Pulmonary sequestration is a rare malformation, wherein a portion of lung is non-functional and is not in normal continuity with the tracheo-bronchial tree, and may derive its blood supply from systemic vessels. Two types are described: Intralobar and extralobar types. Intralobar sequestration is more common type, which shares visceral pleura of the involved lobe and is localized within the normal pulmonary parenchyma. Whereas extralobar forms are uncommon and are totally separate from the lung and usually have own covering. Infra-diaphragmatic pulmonary sequestration is of extralobar type and is extremely rare, and usually is associated with other congenital malformations. We present an extremely rare case of isolated infra-diaphragmatic pulmonary sequestration which was antenatally detected and followed up with postnatal CT scan, where it masqueraded as suprarenal mass, and was surgically treated. This case emphasises to add a differential diagnosis of malformation in congenital supra-renal masses, which remain stable in size and appearance, and hence avoid immediate surgery.
Endometrial stromal sarcoma (ESS) is an aggressive uterine sarcoma. We report a case of a large endometrial stromal sarcoma in a 42 year nulliparous woman with chronic kidney disease presenting with acute urinary retention and irregular per vaginal bleeding. Ultrasound and Doppler imaging revealed a heterogeneous mass in the endometrial cavity with internal vascularity. Magnetic resonance imaging (MRI) revealed a large lobulated mass in the endometrial cavity extending into the vagina, causing local mass effect. Multiple linear hypointense bands on magnetic resonance T2 weighted (T2wt) images were characteristic of ESS. MRI is a very useful imaging modality in characterizing the lesion and also for the staging. It is necessary to distinguish these tumors from benign as well as other uterine malignancies for better management. We also review relevant literature discussing imaging findings of ESS.
Introduction: Low Back Pain (LBP) is the most common musculoskeletal symptom encountered on a daily basis in clinical practice and has a significant impact on healthcare resources. Magnetic Resonance Imaging (MRI) is the most sensitive tool for diagnosing spinal degenerative disease and has proven to be a standard imaging modality for its evaluation. Assessment of the correlation between clinical and radiological severity of lumbar disc degeneration will help in better management of the LBP patients. Aim: To determine the correlation between the clinical and radiological severity of lumbar disc degeneration in non surgical LBP patients. Materials and Methods: This observational, cross-sectional study was conducted at the Department of Radiology and Imaging, Sagar Hospitals, Bengaluru, Karnataka, India, from December 2019 to June 2021. A total of 90 patients with LBP who were referred for MRI evaluation were included. Modified Oswestry questionnaire was given to the patients and the clinical severity of the LBP was quantified. Patients with disc degeneration were evaluated on MRI based on six parameters viz., T2-signal intensity, Disc Extension Beyond Interface (DEBIT), annular fissure, modic changes, endplate integrity and osteophytes. Fisher's exact test was used for qualitative data to look into the association between clinical and MRI grades of severity. Correlation was assessed for continuous variables using Pearson correlation analysis. Results: The study included a total of 90 patients with LBP, with a mean age of 57±13.75 years with equal sex preponderance (45 (50%) male and 45 (50%) female). Clinically, 51 (56.7%) of the study population revealed moderate disability. On quantifying the MRI total score of disc degeneration, 65 (72.3%) of the patients were found to show mild degeneration. In terms of involvement of all the evaluated six MRI parameters, the L4-L5 disc was most commonly affected, followed by the L5-S1 disc. Disc desiccation 353 (78.45%) and osteophytes 336 (74.67%) were the most consistently observed variations. Disc bulges 251 (55.78%) were the next most frequently observed parameter in disc degeneration. Conclusion: The correlation between the clinical and radiological severity of disc degenerative disease was found to be weakly positive and statistically insignificant. Disc desiccation, osteophytes and disc bulges were the most commonly observed parameters that contributed to lumbar degenerative disease.
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