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Lymphatic filariasis is an endemic infection seen predominantly in the tropical and subtropical regions, and approximately 120 million people are infected and 1.1 billion are at risk of infection all over the globe. It presents with lymphatic dysfunction in various forms such as elephantiasis, lymphocele, hydrocele, chyluria, and groin lymphadenovarix. The patient may complain about symptoms of fever, redness and pitting edema, etc. We report a rare presentation of filariasis in an unusual and uncommon location, presenting as an intra-abdominal mass.

Osteomas of paranasal sinuses are common benign tumors and are diagnosed incidentally. However, osteomas complicated by pneumocephalus with air fluid level presenting with progressive hemiparesis is rare. Here, we present a case report of a 22-year-old male who presented with left-sided progressive hemiparesis with history of generalized headache since 2 years.

We are presenting a rare case of anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) in an adult patient. The patient underwent coronary CT angiography for exertional dyspnoea, suspected as coronary artery disease; however there were no atherosclerotic plaques. There was anomalous origin of left coronary artery from pulmonary artery. Conventional catheter angiography confirmed the origin of left coronary artery from pulmonary artery, which was retrogradely filling through right coronary artery.

Introduction: We present an unusual case of an anterior rectal duplication cyst in a 9-month-old male infant. This rare variant of rectal duplications is presented with acute urinary retention. The diagnosis is challenging and multiple differential diagnoses can be considered. Varied clinical presentations and imaging characteristic of this rare entity are discussed. The awareness of this variant leads to the early diagnosis and the curative resection.

Gastrointestinal stromal tumours (GISTs), are relatively common tumours of the gastrointestinal tract, most commonly found in the stomach. Previously they were termed as leiomyomas and leiomyosarcomas. Clinically, they are asymptomatic but may cause abdominal pain or bleeding from ulceration of the overlying mucosa. We present a case of gastroduodenal intussusception secondary to large gastric stromal tumour in a 50 year old male, which presented with intermittent abdominal pain and gastric outlet obstruction. Pre-operative diagnosis was made on abdominal CT and confirmed at laparotomy. DOI: http://dx.doi.org/10.3126/njr.v4i1.11573 Nepalese Journal of Radiology, Vol.4(1) 2014: 71-75

Klippel-Trenaunay syndrome (KTS) is a cutaneous capillary malformation on a limb in association with soft tissue swelling with or without bony hypertrophy and atypical varicosity. The capillary malformation associated with KTS is port wine stain. Angiokeratoma circumscriptum naeviforme (ACN) is a congenital variant of angiokeratoma commonly present on the lower limb as a hyperkeratotic plaque. ACN is rarely associated with KTS. We report a case of ACN with soft tissue hypertrophy and deep venous malformation (possibly a variant of Klippel-Trenaunay) in a 4-year-old male child.

Fetus in fetu is an extremely rare condition embryologically arising in monozygotic diamniotic twins with an incidence of 1:500,000 births. To the best of our knowledge, number of reported cases should not be more than 100 with majority of cases presenting in post natal life with only 5 cases detected prenatally. We are presenting a case diagnosed at 24 weeks of gestation on ultrasound with presence of well formed skull, facial skeleton and bony orbit.

Mediastinal lipomatous tumors with additional malignant soft tissue components are exceedingly rare. Patients can have substantially large sized tumors with long duration of symptoms and can be misinterpreted on radiographs. Enhancing soft tissue component within a fat density lesion within the mediastinum is alarming and should raise the suspicion of sarcomatous component. Along with diagnostic imaging, selective CT guided biopsy/FNAC from the enhancing soft tissue component can help in making correct diagnosis.

Distal appendicular skeletal involvement is a rare finding. Skeletal metastases by far is ranked 3rd in place after liver & brain. Among the skeleton, axial skeleton has a predilection. We report a 65-year-old male with lung cancer with distal ulnar metastases. Patient has swelling of left wrist from last 6 months. Physical examination revealed ill-defined, painful, swelling of left wrist joint. Radiograph revealed permeative destruction of distal ulna. On examination infectious/neoplastic etiology was considered but on evaluation the primary was found to be lung malignancy with dis- tal ulnar metastases.

Isolated Cardiac hydatidosis is a rare occurrence [1]. Involvement of left ventricle is more common followed by right ventricle, interventricular septum, left atrium, right atrium and interatrial septum. Here, we present a case report of 26-year-old male patient who was suspected to have left ventricle cystic lesion on 2D-Echocardiography which was confirmed to be Hydatid cyst situated in inter-ventricular septum on Magnetic resonance imaging which is itself a rare phenomenon.

Infantile myofibromatosis is the most common fibrous disorder of infancy and early childhood. It can present in three forms—solitary lesion, multicentric with visceral involvement and multi-centeric without visceral involvement. Intracranial involvement is rare and when it occurs, it is generally extension of extracranial lesion into the intracranial compartment. Here we present a rare case of isolated posterior fossa involvement presenting clinically as congenital facial palsy.

Chyluria is a urological manifestation of lymphatic system abnormality as a result of some abnormal communication between these two systems. Although chyluria as such is rare, filariasis is most common cause in Asian countries. This parasitic tropical debilitating disease is known for chronicity, recurrence and resultant complications. This article provides importance of Magnetic Resonance Imaging (MRI), as a non-invasive modality, in the diagnosis of exact etiopathogenesis of chyluria along with clinical symptoms, other investigations required and brief about the management protocols. On MRI, abnormally dilated lymphatics are visualized as meshwork of multiple tubular, tortuous, fluid-filled structures in the retroperitoneum. We report a case of 20 year young adult who presented with history of passing whitish urine on and off since 8 months. MRI helped in the detection of the site and level of lymphatic obstruction and resultant lympho-urinary fistula.

Purpose: To study the specificity of mammography and ultrasonography separately and in combination for detection of breast masses (ultrasonography-mammography correlation); To study the investigations to evaluate various breast masses; To describe suitable indications, advantages and limitations of each technique compared with other available modalities; To study the mimics of breast masses; To have histopathology follow-up and retrospective evaluation with imaging findings to improve diagnostic skills in series of 166 patients complaining of breast mass. Material: The prospective clinical study was carried out in the department of Radiodiagnosis for a period of 2 year extending from December 2010 to December 2012 infemale patients complaining of breast mass. Well informed written consent was obtained from them. Histopathology follow up was obtained from either biopsy or post operative tissue. USG machine: Philips HD 11 XE USG of the breasts and axillary region done in supine position in presence of female attendant; Mammography machine: Allengers machine with Agfa special mammography cassettes. Cranio caudal and Medio-Lateral Oblique views are taken in the presence of female attendant. MRI: PHILIPS 1.5 T machine; CT: SIEMENS duel slice CT machine. Results: Ultrasonography and mammography was done in most of the cases were sufficient to diagnose the lesion in most of the cases especially in benign breast masses. MRI and CT scan was used in special cases to know the extent of the lesions, in mimics of breast masses, bony extensions, primary muscular and bony lesions. Total 166 patients complaining of breast mass in one or both breasts were examined and evaluated with USG and mammography. The lesions were confirmed on histopathology (FNAC/biopsy). Out of 30 diagnosed malignancies two lesions were missed on mammography and four lesions were missed on ultrasonography. One of them was missed on both. For malignancies specificity of mammography is 93.3% and that of ultrasonography is 86.67%. Combining both the modalities specificity is near 97%. Out of total 92 abnormal breasts 12 were missed on USG and 20 were missed on mammography. Combining both the modalities only 2 lesions were missed and were diagnosed on histopathology alone. Overall specificity for USG in breast masses is 86.9% and for mammography it is 78.6%. Combining both the modalities the specificity is 97.6%. The “p” value is obtained which is highly significant for combination of ultrasonography and mammography in comparison with any individual modality (p = 0.0059 & p = 0.0001 respectively). Conclusion: Our study confirms the higher combined sensitivity rate for ultrasonography and mammography for detection of breast masses including malignancies. USG is useful in cystic lesions, ectasias, infections, pregnancy-lactation, and dense breast evaluation and for image guidance, whereas mammography is useful in detecting microcalcifications, spiculated masses for early detection of malignancies and for stereotactic biopsies. To suggest single modality, ultrasonography is better in younger population and BIRAD 1, 2 & 3 lesions. Whereas, mammography is better in older population and BIRAD 4 & 5 lesions. However, sono-mammographic correlation is best in both.

The MURCS association which stands for Mullerian, Renal, Cervicothoracic Somite Abnormalities is a rare developmental anomaly seen in females. The clinical course of this disorder is not clearly defined as of yet-which may range from asymptomatic to severe disability. Here we present the case of a young 22-year-old female who was incidentally detected to have a generalized increase in bone density with an absent uterus. Further workup revealed a case of MURCS association with renal osteodystrophy. This is an as of yet unreported complication/association and must be kept in mind in the treatment of these patients.

Purpose: To determine whether endovascular embolization of pseudoaneurysms complicating pancreatitis with microcoils was associated with better therapeutic outcome. Materials and Method: The prospective clinical study was carried out in the Department of Interventional Radiology for a period of 2 years extending from May 2010 upto August 2012 on 16 male patients in the age group of about 30 - 55 years, with each one of them having vascular complications as a sequel to pancreatitis, after obtaining well informed written consent from each one of them. Results: The outcome of the procedure was judged by the following parameters—a) Restoration of the blood pressure of the patient; b) Cessation of the hemetemesis and malena; c) Reduction in abdominal pain and discomfort and d) Overall improvement in the general condition of the patient. Each of the patients had been on follow up for at least 6 months, except 2 of them, with no new complaints in any of them. The procedure related mortality was none. Conclusion: Vascular complications of pancreatitis need immediate and accurate diagnosis and prompt treatment. Micro coil embolisation, is a minimally invasive technique which helps to exclude the pseudoaneurysm from the circulation and thus reduces the scope for massive life threatening internal hemorrhage, and is a better alternative to surgery.

Gestational trophoblastic diseases (GTD) are one of the rare complications of pregnancy, which include partial and complete moles with their more aggressive counterparts termed as Gestational trophoblastic neoplasias (GTN). Their association with uterine vascular malformations is well recognised and should be suspected in appropriate clinical settings. Selective uterine artery embolization is a safe and effective alternative method of treatment in a patient with severe per vaginal bleeding from residual uterine vascular malformations due to GTN which has relative lower morbidity and mortality than surgical procedures. Here, we report a case of residual uterine arterio-venous malformation due to invasive mole detected by ultrasonography (US) and contrast enhancedMRI & referred to Interventional Radiology for Transcathetor arterial embolization.

Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].

Partial mole is a form of gestational trophoblastic disease that may be associated with serious medical complications and occasionally progresses to the second trimester of pregnancy. We present a case report of a partial mole diagnosed at 18 weeks of gestation in a septate uterus with molar placenta in one horn and a dead fetus in the other. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped) and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.

Prolapsed ureterocele is a rare complication that may present with acute bladder outlet obstruction, generally in female infants. We present a case of prolapsed simple ureterocele in an adult woman, evaluated by transvaginal micturating sono-urethrography. High-frequency transvaginal sonography of the urethra performed during micturation revealed the relationship of the ureterocele with the urethral wall.

Hydranencephaly is an encephaloclastic central nervous system disorder characterised by severe destruction of the cerebral hemispheres with preservation of posterior fossa structures. We present MRI and neurosonography features of a unique case of hydranencephaly involving cerebellum (in the form of complete liquefaction of cerebellar hemispheres) and cerebral hemispheres with associated bilateral microphthalmia and ocular colobomas. This is an exceptional case as to the best to our knowledge. In humans, such a severe involvement of cerebellum has not been reported in cases of hydranencephaly. It is essential to distinguish hydranencephaly from gross hydrocephalus, as treatment and prognosis of the two are totally different. During differentiation, it is important to remember that severe cerebellar involvement can be seen in hydranencephaly.

Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.