Sonographic appearance of testicular adrenal rest tumour in a patient with congenital adrenal hyperplasia

Background: Testicular adrenal rest tumours (TARTs) are benign testicular masses that are found in inadequately treated patients with congenital adrenal hyperplasia (CAH). Recognizing this association and identifying characteristic ultrasound features of TARTs is important so as to avoid misdiagnosing them as malignancies, which can lead to unnecessary interventions. Case Report: We describe a case of a 9-year-old boy, with a diagnosis of CAH and precocious puberty, who was referred to our department for an ultrasound evaluation of the abdomen and scrotum. On ultrasound, there were well-defined, heterogeneous, predominantly hypoechoic, round-to-oval masses in both testes. Taking into account the presence of CAH and a typical sonographic appearance of bilateral testicular masses, a diagnosis of testicular adrenal rest tumour was made; biopsy was deferred and hormonal treatment was modified. Conclusions: Prompt diagnosis of testicular adrenal rest tumours is essential, as it only indicates inadequate hormonal control. Moreover, it can prevent unnecessary biopsies and orchidectomies, and can maintain fertility. TARTs have a typical imaging appearance that every radiologist must be aware of

Predicting and grading the degree of difficulty of cochlear implant surgery by evaluating temporal bone using high resolution computed tomography and magnetic resonance imaging

Background: The current study was designed to assess the challenges that arise during cochlear implantation. Hence imaging based grading system, using a structured, 12-point scoring chart was developed with an aim to assess various anatomical factors of temporal bone helpful in contemplating complications involved in surgery and to assess various congenital and acquired abnormalities if detected during scan which can affect cochlear implant surgery.Methods: This was a descriptive study done on 60 patients with sensorineural hearing loss. They were evaluated preoperatively by using HRCT and MRI findings and subsequently underwent cochlear implantation. A 12-point scoring chart was developed based on imaging findings. Surgical times were noted in each case and each imaging point on the scoring chart was correlated with the surgical times.Results: Eleven out of 12 points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. One point was not correlating with the surgical timings. Based on the grading system, in the present study, there were 37 patients (61.66%) classified as Grade 1, 16 patients (26.67%) classified as Grade 2 and 7 patients (11.67%) classified as Grade 3.Conclusions: These radiological image findings and its related grading system are relatively easy and quick to assess on readily available pre-operative temporal bone CT scan and MRI. They can form a pre-operative checklist that provides a formalized approach for the surgeons and, in particular surgical trainees, predict and, thus prepare for, potentially challenging cochlear implant cases

Estimation and quantification of liver iron concentration by magnetic resonance imaging

Background: Liver iron overload is considered to be the histological hallmark of genetic hemochromatosis. The accurate estimation of iron overload is important to establish the diagnosis of hemochromatosis. The aim of the present study was to estimate T2* liver value, quantify liver iron concentration (in milligram of iron per gram dry weight) and find out the appropriate therapy for patients with iron overload according to severity index.Methods: A cross-sectional observational study was carried out in Department of Radio Diagnosis, at B.Y.L. Nair Hospital and medical college, Mumbai from June 2017 to August 2018. A total of 50 cases were enrolled for the present study.Results: Male predominance (66.0%) was seen. Mean duration of disease among the studied cases was 10.52±6.06 years, with minimum and maximum duration of disease of 1 and 26 years respectively. Eight percent had compliance to visit and treatment among the enrolled cases.Conclusions: MRI was concluded to be potentially useful non-invasive method for evaluating liver iron stones in a wide spectrum of haematological and liver diseases