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ADICHUNCHANAGIRI
INSTITUTE OF MEDICAL
SCIENCES
Patron
Jagadguru Sri Sri Sri
Nirmalanandanatha
Mahaswamiji
Advisor
Dr.Shivaramu.G Principal, AIMS
Chief Editor Dr. Prashantha Ishwar H S
Professor & HOD
Dept Of Radiology
Editorial Board
Dr Ravishankar (Asst Prof) Dr Skandesh (Asst Prof)
Dr Sreenivasa Raju (JR)
Members Dr Ravishankar(Asst Prof) Dr Shama
Dr Likitha
Dr Vinoth Kumar
Dr Rajath
Dr Surabhi
Dr Abilash
Dr Rumpa
Dr Chinju
Dr Abhay
Editorial Greetings from the Department of Radiology,
With the blessings of Paramapujya, , Jagadguru, Sri Sri Sri Dr
Balagangadharanatha Mahaswamiji & His holiness jagadguru
Sri Sri Sri Nirmalanandanatha Mahaswamiji and under the able
guidance of our beloved
Principal Dr MG Shivaramu , we shall take great pleasure to
introduce
“IMAGING WORLD” , the quarterly newsletter from our
department.
At the outset, we wish express our sincere thanks to our Principal
Dr MG Shivaramu for bringing forth the novel concept of
newsletter in our institution.
IMAGING THE WORLD , is presented by the Department of
Radiology , the branch that has an amazing ability to visualize
the body without a scalpel!! . Radiology is now the key
diagnostic tool for many diseases and has important role in
monitoring and predicting the outcome. Radiologist have
become clinical specialists, who have been obliged to also
become experts in image capture technology.
Our Department is equipped with dynamic faculty members who
are actively involved in both diagnostic workup and academic
activities.
In this edition we present to you few interesting cases that we came
across , ongoing research projects, upcoming events which will
enlighten our dear fellow colleagues and postgraduates in the all
the department in their academic venture. The newsletter will be
published on a quarterly basis.
We are open for your valuable comments and suggestions. You
may contact us at aimsradiology@gmail.com.
Dr. Prashantha Eshwar.
INTERESTING CASE FROM OUR CT CONSOLE ROOM
Takayasu arteritis concealed as dilated cardiomyopathy.
Clinical history:
An 18 year old young female presented
with history of easy fatigability,
breathlessness, weight loss, since two
months associated with cough with
whitish sputum for 3 days.
Clinical examination: Absent pulses in
the left brachial, ulnar and radial
arteries.
Doppler: long segment circumferential
hypoechoic wall thickening involving
the left subclavian (fig 1) and axillary
artery causing 75% luminal narrowing
with monophasic flow in the brachial ,
radial and ulnar arteries and reduced
systolic velocities.
CT Angiography: circumferential wall
thickening involving the ascending
aorta , aortic arch and the descending
thoracic & abdominal aorta. There was
also associated circumferential wall
thickening involving the left subclavian
artery from its origin with significant
narrowing distal to the origin of the
vertebral artery . Circumferential wall
thickening without significant
narrowing was noted involving the
bilateral common carotid arteries up to
the carotid bulb, right brachiocephalic
and right subclavian arteries.
Echocardiography: DCM with grade III
diastolic dysfunction and ejection
fraction of 30%.
Discussion: Takayasu arteritis is a chronic inflammatory disease that involves the elastic arteries including the aorta, its branches and the pulmonary arteries. The disease is diagnosed based on the American College of Rheumatology (ACR) 1990 diagnostic criteria. The disease is classified based on the site of involvement according to New angiographic classification of Takayasu arteritis, Takayasu conference 1994. The site of arterial disease determines its clinical presentation which usually includes diminished or absent pulses, vascular bruits particularly affecting the carotids, subclavian, and abdominal vessels, hypertension secondary to renal artery stenosis. The presentation as DCM is rarely reported in 5-6% of cases and is due to involvement of coronary artery & severe hypertension. Therapeutic modalities include steroids, immunosuppressive agents, and antihypertensive drug therapy. In the acute phase of TA, treatment with corticosteroids (1mg/kg/d) leads to clinical remission in 60% of cases.
15 Immunosuppression with Cyclophosphamide (1-2mg/kg/d), azathioprin (1-
2mg/kg/d) or methotrexate (0.15-0.35 mg/kg/week) may be tried in resistant cases, or in order to reduce steroid dosages .Standard therapy may include salt-restricted diet, diuretics, and digitalis. Percutaneous transluminal renal arterial dilatation is done in case of renal artery involvement.
Conclusion: Awareness of HD in the diaphragm is necessary to avoid erroneous preoperative diagnosis and the possibility of hydatid disease should be considered in patients with preoperative cross sectional imaging indicating cystic lesions adjacent to the diaphragm, especially in endemic areas like India.
Introduction: Takayasu arteritis is a
form of large vessel granulomatous
vasculitis3 affecting often young or
middle-aged women of Asian descent. It
mainly affects the aorta and its
branches, as well as the pulmonary
arteries. In DCM, the heart becomes
weakened and enlarged and cannot
pump blood efficiently with left
ventricle (LV) most commonly affected.
Circumferential hypoechoic wall
thickening involving the left
subclavian
Circumferential wall thickening involving the left subclavian artery in from its origin with significant narrowing distal to the origin.
CT angiography circumferential wall thickening involving the ascending (a), arch (b) and the descending thoracic (c) & abdominal aorta (d).
Circumferential hypoechoic wall
thickening of the bilateral common
carotid arteries.
INTERESTING CASE FROM THE CT CONSOLE ROOM
Giant Cell Tumour of the Talus.
Introduction: Giant cell tumours
(GCT) are locally aggressive lesions
that primarily affect the epiphyses
of long bones. They typically
present in the third to fourth
decades of life and are rare under
20 years of age. Involvement of the
foot is uncommon, frequently
affecting the calcaneus and
metatarsals, rarely the talus.
Clinical history: A 7-year-old boy
came with progressively increasing
pain and swelling in the right
ankle joint of several months
duration.
Plain radiograph of ankle: Expansile
lytic lesion of the right talus.
CECT ankle: an expansile lesion with
enhancing soft tissue at the
periphery. There was significant
thinning of the cortex. No intra
articular extension was seen.
The diagnosis of gaint cell tumour
was given which was later
confirmed by histopathological
analysis. Partial resection of the
talus with bone grafting was done.
The patient was followed up for
two years. No recurrence was
found.
.
Discussion: Giant cell tumour, also known as osteoclastoma, accounts for
approximately 5% of bone tumours and 20% of benign bone tumours . The incidence
of GCT is highest in the second to fourth decades of life with a peak in the third and
only about 1% occurring in the first decade of life.
50% of GCTs arise around the knee, most often in the distal femur and proximal tibia,
followed by the distal radius and then the sacrum. Typically, GCTs are metaphyseo-
epiphyseal in location but tend to be metaphyseal in skeletally immature patients.
The phalanx, metacarpal, maxilla, and metatarsal are rarely affected and tend to be
more aggressive than those in other bones.
GCT of the talus usually presents as ankle pain and swelling or sinus tarsi syndrome of
several months duration with or without history of trivial trauma. Conventional
radiographs demonstrate a lytic lesion centered in the epiphysis but may involve the
metaphysis and extend to the adjacent articular cortex. The tumour usually bulges
beyond the confines of the cortex. No periosteal reactions are appreciated unless a
fracture is present. Histological analysis of biopsy tissue is necessary for diagnosis, as
radiological images are not conclusive.
The treatment of GCT is directed towards local control without sacrificing joint function. This can be achieved by intralesional
curettage with autograft reconstruction by packing the cavity of the excised tumour with morsellised iliac cortico-cancellous
bone. Since the recurrence rate is as high as 60%, attempts to extend the curettage or intralesional excision by chemical or
physical means such as phenol or cytotoxic agents like chlorpactin have been tried with varying results.
Sagittal non contrast CT of the ankle joint (bone window) showing a osteolytic lesion involving the talus showing cortical thinning. Lesion is seen minimally extending beyond the confines of the cortex [Table/Fig-2a&b]: Sagittal contrast enhanced CT scan showing a soft tissue mass with peripheral enhancement and minimal extension beyond the confines of the cortex anteriorly [Table/Fig-3]: Histopathology showing multiple giant cells on a background of homogenous mononuclear stromal cells,
A
B C
D F
G H
Publications:
1. Sonographic evaluation of uterus size in relation to maternal parity and Caesarean section delivery. Dr. Prashantha Eshwar, Dr. Sreenivasa Raju, Dr. Ravishankar and Dr. Rumpa banerjee.International journal of current research. 2016, 8, (04), 29900-29902.
2. Giant cell tumour of the talus in a 7-year-old boy. Ravishankar Pillenahalli Maheshwarappa. Journal of clinical and
diagnostic research, vol-8(11): rj03. 3. Takayasu arteritis concealed as dilated cardiomyopathy with review of literature. Dr. Sreenivasa Raju, Dr. Skandesh,
Dr. Prashantha Eshwar and Dr. Rumpa Banerjee. International journal of current research. 2016, 8, (04), 29903-29906.
Paper presentations:
1. MRI evaluation in Myelopathy. Dr Surabhi Chakraborty, Dr Prashantha Eshwar, Dr Chandramouly .69th
Annual
conference of Indian radiological imaging and association. Orissa.
2. MR evaluation of meniscal injuries of knee joint with arthroscopic correlation. Dr Skandesh, Dr Chandramouly .32nd
Annual conference, Indian radiological imaging and association. Karnataka.
Paper
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