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The case pertains to a 29-year-old male who presented with epigastric pain at the hospital. On evaluation, he was sonographically detected to have “comet tail” reverberation artifacts involving the echogenic floaters in the lumen of the urinary bladder. The patient was subsequently diagnosed with Type V hyperlipidemia and acute pancreatitis. The association between this classic sonographic finding and hyperlipidemia has not been previously found documented in the available literature and hence merits a discussion of the relevant clinical details pertaining to the case.

Introduction: There are three independent variables used in clinical practice to evaluate patients suffering from alcohol use disorder (AUD); these are Alcohol Use Disorders Identification Test (AUDIT), liver function tests (LFTs), and imaging findings on ultrasound of the abdomen. There is limited literature about the association of imaging findings with LFT and AUDIT scores in cases of AUD. Objective: The study was conducted to determine the association of ultrasound abdomen findings with LFTs and AUDIT scores in patients with AUD. Methods: This study was conducted using data from 439 patients of AUD (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) treated in the psychiatry department of a tertiary care hospital. The data hence obtained were subjected to statistical analysis. The ordinal data sets were compared using the Chi-square test, and P < 0.05 was taken as statistically significant. Results: The ultrasonography (USG) findings of hepatic/portal system changes in patients of AUD show a significant association with the corresponding changes in AUDIT scores, serum bilirubin, and aspartate transaminase (AST) levels. The ultrasound findings were also significantly associated with total years of drinking and average drinking (in g) per day in the last 3 years. The USG findings did not show a significant statistical association between ALT (alanine transaminase) and serum gamma-glutamyl transferase levels. Conclusion: In patients with alcohol use disorder, USG abdomen findings correlate with the severity of dependence as indicated by years of drinking, average alcohol consumption per day for the last 3 years, AUDIT score (last 1 year), and markers of liver injury (serum bilirubin and AST). Combined use of clinical severity indicators (e.g., AUDIT), lab parameters, and USG abdomen can help in the early diagnosis of ALD.

Introduction Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities. Materials and Methods The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis. Results Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy. Conclusion In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.

Objectives: Primary objective of the study was to determine the association between the TI-RADS system of thyroid lesion evaluation on ultrasound and the cytological findings of thyroid lesions by FNAC (graded as per the Bethesda system). The secondary objective was to study the outcome of high TI-RADS and high Bethesda grades in terms of malignant potential determined by histopathological examination. Materials and Methods: A multi-centric retrospective hospital-based study was done for all patients who underwent sonography for evaluation of thyroid lesions and subsequently fine needle aspiration cytology (FNAC) from 2018 to 2021 at two hospitals in two different states of India. Clinical and radiological data were obtained from hospital records. The data hence obtained was subjected to statistical analysis. The outcome of high-grade TIRADS and Bethesda scores in terms of malignant potential (confirmed by histopathology) was also evaluated. Results: A total of 249 patients fulfilled the inclusion criteria. 129 patients (51.8%) were in 36-55 year age group with female predominance. The majority of cases in the study belonged to TI-RADS 3 category (33.73%) on sonography and Bethesda Grade III (28.91%) after cytological analysis. Out of 72 Bethesda grade III cases, 59 (81.9%) had TI-RADS 3 score. Similarly, out of 67 Bethesda Grade IV cases, 55 (82%) had TI-RADS 4 scores showing maximum concordance. The accuracy of TIRADS 4 and 5 lesions and Bethesda grade 4-6 lesions in detecting malignancy confirmed on HPE was 67.9 and 73.6%. Discussion: Our study done on 249 patients from varying demographic profiles showed that the correlation between sonography and cytological findings of thyroid lesions was statistically significant. Both diagnostic modalities helped to correctly determine the severity of the lesions, and malignant potential and enabled grading into clinically relevant groups that decided the further management as per laid down guidelines. Conclusion: The concurrent use of ACR-TIRADS on sonography coupled with the Bethesda system of cytological evaluation for thyroid nodules is clinically appropriate in ascertaining the RoM (Risk of malignancy) in a thyroid nodule.

Intracranial teratomas represent a rare lesion accounting for 0.1%–0.7% of all intracranial tumors. Those in the fourth ventricle have rarely been reported. The present case is that of a 28-year-old man with occipital headache for two months. MRI examination revealed a well-defined extra-axial cystic lesion in posterior fossa in the midline herniating through the foramen magnum. Pre operatively, the mass was seen to be occupying the whole of the posterior fossa and arising from the roof of the fourth ventricle. On gross examination, the lesion had both solid and cystic components. Histopathological examination showed multiple cystic areas lined by brain tissue admixed with islands of cartilage and salivary gland elements and intestinal type glands. A diagnosis of mature cystic teratoma was made.