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Testicular adrenal rest tumors (TARTs) are rare benign ACTH-dependent tumors that occur in males with congenital adrenal hyperplasia (CAH) mostly in those who have defaulted treatment but can also be seen in wellcontrolled patients and if left untreated can destroy testicular tissue leading to infertility. Early diagnosis and treatment of tart are important for gonadal function and fertility treatment. Tarts have very characteristic ultrasound features and recognizing them avoids misdiagnosing them as malignancies, which can lead to unnecessary intervention. We describe a case of a 12-year-old boy who initially presented to our hospital for bone age assessment, followed by serial endocrine workup for congenital adrenal hyperplasia. The diagnosis of CAH was confirmed afterwards on hormonal studies showing significantly raised 17-Oh progesterone and mildly raised LH and testosterone while ACTH and HbA1c were however within normal range. Ultrasound abdomen was also performed which was unremarkable at that time. Patient again presented for bone age assessment which was more that the chronological age due to steroid therapy. Recently scrotal ultrasound was performed, there were multiple bilateral hypo-echoic heterogeneous lesions with significant internal vascularity were seen along mediastinum testis and diagnosis of rare benign deposits of TART was made in bilateral testes. [ABSTRACT FROM AUTHOR]

The aim of this study is to determine the association of imaging spectrum of hepatocellular carcinoma with post-transplant pattern of metastatic disease.METHOD AND MATERIAL: A seven-year retrospective study (20142020) of live donor liver transplant (LDLT) patients at Shifa International Hospital (SIH) involved comparing pre-transplant CT scans to post-transplant dynamic CT images using a picture archiving and communication system (PACS). Disease recurrence in potential sites, including the hepatic graft, abdomino-pelvic viscera, lungs, bones, and more, was documented. Data was analyzed using frequency statistics, histograms, and tables. RESULTS: Out of 221 transplants, 36 individuals (4F, 32M) experienced recurrences; 27.8% had prior Transarterial chemo-embolization (TACE). Segment VII had the most HCCs (14 patients, 38.9%); Segments V and VI had 6 patients each (16.7%) with average sizes of 4.372 - 1.912 cm. Most patients (69.4%) showed capsular involvement on pre-transplant CT, followed by diaphragmatic involvement in 8, segmental portal venous (PV) tumor in 6, and APS in 3 individuals (22%, 16.7%, 8.3% respectively). Post-transplant CT showed recurrence in the lungs (44.4%), bones (41.6%), hepatic graft (30.5%), lymph nodes (22.2%), adrenals (8.3%), and other sites. Pre-transplant factors had varying associations with recurrence, but none were statistically significant (P-values > 0.05). CONCLUSION: Our study does not show significant association between presence of diaphragmatic involvement, hepatic capsular invasion, thrombosed segmental branches, and arterioportal shunting (APS) and the site of tumor recurrence. However, presence of significant capsular and diaphragmatic bulge particularly in segment VII and VIII HCCs, robust scrutiny should be carried out for evaluation of these areas both intra-operatively by surgeon and in post-transplant follow-up CT reporting by radiologist. Furthermore, in post-transplant CTs, comparison and correlation with pre-transplant CT findings should be carried out. The study also highlights the key role of radiologist in highlighting these features of HCCs for assistance in ensuring safe surgical practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this article is to present imaging findings in tuberous sclerosis complex (TSC), which will eventually help in imaging based diagnosis. STUDY DESIGN: Retrospective study PLACE AND DURATION OF STUDY: Radiology Department, Shifa International Hospital, from 2010 to 2021. METHODOLOGY: Total of 20 patients were selected from the radiology database retrospectively from 2010 to 2021. These patients were diagnosed with Tuberous Sclerosis by radiology department and their scans were performed and reviewed at CT and MRI machines of Shifa International Hospital. CT scan was performed on Toshiba 640 slices, Siemens 128 slices and Siemens 16 slices, and MRI was performed on Siemens 3 tesla, Toshiba-titan 1.5 tesla and Hitachi 0.4 tesla. The literature review was also done to identify different organ system involvement of this disease. RESULT: Different organ system involvement by this disease and imaging features of them are reported. CONCLUSION: TSC has wide range of radiological imaging findings. Recognition of various organ manifestations on imaging is necessary for making the accurate diagnosis and is helpful in the treatment plan. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship of variant biliary anatomy with hepatic vascular variants in living liver donors. Methods: A retrospective cross-sectional study was conducted at Shifa International Hospital, Islamabad, from January 2017 to Feb 2020. Two radiologists reviewed pre-operative Computed tomography (CT) angiography and Magnetic resonance cholangiopancreatography (MRCP) of live liver donors having the variant biliary anatomy only, in consensus. The classification of the conventional or variant hepatic artery, hepatic veins, and portal vein was done based on CT angiography scans, while biliary anatomy was characterized based on MRCP images. Results: Of 165 liver donors with variant biliary anatomy, standard anatomy involving hepatic arteries observed in 88 (53.3%) and portal veins in 125 (75.8%) individuals. Twenty-nine (17.5%) liver donors had trifurcation pattern (B) and 26 (15.7%) had short right hepatic duct (C). Forty (24.2%) had anterior right hepatic duct (RAHD) continuing into common hepatic duct (D). In 49 (29.6%) donors, abnormal right posterior hepatic duct (RPHD) configurations draining into left hepatic duct (E) were found. In 21 (12.7%), RAHD had separate drainage into left hepatic duct (F). Trifurcation, short right hepatic artery, drainage of RPHD into left hepatic duct, and drainage of RAHD into left hepatic duct were mostly observed in conventional-Michel's I, i.e., 16 (9.7%), 12 (7.2%), 28 (16.9%), 14 (5.4%), and 88 (53.3%) respectively. Conclusion: Among the biliary variants, type D and E were most frequent. There was also an increased incidence of a concurrent variant hepatic arterial supply in liver donors in presence of variant biliary drainage. [ABSTRACT FROM AUTHOR]

Extra-neural metastases of glioblastoma multiforme are uncommon with unidentified metastatic mechanism. There is no consensus over optimum treatment regimen. The current narrative review was planned to illuminate the presence criteria, sites of metastatic spread, incidence, mechanism, risk factors and management.