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The dot-in-circle sign is a specific sign of musculoskeletal mycetomas at MR imaging and US, and these imaging modalities could help in the early diagnosis of this disease.

To evaluate the utility of the GeneXpert MTB/RIF assay for the diagnosis of tuberculous spondylitis in samples obtained by CT-guided aspiration. The effect of anti-tubercular treatment, specimen type, and imaging findings on laboratory results was also assessed along with a comparison of imaging findings in tubercular versus non-tubercular cases.

A 57-year-old man presented with progressive difficulty in walking for 2 weeks, resting hand tremors for 1 week, and low-volume speech for 2 days. Initially, he had difficulty in initiation of walking. Soon, he developed short-stepped gait with history of en bloc falling forward. Within 2 weeks of the onset of illness, he became bed-bound. While in bed, he remained very stiff and could not sit or turn sides by himself. He also had tremors in his upper limbs on action. His speech volume was reduced, but he always remained coherent. There was no bowel or bladder involvement, flexor spasms, or zonesthesia. The patient had been treated for ankylosing spondylitis (AS) with nonsteroidal anti-inflammatory drugs for 4 years because of low back pain, progressively increasing stooped-forward gait, and sclerosis of sacroiliac joints on X-ray. On examination, he had a masklike face. His blink rate was 1 to 4 blinks per minute. His Mini-Mental State Examination score was 29 of 30. He had hypophonic monotonous speech. His eye movements showed slow saccades and broken pursuit movements. Examination of motor system revealed normal muscle bulk, cogwheel rigidity of the upper limbs, and lead-pipe rigidity in the legs. His strength could not be tested because of profound muscle stiffness. Coarse action tremors were noticed in both hands. The patient had fixed-flexion deformity at the hip joint. Deep tendon jerks could not be elicited because of profound muscle rigidity. Plantar responses and abdominal reflexes also could not be elicited.

Aim To compare multidetector computed tomographic angiography with the gold standard cardiac catheterization and angiography in tetralogy of Fallot.Methods In 40 consecutive patients over 5 years of age with tetralogy of Fallot, multidetector computed tomographic angiography and catheterization angiography studies were compared for intracardiac anatomy, pulmonary anatomy and indices, coronaries and collaterals. Safety parameters, relative advantages and limitations were also analyzed.Results All catheterization studies required hospitalization whereas all tomographic studies were performed as outpatient procedures. The need for sedation and amount of contrast used were significantly greater in catheterization than in tomographic studies. Complications noted during catheterization were access site complications in 4 patients, cyanotic spells in 2, transient complete heart block requiring temporary pacing in 2, and air embolism in one. No complication was observed during tomographic studies. All tomographic studies were adequate, but 2 catheterization studies were inadequate. Ventricular septal defects, aortic override, level of right ventricular outflow tract obstruction, and pulmonary artery anatomy were equally assessed by both imaging modalities. However, tomographic studies missed additional small muscular ventricular septal defects. There was a linear correlation between tomographic and catheterization studies for pulmonary annulus size, artery sizes, Z-score, and Nakata index. There was complete concordance with respect to side of aortic arch and detection of collaterals. Coronary anatomy was better delineated in tomographic studies.Conclusions For preoperative evaluation of tetralogy of Fallot patients, multidetector computed tomographic angiography can be used as a reliable noninvasive alternative to cardiac catheterization angiography.

Renovascular hypertension is the most common cause of secondary hypertension. Imaging plays an important role in establishing the diagnosis in these cases. Digital subtraction angiography (DSA) is the gold standard investigation in suspected cases. Colour Doppler Ultrasound (CDUS) is a very effective and cheap screening tool. CT angiography and MR angiography are effective and comparable alternatives to DSA. Captopril scintigraphy and renal vein renin sampling are used in selected patients in whom the functional significance of the renal artery stenosis is to be determined.

This report describes a rare case with hemitruncus with large left sided patent ductus arteriosus with severe pulmonary hypertension with reversal of shunt across patent ductus simulating transposition of great arteries. The case illustrates the role of echocardiography and cardiac multidetector CT in diagnosing such complex congenital heart disease.

A 55-year-old woman developed recurrent short-lasting shock-like pain involving her left lower face. Initiation of amlodipine for concurrently detected hypertension relieved her of pain besides normalizing her blood pressure. Interestingly, occasions of noncompliance with amlodipine brought her pain back. Her cranial MRI revealed tortuous blood vessels compressing the left rostro-antero-lateral medulla and left trigeminal nerve root (figure 1). Vascular compression of medulla is known to produce neurogenic hypertension1(figure e-1 at Neurology.org). Possibly, a decrease in vessel tortuosity2mediated by voltage-gated L-type calcium channels (antihypertensive effect) and an action on N-type channels (sympathetic modulation/antinociceptive effect) played a role in amlodipine's inadvertent efficacy (figure e-2).