A prospective hospital based study of relation between carotid artery intimal medial thickness in patients with type 1 diabetes

Background: The aim of this study was to found association between Type 1 Diabetes Mellitus and Carotid Arterial Intimal Thickness (CIMT).Methods: Study design: It was a prospective case control hospital-based study. One hundred type 1 diabetes patient between the age group 3-36 years were taken. The association between type 1 diabetes with CIMT was studied. All the measurements were standardized. 50 age and sex matched controls were taken for comparison.Results: There is positive correlation between type 1 diabetes and CIMT (p<0.0001). The correlation further extends between duration of diabetes, glycemic control, age of onset, frequency and severity of diabetic related complication with CIMT.Conclusions: Carotid atherosclerosis as measured by CIMT has definite association with type 1 diabetes

Renal Artery Pseudo-aneurysms: Do All of Them Require Endovascular Management?

Purpose: Our study examines the etiological profile, clinical and imaging features of renal artery pseudo aneurysms (RAPs), as well as the efficacy and need for the angioembolization of RAPs in a resource-constrained setting. Materials and Methods: A total of 36 patients with RAPs were included in our study. Initial diagnosis was made by Doppler Ultrasonography (USG) followed by CT renal angiography in all cases. DSA was performed in 28 patients, as eight patients showed spontaneous resolution by thrombosis on immediate pre-procedure Doppler study. Angioembolization with a microcoil was performed for 30 aneurysms in 28 patients. Technical success was confirmed at the end of the procedure by a renal angiogram. To assess clinical success, we followed up with patients (with clinical and Doppler USG) for a period of six months. Results: The most common cause of RAPs in our study was percutaneous nephrolithotomy (PCNL), seen in 21 patients (58.3%), followed by trauma (25%), and partial nephrectomy (11%). All patients presented to us were within 21 days of the etiological event of hematuria or flank pain. USG was able to detect the RAP in 22 cases (61%). CT renal angiography was diagnostic in all patients but failed to demonstrate two additional aneurysms in one patient. RAP size ≤ 4 mm and absence of brisk filling on CT renal angiography was associated with spontaneous resolution in eight patients, probably an indication of the beginning of spontaneous thrombosis. Angioembolization was done using microcoils and showed 100% technical and clinical success. Conclusion: PCNL is the most common etiological factor for RAPs in our setting. Such patients should have a Doppler USG done prior to discharge from the hospital. CT angiographic flow dynamics (delayed peak enhancement) may be helpful in the identification of RAPs with a high probability of subsequent spontaneous resolution. Angiography followed by embolization using microcoils is the most effective and safe treatment for RAPs with no significant loss of renal parenchyma, although cost remains a limiting factor in our setting

Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy

Purpose: To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Material and methods: In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. Results: Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient (p = 0.0020), size (p = 0.0044) and depth (p = 0.0001) of the lesion, and needle-pleural angle (p = 0.0200). Gender of the patient (p = 0.7761), emphysema (p = 0.2724), site of the lesion (p = 0.9320), needle gauge (p = 0.7250), patient position (p = 0.9839), and dwell time (p = 0.9330) had no significant impact on the pneumothorax rate. Conclusions: This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy

The spectrum of imaging findings in pulmonary hydatid disease and the additive value of T2-weighted magnetic resonance imaging in its diagnosis

Purpose: To describe the spectrum of imaging findings in pulmonary echinococcosis and to study the additive value of T2-weighted magnetic resonance imaging (MRI) in the characterisation of pulmonary hydatid disease. Material and methods: This was a descriptive, prospective study conducted for a period of 3 years from December 2016 to November 2019. Patients suspected of having pulmonary echinococcosis (n = 110) on preliminary chest radiography were examined with chest computed tomography (CT). Among them 41 cases were additionally examined with T2-weighted MRI of thorax. Final diagnosis was based on surgery or histopathology. Results: Of the 110 patients enrolled for the study 15 were lost to attrition, and among the final cohort of 95 patients CT correctly diagnosed 68/84 (80.9%) as hydatid cyst, whereas 16/84 (19.1%) received an erroneous alternate diagnosis on CT. Based on the classical findings of hyperintense pulmonary cystic lesion with T2-weighted hypointense rim or detached internal T2-weighted hypointense membrane, a correct diagnosis of hydatid cyst was possible in 30 patients whereas a correct alternate diagnosis was made in 8 cases. T2-weighted MRI was found to have sensitivity of 96.7%, specificity of 80%, positive predictive value (PPV) of 93.7% and negative predictive value (NPV) of 88.9% with an overall diagnostic accuracy of 92.6%. Using the McNemar test, MRI was found to be diagnostically superior to CT (p = 0.019). Conclusions: Most of the pulmonary hydatid cysts can be diagnosed on CT; however, sometimes the findings may be indeterminate or atypical, leading to a diagnostic dilemma. MRI, owing to its ability to demonstrate hypointense endocyst, can act as a useful adjunct to correctly diagnose hydatid cyst or suggest an alternative diagnosis

Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in pediatric population

Background: The size of the airway varies greatly in pediatric patients, making it difficult to predict an appropriate size Endotracheal tube (ETT) for securing the airway. Several formulae are used to predict approximate ETT size. With the wider availability of ultrasonography (USG), many clinicians have suggested it as a useful tool for airway management and have used USG to measure tracheal dimensions in adults and children. Aims and Objectives: The primary aim of this study was to evaluate the usefulness of USG for the selection of correct sized uncuffed ETT in pediatric patients and the secondary aim was to correlate the age-based formula with ultrasound measured subglottic diameter for predicting the size of ETT. Materials and Methods: A total of 64 patients of either gender in the age group of 2–6 years were enrolled in the study. Standard anesthetic induction was done and transverse subglottic diameter was measured using USG. The minimal transverse subglottic diameter was measured and noted and the patient was intubated with the tube size as determined by modified Cole’s age-based formula. Results: Out of 64 patients, 33 were male and 31 female. Average age was 3.9 (±1.47) years, 42.2% belonged to the age group of (2–3) years, average weight of the patients was 20.3 (±10.45) kg. The mean ETT outer diameters (OD) based on age-based formula was 6.81 mm compared to 6.91 mm and 6.78 mm by USG based and actual ETT OD, respectively. Both the age based ETT OD and USG-based ETT OD showed good correlation with actual ETT OD used with r-value of 0.891 and 0.876, respectively. Conclusion: Although USG is a non-invasive, cost-effective, and reproducible technique its routine use for estimating ETT size in pediatric patients could not be justified over age-based formula as both of them have comparable results (statistically insignificant). The success rate of age-based formula and USG in precisely predicting ETT outer diameter is comparable with the size of actual ETT outer diameter (78% vs. 75%, P=0.86)

Role of Diffusion-Weighted and Chemical Shift Magnetic Resonance Imaging in Differentiation of Benign and Malignant Spinal Fractures

Atraumatic spinal compression fractures are common clinical problem. Differentiating benign osteoporotic fractures from pathological fractures due to malignant/metastatic lesions affects the management and prognoses in patients with known extraspinal malignancy. &nbsp;&nbsp; The objective of the research was to assess the role of conventional magnetic resonance imaging sequences with diffusion-weighted imaging and chemical-shift imaging in differentiating benign and malignant acute spinal compression fractures. Materials and Methods. The study included 40 patients with acute spinal compression fractures. Patients were evaluated using magnetic resonance imaging with diffusion-weighted imaging and chemical-shift imaging to differentiate benign etiology from malignant one. The results obtained were compared with histopathological follow-up for 6 months for definite clinical diagnoses. Results. No significant difference was noted in signal characteristics of benign and malignant fractures on T1, T2 and short-tau inversion recovery. However, posterior element involvement, soft tissue component and post-contrast enhancement were seen more frequently in malignant fractures (p&lt;0.05). On diffusion-weighted images, 77.8% of malignant fractures were hyperintense and 59.1% of benign fractures were hypointense (p&lt;0.05). The mean apparent diffusion coefficient value was 0.81 ± 0.19 for malignant and 1.24 ± 0.24 for benign fractures (p&lt;0.5). The mean signal intensity ratio for malignant fractures was 0.91 ± 0.125, whereas the signal intensity ratio for benign fractures was 0.64 ± 0.096 (p&lt;0.001). Conclusions. Signal characteristics on T1, T2 and short-tau inversion recovery sequences do not differentiate benign from malignant fractures; however, posterior element involvement, soft tissue and post contrast enhancement help in differentiating the etiology. Diffusion-weighted imaging and apparent diffusion coefficient values, as well as using chemical shift imaging further improve the diagnostic accuracy of magnetic resonance imaging

Pseudoaneurysm of mitral-aortic intervalvular fibrosa in a child: Demonstration by MDCT and MRI

Subaortic left ventricular outflow tract pseudoaneurysms are rare lesions that are associated with aortic valve diseases, infective endocarditis, trauma or surgery. We present dynamic multidetector computerized tomography and cine magnetic resonance imaging features of a case of subaortic aneurysm arising from interaortic-mitral valvular region in a child with past history of infective endocarditis

High resolution B Mode ultrasound of common carotid artery in evaluation of atherosclerosis in patients of rheumatoid arthritis.

Research Question: Can atherosclerotic changes be detected using b mode ultrasound. (Carotid Doppler) Objectives: The aim of our study was 1) to confirm the presence of atherosclerosis in patients of rheumatoid arthritis; 2) Role of high resolution B mode ultrasound Doppler to assess the existence of atherosclerosis in RA patients, measuring the intima-medial thickness (IMT) of the common carotid arteries; and 3) Role of inflammation in development of atherosclerosis in absence of traditional risk factors. Study Design: Hospital based cross-sectional case control study. Methods: Carotid IMT was measured using high-resolution B-mode ultrasound in 40 patients with RA and 20 age- and sex-matched healthy controls. Serum total cholesterol, serum triglycerides, rheumatoid factor, body mass index (BMI) was determined. ESR, C-reactive protein (CRP) were used to measure systemic inflammation. DAS 28 was used to measure disease activity and x ray hands were used to determine erosions for bone damage. Results: Common carotid IMT were significantly higher (p=0.0000) in RA patients (0.61±0.02) compared with controls (0.45±0.07). In RA patients common carotid IMT significantly correlated with serum triglycerides (p=0.037), and ESR (p=0.034). No significant correlation was found with other clinical and laboratory parameters reflecting disease activity. Significant positive correlation was observed with use of non steroidal anti inflammatory drugs and use of ayurvedic drugs. Conclusions: Our results confirm an accelerated atherosclerosis, as shown by increased common carotid IMT, in patients with RA compared with controls even in the absence of traditional risk factors. There is definite role of inflammation in development of atherosclerosis in these patients. High-resolution B-mode ultrasound may be considered a promising, sensitive, non invasive, and cost effective tool for assessing the existence of atherosclerosis in RA patients

64-slice CT imaging in a case of total anomalous pulmonary venous circulation

For long, catheter angiography has been the investigation of choice for the diagnosis of congenital anomalies of the heart such as total anomalous pulmonary venous circulation (TAPVC). In the last few years, MRI and multislice CT scan have also been introduced for this purpose. We report a case where 64-slice CT scan was found very useful in the evaluation of TAPVC