Zinner syndrome is a rare developmental anomaly of the Wolffian (mesonephric) duct which is characterised by a triad of obstruction of the ejaculatory duct, the ipsilateral seminal vesicle cyst, and the ipsilateral renal agenesis. The aim of this case report is to emphasize the importance of radiological imaging in diagnosing the condition and to report its rare unusual variant.

ObjectiveTo evaluate the role of a transrectal ultrasound (TRUS) guided biopsy and a color Doppler test in the detection of prostate cancer in patients with increased serum prostate-specific antigen (PSA) levels and/or an abnormal digital rectal examination (DRE).MethodA total of 40 cases, ranging in age from 50 to 80 years and showing increased serum PSA levels (4-10 ng/ml) and/or abnormal DRE, were enrolled and underwent TRUS evaluation followed by color Doppler flowmetric studies. A TRUS-guided biopsy was performed in all the cases. The findings were confirmed histopathologically. Data were analyzed using the chi-square test.ResultsHistopathologically, a total of 13 cases (32.5%) were malignant. On TRUS, irregular shape, heterogeneous echotexture loss of differentiation between the peripheral and internal zones, less mean weight of the prostate, and capsular invasion were significantly associated with malignancy. On flowmetry, moderate vascularity and focal asymmetry were significantly associated with malignancy. The combined use of TRUS and color Doppler flowmetry was found to be 100% sensitive and 92.6% specific and had a positive predictive value (PPV) and a negative predictive value (NPV) of 86.7% and 100%, respectively.ConclusionTRUS with color Doppler flowmetry was highly sensitive and specific in the detection of prostate malignancy.

Caffey’s disease, also known as Infantile Cortical Hyperostosis, is a rare, self-limited, benign, inflammatory gene-related disorder of infants that causes bone changes, soft tissue swelling, and irritability. The mandible (75%), clavicles, and ulnae are the bones most frequently involved, others being long bones, lateral ribs, ilia with skull being the rarest. However, we report a case of a 5-month-old male diagnosed with Infantile cortical hyperostosis but with absent mandibular and clavicular involvement, thus depicting the unusual presentation of this disease.

BackgroundLocalized cystic disease of the kidney is a rare, non-familial condition. Its imaging and clinical features are unique and need to be differentiated from autosomal dominant polycystic kidney disease and focal cystic masses such as multicystic nephroma and cystic renal cell carcinoma. It is always restricted to one kidney and is characterized by multiple cysts of varying sizes separated by residual normal renal tissue.Materials and methodsThis study reports 12 cases of localized cystic disease of the kidney based on imaging findings and clinical histories. The modalities of choice were ultrasonography followed by contrast-enhanced computed tomography. Eight out of 12 patients were men and the average age of presentation was 46 years. The screening of family members and relatives was done to rule out the differentials.ResultsLocalized cystic disease of kidney was diagnosed in all the patients and it presented in two different forms. In three patients, multiple cysts involved whole of the kidney, resulting in thinned-out residual renal parenchyma. In the rest nine patients it remained localised to a particular segment of the kidney. No cysts were observed in the contralateral kidney in seven patients, and one or two simple cysts were observed in five. Clinical presentations included only flank pain in six patients, flank pain with palpable abdominal mass in four patients, two patients presented as asymptomatic cases with diagnosis as an incidental finding and one patient with hematuria. Eight patients underwent imaging and two underwent clinical follow-up for a period of two years showing stability of the disease. One patient underwent nephrectomy for suspected renal neoplasm.ConclusionLocalized cystic disease of the kidney is a unilateral, rare and stable disease that has two different forms of presentations. Its imaging findings should be clearly understood so as to not classify it as a separate disease and avoid unnecessary surgery. It rarely leads to hypertension or polycythemia, and until then no definitive management is required. It can be followed up using imaging techniques and requires nephrectomy only when the suspicion of malignancy is strong.

Background: Takayasu arteritis (TA) alternatively known as a pulseless disease and aortic arch syndrome is an inflammatory and stenotic disease of medium-and large-sized arteries. Extensive research has revealed the prevalence of TA in Asia among teenagers and adults, resulting in consistent high blood pressure. In this study, selected patients with the prevalence of TA suspected on color Doppler ultrasound study were further evaluated with 128-slice computed tomography (CT) angiography. Methods: It is a prospective study consisting of 4012 patients who were referred to Radiology Department of Chaudhary Pervaiz Ellahi Institute of Cardiology, Multan (Pakistan) (which is a hub of vascular diseases), for 1 year. All patients underwent color Doppler ultrasound study for limb ischemia, renovascular hypertension, and carotid Doppler ultrasound for stroke-like symptoms, followed by CT angiography using 128-slice CT scan and low-osmolar contrast media. Maximum intensity projection, multiplanar reconstruction, and three-dimensional reconstruction of image data were done. Results: A total of 4012 patients were studied. Among them, six patients were diagnosed with the disease (TA) with a male:female ratio of 1:5. Conclusion: CT angiography is a very useful and reliable method of diagnosing TA, assessing disease activity, and a guide to treatment and follow-up.

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ObjectiveTo suggest a low-cost, easily-operable, non-invasive imaging modality for cancer detection in rural settings.MethodA total of 212 cases with palpable breast masses aged 18 - 65 years were enrolled and underwent thorough clinical, mammographic, and ultrasonographic (USG) evaluation. Imaging findings were reported using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS®) criteria. The findings were confirmed histopathologically. Data were analyzed using the Chi-square test.ResultsThe malignancy rate was 35.8% (n = 76). On mammography, lesions size, margins, shape, calcification, and distorted arch/skin thickening were significantly associated with malignancy. On USG, the number of nodules, shape, margins, echotexture, posterior wall echo, through transmission changes, distorted arch/skin thickening, microlobulation, duct extension, and height/width ratio were significantly associated with malignancy. Independently, mammography and USG had a sensitivity of 78.1% and 80.3%, respectively, and a specificity of 83.3% and 89.0%, respectively. Using a positive result of either study as the criteria, the sensitivity was 97.4% and the specificity was 80.1%.ConclusionThe combined use of mammography and USG provides high sensitivity and specificity, thus showing that a combination of two can be used as a screening tool for use in low resource rural settings.