Multidetector Computed Tomography (MDCT), with an accuracy of 95-100%, is the modality of choice for preoperative assessment of hepatic artery anatomy in this era of modern hepatic surgeries. Celiac trunk is the first anterior branch of the abdominal aorta and trifurcates into left gastric, splenic, and common hepatic artery which branches into gastroduodenal and proper hepatic artery which then divides into right, middle and left hepatic arteries. Superior mesenteric artery (SMA) originates from abdominal aorta one centimeter below the celiac trunk. This “classic” anatomy pattern is seen only in approximately 61.3% of patients. This study aims at establishing prevalence of hepatic artery anatomical variations on MDCT in Nepalese population since such study has not been published in context of Nepal yet. Cross-sectional descriptive study was performed on MDCT images of all patients undergoing CT abdomen and pelvis with angiography between November 2018 and October 2022 (four years) at Nepal Medical College and Teaching Hospital. The Type of variation was categorized according to Michel’s classification. The values were further grouped under male and female categories. Data obtained was compiled and analyzed using SPSS 16. Out of 504 patients, 258 were males (51.2%) and 246 were females (48.8%). Youngest was nine years and the eldest was 93 years old with mean age of 48.1 years. The commonest variation was Michel’s Type 1, seen in 371 (73.6%) followed by Type 2 in 61 patients (12.1%) and Type 3 in 46 (9.1%). Type 4 was seen in 11 patients (2.2%) and Type 5 variant in nine patients (1.8%). Only one patient each had Type 6 and 7 (0.2 % each). Two had Type 9 (0.4%). We did not find Type 8 and 10. Statistically significant difference between male and female was found only in Type 2 with females having higher prevalence. Two patients showed celiac trunk and SMA arising from single celiomesenteric trunk of abdominal aorta, accounting for 0.4% of total cases which was tabled under unclassified category. MDCT is excellent modality to depict normal and variant hepatic arterial anatomy. Michel’s Type 1 is the commonest hepatic arterial anatomy variant and should be considered as normal “classic” pattern.
Introduction: Computed tomography imaging provides detailed information about the paranasal sinuses and is now well established as an alternative to standard radiographs in evaluating patients with sinusitis. Sinusitis can have dangerous complications which can even lead to death if not diagnosed and treated on time. This study aimed to find the prevalence of sinusitis among the patients undergoing Computed Tomography scan of paranasal sinuses in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Radiology at a tertiary care hospital from 1 October 2021 to 30 April 2022 after taking ethical approval from the Institutional Review Committee (Reference Number: 023-078/079). The patients undergoing Computed Tomography paranasal sinuses and meeting the eligibility criteria were enrolled for the study after taking informed consent. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 113 patients, 109 (96.46%) (93.05-99.87, 95% Confidence Interval) patients had sinusitis. The most common subtype was found to be acute sinusitis in 63 (57.79%) individuals. Conclusions: The prevalence of sinusitis was higher than in other studies done in similar settings.
Amniotic fluid volume (AFV) is estimated in almost all the antenatal scans referred for ultrasonography (USG). It has proven to be a very good predictor for poor pregnancy outcomes. Several standard text books have quoted normal range of amniotic fluid index (AFI). These reference range may not be applicable to all the population as over the years different studies have shown that it varies among different population. Since such variations has been postulated, our aim is to formulate a reference range of gestational age specific AFI in normal pregnancy among Nepalese women. Therefore, a cross-sectional study was carried out among 537 normal pregnancies who attended the out-patient department of Nepal Medical College Teaching Hospital. Women with any maternal and fetal complications were excluded from the study. Subsequently median, the 5th, 50th and the 95th percentile values were calculated for each gestational week and were compared with studies among other population. Among the 537 women enrolled in the study, the mean maternal age was 26.5 years with the estimated fetal weight (EFW) at term pregnancy ranged from 2372 grams to 3750 grams with the mean being 3261 grams. The mean AFI at preterm was found to be 12.6 cm ± 2.36 and at term 11.0 cm ± 2.82. The percentiles values for first to 99th percentile of the entire data was calculated and the normal range of the AFI was estimated to be between 6 – 17 cm. As studies have shown the variance in AFI range among different population. It is imperative to formulate a reference of AFI among different population. In our study we found they are lower as compared to the Caucasian population, similar to Indian population and higher than the Chinese population.
Adrenal ganglioneuromas are rare sympathetic differentiated tumors which originate from neural crest cells. These lesions are usually discovered incidentally on imaging and tend to be hormonally silent. Preoperative diagnosis of adrenal ganglioneuroma remains extremely challenging and the gold standard treatment is adrenalectomy. There is good prognosis after surgery without recurrence. We herein report a case of adrenal ganglioneuroma in a 15 year old female who presented with complaint of abdominal discomfort. Contrast Enhanced Computed Tomography abdomen showed a large septated hypodense right suprarenal mass which was echogenic on Ultrasonography. It showed T1 hypointense and T2 hyperintense signal on Magnetic Resonance Imaging of abdomen and pelvis. Excisional biopsy and histological examination of the mass was suggestive of adrenal ganglioneuroma. This report presents the clinical and radiological data for the rare tumor which would share some experience to facilitate the diagnosis of adrenal ganglioneuroma.
Introduction: The Post Void Residual Urine volume (PVRU) is frequently significant in patients with bladder outflow obstruction; especially in patients with enlarged prostate and prostatism. The PVRU forms an important part of radiological investigation. Accurate measurement of the residual urine volume changes observed serially over a period of time may indicate clinical progress. The purpose of this study was to evaluate the effect of pre-void bladder volume on PVRU measurements. Methods: A prospective study was conducted to determine the accuracy of PVRU measurement in patient presenting with lower urinary tract symptoms (LUTS). 50 patients with LUTS were assessed ultrasonographically for pre void and post void bladder volumes during the study period of March 2017 till August 2017. PVRU measurements done in patients with bladder filling sensation at moderate to full capacity resulted in high estimations of PVRU which was quite significant in this study. Results: There was significant difference in the estimated PVRU between patients having high initial premicturitional volume (546±144 ml) than those with lower or moderate filling volume (261±58 ml) with mean of 173 ml and 35 ml respectively. The difference in estimated PVRU was highly significant with p value of < 0.0001. Conclusions: Measurement of pre void urinary bladder volume with an uncomfortably full bladder results in high post micturitional (PMRU) values even in most patients without lower urinary tract symptoms which may be false-positive. We advise that initial or pre-void urine volume be measured when the patient has initial or moderate feeling of bladder fullness.
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