Imaging in Van Wyk Grumbach syndrome: An uncommon presentation of hypothyroidism

Isosexual precocious puberty with ovarian masses in long-standing juvenile hypothyroidism is well described in the literature as Van Wyk Grumbach syndrome (VWGS). The present case reports this rare entity in a 4-year-old girl who was referred for imaging to evaluate the cause of non-traumatic bleeding per vagina. Antecedent history, clinical features and thyroid function tests were consistent with long-standing juvenile hypothyroidism with documented clinical response to thyroxine replacement therapy. Contribution: Typical clinical and radiological features of the syndrome are reported, which helps in the early diagnosis and management, henceforth avoiding the associated complications

Diagnostic dilemma in left flank mass in an infant: A rare case of intrarenal neuroblastoma

Neuroblastoma (NBL) and nephroblastoma present with abdominal mass and various imaging features help in differentiating the two; however, localisation is difficult in large masses and at times imaging features can be confusing. Here, we describe the case of large left-sided NBL arising from the adrenal and involving the left kidney with moderate hydronephrosis

Umbilical venous catheterization gone wrong: Hepatic complications

Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby

Assessment of Carotid Plaque Enhancement on Contrast-Enhanced Ultrasound as a Predictor for Severe Coronary Artery Disease

Background and Aim Contrast-enhanced ultrasound (CEUS) can reliably identify vulnerable plaques. As atherosclerosis is a systemic disease, we evaluated whether contrast enhancement of carotid plaque (CECP) can predict severe coronary artery disease (CAD) by comparing CECP in patients who have had acute coronary syndromes (ACS) recently with asymptomatic individuals

Efficacy and safety of 90,000 IU versus 300,000 IU single dose oral Vitamin D in nutritional rickets: A randomized controlled trial

Aim: To compare efficacy and safety of 90,000 IU versus 300,000 IU oral single dose vitamin D for treatment of nutritional rickets. Study Design: Randomized controlled trial. Setting: Tertiary care hospital. Participants: One hundred ten children (6 months to 5 years, median age 10.5 months) with rickets. Exclusion criteria were disease affecting absorption, intake of calcium/vitamin D preparation in last 6 months, abnormal renal function, and rickets other than nutritional. Intervention: Vitamin D3 as a single oral dose 90,000 IU (group A, n = 55) or 300,000 IU (group B, n = 55). Methodology: Severity of rickets was scored on knee and wrist X-ray as per Thacher's radiographic score. Baseline serum levels of calcium, SAP, 25(OH)D, iPTH were measured. Follow up was done at 1 week, 4 weeks, and 12 weeks. Outcome Variable: Primary – Radiographic score at 3 months. Secondary – Serum levels of 25(OH)D, SAP, and iPTH at 3 months, clinical and biochemical adverse effects. Results: Eighty-six subjects (43 in each group) completed the study. The radiographic score reduced from 6.90 to 0.16 in group A and from 6.93 to 0.23 in group B. The levels of 25(OH)D, ALP, and PTH were similar between the groups at baseline and follow up. Hypercalciuria and hypercalcemia were seen more often in group B as was hypervitaminosis D. There were no clinical adverse events. Conclusions: Single oral dose vitamin D3 90,000 IU is safe and effective in achieving healing of rickets

Concurrent nonfunctional paraganglioma of the retroperitoneum and urinary bladder: A case report with literature review

Paragangliomas are the neuroendocrine tumors which arise from the chromaffin cell. Tumors arising from the adrenal medulla are known as pheochromocytomas, while others originating from the extra-adrenal site are known as extra-adrenal paragangliomas. Paraganglioma can be multifocal which can arise synchronously or metachronously. Paragangliomas are less functionally active than the pheochromocytomas; they secrete noradrenaline and rarely dopamine, while adrenal pheochromocytomas secrete adrenaline or nor-adrenaline. Nonfunctional multifocal paragangliomas are very rare. We report a case of a 45-year-old female with multifocal nonfunctional paragangliomas of the retroperitoneum and urinarybladder which were surgically removed, and the diagnosis was confirmed on histopathology

Diagnostic accuracy of shear wave elastography in evaluating renal fibrosis in children with chronic kidney disease: a comparative study with nuclear scan

Abstract Background Chronic kidney disease (CKD) is a significant health issue in pediatric patients due to fibrosis progression. Shear wave elastography (SWE) is a noninvasive technique used to assess fibrosis in CKD, but its efficacy needs to be better established. This study aimed to compare SWE with nuclear scan in assessing fibrosis in pediatric CKD patients. Aim To determine the area of scarring/fibrosis of each kidney using shear wave elastography in chronic kidney disease and compare it with technetium-99m dimercaptosuccinic acid (DMSA) results. Methods A prospective study included 39 chronic kidney disease patients who underwent shear wave elastography and grayscale ultrasound. DMSA scans were performed to identify scar areas of the kidneys. Young modulus was recorded for each pole of both kidneys and compared with scar areas on DMSA. Thirty-nine age-matched controls underwent shear wave elastography to estimate the average elasticity value in the normal population. Results Thirty-nine CKD patients underwent this study, with 10 females and 29 males. The median age was 6.5 years. The cutoff value of cortical thickness ≤ 10.2 predicted scar on DMSA with a sensitivity of 79% and a specificity of 77%. The cutoff value of elasticity value ≥ 5.57 kPa predicted scar on DMSA with a sensitivity of 87% and a specificity of 96%. Median SWE values were significantly higher with the scar on DMSA (12.6 kPa) compared to no scar on DMSA (4.1 kPa). The controls mean values and standard deviation were 2.42 kPa and 0.45 kPa, respectively. Conclusions Shear wave elastography has revealed that patients with chronic kidney disease exhibit higher values in the areas where scarring has occurred, compared to non-scarred areas. Fortunately, integrating shear wave elastography into routine ultrasonography assessments is a straightforward and painless process that requires no additional preparation from the patient. Not only is this method time efficient, but it also eliminates the need for potentially risky radiation exposure from radionuclide tests in the future