Anomaly of the biliopancreatic junction with associated hepatic duct anomaly – a rare case report

Pancreaticobiliary maljunction (PBM) or anomaly is defined as an anatomical maljunction of the biliary duct and pancreatic duct outside of the duodenal wall beyond the influence of the sphincter of Oddi. Children with this anomaly can present with choledochal cyst with recurrent attacks of acute pancreatitis, and condition can be worse when not treated appropriately. Pancreaticobiliary maljunction or anomaly is considered to be a major risk factor for biliary tract cancer. In patients with this anomaly, free reflux of pancreatic juice into biliary tract may cause biliary tract damage, resulting biliary malignancy can occur. Therefore, in this condition total excision of the extrahepatic bile duct with hepaticojejunostomy is recommended. Early diagnosis of this condition and early surgical treatment is the mainstay to prevent further complications. Proper follow-up is necessary to detect biliary tract malignancy in early post-operative period, especially in patients demonstrating post-operative complications. Here we are describing a young boy with an abnormal pancreaticobiliary junction (PBM) with choledochal cyst associated with hepatic duct anomaly and biliary and pancreatic stones causing recurrent attack of acute pancreatitis

Median arcuate ligament syndrome diagnosed on multi-detector computed tomographic angiography

Median arcuate ligament syndrome or coeliac artery compression syndrome is one of the abdominal vascular compression syndromes characterized by postprandial intestinal angina in the expiratory phase of respiration due to focal proximal coeliac root compression by a fibrous ligamentous band with resultant inadequate blood supply to the respectively supplied part of the gastrointestinal tract. Multi-detector computed tomography is extremely useful noninvasive modality in differentiating the cause of compression of the coeliac artery along with evaluation of collaterals due to multiplanar imaging capability

The Herlyn-Werner-Wunderlich syndrome : a case report with radiological review

BACKGROUND: HWW syndrome is a very rare congenital anomaly of urogenital tract involving Mullerian ducts and mesonephric ducts. It is characterised by a triad of symptoms - uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. It can be classified based on a completely or incompletely obstructed hemivagina. It presents soon after menarche or shows delayed presentation depending on the type. It can exhibit acute pelvic pain shortly after menarche and may show non-specific and variable symptoms with resultant delay in diagnosis. The most common presentation is pain and dysmenorrhea, and pain and abdominal mass in the lower abdomen secondary to haematocolpos and/or haematometra. CASE REPORT: Presentation of a clinical case of a 13-year-old patient with HWW syndrome presenting with regular menses, dysmenorrhea and painful lump in hypogastric region on the left side of midline. We described the role of imaging modalities in diagnosis of the Herlyn-Werner-Wunderlich syndrome with a review of literature. USG and MRI showed left renal agenesis with compensatory hypertrophy of the right kidney, uterus didelphys with haematometra and haematocervix in the left uterus with evidence of blood in a dilated retort-shaped left fallopian tube and a normal right uterus. The unique feature of our case is haematometra and haematocervix with cervical and vaginal atresia found on the left side (classification 1.2) with associated left renal agenesis. CONCLUSIONS: HWW syndrome can present early or late, depending on the type. In patients with uterine and vaginal abnormalities, a work-up for associated renal anomalies should be performed. Early intervention is needed to reduce the risk of endometriosis and infertility

Thyroid hemiagenesis with isthmic agenesis: A case report with review of the literature

Thyroid hemiagenesis (THG) is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. Agenesis may be unilateral, total or isthmic. Left thyroid lobe is commonly involved than right lobe in hemiagenesis. Clinically patients can be euthyroid, hypothyroid or hyperthyroid. Often it is diagnosed as an incidental finding during ultrasonography (USG) study of neck, which easily diagnose this condition. Actual incidence of THG is unknown, most cases are diagnosed in patients admitted for thyroid scan or thyroid surgery because of suspicion of other thyroid abnormalities. This explains high frequency of association of hemiagenesis with other thyroid abnormalities such as multinodular goiter, adenoma, hyperthyroidism, hypothyroidism, chronic thyroiditis, and carcinoma. We report a case of 58-year-old male patient detected to have hemiagenesis of left thyroid lobe and isthmus when USG neck was performed for carcinoma right buccal mucosa with metastatic cervical lymphadenopathy

Biliary duct communication in massive hepatic hydatidosis managed with minimally invasive techniques

Hydatid cyst most commonly involves the liver. Intrabiliary rupture is one of the complications of hepatic hydatidosis. We present a case of 45-year-old lady with a large hydatid cyst occupying the left lobe of the liver with jaundice and upper gastrointestinal pressure symptoms. Contrast-enhanced computed tomography revealed a large hepatic cyst with rupture of contents into the left hepatic duct. The patient underwent laparoscopic excision of the cyst with closure of the biliary communication. Bilious drainage was observed from intra-cavitory drain in the postoperative period for which patient underwent endoscopic retrograde cholangiopancreatography with selective left duct stenting following which bile output decreased over 1-week. The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. Laparoscopic treatment is an effective mode of treatment for biliary fistulas complicating hepatic hydatid cyst in well-selected patients

Interrupted aortic arch by multi-detector computed tomography angiography: A case report with radiological review

Interrupted aortic arch (IAA) is a rare congenital vascular malformation, which is defined as lack of luminal continuity, between the ascending and descending thoracic aorta. Many times it is associated with various congenital cardiac anomalies. Early diagnosis is mandatory to assess the patient condition and to plan medical and surgical treatment. Traditionally, chest X-ray, echocardiography, and conventional catheter angiography are the imaging tools being used. Multi-detector computed tomography (MDCT) can accurately diagnose and characterize the various forms of IAA and associated cardiac defects. We report a case of 8-year-old male child detected to have Type A IAA on MDCT with an associated ventricular septal defect and patent ductusarteriosus

A dual tangent based algorithm for maximum power point tracking of solar PV systems

In this paper, a new algorithm is presented for maximum power point tracking (MPPT) of solar PV array. This method first forecasts the maximum power point (MPP) by using tangents to the power-voltage curve at two end points of an interval and then iteratively converges to the MPP by evaluating whether the true MPP lies on the left or right side of the estimated MPP. The proposed algorithm has the advantage that MPPT is achieved within an almost fixed and small number of iterations irrespective of the power level. The working of the control approach is first demonstrated through MATLAB/Simulink simulation and simulated results are then verified experimentally by the hardware implementation of a standalone photo-voltaic (PV) system

Role of imaging in Mayer-Rokitansky-Kuster-Hauser syndrome

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus and upper 2/3 rd of vagina with a normal 46, XX karyotype and normally developed secondary sexual characteristics. It affects 1:4000 women. It may be isolated (Type I) or frequently associated with renal, vertebral anomalies and less frequently associated with auditory, cardiac defects (Type II). It presents with primary amenorrhea in young women with normal external genitalia and normal development of secondary sexual characteristics with normal functioning ovaries and karyotype 46, XX without visible chromosomal anomaly. It was considered as sporadic anomaly but an increasing number of familial cases is suggestive of genetic cause in whom it is transmitted as autosomal dominant trait with incomplete penetrance and variable expressibility. This is suggestive of involvement of mutation in a major development gene or a limited chromosomal imbalance. Etiology of MRKH syndrome is still unclear. In order to allow sexual intercourse, treatment is aimed at creation of neovagina. Patients and their families must attend counseling before and throughout treatment as psychological distress is very important in young women with MRKH. We hereby report a rare case of MRKH syndrome in a 19-year-old married female patient presenting with primary amenorrhea, coital difficulty and no other clinical disorder