Sriram Jaganathan - Academia.edu (original) (raw)

Papers by Sriram Jaganathan

Research paper thumbnail of Pentalogy of Cantrell

Research paper thumbnail of Our Experience in Tracking the Tract: Normal Biliary Anatomy and Variants on Magnetic Resonance Cholangiopancreatography in Living Donor Liver Transplantation

Cureus, Feb 6, 2023

Biliary anatomy is of paramount importance for hepatobiliary pancreatic surgeons for operative pl... more Biliary anatomy is of paramount importance for hepatobiliary pancreatic surgeons for operative planning. Preoperative assessment with magnetic resonance cholangiopancreatography (MRCP) to evaluate the biliary anatomy plays a vital role, especially for prospective liver donors in living donor liver transplantation (LDLT). Our objective was to evaluate the diagnostic accuracy of MRCP in assessing the anatomical variations of the biliary system and the frequency of biliary variation in the donors of LDLT. Materials and Methods Sixty-five donors of living donor liver transplantation in the age range of 20 to 51 years were studied retrospectively to evaluate the anatomical variations of the biliary tree. As a part of the pre-transplantation donor workup, MRI with MRCP was performed in a 1.5T machine for all these candidates. MRCP source data sets were processed with maximum intensity projections, surface shading, and multi-planar reconstructions. Images were reviewed by two radiologists, and the classification system of Huang et al. was utilized to evaluate the biliary anatomy. The results were compared with the intraoperative cholangiogram, considered the gold standard. Results We identified standard biliary anatomy in 34 candidates (52.3%), and variant biliary anatomy was observed in 31 candidates (47.7%) on MRCP. An intraoperative cholangiogram showed standard anatomy in 36 candidates (55.4%) and biliary variation in 29 candidates (44.6%). Our study showed a sensitivity of 100% and a specificity of 94.5% for identifying biliary variant anatomy on MRCP in comparison with the gold standard intraoperative cholangiogram. The accuracy of MRCP in detecting the variant biliary anatomy in our study was 96.9%. The most common biliary variation was the right posterior sectoral duct draining into the left hepatic duct, Huang type A3. Conclusion The frequency of biliary variations is high in potential liver donors. MRCP is sensitive and highly accurate in identifying the biliary variations of surgical significance.

Research paper thumbnail of Improving Outcomes in Catheter-Directed Thrombolysis for the Management of Acute Budd-Chiari Syndrome: A Case Report

Research paper thumbnail of Asymptomatic Mediastinal Mass – Venous Aneurysm of the Left Innominate Vein – Be It a Differential

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Nov 1, 2022

Research paper thumbnail of Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

International Surgery Journal

Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require im... more Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require immediate attention and treatment. The most common cause of AMI is superior mesenteric artery (SMA) occlusion secondary to an embolic phenomenon. We present a 55-year-old gentleman with acute SMA thromboembolism, treated by catheter directed thrombolysis (CDT) that helped in avoiding a major surgery. A 55-year-old male, with known diabetes, hypertension and atrial fibrillation, presented with acute abdominal pain and found to have SMA thromboembolism on contrast computed tomography (CT) abdomen. As there were no evidences of bowel ischemia clinically and on the CT imaging, endovascular CDT was performed following which the patient improved and discharged after 10 days of hospital stay. Timely endovascular intervention in appropriate patient population with acute mesenteric arterial thromboembolic occlusion can help avoid major surgeries, reduce the extent of non-viable bowel and decrease t...

Research paper thumbnail of Marchiafava-Bignami disease: an interesting case report!

International Journal of Research in Medical Sciences

Marchiafava-Bignami Disease (MBD) is a rare neurodegenerative disease usually associated with chr... more Marchiafava-Bignami Disease (MBD) is a rare neurodegenerative disease usually associated with chronic alcoholism characterized by demyelination and necrosis of the corpus callosum. Here, we report a 57-year-old patient who presented to our hospital with acute aphasia, disorientation and altered mental state. Diffusion weighted imaging (DWI) magnetic resonance imaging (MRI) revealed areas of restricted diffusion in the corpus callosum, bilateral periventricular white matter and right cerebellar peduncle. Given that the patient was a chronic alcoholic, a diagnosis of Marchiafava-Bignami disease was made. Supportive management with intravenous Thiamine and multivitamins was offered. The patient improved clinically after one week of treatment and a repeat DWI MRI revealed complete resolution of the abnormalities. It is imperative to diagnose MBD promptly and distinguish this from other neurological manifestations related to chronic alcoholism. An early diagnosis can aid in a better outc...

Research paper thumbnail of Cystic artery pseudoaneurysm: an uncommon complication of a common disease

International Surgery Journal

Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report ... more Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report an unusual presentation of upper gastrointestinal haemorrhage due to a cystic artery pseudoaneurysm secondary to acute cholecystitis in a 54-year-old male. Initial imaging revealed cholelithiasis with evidence of acute cholecystitis. Further investigations with Doppler ultrasound and CT suggested evidence of a cystic artery pseudoaneurysm with hyperdense contents in the gall bladder suggesting blood products. Taking into consideration the risk of hemorrhage during the procedure, the patient was taken up for open cholecystectomy. This case emphasizes the need for a high level of awareness of pseudo-aneurysmal disease and inclusion of cystic artery pseudoaneurysm as one of the differential diagnosis for a patient presenting with recurrent upper quadrant pain, jaundice and melena or hemobilia.

Research paper thumbnail of Nodular fasciitis-often a tumor mimic

International Journal of Research in Medical Sciences

Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It is frequently m... more Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It is frequently mistaken for a sarcomatous lesion because of its rapid growth, imaging features and aggressive pathological findings. Though imaging plays a vital role in evaluating these lesions, strong suspicion with a careful histopathology is the final answer. We present a patient with nodular fasciitis involving the upper extremity. A 15-year-old boy presented with complaints of progressively increasing right wrist swelling since 2 months, and had been having severe pain on exertion. On clinical examination the swelling was tender. MRI revealed T2 hyperintense lesion along the volar-lateral aspect of wrist, completely encasing the abductor pollicis longus tendon and indenting the extensor pollicis brevis tendon. Per operatively, the tumor was seen to involve the abductor pollicis longus tendon sheath and insinuating between the tendons. Excision biopsy was performed and histopathology confirmed the ...

Research paper thumbnail of Cystic artery pseudoaneurysm: an uncommon complication of a common disease

International Surgery Journal , 2022

Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report ... more Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report an unusual presentation of upper gastrointestinal haemorrhage due to a cystic artery pseudoaneurysm secondary to acute cholecystitis in a 54-year-old male. Initial imaging revealed cholelithiasis with evidence of acute cholecystitis. Further investigations with Doppler ultrasound and CT suggested evidence of a cystic artery pseudoaneurysm with hyperdense contents in the gall bladder suggesting blood products. Taking into consideration the risk of hemorrhage during the procedure, the patient was taken up for open cholecystectomy. This case emphasizes the need for a high level of awareness of pseudo-aneurysmal disease and inclusion of cystic artery pseudoaneurysm as one of the differential diagnosis for a patient presenting with recurrent upper quadrant pain, jaundice and melena or hemobilia.

Research paper thumbnail of Spectrum of Synovial Pathologies: A Pictorial Assay

Current Problems in Diagnostic Radiology, 2012

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sh... more The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Research paper thumbnail of Bilateral trigeminal neurofibromas-keep an eye out

International Journal of Research in Medical Sciences

Neurofibromatosis type 1 (NF1) and type 2 (NF2) are inherited phakomatoses which occur due to mut... more Neurofibromatosis type 1 (NF1) and type 2 (NF2) are inherited phakomatoses which occur due to mutations in tumor suppressor genes NF1 and NF2, and present with protean manifestations. One of the important manifestations of these neurocutaneous conditions is multiple benign and malignant nerve sheath tumors which can occur anywhere in the body. Multidisciplinary team involvement and timely imaging plays a vital role to precisely identify the culprit tumors and treat promptly. Our patient is a 35 years-old female presented with proptosis, bilateral upper limb and lower limb weakness. MRI performed on an urgent basis showed multiple neurogenic tumors involving trigeminal nerves bilaterally and multiple peripheral nerves. Later, the patient was diagnosed as NF1 based on national institute of health (NIH) clinical diagnostic criteria. Bilateral plexiform trigeminal neurofibromas, as seen in our patient, are uncommon tumors of NF1 and are not described in the imaging literature. The tumo...

Research paper thumbnail of Inadvertent Dialysis Catheter—An Interventional Bailout!

DOI https://doi.org/ 10.1055/s-0038-1666964. ISSN 2457-0214. Copyright ©2018 by Indian Society of... more DOI https://doi.org/ 10.1055/s-0038-1666964. ISSN 2457-0214. Copyright ©2018 by Indian Society of Vascular and Interventional Radiology Here is a 38-year-old male patient who presented in the emergency with complaints of severe abdominal pain, vomiting since 4 days, and breathlessness since 2 days. On clinical examination, the patient was drowsy, with dyspnea and moderate dehydration. Blood evaluation showed elevated lipase (63,365 U/L), amylase (2,457 U/L), and total count (17,000 cells/μL of blood). Imaging was suggestive of acute necrotizing pancreatitis. The patient developed secondary renal and respiratory failure for which the patient was shifted to the intensive care unit (ICU) for ventilatory support. Because of rising serum creatinine levels, central venous access was planned for hemodialysis. Right internal jugular access was planned by the ICU intensivist. The procedure was performed by Seldinger technique using 16G needle without any ultrasound guidance. After the initia...

Research paper thumbnail of Evaluation of hepatocellular carcinoma by contrast enhanced ultrasound: a novel technique

Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more... more Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more so when there is associated underlying chronic liver disease (CLD). Imaging plays a vital role and there has been a constant endeavor to improve the diagnostic accuracy of liver lesions. The introduction of mutiphasic CT and MRI has revolutionized the diagnostic ability of liver lesions. With the advent of ultrasound contrast agents (UCAs), it is possible to evaluate liver lesions using the non-invasive imaging technique of “contrast-enhanced ultrasonography” (CEUS). CEUS can overcome the limitations of grey scale and color doppler sonography and has been used for characterisation of focal liver lesions.. It can depict arterialisation of hypervascular hepatocellular carcinoma (HCC) and can also help in assessment of the post-therapeutic response. We present two such cases of HCC evaluated by a recently available second generation ultrasound contrast agent, SonoVue (Bracco, UK).

Research paper thumbnail of Radial Arterial Access for Hepatobiliary and Gastrointestinal Arterial Interventions: Initial Experience

Journal of Clinical Interventional Radiology ISVIR, Apr 1, 2018

Introduction Radial artery access is being more commonly used for visceral and peripheral arteria... more Introduction Radial artery access is being more commonly used for visceral and peripheral arterial interventions. Its use in the Indian subcontinent is not well reported. The aim of this study was to report outcomes of radial arterial access during arterial interventions of the hepatobiliary and gastrointestinal system. Methods In this retrospective study, patients who underwent radial artery access for hepatobiliary and gastrointestinal interventions from January 2015 to June 2017 were identified from the interventional database. Complications related to radial artery access and catheter placement in the visceral arteries, procedural modifications, and conversion to the standard femoral arterial access were analyzed. Results Total 32 patients were included in this study. Total 46 procedures (radial artery access) were performed. Nine patients had radial artery access on more than two occasions; 95% of the procedures involved interventional oncologic treatments. Patients were followed up for an average of 4 months following radial arterial access. Technical success was 98.7%. One patient developed radial artery spasm, and the access was abandoned. This patient subsequently underwent brachial arterial access. No patient required conversion to a femoral arterial access. No other complications were encountered during the follow-up. Compared with femoral arterial access, radial arterial access required longer catheters were needed for super selective catheterization of the visceral arteries. Conclusion Radial arterial access for arterial interventions in the hepatobiliary and gastrointestinal systems was technically feasible with no significant complications. Long catheters are required for selective catheterization of the visceral arteries with this approach.

Research paper thumbnail of Musculoskeletal manifestations of hemophilia: imaging features

Current Problems in Diagnostic Radiology, Sep 1, 2011

The purpose of this pictorial assay is to demonstrate the imaging features of the various musculo... more The purpose of this pictorial assay is to demonstrate the imaging features of the various musculoskeletal manifestations of hemophilia, an X-linked disorder. Depending on the site of recurrent bleeding, musculoskeletal manifestation can be in the form of hemophilic arthropathy and/or soft tissue, intraosseous, or subperiosteal pseudotumors. Radiography, sonography, computed tomography, and especially magnetic resonance imaging help in the evaluation of hemophilic arthropathy and pseudotumors, providing accurate diagnosis, thus avoiding inadvertent procedures and related complications. Treatment includes replacement of clotting factors either continuously or when indicated, radionuclide or open synovectomy in cases of disabling arthropathy.

Research paper thumbnail of SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT... more Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A 99m Tc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrastenhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

Research paper thumbnail of Evaluation of hepatocellular carcinoma by contrast enhanced ultrasound: a novel technique

Tropical …, 2010

Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more... more Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more so when there is associated underlying chronic liver disease (CLD). Imaging plays a vital role and there has been a constant endeavor to improve the ...

Research paper thumbnail of Bleeding scrotal vascular lesions: interventional management with transcatheter embolization

Cardiovascular and …, 2011

Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. ... more Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly ...

Research paper thumbnail of Spectrum of Synovial Pathologies: A Pictorial Assay

Current Problems in Diagnostic Radiology, 2012

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sh... more The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Research paper thumbnail of HRCT Temporal Bone in Microtia: A Wider Vision beyond the Tunnel!

Research paper thumbnail of Pentalogy of Cantrell

Research paper thumbnail of Our Experience in Tracking the Tract: Normal Biliary Anatomy and Variants on Magnetic Resonance Cholangiopancreatography in Living Donor Liver Transplantation

Cureus, Feb 6, 2023

Biliary anatomy is of paramount importance for hepatobiliary pancreatic surgeons for operative pl... more Biliary anatomy is of paramount importance for hepatobiliary pancreatic surgeons for operative planning. Preoperative assessment with magnetic resonance cholangiopancreatography (MRCP) to evaluate the biliary anatomy plays a vital role, especially for prospective liver donors in living donor liver transplantation (LDLT). Our objective was to evaluate the diagnostic accuracy of MRCP in assessing the anatomical variations of the biliary system and the frequency of biliary variation in the donors of LDLT. Materials and Methods Sixty-five donors of living donor liver transplantation in the age range of 20 to 51 years were studied retrospectively to evaluate the anatomical variations of the biliary tree. As a part of the pre-transplantation donor workup, MRI with MRCP was performed in a 1.5T machine for all these candidates. MRCP source data sets were processed with maximum intensity projections, surface shading, and multi-planar reconstructions. Images were reviewed by two radiologists, and the classification system of Huang et al. was utilized to evaluate the biliary anatomy. The results were compared with the intraoperative cholangiogram, considered the gold standard. Results We identified standard biliary anatomy in 34 candidates (52.3%), and variant biliary anatomy was observed in 31 candidates (47.7%) on MRCP. An intraoperative cholangiogram showed standard anatomy in 36 candidates (55.4%) and biliary variation in 29 candidates (44.6%). Our study showed a sensitivity of 100% and a specificity of 94.5% for identifying biliary variant anatomy on MRCP in comparison with the gold standard intraoperative cholangiogram. The accuracy of MRCP in detecting the variant biliary anatomy in our study was 96.9%. The most common biliary variation was the right posterior sectoral duct draining into the left hepatic duct, Huang type A3. Conclusion The frequency of biliary variations is high in potential liver donors. MRCP is sensitive and highly accurate in identifying the biliary variations of surgical significance.

Research paper thumbnail of Improving Outcomes in Catheter-Directed Thrombolysis for the Management of Acute Budd-Chiari Syndrome: A Case Report

Research paper thumbnail of Asymptomatic Mediastinal Mass – Venous Aneurysm of the Left Innominate Vein – Be It a Differential

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Nov 1, 2022

Research paper thumbnail of Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

International Surgery Journal

Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require im... more Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require immediate attention and treatment. The most common cause of AMI is superior mesenteric artery (SMA) occlusion secondary to an embolic phenomenon. We present a 55-year-old gentleman with acute SMA thromboembolism, treated by catheter directed thrombolysis (CDT) that helped in avoiding a major surgery. A 55-year-old male, with known diabetes, hypertension and atrial fibrillation, presented with acute abdominal pain and found to have SMA thromboembolism on contrast computed tomography (CT) abdomen. As there were no evidences of bowel ischemia clinically and on the CT imaging, endovascular CDT was performed following which the patient improved and discharged after 10 days of hospital stay. Timely endovascular intervention in appropriate patient population with acute mesenteric arterial thromboembolic occlusion can help avoid major surgeries, reduce the extent of non-viable bowel and decrease t...

Research paper thumbnail of Marchiafava-Bignami disease: an interesting case report!

International Journal of Research in Medical Sciences

Marchiafava-Bignami Disease (MBD) is a rare neurodegenerative disease usually associated with chr... more Marchiafava-Bignami Disease (MBD) is a rare neurodegenerative disease usually associated with chronic alcoholism characterized by demyelination and necrosis of the corpus callosum. Here, we report a 57-year-old patient who presented to our hospital with acute aphasia, disorientation and altered mental state. Diffusion weighted imaging (DWI) magnetic resonance imaging (MRI) revealed areas of restricted diffusion in the corpus callosum, bilateral periventricular white matter and right cerebellar peduncle. Given that the patient was a chronic alcoholic, a diagnosis of Marchiafava-Bignami disease was made. Supportive management with intravenous Thiamine and multivitamins was offered. The patient improved clinically after one week of treatment and a repeat DWI MRI revealed complete resolution of the abnormalities. It is imperative to diagnose MBD promptly and distinguish this from other neurological manifestations related to chronic alcoholism. An early diagnosis can aid in a better outc...

Research paper thumbnail of Cystic artery pseudoaneurysm: an uncommon complication of a common disease

International Surgery Journal

Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report ... more Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report an unusual presentation of upper gastrointestinal haemorrhage due to a cystic artery pseudoaneurysm secondary to acute cholecystitis in a 54-year-old male. Initial imaging revealed cholelithiasis with evidence of acute cholecystitis. Further investigations with Doppler ultrasound and CT suggested evidence of a cystic artery pseudoaneurysm with hyperdense contents in the gall bladder suggesting blood products. Taking into consideration the risk of hemorrhage during the procedure, the patient was taken up for open cholecystectomy. This case emphasizes the need for a high level of awareness of pseudo-aneurysmal disease and inclusion of cystic artery pseudoaneurysm as one of the differential diagnosis for a patient presenting with recurrent upper quadrant pain, jaundice and melena or hemobilia.

Research paper thumbnail of Nodular fasciitis-often a tumor mimic

International Journal of Research in Medical Sciences

Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It is frequently m... more Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It is frequently mistaken for a sarcomatous lesion because of its rapid growth, imaging features and aggressive pathological findings. Though imaging plays a vital role in evaluating these lesions, strong suspicion with a careful histopathology is the final answer. We present a patient with nodular fasciitis involving the upper extremity. A 15-year-old boy presented with complaints of progressively increasing right wrist swelling since 2 months, and had been having severe pain on exertion. On clinical examination the swelling was tender. MRI revealed T2 hyperintense lesion along the volar-lateral aspect of wrist, completely encasing the abductor pollicis longus tendon and indenting the extensor pollicis brevis tendon. Per operatively, the tumor was seen to involve the abductor pollicis longus tendon sheath and insinuating between the tendons. Excision biopsy was performed and histopathology confirmed the ...

Research paper thumbnail of Cystic artery pseudoaneurysm: an uncommon complication of a common disease

International Surgery Journal , 2022

Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report ... more Cystic artery pseudoaneurysm, though rare, is a notable cause of upper GI bleed. Here, we report an unusual presentation of upper gastrointestinal haemorrhage due to a cystic artery pseudoaneurysm secondary to acute cholecystitis in a 54-year-old male. Initial imaging revealed cholelithiasis with evidence of acute cholecystitis. Further investigations with Doppler ultrasound and CT suggested evidence of a cystic artery pseudoaneurysm with hyperdense contents in the gall bladder suggesting blood products. Taking into consideration the risk of hemorrhage during the procedure, the patient was taken up for open cholecystectomy. This case emphasizes the need for a high level of awareness of pseudo-aneurysmal disease and inclusion of cystic artery pseudoaneurysm as one of the differential diagnosis for a patient presenting with recurrent upper quadrant pain, jaundice and melena or hemobilia.

Research paper thumbnail of Spectrum of Synovial Pathologies: A Pictorial Assay

Current Problems in Diagnostic Radiology, 2012

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sh... more The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Research paper thumbnail of Bilateral trigeminal neurofibromas-keep an eye out

International Journal of Research in Medical Sciences

Neurofibromatosis type 1 (NF1) and type 2 (NF2) are inherited phakomatoses which occur due to mut... more Neurofibromatosis type 1 (NF1) and type 2 (NF2) are inherited phakomatoses which occur due to mutations in tumor suppressor genes NF1 and NF2, and present with protean manifestations. One of the important manifestations of these neurocutaneous conditions is multiple benign and malignant nerve sheath tumors which can occur anywhere in the body. Multidisciplinary team involvement and timely imaging plays a vital role to precisely identify the culprit tumors and treat promptly. Our patient is a 35 years-old female presented with proptosis, bilateral upper limb and lower limb weakness. MRI performed on an urgent basis showed multiple neurogenic tumors involving trigeminal nerves bilaterally and multiple peripheral nerves. Later, the patient was diagnosed as NF1 based on national institute of health (NIH) clinical diagnostic criteria. Bilateral plexiform trigeminal neurofibromas, as seen in our patient, are uncommon tumors of NF1 and are not described in the imaging literature. The tumo...

Research paper thumbnail of Inadvertent Dialysis Catheter—An Interventional Bailout!

DOI https://doi.org/ 10.1055/s-0038-1666964. ISSN 2457-0214. Copyright ©2018 by Indian Society of... more DOI https://doi.org/ 10.1055/s-0038-1666964. ISSN 2457-0214. Copyright ©2018 by Indian Society of Vascular and Interventional Radiology Here is a 38-year-old male patient who presented in the emergency with complaints of severe abdominal pain, vomiting since 4 days, and breathlessness since 2 days. On clinical examination, the patient was drowsy, with dyspnea and moderate dehydration. Blood evaluation showed elevated lipase (63,365 U/L), amylase (2,457 U/L), and total count (17,000 cells/μL of blood). Imaging was suggestive of acute necrotizing pancreatitis. The patient developed secondary renal and respiratory failure for which the patient was shifted to the intensive care unit (ICU) for ventilatory support. Because of rising serum creatinine levels, central venous access was planned for hemodialysis. Right internal jugular access was planned by the ICU intensivist. The procedure was performed by Seldinger technique using 16G needle without any ultrasound guidance. After the initia...

Research paper thumbnail of Evaluation of hepatocellular carcinoma by contrast enhanced ultrasound: a novel technique

Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more... more Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more so when there is associated underlying chronic liver disease (CLD). Imaging plays a vital role and there has been a constant endeavor to improve the diagnostic accuracy of liver lesions. The introduction of mutiphasic CT and MRI has revolutionized the diagnostic ability of liver lesions. With the advent of ultrasound contrast agents (UCAs), it is possible to evaluate liver lesions using the non-invasive imaging technique of “contrast-enhanced ultrasonography” (CEUS). CEUS can overcome the limitations of grey scale and color doppler sonography and has been used for characterisation of focal liver lesions.. It can depict arterialisation of hypervascular hepatocellular carcinoma (HCC) and can also help in assessment of the post-therapeutic response. We present two such cases of HCC evaluated by a recently available second generation ultrasound contrast agent, SonoVue (Bracco, UK).

Research paper thumbnail of Radial Arterial Access for Hepatobiliary and Gastrointestinal Arterial Interventions: Initial Experience

Journal of Clinical Interventional Radiology ISVIR, Apr 1, 2018

Introduction Radial artery access is being more commonly used for visceral and peripheral arteria... more Introduction Radial artery access is being more commonly used for visceral and peripheral arterial interventions. Its use in the Indian subcontinent is not well reported. The aim of this study was to report outcomes of radial arterial access during arterial interventions of the hepatobiliary and gastrointestinal system. Methods In this retrospective study, patients who underwent radial artery access for hepatobiliary and gastrointestinal interventions from January 2015 to June 2017 were identified from the interventional database. Complications related to radial artery access and catheter placement in the visceral arteries, procedural modifications, and conversion to the standard femoral arterial access were analyzed. Results Total 32 patients were included in this study. Total 46 procedures (radial artery access) were performed. Nine patients had radial artery access on more than two occasions; 95% of the procedures involved interventional oncologic treatments. Patients were followed up for an average of 4 months following radial arterial access. Technical success was 98.7%. One patient developed radial artery spasm, and the access was abandoned. This patient subsequently underwent brachial arterial access. No patient required conversion to a femoral arterial access. No other complications were encountered during the follow-up. Compared with femoral arterial access, radial arterial access required longer catheters were needed for super selective catheterization of the visceral arteries. Conclusion Radial arterial access for arterial interventions in the hepatobiliary and gastrointestinal systems was technically feasible with no significant complications. Long catheters are required for selective catheterization of the visceral arteries with this approach.

Research paper thumbnail of Musculoskeletal manifestations of hemophilia: imaging features

Current Problems in Diagnostic Radiology, Sep 1, 2011

The purpose of this pictorial assay is to demonstrate the imaging features of the various musculo... more The purpose of this pictorial assay is to demonstrate the imaging features of the various musculoskeletal manifestations of hemophilia, an X-linked disorder. Depending on the site of recurrent bleeding, musculoskeletal manifestation can be in the form of hemophilic arthropathy and/or soft tissue, intraosseous, or subperiosteal pseudotumors. Radiography, sonography, computed tomography, and especially magnetic resonance imaging help in the evaluation of hemophilic arthropathy and pseudotumors, providing accurate diagnosis, thus avoiding inadvertent procedures and related complications. Treatment includes replacement of clotting factors either continuously or when indicated, radionuclide or open synovectomy in cases of disabling arthropathy.

Research paper thumbnail of SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT... more Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A 99m Tc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrastenhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

Research paper thumbnail of Evaluation of hepatocellular carcinoma by contrast enhanced ultrasound: a novel technique

Tropical …, 2010

Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more... more Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more so when there is associated underlying chronic liver disease (CLD). Imaging plays a vital role and there has been a constant endeavor to improve the ...

Research paper thumbnail of Bleeding scrotal vascular lesions: interventional management with transcatheter embolization

Cardiovascular and …, 2011

Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. ... more Vascular lesions of the scrotum are uncommon; the most common among them are varicocele lesions. The other vascular lesions that may involve the scrotum are hemangioma, lymphangioma, and arteriovenous malformations, which are exceedingly ...

Research paper thumbnail of Spectrum of Synovial Pathologies: A Pictorial Assay

Current Problems in Diagnostic Radiology, 2012

The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sh... more The synovium, a specialized vascular tissue, lines the diarthrodial joints, bursae, and tendon sheaths of the body. It helps in nourishment of articular structures. The synovium is affected by a variety of disorders that can be either localized or systemic. Although normal synovium is barely perceptible on magnetic resonance imaging, it provides an excellent imaging modality for the evaluation of pathologic processes involving the synovium. The pathologic processes affecting the synovium include 1 of the following etiologies: inflammatory, infectious, degenerative, traumatic, or neoplastic and tumor-like conditions. In this article, we discuss the magnetic resonance imaging technique and the sequences used in the evaluation of synovial pathologies and review the characteristic imaging findings of specific conditions thus narrowing the differential diagnoses.

Research paper thumbnail of HRCT Temporal Bone in Microtia: A Wider Vision beyond the Tunnel!