Friday, August 31, 2012

Spermatic Cord Hydrocele-USG

Hydrocele of the spermatic cord is a rare anomaly that results from an aberration in the closure of the processus vaginalis. It is a loculated fluid collection along the spermatic cord, separate from the testis and the epididymis and located above them. Clinically it manifests as groin swelling that is indistinguishable from a mass at palpation. There are three types of spermatic cord hydrocele: communicating, funicular, and encysted. An encysted hydrocele is enclosed between two constrictions at the deep inguinal ring, just above the testis. It does not communicate with the peritoneum. An encysted hydrocele may be located anywhere along the spermatic cord. It may be any size or shape, but it does not change with increased peritoneal pressure. At US, an ovoid or round mass is seen in the groin along the spermatic cord; internal echogenicity varies depending on the contents. 

Case submitted by : Dr. Vougiouklis Nikolaos


A 4 year old male child presented with left lower limb shortening with bilateral foot is in equinovalgus position . Deformity is present since birth. On radiograph , left fibula is completely absent with anterior bowing of left tibia. Bilateral club foot deformity is noted.
DIAGNOSIS : FIBULAR HEMIMELIA [TYPE III ]. Case Submitted by:  Dr. Hema Chaudhry  &  Dr Sangeeta  Aneja ( Professor & HOD), LLRM medical college , Meerut

Sunday, August 26, 2012


A newborn presented with midline abdominal wall defect into which abdominal contents are extruded into the base of umblical cord.  It is covered by the thin membrane [amnion]. on ultrasonography , bowel loop are noted as a content. Rest abdominal organ was normal. OMPHALOCELE is likely.   

Case Submitted by:  Dr. Hema Chaudhry  &  Dr Sangeeta  Aneja ( Professor & HOD), LLRM medical college , Meerut

Saturday, August 25, 2012

Supernumerary kidney -Ultrasound

A 35 yr old male patient presented with a complain of pain in left renal angle.  On USG, two kidneys are noted fused with each other with two pelvicalyceal system .However both are normal in echotexture.  Right kidney is normal in size, position & echotexture & its place.  Supernumerary kidney is likely.

 Case Submitted by:  Dr. Hema Chaudhry  &  Dr Sangeeta  Aneja ( Professor & HOD)
 LLRM medical college , Meerut

Thursday, August 23, 2012

Transient Synovitis-Plain Film & MRI

12 year old male presents with acute hip pain of 10 days duration. X-ray suggests mild widening of the joint space with positive "Waldenstorm"  sign and negative obturator sign. MRI shows free fluid of grade II variety with synovial capsular distention  with no significant marrow edema of the bony margins or soft tissues abnormality - Transient Synovitis is likely.

Teaching Points by Dr MGK Murthy :

  1. Most common cause of hip pain children (usually 3 to 10 years). Etiology not understood. However trauma, viral, post vaccineal  and drug mediated responses could play a role.
  2. Usually self limiting and resolves in about 12 to 14 days. Exact Incidence not known.
  3. Boys more effected (2 to 1). Recent history of upper respiratory infection / Others present in more than 50 %.
  4. Accentuated pericapsular shadow / Increase in tear drop distance  (medial acetabulum to the femoral head), Waldenstorm sign (lateral displacement of the femoral epiphysis with surface flattening), obturator  sign ( soft tissue shadow over the interpelvic aspect of acetabulum),  are plain X-ray findings suggested.
  5. MRI suggests increased joint fluid with no marrow edema.  Contrast study suggests synovial enhancement and no significant soft tissue enhancement unlike the differential of septic arthritis. 
  6. Bone scintigraphy is non-contributory with increase in uptake and decrease in uptake groups.
  7. Fluid aspiration with negative gramstain will go in favour of Transient Synovitis.
  8. A Review X-ray after 6 months would help exclude Recurrence and  possible follow up Perthes disease. 

Starry Sky USG-Acute Hepatitis

Ultrasound of the liver shows centrilobular or starry sky pattern characterized by increased brightness portal venules and diminished parenchymal echogenicity accentuating the portal venule walls. Acute hepatitis is the most common cause of starry sky appearance. This sonographic appearance is due to the intralobular edematous swelling of the hepatocytes and a change in acoustic properties between the portal venous radicals and hepatic lobules.

Sunday, August 19, 2012

Bilateral Chocolate Cysts-MRI

27 year old female on MRI study shows well defined lesions in right adnexa measuring 13 x 9 cm abutting fundus of uterus. Other lesion with similar appearance is noted  in Pouch of Douglas which arises from left ovary. It measures 7.3 x 5.3 cm.  The lesions are hyperintense on T1W and hypointense on T2W sequence. Few nodular T1 hypointense and T2 hyperintense nodular foci are noted in larger right adnexal lesion. Peripheral hypointense rim is noted predominantly in left adnexal lesion.   Cystic contents with heterogeneous pattern in larger leison, appear to be haemorrhagic products in variable stage predominantly in early subacute phase. Possibility of bilateral chocolate / haemorrhagic cysts appear to be likely.  Case by Dr Swati Shah.

Tuesday, August 14, 2012

Neurenteric cyst-MRI

A young adult referred for MRI with neck pain, shows a relatively well defined cyst in the anterior and anterolateral aspect of the cervical cord,measuring 5 mm appx with rest of the study normal including CV junction and vertebral bodies as well as posterior elements. Radiological diagnosis of Neurenteric cyst was suggested. Contrast study is declined by the patient. Case submitted by Dr MGK Murthy.

Teaching points

• Neurenteric cysts are rare with about 0.3 to 0.5% of spinal cord tumours

• Also refd to as enteric/enterogenous/gastrocytoma/teratomatous cysts

• Etiology is controversial

• One theory suggests normally interposed notochordal plate (between neurendoderm and ectoderm) may split , if there is accessory neurenteric canal

• Others believe primary splitting of chord is responsible due to incomplete/faulty escalation of notochord

• MRI is usually the best modality and usually shows cervical location anteriorly or anterolaterally

• Dorsal and lumbosacral regions account for minority

• Asymptomatic or may present with motor symptoms if anterior and sensory if posterior location

• Moderate enhancement after contrast occurs

• D/d includes, parasitic, dermoid etc and uncommon presentation of all etiologies including neoplasms

Split Pleura Sign-CT

The split pleura sign is seen with pleural empyemas and is considered the most reliable CT sign helping to distinguish an empyema from a peripheral pulmonary abscess. The sign results from fibrin coating both the parietal and pleural surface of the pleura with resulting ingrowth of blood vessels with accompanying enhancement. Both layers of the pleura can then be visualised as linear regions of enhancement that come together at the margins of the collection.

Monday, August 13, 2012

Radiology Department in 2012 Olympics

Radiology has now a central role to play in sports medicine, and you cannot imagine event like olympics to be without proper radiology facilities. These facilities are  enough to support a moderate size hospital. The radiology department in London Olympics had GE imaging equipment consisting of two MRI’s: a Discovery MR750w wide-bore 3-tesla  system, and an Optima MR450w wide-bore 1.5-tesla unit.  There’s also a Discovery 750HD CT scanner, a Discovery XR656 wireless digital X-ray system and Venue 40 and Logiq E9 ultrasound systems. 50% of the studies done were MRIs, obviously for its imaging capability in MSK.  The medical staff were all volunteers. 

Wednesday, August 01, 2012

Jumper's Knee-MRI

This patient with athletic activities presented with pain on flexion in knee. MRI showed altered signal intensity and thickening involving the infrapatellar patellar tendon, possible tendonitis (jumper's knee). Patella appears high up consistent with patella alta.


Blog Archive