Multi detector computed tomography fistulography in patients of fistula-in-ano : an imaging collage

Fistula-in-ano, or perianal fistula, is a challenging clinical condition for both diagnosis and treatment. Imaging modalities such as fistulography, anal endosonography, perineal sonography, magnetic resonance imaging (MRI), and computed tomography (CT) are available for its evaluation. MRI is considered as the modality of choice for an accurate delineation of the tract in relation to the sphincter complex and for the detection of associated complications. However, its availability and affordability is always an issue. Moreover, the requirement to obtain multiple sequences to depict the fistula in detail is cumbersome and confusing for the clinicians to interpret. The inability to show the fistula in relation to normal anatomical structures in a single image is also a limitation. Multi detector computed tomography fistulography (MDCTF) is an underutilized technique for defining perianal fistulas. Acquisition of iso-volumetric data sets with instillation of contrast intothe fistula delineates the tract and its components. Post-processing with thin sections allows for a generation of good quality images for presentation in various planes (multi-planar reconstructions) and formats (volume rendered technique, maximum intensity projection). MDCTF demonstrates the type of fistula, its extent, whether it is simple or complex, and shows the site of internal opening and associated complications; all in easy to understand images that can be used by the surgeons. Its capability to represent the entire pathology in relation to normal anatomical structures in few images is a definite advantage. MDCTF can be utilized when MRI is contraindicated or not feasible. This pictorial review shares our initial experience with MDCT fistulography in evaluating fistula-in-ano, demonstrates various components of fistulas, and discusses the types of fistulas according to the standard Parks classification

Late recovery of phrenic nerve palsy in a neonate: A case report

Hyperextension of the neck at birth can injure the phrenic nerve and/or brachial plexus usually at the point where the phrenic nerve crosses the brachial plexus. We present a case of the preterm baby, who had Erb’s palsy and diaphragmatic paralysis since birth after breech delivery. Persistent respiratory distress and chest X-ray gave a clue to diagnosis, which was confirmed on ultrasound. The baby recovered on the conservative approach at 2 months of life without surgical plication. This study describes that late spontaneous recovery up to 2 months is possible in a newborn with respiratory distress due to phrenic nerve palsy

Utility of Bedside Lung Ultrasound in the Assessment of Volume Status in Patients on Chronic Haemodialysis

Alzheimer’s disease (AD) is the most common form of progressively disabling degenerative dementia. In dementia in general, there are, unfortunately, even from the earliest stages of the disease, associated behavioural and psychological symptoms of dementia (BPSD), and even more pronouncedly in AD, in addition to cognitive impairment. There are no specific drugs for the treatment of BPSDs. Therefore, there remains an unmet medical need. To date, despite side effects, benzodiazepines, anti-psychotics, mood stabilisers, and anti-depressants continue to be used in the clinic. The aim of this research work is to provide an understanding of the role of benzodiazepines when used for the treatment of BPSD and cognitive impairment in AD

Tubercular Retropharyngeal Abscess in Association with Aberrant Retropharyngeal Internal Carotid Arteries - A Rare Entity: Imaging Diagnosis and a Word of Caution

Retropharyngeal (RP) abscess is rarely encountered in adults. Still rare is an abscess of tubercular etiology especially without involvement of the underlying cervical spine. We present a case of an immunocompetent woman with a tubercular RP abscess diagnosed on contrast-enhanced cervical computed tomography and confirmed on cytology. Another interesting feature was an aberrant RP course of the internal carotid arteries in this patient. This case report stresses the importance of imaging in establishing an unexpected diagnosis of an RP abscess, suggesting its likely cause, and also in demonstrating the aberration in regional vascular anatomy, and warns the clinician of life-threatening hemorrhagic complication in the event of any diagnostic or therapeutic intervention