Decoding neonatal chest radiographic patterns of disease: retrospective analysis from a tertiary care hospital

Background: To evaluate chest radiographic patterns in neonatal respiratory distress using a predesigned performa and algorithm and to correlate results with the clinical diagnosis.Methods: A retrospective review was done of bedside chest radiographs acquired over a month for respiratory distress from the neonatal intensive care unit. The radiographs were systematically evaluated according to a predesigned performa and algorithm. A presumptive radiographic diagnosis was assigned to each patient based on the combination of radiographic features. Radiographic diagnosis was compared with the clinical diagnosis. The most important diagnostic features were outlined.Results: The radiographic diagnosis correlated with clinical diagnosis in 93.3% of cases. Most common radiographic feature was pulmonary air space opacity (n=21). Air space opacity without any mediastinal shift in absence of any compensatory factors was a reliable diagnostic feature for pneumonic consolidation, which was the most common diagnosis (n=10). Bilateral granular lung fields were a specific indicator of respiratory distress syndrome. Flattening of domes of diaphragm was the most frequent feature for hyperinflation. Bilateral hyperinflation could be accurately used to diagnose bronchiolitis in all but one case (n=4/5). Pleural complications were accurately diagnosed.Conclusions: Systematic evaluation of neonatal chest radiographic patterns of disease has a high diagnostic accuracy

Urinary bladder agenesis with bilateral single system vaginal ectopic ureters in adult

Agenesis of urinary bladder is an extremely rare condition with only 60 cases and 22 live births being reported previously. Ureteric ectopia is a must for survival. We present a unique case of bladder agenesis detected in adulthood where bilateral single system ureters were draining ectopically in a grossly dilated vagina in normally developed female genital tract

MDCT angiography in evaluation of pediatric hemangiomas and peripheral vascular malformations

Background: To evaluate the role of MDCT angiography in peripheral hemangiomas and vascular malformations in pediatric patients.Methods: Total of 36 consecutive pediatric patients with clinically suspected peripheral hemangiomas and peripheral malformations were included in the study. MDCT angiography and doppler sonography was done for all patients. Final diagnosis was made by response to treatment and follow up. The statistical significance of various MDCT findings and post processing techniques was calculated. p value of <0.05 was considered significant.Results: Venous malformations were the most common. The MDCTA features which were significant in diagnosing venous malformations were phleboliths (p=0.039), peak enhancement in venous or delayed phase, absence of soft tissue mass, lacy tangle of vessels on maximum intensity projection and volume rendered images. Features significant in diagnosing arteriovenous malformations were tortuous arterial feeders, peak enhancement in arterial phase (0.0001), early draining vein (p=0.0001), venous phase wash out (p=0.0001), tense tangle of vessels on maximum intensity projection and volume rendered images (p=0.0003). Phleboliths (p=0.43) and venous or delayed phase peak enhancement (p=0.69) were overlapping features in congenital hemangiomas and venous malformations. Arterial phase enhancement (p=0.10) and early draining veins (p=0.39) were overlapping features in infantile proliferating hemangiomas and arteriovenous malformations. However, presence of soft tissue mass (p=0.0001) and lack of venous phase wash out (p=0.0003) were differentiating features for hemangiomas.Conclusions: MDCT angiography can be used as a highly accurate modality to diagnose hemangiomas and vascular malformations. It has an advantage over color Doppler in depicting entire extent of deep lesions

Role of combined wash-in and wash-out threshold criteria on dynamic multislice CECT for solitary pulmonary nodule characterisation: data from Indian tertiary care hospital

Background: To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material–enhanced multi– detector row computed tomography (CT in distinguishing benign from malignant solitary pulmonary nodule (SPN).Methods: Institutional review board approval and informed consent were obtained. The study included 30 patients (16 men, 14 women; mean age, 52 years; range, 25-80 years) with SPN. After unenhanced CT (1.25mm collimation) scan, dynamic CT was performed (series of images obtained throughout the nodule, with 0.6mm collimation, at 30, 60, 90, and 120 seconds and 4, 5, 9, 12, and 15 minutes) after intravenous injection of contrast medium (120 mL). The HU value of nodule was noted at each of the scans. Data was analyzed for dynamic enhancement characteristics. FNAC from the nodule was done in all patients. The data were correlated with the cytopathological and follow –up results. The significance of various dynamic enhancement features and different threshold criteria for wash-in and wash-out of contrast medium for differentiation between benign and malignant nodules were derived.Results: There were 16 malignant and 14 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-34 HU were applied, sensitivity, specificity, and accuracy for malignancy were 100%, 92.8% and 96.7% respectively.Conclusions: Evaluation of solitary pulmonary nodules by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced multi– detector row CT showed 96.7% accuracy (p<0.001) for distinguishing benign nodules from malignant nodules

Urinary bladder agenesis with bilateral single system vaginal ectopic ureters in adult

Agenesis of urinary bladder is an extremely rare condition with only 60 cases and 22 live births being reported previously. Ureteric ectopia is a must for survival. We present a unique case of bladder agenesis detected in adulthood where bilateral single system ureters were draining ectopically in a grossly dilated vagina in normally developed female genital tract

Role of combined wash-in and wash-out threshold criteria on dynamic multislice CECT for solitary pulmonary nodule characterisation: data from Indian tertiary care hospital

Background: To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material–enhanced multi– detector row computed tomography (CT in distinguishing benign from malignant solitary pulmonary nodule (SPN).Methods: Institutional review board approval and informed consent were obtained. The study included 30 patients (16 men, 14 women; mean age, 52 years; range, 25-80 years) with SPN. After unenhanced CT (1.25mm collimation) scan, dynamic CT was performed (series of images obtained throughout the nodule, with 0.6mm collimation, at 30, 60, 90, and 120 seconds and 4, 5, 9, 12, and 15 minutes) after intravenous injection of contrast medium (120 mL). The HU value of nodule was noted at each of the scans. Data was analyzed for dynamic enhancement characteristics. FNAC from the nodule was done in all patients. The data were correlated with the cytopathological and follow –up results. The significance of various dynamic enhancement features and different threshold criteria for wash-in and wash-out of contrast medium for differentiation between benign and malignant nodules were derived.Results: There were 16 malignant and 14 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-34 HU were applied, sensitivity, specificity, and accuracy for malignancy were 100%, 92.8% and 96.7% respectively.Conclusions: Evaluation of solitary pulmonary nodules by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced multi– detector row CT showed 96.7% accuracy (p&lt;0.001) for distinguishing benign nodules from malignant nodules

Morphological Changes in Paraspinal Muscles on MR Imaging in Chronic Low Back Pain Patients with Unilateral Lumbar Disc Herniation: A Cross-sectional Study

Introduction: Low Back Pain (LBP) caused by Lumbar Disc Herniation (LDH) is a major cause of chronic disability worldwide. The management of LDH depends on clinical assessment and Magnetic Resonance Imaging (MRI) findings. Atrophy or fatty replacement of paraspinous muscles has a negative impact on the outcomes of both conservative and surgical treatment for LBP due to LDH. Aim: To analyse the morphological changes in paraspinous muscles using MRI in patients with chronic LBP and unilateral LDH. Materials and Methods: A cross-sectional study was conducted at Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, India, from December 2020 to May 2022. A total of 59 patients, aged 21-65 years, with chronic LBP and unilateral LDH on MRI, were included in the study. The morphological changes in the Multifidus Muscle (MM) and Erector Spinae Muscle (EM) were analysed. The Cross-Sectional Area (CSA) of MM and EM, as well as the Signal Intensity (SI) of MM on the herniated side of the lumbar disc, were recorded and compared to the contralateral side at the same level. Continuous variables were expressed as mean±SD, median, and interquartile range, while categorical variables were presented as numbers and percentages. The Mann-Whitney test was used to compare continuous variables, and a p-value of <0.05 was considered statistically significant. Results: The mean age of the study participants was 39.17±12.82 years, with 59.3% male and 40.7% female participants. The CSA of MM on the side of disc herniation was 5.84±1.53 cm2 , compared to 6.52±1.69 cm2 on the unaffected side (p=0.02). The CSA of EM on the side of unilateral disc herniation was 13.08±3.04 cm2 , compared to 14.29±3.22 cm2 on the unaffected side (p=0.01). The SI of MM on the affected side was 175.84±100.99, compared to 147.70±83.50 on the unaffected side (p=0.02). Conclusion: Chronic LBP due to unilateral LDH resulted in a reduction in the Cross-Sectional Area (CSA) and fatty infiltration of the ipsilateral paraspinous muscles