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Takayasu arteritis is an inflammatory disease of large- and medium-sized arteries, with a predilection for the aorta and its branches. Advanced lesions demonstrate a panarteritis with intimal proliferation. It can affect the aorta, subclavian artery, renal artery, iliac artery, coronary artery, and other blood vessels. Pulmonary arteritis is very uncommon in TA. We describe a case of TA, who primarily presented with pulmonary hypertension. more...

BACKGROUND The advent of Multidetector Computed Tomography (MDCT) has created several important advances in the detection and characterization of renal masses due to its high accuracy, low cost, and easy availability. There is a growing need to separate benign lesions from malignant ones so as to provide an appropriate timely treatment. It can be used with contrast agents and helps in providing data during multiple phases along with the possibility of multiplanar image reconstruction anytime in the future. We wanted to study the role of CT imaging as a diagnostic modality for the evaluation of renal masses. METHODS This is a prospective study conducted among 50 cases, with clinically or radiologically diagnosed renal mass who were referred to our department . A detailed clinical history, thorough clinical examination, ultrasonography and multiphase - CECT using a Philips 128 - slice multi detector scanner (Ingenuity), were performed using the set - protocol followed by multiplanar reconstruction and detailed evaluation. Findings of CT scan were correlated with clinical / biopsy / surgical findings. RESULTS Renal cell carcinoma (RCC) was the most common renal mass in our study group (48 %) followed by renal cyst (30 %). The most common presenting symptom of RCC was haematuria (91.6 %) followed by flank pain (58.3 %). Renal cyst was a fairly common lesion with majority (93.3 %) being BOSNIAK - I category. RCC most commonly showed malignant extension via lymph nodes (83.3 %) while transitional cell cancer (TCC) most commonly spread via ureteric extension (75 %). Inferior vena cava (IVC) extension, even though seen only in a small fraction of cases (4 %), was only associated with RCC. On correlation with histopathological findings, a sensitivity of 95.8 %, specificity of 96.15 % and a diagnostic accuracy of 96 % was found, for diagnosing RCC in our study. CONCLUSIONS MDCT is a robust technique for detection and characterisation of renal mases. It is rapid and easily available with excellent patient compliance. MDCT has excellent sensitivity and specificity for characterisation of renal masses. KEY WORDS MDCT, Renal Mass, Renal Cell Carcinoma, Cyst, Attenuation, Enhancement more...

BACKGROUND Small bowel imaging often questions clinicians due to its long, tortuous and undulating morphology. The current study was undertaken to establish the efficacy of multidetector computed tomography (MDCT) enterography in the evaluation of small bowel diseases using iso-osmotic mannitol as oral contrast agent. METHODS A prospective observational study was conducted among thirty patients (mean age 40 years; range 14 - 66 years), 16 males and 14 females presenting with clinical suspicion of small bowel diseases based on clinical, laboratory or other imaging investigations underwent CT enterography on a 128 slice CT scanner using isoosmotic mannitol as neutral enteral contrast. RESULTS Intestinal tuberculosis was the most common diagnosis. Non neoplastic cases predominantly showed segmental symmetrical involvement with target pattern of enhancement. Small bowel tumours (adenocarcinoma) were seen in 2 cases. Neoplasms were associated with focal asymmetrical involvement with heterogeneous enhancement pattern. Computerized tomography enterography (CTE) clearly depicted the site, level and cause of the obstruction in all the patients with a sensitivity and specificity of 96 % and 100 % respectively. Diagnostic accuracy of CTE in detection of small bowel diseases came out to be 98 %. CONCLUSIONS CT enterography is an effectual, non-invasive, well-tolerated, sensitive and specific imaging modality for the evaluation of small bowel diseases which provides superior assessment of the intraluminal, mural and extraintestinal pathologies. KEY WORDS CT enterography, mannitol, Tuberculosis, Small Bowel more...

Endodontic failure can be due extra canals in the root morphology left untreated by the clinician. Careful assessment and modifications may be required in the cavity preparation for stress free entry to complex root anatomy. This case report depicts a 36- year old male with three roots in his maxillary second molar more...

Post-traumatic portal venous thrombosis is a rare event, and is usually seen in association with penetrating injuries. Portal venous thrombosis following blunt abdominal trauma is extremely rare with only few reports in the literature, some associated with underlying coagulation disorders. We report multidetector computed tomography findings in a case of blunt abdominal trauma with otherwise normal coagulation profile, which showed shattered spleen and MDCT evidence of acute thrombosis in the right branch of the portal vein. To the best of our knowledge, this is the first documented report of acute portal venous thrombosis in association with shattered spleen. more...

Introduction: Magnetic resonance imaging (MRI) is the modality of the first choice for evaluation of vertebral compression/collapse. Many MRI qualitative features help to differentiate benign from malignant collapse. We conducted this study to look for a quantitative difference in chemical shift values in benign and malignant collapse using dual-echo gradient echo in-phase/out-phase imaging. Materials and Methods: MRI examinations of a total of 38 patients were retrospectively included in the study who had vertebral compression/collapse with marrow edema in which final diagnosis was available at the time of imaging/follow-up. Signal intensity value in the region of abnormal marrow signal and adjacent normal vertebra was measured on in phase/out phase images. Signal intensity ratio (SIR) was measured by dividing signal intensity value on opposite phase images to that on in phase images. SIR was compared in normal vertebrae and benign and malignant vertebral collapse. Results: There were 21 males and 17 females with mean age of 52.4 years (range 28–76 years). Out of total 38 patients, 18 were of benign vertebral collapse and 20 of malignant vertebral collapse. SIR in normal vertebrae was 0.30 ± 0.14, 0.67 ± 0.18 in benign vertebral collapse, and 1.20 ± 0.27 in malignant vertebral collapse with significant difference in SIR of normal vertebrae versus benign collapse (P < 0.01) and in benign collapse versus malignant collapse (P < 0.01). Assuming a cutoff of more...

Wandering spleen is a rare condition resulting from laxity of the suspensory ligaments of the spleen which predisposes it to torsion. We present a 24-year-old female who presented with acute abdominal pain due to torsion of the wandering spleen. more...

Background: Anemia, the decrease of haemoglobin (Hb) concentration is a common disorder complicating pregnancy mostly due to hemodilution, increased demand of iron and poor dietary intake of iron. The aim of this study was to evaluate whether parenteral iron sucrose can be used as an alternative to daily oral iron during pregnancy.Methods: It was a prospective interventional study conducted in the Department of Obstetrics and Gynaecology, Rohilkhand Medical College and Hospital, Bareilly involving pregnant women at 16-24 weeks with Hb 7-10 g/dl. They were randomly allocated to two groups I and II. Group I (oral group) was given oral iron tablets containing 100 mg of elemental iron and 0.5 mg of folic acid as per therapeutic requirement. Group II (parenteral group) were admitted as day care patients and given a total calculated dose of iron sucrose in divided doses of 200 mg each in 100 ml of normal saline as slow intravenous infusion. Hb, packed cell volume (PCV), blood indices were measured at the start, 2 weeks and 4 weeks of treatment. Any side-effects of treatment were also studied.Results: A statistically significant increase in values of Hb, hematocrit, reticulocyte count, red blood cells (RBC's) indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular hemoglobin (MCH) coupled with no serious side effects with iron sucrose as compared with oral iron.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective alternative to oral iron for treatment of iron deficiency anemia in pregnancy. more...

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. NST is primarily a test of fetal condition and it differs from contraction stress test which is a test of uteroplacental function. The present study aimed at evaluating the efficacy and diagnostic value of NST for antenatal surveillance in high-risk pregnancy and comparing the mode of delivery with test results.Methods: A clinical study of NST was done between November 2014 to October 2015. NST was used for their surveillance from 32 weeks of gestation and NST was recorded weekly, biweekly, on alternate days or even on daily basis depending on high risk factors and were followed up.Results: A total of 100 cases were enrolled in the study. The mean age of patients was 25.09±3.78 years. In all 14 cases (23.3%) with reactive NST underwent lower caesarean section (LSCS) whereas 36 cases (90%) with non-reactive NST underwent LSCS. The mean NST delivery interval with reactive NST was 9.8±7.1 hours and in cases with non-reactive NST it was 9.2±8.6 hours, the difference was statistically not significant (p=0.70).Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. An abnormal NST should alert the clinician of fetal compromise and has to be followed up by other biophysical tests. more...

In the present study five Eimeria species viz. Eimeria tenella, E. acervulina, E. necatrix, E. maxima and E. brunetti responsible for coccidiosis are reported and its general prevalence was found to be 24 percent. Among the five Eimeria species, prevalence of E. tenella was recorded to be the highest (25%), followed by E. acervulina (15%), E. necatrix (10%). E. maxima (7%) and E. brunetti (3%). Altogether 400 stool samples (dropping) were collected by random sampling methods from four poultry farms. These samples were preserved in preservative solution (2% potassium dichromate solution). Stool samples were examined by thin feacal smear methods. There were altogether 96 cases of coccidiosis of which 25% were caecal, 35% intestinal and 40% mixed. Prevalence of coccidiosis was recorded in all the 12 months and four seasons of the study period. The highest (38%) prevalence rate was found in the month of July and the lowest (5.71%) in the month of October. The difference in monthly prevalence of Eimeria was insignificant (x2 =19.675, P 0.05). The age- wise prevalence was the highest (34.66%) in 61 weeks above chicken, followed by 30% in the 46-60 weeks age group, 22.5% in the 31-45 weeks age group, 17.14% in the 0-15 weeks age group and 15.78% in the 16-30 weeks age group. The difference in age- wise prevalence was found to be insignificant (x2= 9.488,P> 0.05). J. Nat. Hist. Mus. Vol. 28, 2014: 66-72 more...

An entomological study was carried out in Bhelukhel, Bode and Tathali of Bhaktapur district to compare fluctuation in population size of Culex mosquitoes in relation to relative humidity and temperature. Mosquitoes were collected during July-December 2012 around the pig enclosures and cattle sheds by means of dark activated rechargeable CDC light trap. The study resulted 73.41% of Culex mosquitoes out of the total mosquitoes collected (884). Total eleven species of Culex mosquitoes were recorded namely Cx. tritaeniorhynchus, Cx. fuscocephala, Cx. gelidus, Cx. vishnui, Cx. pseudovishnui, Cx. bitaeniorhynchus, Cx. quinquefasciatus, Cx. edwardsi, Cx. hutchnsoni, Cx. whitei and Cx.whitmorei . Distribution of Culex species was abundant in July and August. Cx . quinquefasciatus, the principal vector of Lymphaticfilariasis (LF) was recorded to be the most dominant species in all the three sites. Cx . tritaeniorhynchus, the principal Japanese encephalitis (JE) vector was collected in higher number during August from Tathali and Bode site and during July from Bhelukhel site. Significant variation was not observed in abundance of Culex mosquito in three study sites in six different months. J. Nat. Hist. Mus. Vol. 28, 2014: 118-126 more...

A cross sectional survey was carried out by taking 516 mid night blood samples from 206 households in 1,2 and 3 wards of Salyantar village development committee of Dhading district, Nepal with the objective to analyze the epidemiological situation of lymphatic filariasis. The main aim of the study was to provide the data essential for the planning, implementation and evaluation of the services to the prevention, control and treatment of lymphatic filariasis.Questionnaire survey was conducted for the collection of information of the respondents. Blood samples were collected by means of ear-lobe prick method. Microscopical examination of the collected blood samples revealed 117 positive cases i.e. 22.67%. Males (24.54%) were found to be infected more than females (21.28%) in the ration of 1.2:1. The highest distribution of microfilarial parasites was in the age group >70 years (36.36%) while the least was in the age group ≤10 years (12.37%). The infected youngest person was 4 years old boy and the oldest was 85 years old man. Endemicity rate and crude disease rate was reported to be 44.76% and 22.09% respectively. Illiteracy, lack of awareness about the disease, poor sanitation, carelessness in using bed-nets and health were identified as the major risk factors for filariasis.J. Nat. Hist. Mus. Vol. 26, 2012: 136-145 more...

A descriptive cross-sectional questionnaire survey on Japanese encephalitis was conducted in Bhaktapur district. Mosquitoes were collected for six months by means of dark activated rechargeable CDC light trap. Out of 884 mosquitoe individuals collected, 73.41 percent were Culex species. The highest numbers of mosquitoes were collected in July and August. There was no significant variation in Culex vectors abundance during six months in three study sites Tathali, Bode and Bhelukhel. Significant correlation was found between level of knowledge and attitude towards JE prevention. Fair level of practice towards JE prevention but having no good attitude shows that though people are supportive towards JE control. Journal of Institute of Science and Technology, 2015, 20(1): 112-118 more...

Summary Background Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation. Case Report We present imaging findings in a case of portal annular pancreas in a 45-year-old male patient. Conclusions Portal annular pancreas is a rare and often neglected pancreatic anomaly due to a lack of awareness of this entity. With the advent of MDCT and MRI, accurate preoperative diagnosis of this condition is possible. more...

Introduction: Back pain is a common clinical problem and is the frequent complaint for referral of lumbar spine magnetic resonance imaging (MRI). Coronal short tau inversion recovery sequence (STIR) can provide diagnostically significant information in small percentage of patients. Materials and Methods: MRI examinations of a total of 350 patients were retrospectively included in the study. MR sequences were evaluated in two settings. One radiologist evaluated sagittal and axial images only, while another radiologist evaluated all sequences, including coronal STIR sequence. After recording the diagnoses, we compared the MRI findings in two subsets of patients to evaluate additional merit of coronal STIR imaging. Results: With addition of coronal STIR imaging, significant findings were observed in 24 subjects (6.8%). Twenty-one of these subjects were considered to be normal on other sequences and in three subjects diagnosis was changed with the addition of coronal STIR. Additional diagnoses on STIR included sacroiliitis, sacroiliac joint degenerative disease, sacral stress/insufficiency fracture/Looser's zones, muscular sprain and atypical appendicitis. Conclusion: Coronal STIR imaging can provide additional diagnoses in a small percentage of patients presenting for lumbar spine MRI for back pain. Therefore, it should be included in the routine protocol for MR imaging of lumbar spine. more...

Obstructed hemivagina and ipsilateral renal anomaly syndrome is a rare group of urogenital anomalies in which unilateral genital anomaly is associated with ipsilateral renal anomaly. We describe imaging findings in a 14-year-old female patient who presented with cyclical lower abdominal pain. more...

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament. more...

Snakebite is an important and serious medical problem throughout the entire terai region of Nepal. But comprehensive study of snakebite epidemiology in Western Development Region of Nepal is scarce. We described the status of snakebite situation in the region based on retrospective data retrieved from 10 snakebite treatment centers during June 2011 to February 2012. We reported six thousand and nine hundred ninety three snakebites in 2008–2010. Of all, we found 640 (9%) cases envenomed and received anti-venom therapy. We recorded the highest number of snakebites in July, August and September, which account 57% of all snakebite victims, during 15.00 and 21.00 h. People aged 11–20 years were mostly victimized by snakebite as compared to other age groups. Female suffered more than male. The average requirement of polyvalent snake anti-venom was 16 vials. Overall, case fatality rate was 13%. more...

Summary Background Robert’s uterus is a very rare müllerian duct anomaly which is characterised by septate uterus with obstruction of a one-sided cavity and formation of hematometra. Therefore, patients present with cyclical abdominal pain during menstruation along with normal menstrual flow. Case Report We present magnetic resonance imaging (MRI) findings in a case of Robert’s uterus in a young woman. Conclusions Robert’s uterus is a very rare anomaly which can be very well characterized by magnetic resonance imaging (MRI). MRI can also show any associated hematometra and endometriomas complicating this condition and aid in the institution of appropriate management in such cases. more...

Background Doppler ultrasound is the accepted gold standard for assessing direction of flow in the portal vein (PV). Moreover, it is non-invasive; therefore, it is well accepted by the patients and does not interfere with flow hemodynamics. Objectives The present study was aimed to evaluate the association between color Doppler findings and the severity of portal hypertension in patients with cirrhosis. Patients and Methods The study group included 50 patients referred for ultrasound (US) evaluation over a period of six months from March to August, 2007. The patients were divided into three groups (Child’ A, B and C) based on Child Pugh classification. The direction of flow in the main portal vein (hepatopetal or nonhepatopetal) and peak venous velocity (PVV) in the main portal vein were measured and correlated with the presence or absence of ascites, splenomegaly, splenic and esophageal varices (assessed by Doppler US). These findings were correlated with clinical features and laboratory findings (using Child Pugh’s criteria). Results There was significant association between the decrease of peak portal venous velocity (PVV) and the increase in Child Pugh score. Hepatofugal flow was seen only in patients with more advanced disease. There was also significant association between PVV and splenic varices and ascites, while PVV was not affected by the presence or absence of esophageal varices or splenomegaly. Presence of a recanalized umbilical vein (UV) was associated with increased PVV even in advanced disease. Conclusions Color Doppler is an excellent modality for detecting and characterizing the complex hemodynamics of portal hypertension in cirrhosis and they correlate with the clinical stage of disease. more...

Five different species of Eimeria viz. E. acervulina , E. maxima, E. necatrix, E. tenella and E. brunetti were identified. The highest percentage (50%) was found with mixed infection. Specieswise infection with E. tenella was recorded in the present study. Monthwise highest prevalence rate (50%) was observed in March and the lowest (10%) in the months of April and September. Seasonwise prevalence showed the highest prevalence rate (33%) in the summer and spring, and the least (14%) in the autumn. The agewise prevalence was the highest (48%) in the 31-45 days age group and the least (6%) in 0-15 days age group of layers. The coccidiosis was found highly prevalence in mud/mud+brick type floor than in concrete type floor farms. Key words: Coccidiosis; Eimeria; infection; layers; percentage; summer; spring Journal of Natural History Museum Vol. 23, 2008 Page 45-50 more...

Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein. more...

A 55-year-old male patient presented with backache for 1 month. There was no history of trauma. Haematological evaluation revealed an elevated erythrocyte sedimentation rate. Radiographic examination showed partial collapse of D12 vertebra with suspicious lytic lesion. MRI showed well-defined lytic lesion in D12 vertebral body appearing mildly hypointense on T1-weighted (T1W) images and mildly hyperintense on T2-weighted (T2W) images, with associated radially arranged thickened cortical struts appearing hypointense on T1W/T2W images, mimicking cortical … more...

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Abdominal cocoon formation is a chronic condition which usually presents with intermittent bowel obstruction and is typically described with benign conditions. In developing countries like India, where tuberculosis is endemic, abdominal cocoon in young patients without any other known chronic disease is mostly associated with abdominal tuberculosis. Abdominal cocoon secondary to malignant causes has been reported but is extremely rare, mostly in association with ovarian thecomas. Abdominal cocoon secondary to abdominal tuberculosis has been described only in few reports. We present a case of young female who presented with abdominal cocoon which was subsequently proven to be secondary to diffusely infiltrative gastric carcinoma. more...

Aorto-esophageal fistula (AEF) is a rare and life threatening condition, which can be rapidly fatal. More than half of such cases are secondary to aortic aneurysm rupture. There are only two previous reports describing AEF caused by penetrating atherosclerotic ulcer. We present multidetector computed tomography findings in a case of AEF secondary to penetrating atherosclerotic ulcer. more...

We present a case of an adult male who presented with herniation of soft tissues of temporomandibular joint into the external auditory canal (EAC) through a persistent foramen tympanicum. The patient was referred for computed tomography (CT) for suspicious mass in the left EAC. Multidetector CT helped in correctly characterizing the lesion with retraction of the soft tissue mass in open mouth biopsy and thereby avoiding unnecessary biopsy. more...

the omentum and the stranding continued inferiorly into left inguinal hernia sac (Fig. 2). The diagnosis of omental torsion with hernia was confirmed on laparotomy. Omental torsion usually occurs on the right side because of greater mobility of the right omentum. A left-sided omental torsion is rare and is difficult to diagnose clinically. Torsion may be primary, or secondary to underlying causes like hernia, tumors or adhesions [1]. Omental torsion results in vascular congestion with subsequent obstruction and omental infarction. Omental torsion is only rarely diagnosed preoperatively. CT is the investigation of choice for making the diagnosis. Omental torsion presents with characteristic fatty mass with central hyperdensity with surrounding whirling pattern [2]. more...

A 65-year-old lady presented with sudden onset of palpitations, headache, perspirations and flushing. Clinical examination revealed tenderness in right lumbar region. Ultrasound abdomen revealed multiple hyperechoic hepatic lesions and a mesenteric mass. Contrast-enhanced computerized tomography (CECT) abdomen revealed multiple hypervascular hepatic lesions. Two enhancing mesenteric masses with desmoplastic reaction were seen encasing the mesenteric branches of superior mesenteric artery. Subcentimeter mesenteric nodes were also seen. A small 1.5 cm×1.35 cm enhancing submucosal lesion was noted in the distal ileum (Fig. 1). Diagnosis of ileal carcinoid with mesenteric and hepatic metastases was made. FNAC from hepatic lesions proved the diagnosis. Almost 90% of carcinoids occur in terminal ileum. Carcinoid syndrome is seen in patients with metastases from carcinoid tumors and is characterized by dry flushing, diarrhea and asthma attacks [1]. MDCT has revolutionised the diagnosis of primary ileal carcinoid, as subcentimeter masses can be diagnosed with confidence while other indirect signs like mesenteric mass with desmoplastic reaction acting as supportive evidence [2]. more...

Annular pancreas is a well-known developmental anomaly. It usually presents in neonatal period with duodenal obstruction due to pancreatic tissue enveloping the second part of duodenum. It is associated with other anomalies such as Down's syndrome, duodenal atresia, and Hirschsprung disease. Presentation in adults can be due to pancreatitis or obstruction. While complete annular pancreas is well described in literature, imaging appearance of incomplete annular pancreas is only described recently. We present imaging findings in two cases of partial annular pancreas. more...

Extraosseous fat-fluid level is a rare but specific sign of hematogenous osteomyelitis. It results due to marrow necrosis due to infection with the release of fat globules and pus which extends into periosseous tissues through bony erosions. To form a fat-fluid level, the marrow necrosis has to be extensive which is not always present. However, when present and in appropriate clinical settings, it is fairly specific for hematogenous osteomyelitis. We describe radiographic, computed tomography, and magnetic resonance imaging findings in a case of osteomyelitis with extraosseous fat globules and fat-fluid level. more...

Cyclospora caytanensis, a human pathogenic coccidian parasite owes its recognition as an emerging parasite, which continues to be found throughout the world. Its prevalence was investigated in Kathmandu valley, Nepal in 2003. Stool examination was performed with a total of 500 specimens from 3 Hospitals, 1 Geriatric Centre (Briddhaashram), 1 Infectious and Tropical Disease Research Center/Nepal and 8 Slum areas by direct smear technique. Out of these specimens, Cyclospora caytenensis oocysts were found in 7% of specimens with the age range from 2 months to 67 years. To identify possible sources for Cyclospora infection, water samples from 3 rivers, 134 fecael samples of animals and 43 samples of green leafy vegetables wash were collected and examined by formal-ether sedimentation and floatation technique. As a result, oocyst of Cyclospora was identified only in chicken stool sample, which could be possible reservoir host for Cyclospora infection. However, further studies are needed to shed light on possible sources of infection.Key Words: Cyclospora caytanensis, coccidian parasite, diarrhoea, faecal specimens. more...