Background Estimation of gestational age plays a pivotal role in day to day clinical practice for appropriate management of newborn. The trans-cerebellar diameter can predict gestational age in cases of variations of fetal head shape such as dolichocephaly and brachycephaly or even when fetus is in posterior position. Trans-cerebellar diameter (TCD) may be useful in gestational age estimation. Aim and methodology To determine the accuracy of trans-cerebellar diameter in the estimation of gestational age of fetus and comparing the conventional parameters like head circumference, biparietal diameter, abdominal circumference and femur length in the measurement of gestational age. This is a prospective, cross-sectional analytical study done in the Radiology Department in those patients who were referred to the department for a routine antenatal ultra-sonogram checkup. Results Comparison of trans-cerebellar diameter with gestational age derived from last menstrual period indicates that there is a linear relationship throughout the gestational ages. There is a strong correlation of trans-cerebellar diameter with other conventional parameters namely biparietal diameter, femur length and abdominal circumference of which Femur length correlates well with the trans-cerebellar diameter. Correlation of transcerebellar diameter with gestational age shows a R2 of 0.995 (p value < 0.001). Conclusion Trans-cerebellar diameter is best in estimation of gestational age when compared to biparietal diameter, femur length and abdominal circumference. The regression formula derived from trans-cerebellar diameter measurement can be applied to determine the gestational age of fetus.
Background Bronchopleural fistula (BFF) is a fistulous communication between the trachea or bronchus and the pleural space. Central type of bronchopleural fistula is usually post-surgical. Infective cause for central bronchopleural fistula is rare. This case report encompasses an infective cause of central bronchopleural fistula, mucormycosis. Pulmonary mucormycosis is a rapidly progressive condition with high mortality. A high index of suspicion and timely intervention is required to alleviate fatal outcome. The present case is discussed in detail about the clinical presentation and diagnostic imaging of pulmonary mucormycosis presenting with central bronchopleural fistula. Case presentation Thirty-five years old diabetic male, presented with fever, productive cough, mild haemoptysis and chest pain for 10 days duration. The patient was pale on general examination and had decreased breath sound in the right suprascapular and interscapular areas with coarse crackles in the right infrascapular and infra-axillary areas. The laboratory investigations were unremarkable except for anaemia and raised blood glucose level. Sputum examination on potassium hydroxide (KOH) mount showed broad aseptate hyphae. There was a loculated right hydropneumothorax with collapsed lung in chest radiograph. Multi-detector computed tomography of the thorax revealed central type of bronchopleural fistula with the right main bronchus, consolidation of the middle lobe and superior segment of the right lower lobe with multiple internal thick-walled cavities. Right pneumonectomy was performed as the patient did not improve on medical management and showed worsening of symptoms. Histopathological examination was suggestive of mucormycosis. Conclusion Central bronchopleural fistula due to an infective aetiology is uncommon. However, mucormycosis should be considered as a differential diagnosis in cases of central bronchopleural fistula with the destroyed lung, especially in diabetic individuals. Hence, a high index of suspicion is necessary for early diagnosis and management as mucormycosis is a rapidly progressive disease with delay in treatment leading to high mortality.
Context Progressive supranuclear palsy (PSP) is a neurodegenerative disorder which comes under Parkinsonism plus syndrome. As this spectrum of disease has many overlapping clinical as well as imaging findings, some quantitative parameters like magnetic resonance Parkinsonism index and midbrain/pons ratio are useful to differentiate PSP from other PD patients. Aims The study aimed to detect sensitivity and specificity of magnetic resonance Parkinsonism index in differentiating PSP from PD. Settings and Design It was a retrospective case–control study conducted in Sri Manankula Vinayagar Medical College, Puducherry, during the period of January 2018 to June 2019. Materials and Methods The 87 subjects, who were diagnosed and grouped into three categories (PSP, PD, and control) after performing magnetic resonance imaging brain, were reviewed. The parameters like the area of Pons and midbrain, width of MCP and SCP, P/M, M/P, and MRPI were calculated. Statistical Analysis One-way ANOVA and Chi-square test was used. The sensitivity, specificity, diagnostic accuracy, and cut-off values obtained with receiver operating characteristic curve analysis were determined. Results The mean age of presentation was approximately 75 years with male predominance. The cut-off value of MRPI obtained in this study was 13.4 with 100% sensitivity and specificity. Even though M/P ratio was found to be statistically significant among PSP patients; cut-off value was not obtained. Conclusion MRPI was concluded as the better tool in diagnosing PSP compared with the M/P ratio. Hence the combined qualitative as well as quantitative measurement of MRPI will increase the diagnostic accuracy of PSP.
Background Lymphatic malformations are the second most common vascular malformations after venous malformations. These slow-flow lesions occur most often in the paediatric population and seldom in the extremities. We report a case of lymphangioma at the popliteal fossa in an adult who underwent complete surgical resection. Case presentation A 30-year-old male presented to the department of orthopaedics with a swelling in the right calf region. Clinically, it was suspected to be a Baker’s cyst. Ultrasound showed a multiloculated anechoic cystic lesion in the inferior aspect of popliteal fossa along the intermuscular plane with multiple internal septations. Infected Baker’s cyst was considered, and MRI was suggested for further evaluation. On MRI, the lesion measured 7.2 × 4.6 × 5.8 cm, appeared as a low signal on T1 and high signal on STIR and T2, with multiple internal septations and was situated in the inferior aspect of the right popliteal fossa along the intermuscular plane between the lateral head of gastrocnemius and soleus muscles. No obvious synovial extension. A post-contrast study showed minimal peripheral and septal enhancement. Neither internal enhancing solid components nor significant internal derangement of the knee was observed. Diagnosis of lymphangioma was considered based on the imaging features and ruling out the common differentials for cystic lesions around the knee. Wide local excision was performed. Histopathological evaluation showed multiple irregularly dilated lymphatic channels lined by flatted epithelium. The lymphatic channels were seen to be surrounded by thick fibro collagenous cyst wall with scattered congested blood vessels, skeletal muscle fibre and chronic inflammatory cells. Conclusion Lymphangioma must be included in the differential diagnosis of any cystic lesion if the lesion appears multiseptated and/or infiltrative. At the popliteal fossa, it presents as a multiseptated cyst with no synovial continuity or internal derangement of the knee.
Background Congenital cystic adenomatoid malformation is an uncommon developmental anomaly that is diagnosed prenatally or during early childhood and is rare to present in adulthood. Type 2 congenital cystic adenomatoid malformation is often associated with other anomalies such as congenital cardiac anomalies. We present a case of type 2 congenital cystic adenomatoid malformation in an adult male associated with absence of left pulmonary artery and right aortic arch with mirror image branching. To our knowledge, this is the first case report with the combination of all three anomalies. Case presentation A 33-year-old male presented to the Department of Pulmonary Medicine with high-grade fever, chills and rigor, breathlessness, and productive cough for a duration of one week. He had multiple similar self-limiting episodes in the past which did not require hospitalization. The plain radiograph showed right aortic arch and a small left hilum. CT thorax showed multiple cystic lesions of size 0.5–2.0 cm in the apico-posterior segment of the left upper lobe; anterior, posterior, and lateral segments of the left lower lobe; and the apical segment of the right upper lobe with a maximal cyst wall thickness of 2 mm. Volume of left lung was reduced with trans-thoracic herniation of the medial segment of the right middle lobe; bronchiectatic changes were seen in the apical, anterior, and posterior segments of the right upper lobe; and fibrotic strands were seen in the apical segment of the right lower lobe and the apico-posterior segment of the right upper lobe. Mediastinal window showed right-sided aortic arch with mirror image branching. The pulmonary trunk was seen to continue as the right pulmonary artery with absent left pulmonary artery. Conclusions Though congenital cystic adenomatoid malformation is a disease of infancy and childhood, it should also be considered in adults presenting with recurrent lower respiratory tract infections and/or pneumothorax. Radiologists must be aware of the types of congenital cystic adenomatous malformation (CCAM) and their associations, as type 2 CCAM has a high association with congenital cardiac disease. Proximal interruption of pulmonary artery should be considered if the pulmonary trunk continues as either right or left pulmonary artery.
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