Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection characterized by production of intraparenchymal gas. EPN predominantly affects female diabetics and immunocompromised patients. In a three-year period 2008–2011, a total of 8 patients were admitted to our hospital. All of them were diabetics, and both males and females were equally affected. These patients showed vague symptoms at admission and frequently presented with fever, loin pain, dysuria, and pyuria necessitating urgent medical attention. EPN required radiological diagnosis. CT scan revealed bilateral EPN with urinary obstruction and hydronephrosis in 50% of patients. Escherichia coli was found to be the causative organism in all the patients. Treatment comprised of resuscitation, normalization of serum electrolytes and blood sugars, administration of parenteral antibiotics, and relieving ureteric obstruction if present. All the patients improved with conservative management without any mortality.

The posterior communicating arteries (PCoA) are important component of collateral circulation between the anterior and posterior part of circle of Willis (CW). The hypoplasia or aplasia of PCoA will reflect on prognosis of the neurological diseases. Precise studies of the incidence of hypoplastic PCoA in Andhra Pradesh population of India are hitherto unreported, since the present study was undertaken. Two hundred and thirty one magnetic resonance angiography (MRA) images were analyzed to identify the hypoplasia of PCoA and presence of fetal type of posterior cerebral artery (f-PCA) in patients with different neurological symptoms. All the patients underwent 3.0T MRI exposure. The results were statistically analysed. A total of 63 (27.3%) PCoA hypoplasia and 13 cases with f-PCA (5.6%) cases were identified. The hypoplastic PCoA was noted more in males than females (P<0.05) and right side hypoplasia was common than the left (P<0.04); bilateral hypoplasia of PCoA was seen in 37 cases out of 63 and is significant. The hypoplastic cases of the present study also were associated with variations of anterior cerebral arteries and one case was having vertebral artery hypoplasia. Incidence of PCoA as unilateral or bilateral with other associated anomalies of CW is more prone to develop stroke, migraine and cognitive dysfunction. Knowledge of these variations in the PCoA plays a pivotal role in diagnoses of neurological disorders and in neurovascular surgeries and angiographic point of view.

Observations: In 100 (100%) cases that were taken for the study 22 cases (22%) showed variations in the bifurcation and branching of the renal arteries was observed. There was an early bifurcation of the renal artery in 10 cases (45.45%). There was an accessory renal artery bilateral in 12 cases (54.54%). Conclusion: Identification of renal vascular variants is important, especially before laparoscopic donor or partial nephrectomy and vascular reconstruction for renal artery stenosis or abdominal aortic aneurysm. MDCT angiography is an excellent imaging investigation because it is a fast and non-invasive tool that provides highly accurate and detailed evaluation of normal renal vascular anatomy and variants. The number, size and course of the renal arteries and veins are easily identified by MDCT angiography.

Thymic cysts are usually diagnosed accidentally during radiological evaluation of the chest for unrelated conditions. Symptoms appear late when the mass compresses on adjoining tissues. We report an unusual case of asymptomatic mediastinal thymic cyst which was seen in the neck whenever the patient was asked to perform Valsalva maneuver. This case is being reported for the unusual clinical presentation of a rare disease. The role of imaging in the diagnosis and common differential diagnoses are also discussed.