An unusual anomaly of deep venous system in the lower limb: Complete unilateral agenesis of iliofemoral veins in the absence of persistent sciatic vein

Venous anomalies are the most common congenital vascular anomalies. The rarest of these is complete deep venous agenesis. Here,we report a case of a 15-year-old male patient evaluated on color Doppler and computed tomographic venogram with complete rightiliofemoral deep venous agenesis with the inferior vena cava continuing as the left common iliac vein and the right popliteal veindraining into superficial anomalous veins of the thigh. These superficial veins were seen to drain through a superficial suprapubicarcuate connector vein into the dilated left common femoral vein. Uniquely in our case, there was no persistent embryonic sciaticvein and no demonstrable reflux into the superficial connector vein, suggesting an uncommon embryological mechanism underlyingits pathogenesis. Surgical resection of the dilated superficial veins is absolutely contraindicated in cases of deep venous agenesis andhence accurate diagnosis by the radiologist is absolutely essential in such cases

Isolated sternal hypoplasia: a rare cause of kyphoscoliosis

In most cases, kyphoscoliosis is idiopathic. However, this is a diagnosis of exclusion and can be made only if no cause can be identified. Kyphoscoliosis can occur due to various causes. Isolated sternal anomalies may also cause kyphoscoliosis secondary to the bony deformity though this has not previously been reported in literature. We have reported a case of kyphoscoliosis secondary to isolated sternal hypoplasia with complete absence of bony and cartilaginous elements of the body and xiphoid process of the sternum without any associated deformities of mediastinal structures, lung parenchyma or soft tissues in a young male patient. Careful evaluation of patients with kyphoscoliosis can ensure timely diagnosis of unusual and potentially treatable causes for the same such as sternal anomalies. Addition of lateral chest radiographs to the imaging protocol for evaluation of kyphoscoliosis can play a major role in timely diagnosis of such cases

Magnetic resonance imaging spectrum of intracranial tubercular lesions : one disease, many faces

Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form of the disease, comprising 10% of all tuberculosis cases. The causative organism, Mycobacterium tuberculosis, incites a granulomatous inflammatory response in the brain, the effects of which can be appreciated on magnetic resonance imaging (MRI), which can thus be used for diagnosis of the same. Neurotuberculosis can present in various patterns, which can be identified on MRI. The meningeal forms include leptomeningitis and pachymeningitis. Parenchymal forms of neurotuberculosis include tuberculoma in its various stages, tubercular cerebritis and abscess, tubercular rhombencephalitis, and tubercular encephalopathy. Each pattern has characteristic MRI appearances and differential diagnoses on imaging. Complications of neurotuberculosis, usually of tubercular meningitis, include hydrocephalus, vasculitis, and infarcts as well as cranial nerve palsies. Various MRI sequences besides the conventional ones can provide additional insight into the disease, help in quantifying the disease load, and help in differentiation of neurotuberculosis from conditions with similar imaging appearances and presentations. These can enable accurate and timely diagnosis by the radiologist and early institution of treatment in order to reduce the likelihood of permanent neurological sequelae

Unusual clinical presentation and complications following preoperative embolization of a large adrenal tumor

Authors present a case of a young female presenting with secondary amenorrhea which on further investigation revealed a large intra-abdominal mass, likely arising from the left adrenal gland. As the tumor was highly vascular with large feeders, she was referred for pre-operative embolization to reduce the blood loss during surgery. Post embolization, the patient suffered from an unusual complication of tumor rupture along with excessive secretion of catecholamines resulting in myocarditis and myocardial infarction. Patient ultimately died of the myocardial infarction. Preoperative embolization of a large, hypervascular adrenal mass lesion is not devoid of unusual complications like tumor rupture and subsequent cardiovascular complications even if the tumor is hormonally inactive. This complication is extremely rare and has never been reported in adrenal tumors after embolization

Atypical exophytic liver mass: Giant pedunculated hepatic haemangioma masquerading as a gastrointestinal stromal tumour of the gastric wall

Haemangioma is the most common benign tumour of the liver. However, an exophytic hepatic haemangioma, especially the pedunculated form, is very rare. Giant pedunculated haemangiomas are prone to complications because of the narrow size of the pedicle. A large number of lesions can potentially present as exophytic liver masses, and accurate diagnosis can sometimes be challenging. We report a case of an incidentally discovered asymptomatic giant pedunculated liver haemangioma in the region of the lesser sac in a prospective renal donor, which was initially suspected to be a gastrointestinal stromal tumour of the stomach wall. Multiphasic computed tomography and confirmatory magnetic resonance imaging scans ultimately revealed the true nature of the lesion, which turned out to be an exophytic pedunculated hepatic haemangioma from the left lobe of the liver. The lesion was then surgically resected and histopathologically confirmed to be a haemangioma. The patient subsequently underwent successful renal donation as planned. Being a benign lesion with characteristic imaging features, accurate radiological diagnosis is absolutely essential for the appropriate management of such atypical haemangiomas

Unusual presentation of a rare congenital anomaly: interrupted aortic arch presenting in adulthood with myocardial infarction

Interrupted aortic arch (IAA) is a very rare congenital cardiac anomaly in which there is complete interruption of a part of the aortic arch due to abnormal regression of a segment of the left fourth arch during development. The condition usually presents in the neonatal period with abrupt onset cardiac failure and shock after closure of the ductus arteriosus that maintains perfusion distal to the IAA in fetal life. In most cases, immediate surgery is necessary to save the life of the patient. In very rare cases, a massive collateral circulation can develop to compensate for the arch interruption and the condition may remain asymptomatic until adulthood, when it can present with early cardiovascular disease due to the chronic hemodynamic changes. Cross sectional imaging plays a major role in diagnosis and surgical planning in such adult patients. Surgery is usually recommended, even in asymptomatic cases, to prevent early onset cardiovascular diseases. Possibility of previously undiagnosed cardiovascular disease should always be a consideration when evaluating a young patient with myocardial infarction

Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces

Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form of the disease, comprising 10% of all tuberculosis cases. The causative organism, Mycobacterium tuberculosis , incites a granulomatous inflammatory response in the brain, the effects of which can be appreciated on magnetic resonance imaging (MRI), which can thus be used for diagnosis of the same. Neurotuberculosis can present in various patterns, which can be identified on MRI. The meningeal forms include leptomeningitis and pachymeningitis. Parenchymal forms of neurotuberculosis include tuberculoma in its various stages, tubercular cerebritis and abscess, tubercular rhombencephalitis, and tubercular encephalopathy. Each pattern has characteristic MRI appearances and differential diagnoses on imaging. Complications of neurotuberculosis, usually of tubercular meningitis, include hydrocephalus, vasculitis, and infarcts as well as cranial nerve palsies. Various MRI sequences besides the conventional ones can provide additional insight into the disease, help in quantifying the disease load, and help in differentiation of neurotuberculosis from conditions with similar imaging appearances and presentations. These can enable accurate and timely diagnosis by the radiologist and early institution of treatment in order to reduce the likelihood of permanent neurological sequelae

Customer Satisfaction for Financial Services: The Role of Products, Services, and Information Technology

In this paper, we study the drivers of customer satisfaction for financial services. We discuss a full Bayesian analysis based on data collected from customers of a leading financial services company. Our approach allows us to explicitly accommodate missing data and enables quantitative assessment of the impact of the drivers of satisfaction across the customer population. We find that satisfaction with product offerings is a primary driver of overall customer satisfaction. The quality of customer service with respect to financial statements and services provided through different channels of delivery, such as information technology enabled call centers and traditional branch offices, are also important in determining overall satisfaction. However, our analysis indicates that the impact of these service delivery factors may differ substantially across customer segments. In order to facilitate managerial action, we discuss how specific operational quality attributes for designing and delivering financial services can be leveraged to enhance satisfaction with product offerings and service delivery. Our approach and findings have significant implications for managing customer satisfaction in the financial services industry.financial services, customer satisfaction, Bayesian analysis, information technology