoma / primitive neuroectodermal tumor (PNET) of the sacral nerve plexus in a 9-year-old boy who presented with a soft tissue swelling and severe piercing pain in the lower back region. MRI of the lumbosacral spine showed a lobulated soft tissue mass with clubbed finger-like projections along the path of the sacral nerves, which had caused widening of the spinal canal and the sacral foramina (S2-S4 level). There was presacral extension and posterior scalloping of the sacral vertebrae. Histopathology of the lesion confirmed Ewing′s sarcoma / PNET of the sacral spinal nerve plexus. The patient responded favorably to chemotherapy and radiotherapy, showing clinical and radiological improvement.
Uploads
Papers by Rama Anand