A seven-year-old boy, presented with recurrent respiratory tract infection. The chest radiograph showed reduced left lung volume, small left hilum, and hyperlucent contralateral lung herniated across the midline. A diagnosis of left pulmonary hypoplasia was considered initially. Contrast CT thorax confirmed volume loss in the left haemithorax with hyperinflation of the right lung [Table/ Fig-1b]. There was non-visualization of the entire left pulmonary artery , with paucity of pulmonary vasculature, mild bronchiectasis, subpleural and mediastinal systemic collaterals, pleural thickening and subpleural scarring . The patient underwent pneumonectomy and the gross specimen showed hypoplastic, pale looking left lung with a leash of telangiectatic vessels and absent left pulmonary artery. Microscopy revealed mild bronchiectasis and interstitial inflammation within the hypoplastic lung. Case 2A 27-year-old male patient, with an underlying congenital heart disease (subaortic VSD, mild aortic regurgitation and mild mitral regurgitation) diagnosed on echocardiography, presented with haemoptysis of 3 months duration. Chest radiograph showed loss of right lung volume, with paucity of markings. There were linear opacities and pleural thickening in the right upper zone. The left lung showed increased transradiancy and hyperinflation, with prominence of the left hilum. Contrast enhanced CT thorax We present a few cases of Proximal Interruption of the Pulmonary Artery, an uncommon developmental anomaly associated with congenital heart disease. The cases had varied clinical presentations. Chest radiograph showed a hypoplastic lung with an ipsilateral small hilum on the side of the interruption and hyperinflation of the contralateral lung. Contrast CT confirmed the diagnosis, demonstrating non-visualization of the left or right pulmonary artery, and other related findings.demonstrated loss of right lung volume, non-visualization of the right pulmonary artery and its branches, and collaterals from bronchial and non-bronchial systemic circulation in the subpleural and intercostal spaces [Table/ Fig-2b]. There were discrepancies in the calibre of the intraparenchymal pulmonary arterial branches in the right and left lungs. Right pleural thickening and parenchymal scarring were present. AFB smear was negative and sputum culture showed multiple gram-positive bacteria. The patient was treated with antibiotics and had no haemoptysis at first follow up. He was advised embolization, if haemoptysis recurred. Case 3A 57-year-old male patient, diagnosed elsewhere to have non-small cell carcinoma lung, came for a follow up CT after chemotherapy.

Objectives: The aim of this study was to establish normal diameters for the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels in the Indian population and to study the variation in aortic diameters with age, sex, height, weight, body mass index (BMI), and body surface area (BSA). Materials and Methods: One hundred and forty-two patients who underwent helical contrast-enhanced computed tomography (CT) scans of the abdomen for non-cardiovascular reasons were recruited.. The mean internal diameters of the suprarenal and infrarenal abdominal aorta (maximum anteroposterior and transverse diameter) were measured at T12 and L3 vertebral levels and tabulated according to various age groups for both men and women. Pearson correlation coefficient was used to evaluate the correlation between aortic diameters, height, weight, BSA, and BMI. Results: The mean diameters of the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels, in men were 19.0 ± 2.3 and 13.8 ± 1.9 mm and in women 17.1 ± 2.3 and 12.0 ± 1.6 mm, respectively. The aortic diameter progressively increased in caliber with increasing age of the patients and was smaller in women than men. A significant positive correlation was found in men between the suprarenal and infrarenal aortic diameters and weight, BSA, and BMI. In women, this correlation was significant in the infrarenal aorta but not in the suprarenal aorta. Conclusion: We obtained a set of normal values for the abdominal aorta in the Indian population. The aortic diameters correlated with age, gender, and body size of the patients as seen with previously published data in the Western population. A brief comparison of data between Indian and Western population showed that the values obtained were less than published elsewhere and hence, this should be considered while formulating intervention protocols.

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SummaryBackgroundLocalization of a cerebrospinal fluid [CSF] fistula is a diagnostic challenge. The choice of an optimal imaging technique is necessary to locate the site of CSF leak which is required for surgical/endoscopic repair of the CSF fistula.Material/MethodsRetrospective analysis of imaging was performed in 33 patients who presented with symptoms suggestive of CSF rhinorrhoea over a period of two years. Either a bone defect on high resolution CT [HRCT] or CSF column extending extracranially from the subarachnoid space with or without brain/ meningeal herniation on magnetic resonance [MR] cisternography was considered positive for CSF leak. The MR imaging technique included 1-mm heavily T2-weighted [TR 2000 ms; TE-200 ms] fast spin echo study in coronal and sagittal planes. HRCT sections involved 0.625 to 0.8-mm sections in the coronal plane, with or without axial planes, through the paranasal sinuses, reconstructed in a sharp algorithm and acquired with the patient in prone position. Imaging findings were compared with endoscopic findings, being the gold standard for the assessment of CSF rhinorrhea.ResultsA total of 25 patients had a combination of HRCT and MR cisternography. The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] of both MR cisternography and HRCT together were 93%, 100%, 100% and 50% respectively. Two patients underwent only MR cisternography, 5 patients underwent only HRCT and one patient underwent HRCT, MR cisternography and CT cisternography. Though PPV was 100% in the groups with HRCT alone, MR cisternography alone and combined CT cisternography, HRCT and MR cisternography, the results were not statistically significant as the number of patients in those groups was lower.ConclusionsCombination of MR cisternography and HRCT appears to be complementary, accurate and non-invasive and should be considered as optimal imaging modality for pre-op imaging in the evaluation of CSF rhinorrhoea.

Background Few treatment options exist for patients with severe central nervous system tuberculosis (CNS TB) worsening due to inflammatory lesions, despite optimal antitubercular therapy (ATT) and steroids. Data regarding the efficacy and safety of infliximab in these patients is sparse. Methods We performed a matched retrospective cohort study based on Medical Research Council (MRC) grading system and modified Rankin Scale (mRS) scores comparing two groups of adults with CNS TB. Cohort-A received at least one dose of infliximab after optimal ATT and steroids, between March, 2019 to July, 2022. Cohort-B received only ATT and steroids. Disability-free survival, [(mRS) score ≤2] at 6-months was the primary outcome. Results Baseline MRC grades and mRS scores were similar between the cohorts. Median duration from the start of ATT and steroids to infliximab treatment was 6 (IQR 3.7-13) months, and neurological deficits was 4 (IQR 2-6.2) months. Indications for infliximab were symptomatic tuberculomas (20/30; 66.7%), spinal cord involvement with paraparesis [8/30; 26.7%] and optochiasmatic arachnoiditis (3/30; 10%), worsening despite adequate ATT and steroids. Severe disability (5/30; 16.7% and 21/60; 35%) and all-cause mortality (2/30; 6.7% and 13/60; 21.7%) at 6-months were lower in Cohort-A. In the combined study population, only exposure to infliximab was positively associated (aRR 6.2, p=0.001, 95% CI 2.18-17.83) with disability-free survival at 6-months. There were no clear infliximab related side effects noted. Conclusion Infliximab may be an effective and safe adjunctive strategy among severely disabled patients with CNS TB, not improving despite optimal ATT and steroids. Adequately powered phase-3 clinical trials are required to confirm these early findings.

SummaryBackgroundAssessment of bone graft substitute incorporation is critical in the clinical decision making process and requires special investigations. We examined if the pixel value ratio (PVR) obtained in routine follow-up digital radiographs could be used for such assessment.Material/MethodsRadiographic images were acquired using either computed radiography or flat panel digital radiography systems. The PVR from radiographs of thirty children with ceramic bone substitute grafting were analyzed using the software from the picture archival and communication system (PACS) workstation. Graft incorporation was also assessed using the van Hemert scale. Three independent observers (A, B, C) measured PVRs at two different time points during the first and the last follow-up visits. PVR was compared with the van Hemert scale scores and analyzed using Spearman’s rank correlation.ResultsThe mean intra-observer reliability was 0.8996, and inter-observer reliabilities were 0.69 (A vs. C), 0.78 (A vs. B), and 0.85 (B vs. C) for the first follow-up visit and 0.74 (A vs. C), 0.82 (A vs. B), and 0.70 (B vs. C) for the last follow-up measurements. Spearman’s correlation showed a strong negative association between PVR values and van Hemert scale scores, as the healing process advanced on serial measurements at each follow-up (r=–0.94, n=60, z=–7.24, p≤0.0001). The reliability of the PVR measurements was assessed using an aluminum step wedge and ceramic graft.ConclusionsPVR is potentially a reliable indicator of bone graft incorporation and can aid in clinical decision making provided standard radiographic techniques are used.

Introduction:Varicella zoster virus is an exclusively human neurotrophic virus. The primary infection with the virus causes varicella. The virus remains latent in nervous tissue and upon secondary activation causes a variety of syndromes involving the central nervous system (CNS) including meningoencephalitis and cerebellitis.Materials and Methods:In this study, we looked at the epidemiology, clinical and laboratory features, and outcomes of patients who were admitted with varicella zoster of the CNS from 2005 to 2014.Results:There were 17 patients. Fever was present in 13 patients, seizures in 9 patients and headache and vomiting in 4 patients each. A generalized varicella rash was present in 8 out of 17 patients. A single dermatomal herpes zoster was present in seven patients. Two patients had no rash. Varicella zoster polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) was done in 5 patients of which 4 were positive and 1 was negative. Nine patients had diabetes with an average glycated hemoglobin of 8.6%. Total number of deaths was five.Conclusions:Patients with diabetes who develop varicella or herpes zoster may be at risk for CNS complications. The diagnosis of varicella encephalitis has to rest on a combination of clinical findings and CSF PCR, as neither the rash nor the PCR is sensitive enough to diagnose all the cases with varicella encephalitis.