ADICHUNCHANAGIRI

INSTITUTE OF MEDICAL

SCIENCES

Patron

Jagadguru Sri Sri Sri

Nirmalanandanatha

Mahaswamiji

Advisor

Dr.Shivaramu.G Principal, AIMS

Chief Editor Dr. Prashantha Ishwar H S

Professor & HOD

Dept Of Radiology

Editorial Board

Dr Ravishankar (Asst Prof) Dr Skandesh (Asst Prof)

Dr Sreenivasa Raju (JR)

Members Dr Ravishankar(Asst Prof) Dr Shama

Dr Likitha

Dr Vinoth Kumar

Dr Rajath

Dr Surabhi

Dr Abilash

Dr Rumpa

Dr Chinju

Dr Abhay

Editorial Greetings from the Department of Radiology,

With the blessings of Paramapujya, , Jagadguru, Sri Sri Sri Dr

Balagangadharanatha Mahaswamiji & His holiness jagadguru

Sri Sri Sri Nirmalanandanatha Mahaswamiji and under the able

guidance of our beloved

Principal Dr MG Shivaramu , we shall take great pleasure to

introduce

“IMAGING WORLD” , the quarterly newsletter from our

department.

At the outset, we wish express our sincere thanks to our Principal

Dr MG Shivaramu for bringing forth the novel concept of

newsletter in our institution.

IMAGING THE WORLD , is presented by the Department of

Radiology , the branch that has an amazing ability to visualize

the body without a scalpel!! . Radiology is now the key

diagnostic tool for many diseases and has important role in

monitoring and predicting the outcome. Radiologist have

become clinical specialists, who have been obliged to also

become experts in image capture technology.

Our Department is equipped with dynamic faculty members who

are actively involved in both diagnostic workup and academic

activities.

In this edition we present to you few interesting cases that we came

across , ongoing research projects, upcoming events which will

enlighten our dear fellow colleagues and postgraduates in the all

the department in their academic venture. The newsletter will be

published on a quarterly basis.

We are open for your valuable comments and suggestions. You

may contact us at aimsradiology@gmail.com.

Dr. Prashantha Eshwar.

INTERESTING CASE FROM OUR CT CONSOLE ROOM

Takayasu arteritis concealed as dilated cardiomyopathy.

Clinical history:

An 18 year old young female presented

with history of easy fatigability,

breathlessness, weight loss, since two

months associated with cough with

whitish sputum for 3 days.

Clinical examination: Absent pulses in

the left brachial, ulnar and radial

arteries.

Doppler: long segment circumferential

hypoechoic wall thickening involving

the left subclavian (fig 1) and axillary

artery causing 75% luminal narrowing

with monophasic flow in the brachial ,

radial and ulnar arteries and reduced

systolic velocities.

CT Angiography: circumferential wall

thickening involving the ascending

aorta , aortic arch and the descending

thoracic & abdominal aorta. There was

also associated circumferential wall

thickening involving the left subclavian

artery from its origin with significant

narrowing distal to the origin of the

vertebral artery . Circumferential wall

thickening without significant

narrowing was noted involving the

bilateral common carotid arteries up to

the carotid bulb, right brachiocephalic

and right subclavian arteries.

Echocardiography: DCM with grade III

diastolic dysfunction and ejection

fraction of 30%.

Discussion: Takayasu arteritis is a chronic inflammatory disease that involves the elastic arteries including the aorta, its branches and the pulmonary arteries. The disease is diagnosed based on the American College of Rheumatology (ACR) 1990 diagnostic criteria. The disease is classified based on the site of involvement according to New angiographic classification of Takayasu arteritis, Takayasu conference 1994. The site of arterial disease determines its clinical presentation which usually includes diminished or absent pulses, vascular bruits particularly affecting the carotids, subclavian, and abdominal vessels, hypertension secondary to renal artery stenosis. The presentation as DCM is rarely reported in 5-6% of cases and is due to involvement of coronary artery & severe hypertension. Therapeutic modalities include steroids, immunosuppressive agents, and antihypertensive drug therapy. In the acute phase of TA, treatment with corticosteroids (1mg/kg/d) leads to clinical remission in 60% of cases.

15 Immunosuppression with Cyclophosphamide (1-2mg/kg/d), azathioprin (1-

2mg/kg/d) or methotrexate (0.15-0.35 mg/kg/week) may be tried in resistant cases, or in order to reduce steroid dosages .Standard therapy may include salt-restricted diet, diuretics, and digitalis. Percutaneous transluminal renal arterial dilatation is done in case of renal artery involvement.

Conclusion: Awareness of HD in the diaphragm is necessary to avoid erroneous preoperative diagnosis and the possibility of hydatid disease should be considered in patients with preoperative cross sectional imaging indicating cystic lesions adjacent to the diaphragm, especially in endemic areas like India.

Introduction: Takayasu arteritis is a

form of large vessel granulomatous

vasculitis3 affecting often young or

middle-aged women of Asian descent. It

mainly affects the aorta and its

branches, as well as the pulmonary

arteries. In DCM, the heart becomes

weakened and enlarged and cannot

pump blood efficiently with left

ventricle (LV) most commonly affected.

Circumferential hypoechoic wall

thickening involving the left

subclavian

Circumferential wall thickening involving the left subclavian artery in from its origin with significant narrowing distal to the origin.

CT angiography circumferential wall thickening involving the ascending (a), arch (b) and the descending thoracic (c) & abdominal aorta (d).

Circumferential hypoechoic wall

thickening of the bilateral common

carotid arteries.

INTERESTING CASE FROM THE CT CONSOLE ROOM

Giant Cell Tumour of the Talus.

Introduction: Giant cell tumours

(GCT) are locally aggressive lesions

that primarily affect the epiphyses

of long bones. They typically

present in the third to fourth

decades of life and are rare under

20 years of age. Involvement of the

foot is uncommon, frequently

affecting the calcaneus and

metatarsals, rarely the talus.

Clinical history: A 7-year-old boy

came with progressively increasing

pain and swelling in the right

ankle joint of several months

duration.

Plain radiograph of ankle: Expansile

lytic lesion of the right talus.

CECT ankle: an expansile lesion with

enhancing soft tissue at the

periphery. There was significant

thinning of the cortex. No intra

articular extension was seen.

The diagnosis of gaint cell tumour

was given which was later

confirmed by histopathological

analysis. Partial resection of the

talus with bone grafting was done.

The patient was followed up for

two years. No recurrence was

found.

.

Discussion: Giant cell tumour, also known as osteoclastoma, accounts for

approximately 5% of bone tumours and 20% of benign bone tumours . The incidence

of GCT is highest in the second to fourth decades of life with a peak in the third and

only about 1% occurring in the first decade of life.

50% of GCTs arise around the knee, most often in the distal femur and proximal tibia,

followed by the distal radius and then the sacrum. Typically, GCTs are metaphyseo-

epiphyseal in location but tend to be metaphyseal in skeletally immature patients.

The phalanx, metacarpal, maxilla, and metatarsal are rarely affected and tend to be

more aggressive than those in other bones.

GCT of the talus usually presents as ankle pain and swelling or sinus tarsi syndrome of

several months duration with or without history of trivial trauma. Conventional

radiographs demonstrate a lytic lesion centered in the epiphysis but may involve the

metaphysis and extend to the adjacent articular cortex. The tumour usually bulges

beyond the confines of the cortex. No periosteal reactions are appreciated unless a

fracture is present. Histological analysis of biopsy tissue is necessary for diagnosis, as

radiological images are not conclusive.

The treatment of GCT is directed towards local control without sacrificing joint function. This can be achieved by intralesional

curettage with autograft reconstruction by packing the cavity of the excised tumour with morsellised iliac cortico-cancellous

bone. Since the recurrence rate is as high as 60%, attempts to extend the curettage or intralesional excision by chemical or

physical means such as phenol or cytotoxic agents like chlorpactin have been tried with varying results.

Sagittal non contrast CT of the ankle joint (bone window) showing a osteolytic lesion involving the talus showing cortical thinning. Lesion is seen minimally extending beyond the confines of the cortex [Table/Fig-2a&b]: Sagittal contrast enhanced CT scan showing a soft tissue mass with peripheral enhancement and minimal extension beyond the confines of the cortex anteriorly [Table/Fig-3]: Histopathology showing multiple giant cells on a background of homogenous mononuclear stromal cells,

A

B C

D F

G H

Publications:

1. Sonographic evaluation of uterus size in relation to maternal parity and Caesarean section delivery. Dr. Prashantha Eshwar, Dr. Sreenivasa Raju, Dr. Ravishankar and Dr. Rumpa banerjee.International journal of current research. 2016, 8, (04), 29900-29902.

2. Giant cell tumour of the talus in a 7-year-old boy. Ravishankar Pillenahalli Maheshwarappa. Journal of clinical and

diagnostic research, vol-8(11): rj03. 3. Takayasu arteritis concealed as dilated cardiomyopathy with review of literature. Dr. Sreenivasa Raju, Dr. Skandesh,

Dr. Prashantha Eshwar and Dr. Rumpa Banerjee. International journal of current research. 2016, 8, (04), 29903-29906.

Paper presentations:

1. MRI evaluation in Myelopathy. Dr Surabhi Chakraborty, Dr Prashantha Eshwar, Dr Chandramouly .69th

Annual

conference of Indian radiological imaging and association. Orissa.

2. MR evaluation of meniscal injuries of knee joint with arthroscopic correlation. Dr Skandesh, Dr Chandramouly .32nd

Annual conference, Indian radiological imaging and association. Karnataka.

Paper