Dr. Rupesh Namdev

Fetal Hepatic Calcification

2010-02-13T16:36:00.003+05:30

This Image shows a solitary liver calcification. The causes may be hepatic tumours , intrauterine infection or vascular insult. In the majority of cases they are of unexplained origin in fetuses that appear normal at birth.

Fetal Supra Renal Mass

2010-02-13T16:32:00.001+05:30

The D/D for fetal suprarenal masses include adrenal neuroblastoma or hemorrhage, intra-abdominal pulmonary sequestration, enteric duplication cysts and renal masses like mesoblastemic nephroma, upper pole cystic dysplasia or hydronephrosis in a duplex kidney.

Peritoneal Carcinomatosis

2010-01-31T16:43:00.002+05:30

In this patient we see ascites along with multiple hypoechoic nodules on the undersurface of right hemidiaphragm- they move independent from the movement of liver during respiration, on the visceral surface of liver - they moved in concert with the liver (visceral peritoneum), infiltration of omentum (the omental cake)

Among the tumours involving peritoneum, metastatic tumours are much more than primary peritoneal tumours. Peritoneal carcinomatosis is the term used to describe diffuse involvement of the peritoneum with metastatic disease .

This case was traced to adenocarcinoma of right colon for which he had had hemicolectomy few years back.

Carotid Body Tumour

2010-01-31T16:37:00.003+05:30

Carotid body tuomurs are paraganglionomas of relatively low malignant potential that arise in the carotid body, which is a tiny ovoid structure located in the adventitia of the carotid bifurcation.

common presentation is a palpable mass in neck with headache.

here we see a hypoechoic mass in the bifurcation of common carotid artery. This patient had headache and a palpable neck mass which was considered to be a lymph node mass previously.

MORE IMAGES: ECTOPIC PREGNANCY

2009-12-15T13:39:00.002+05:30

CRUVEILHIER-BAUMGARTEN SYNDROME

2009-12-15T11:30:00.003+05:30

In the above case we saw a liver shows coarse granular echotexture with surface nodularity, splenomegaly, minimal ascites and of course an undilated main portal vein with the left branch of portal vein seen communicating with the systemic epigastric vein through probably what may be called a recanalised paraumbilical vein. This is infact one of the many ways of portosystemic shunting that occurs in a patient with cirrhosis and portal hypertension. This is called Cruveilhier-Baumgarten syndrome

Also known as:Baumgarten’s portal hypertension variant syndrome, Baumgarten’s syndrome, Cruveilhier-Baumgarten cirrhosis, Cruveilhier-Baumgarten sound, Cruveilhier-Baumgarten syndrome, Pégot-Cruveilhier-Baumgarten syndrome

Associated persons:Paul Clemens von Baumgarten, Jean Cruveilhier, Unknown Pégot

Description: A condition where cirrhosis of the liver, portal hypertension and splenomegaly cause the paraumbilical vein to carry the blood. The blood flowing through the paraumbilical vein bypasses the liver. It is associated with prominent periumbilical veins, portal hypertension, liver atrophy, and splenomegaly. An auscultatory sound may be registered in the venus collaterals of the abdominal wall.

According to some gastroenterologists, Cruveilhier-Baumgarten disease and Cruveilhier-Baumgarten syndrome are not the same entity:

Cruveilhier-Baumgarten disease: The disease caused by the umbilical vein remaining open after birth, with all the misery this causes in the portal vein system.

Cruveilhier-Baumgarten syndrome: The condition acquired when the umbilical vein is reopened because of increased pressure on the portal vein system in liver cirrhosis.

Tower Skull

2009-05-31T17:04:00.006+05:30

Known by various terms like acrocephalia, acrocephaly, hypsicephaly, hypsocephaly, oxycephalia, steeple skull, turricephaly tower skull is essentially a type of craniosynostosis in which there is premature closure of the lambdoid and coronal sutures, resulting in an abnormally high, peaked, or conically shaped skull.
It may be seen in various syndromes like Carpenter's syndrome which is characterised by acrocephaly, obesity and syndactyly.
It is also seen in a birth defect like Bahima Disease which is caused by iron deficiency in infants which are fed exclusively on cow's milk. It is characterized by a tower-shaped skull, dilatation of the diploe, and no signs of thalassaemia, sickle cell or other haemolytic anaemia.
A very interesting fact of anthropological aspect about tower skull is its occurence in many tribes where they practice a ritual known as head binding or flattening as in Tomman Island of Australia.
Other examples of craniosynostoses include: trigonocephaly (fusion of the metopic suture), brachycephaly (fusion of the coronal suture), dolichocephaly (fusion of the sagittal suture), plagiocephaly (unilateral premature closure of lambdoid and coronal sutures), oxycephaly (fusion of coronal and lambdoidal sutures), Kleeblattschaedel ( premature closure of all sutures).

Absent radius ; Radial Ray Malformation

2009-05-31T16:36:00.005+05:30

The images show absence of radius in forearm with absent thumb.

The hand is plantar flexed and radial deviated.

Talikng about absent radius, it is a very rare medical condition in which the radius bone is not developed. This results in a typical position of the arm in which the wrist is plantarflexed and radially deviated.
The aetiology of radial club hand or radial dysplasia can be divided into sporadic cases, which are not inherited and are presumed to be due to de novo genetic mutations and syndromal cases in which certain syndromes have a higher than expected association with radial dysplasia. Typically, organ systems are affected that develop at the same time as the upper limb:

VACTERL or VATER syndrome,

Holt-Oram syndrome

Edwards syndrome

Haematopoietic syndromes: Fanconi anemia, Thrombocytopaenia with Absent Radius (TAR syndrome)

Craniofacial syndromes: Nager's syndrome, Goldenhar's syndrome, Mobius syndrome, cleft lip and palate, Treacher-Collins syndrome,

Skeletal syndromes and Isolated skeletal associations: Klippel-Feil syndrome, Sprengel deformity, syndactyly, scoliosis

Teratogens: radiations, valproic acid, thalidomide

Evaluating Obstetric Doppler studies.

2009-05-26T00:46:00.001+05:30

Doppler evaluation has a key role in screening and diagnosis of foetal compromise by intra uterine gestational restriction.

PI (pulsatility index) is the most beneficial of all indices because it most accurately correlates to the pulsatile flow in arteries.

We have to look for waveform changes in MCA (middle cerebral artery), uterine arteries, Umbilical arteries and Ductus venosus.

Middle Cerebral Artery: The Typical MCA waveform is that of high systolic velocities and low diastolic velocities at 28 to 32 weeks, PI > 1.45.

A fall of PI to about 1.12 is noted by cerebral redistribution which increases diastolic flow.

Further fall denotes significant Placental insufficiency.

In the image of the MCA waveform given above at 31-32 weeks GA the PI values are 1.03 and 0.98 which denotes utero placental insufficiency.

Uterine Artery: A normal pregnancy has a high flow and no diastolic flow pattern by 18 to 22 weeks of age. So, a finding of Early diastolic notches bilaterally is considered abnormal.

The PI at 18 to 22 weeks are typically less than 1.2 and PI > 1.45 is abnormal.

Detection of Bilaterally abnormal waveforms and PI values is suggestive of Clinically significant Uteroplacental insufficiency as in the image of uterine artery waveform above.

Umbilical artery: absent end diastolic flow is abnormal finding by the age of 18 to 22 weeks.

Reverse end diastolic flow as seen in the Image above is a ominous sign.

MultiCystic Dysplastic Kidneys in utero

2009-04-23T14:20:00.005+05:30

This is a picture of two kidneys which are replaced by multiple cortical cysts of various sizes. This was associated with severe oligohydramnios as can be see in the images. The majority of cases are associated with pelviinfundibular atresia and atretic ureter. Multicystic dysplastic kidneys are almost always nonfunctional and the prognosis is worse if it is bilateral. The kidneys are enlarged and show multiple cyssts of various sizes that do not communicate with each other. the appearanec and size of the MCDK may change markedly over time. This may be result from residual renal function and/or progressive fibrosis. The natural history of MCDK is towards involution documented both before birth and after birth.

Gastroschisis

2009-04-21T22:07:00.004+05:30

The two pictures of a second trimester scan reveals a cauliflower shaped mass protruding through a ventral abdominal wall defect. These are the Intestine, part of lliver and bladder. This is termed as gastroschisis. The occurence is considered to be somewhere from 1:1000 to 1:2500 as cited by various authors.

A similar but distinct entity is omphalocele where there is protrusion of intestine into the umbilical cord base and the cord is seen to arise from the apex of such lesion.

Omphalocele is considered to be physiological if only the midgut herniates and the age of fetus is less than 11 weeks, but identification of other abdominal visceras like liver, or persistence beyond 12 weeks GA is considered pathological is is considered to be related to various chromosomal disorders including Trisomy 18.

Esophageal Web

2009-04-21T22:00:00.004+05:30

It is seen as a shelf like filling defect usually found in cervical esophagus.

It is considered to be associated with Iron deficiency anaemia (Plummer Vinson Syndrome)
Esophageal webs are thin folds composed of mucosa and
submucosa which result in a 1- to 2-mm–wide shelflike
filling defect along the anterior wall of the lower
hypopharynx, pharyngoesophageal segment, or proximal
cervical esophagus. Occasionally, webs may be multiple
and more masslike in configuration. Esophageal webs are
usually asymptomatic. However, dysphagia can develop
when the web results in marked luminal narrowing.
Clinically significant narrowing may present as a jet
phenomenon, in which a thin column of barium jets
through the center of a circumferential web. Many
investigators have attempted to associate cervical
esophageal webs with other conditions. The association
between esophageal webs and iron deficiency anemia
(Plummer-Vinson syndrome) remains controversial.
Reports also have suggested an association between webs
and upper esophageal or pharyngeal carcinoma. The great
majority of webs remain an isolated finding, often
incidentally discovered without an associated disorder.
Distinction of an esophageal web from the anteriorly
located venous plexus may be difficult. Careful study of the
venous plexus will show variability in its size, whereas a web
remains fixed and unchanging from swallow to swallow.

Renal Angiomyolipoma

2009-02-12T18:50:00.002+05:30

Gastro Intestinal Stromal Tumor

2009-02-10T12:35:00.000+05:30

Invasive Ductal Carcinoma of Breast

2009-02-10T12:31:00.001+05:30

Prostatic Abscess on TR scan

2009-02-10T12:29:00.003+05:30

Reflux Nephropathy

2009-02-10T12:24:00.003+05:30

The pictures show a small echogenic end stage kidney, a dilated tortuous pus filled ureter.

IVU showed a non functioning kidney. MCU showed GR 3 reflux.

Fetal Hydrops

2009-02-10T12:18:00.002+05:30

Intussusception

2009-02-09T13:51:00.005+05:30

Intussusception is the most common cause of small bowel obstruction in the pediatric age group of 6 months to 3 years. Clinical findings are crampy and intermittent abdominal pain with vomiting and usually a palpable abdominal mass. The red currant jelly stool is a classic finding in intussusception.
Ultrasonologically, we get an oval to hypoechoic mass with echogenic center often termed as “pseudo kidney” sign or “target” sign. We also see multiple concentric rings and layers representing the bowel walls. A small amount of peritoneal free fluid is usually seen but a large amount denotes perforation.
The common forms are ilieo-colic, ilieo-ilieal and colo-colic.
In children it usually follows gastrointestinal infection which causes hypertrophy of Peyer’s patches of lymphnodes which then act as lead point for intussusception. The treatment is usually hydrostatic reduction if there is no evidence of perforation in which cases surgery is indicated.

Avascular Necrosis of Head of Femur

2009-02-09T13:46:00.003+05:30

Neuropathic Osteoarthropathy

2009-02-04T19:16:00.004+05:30

Retrosternal Hernia

2009-01-26T13:36:00.002+05:30

Hirschsprung's Disease: X-ray Diagnosis

2009-01-24T13:24:00.003+05:30

A 1 month female neonate presented with gross abdominal distension and h/o not passing fecus since a week. Ultrasound showed nothing but gaseous artefacts. The X -Ray shows multiple fluid level and gaseous distended bowel loops [both small and large ]in whole abdomen suggestive of intestinal obstruction.

I was initially satisfied with my diagnosis till i had a call from pediatrician that can it be a Hirschsprung's disease, any clues? then i reviewed the x ray and noticed the absence of gas shadow in lower pelvis region i.e, empty rectum! or distal cut-off sign in rectosigmoid region.

That's a key finding in diagnosis of Hirshsprung's Disease as far as plain abdomen radiograph is concerned. Patient was referred to a pediatric surgeon outside, where barium enema confirmed the diagnosis.

Osteoid Osteoma of phalanx

2009-01-24T12:45:00.002+05:30

A well defined osteolytic lesion with profound adjacent cortical and medullary sclerosisseen in proximal phlanx of middle finger is suggestive of osteoid osteoma

Single Umbilical Artery with Horse shoe kidney

2009-01-07T19:49:00.003+05:30

Cleft Lip with 2D

2009-01-02T18:50:00.002+05:30

Ultrasound recognition of facial clefts involves obtaining a coronal surface view of the face
showing the lips and nostrils. The second image shows a left para median cleft lip while image on top shows a normal "lips and nose" view, given for comparison

Internal Vs Peripheral Vascularity in Thyroid nodule

2008-12-29T13:50:00.006+05:30

The pattern of vascularity in thyroid nodules is more important than just presence or absence of vascularity. A peripheral pattern is associated with benign nodules and internal pattern is associated with malignant features.

Image 1 shows a malignant follicular neoplasm.

Image 2 shows benign follicular nodule as in multinodular goiter.

Bicornuate Uterus

2008-12-29T11:33:00.005+05:30

A bicornuate uterus, commonly referred to as a "heart-shaped" uterus, is a type of an uterine malformation where two "horns" form at the upper part of the uterus.

The diagnosis should come in mind when you can get long section og uterus in two different planes and get the two endometrium view in transverse plane.

Studies with coronal reformatting like CT, MRI and 3D ultrasound, very well show the heart shaped uterus.

Hydrosalpinx

2008-12-29T11:22:00.004+05:30

This patient was sent for review, having diagnosed as ovarian cyst on ultrasound somewhere. But we can clearly see a tubular or retort shaped structure seen immediately adjacent to uterine fundus. Althogh in sagittal view it very much resembles a cyst!.
But the ovary was clearly visualised and found normal. So, it is a hydosalpinx!.
A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.
A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx
The major cause for distal tubal occlusion is pelvic inflammatory disease (PID), usually as a consequence of an ascending infection by chlamydia or gonorrhea. However, not all pelvic infections will cause distal tubal occlusion. Tubal tuberculosis is an uncommon cause of hydrosalpinx formation.
Other causes of distal tubal occlusion include adhesion formation from surgery, endometriosis, and cancer of the tube, ovary or other surrounding organs
Hydrosalpinx may be diagnosed using ultrasonography as the fluid filled elongated and distended tubes display their typical echolucent pattern. However, a small hydrosalpinx may be missed by sonography. During an infertility work-up a hysterosalpingogram (HSG), an X-ray procedure that uses a contrast agent to image the fallopian tubes, shows the retort-like shape of the distended tubes and the absence of spillage of the dye into the peritoneum.

Cervical Incompetence

2008-12-25T12:57:00.006+05:30

Cervical incompetence is a medical condition in which a pregnant woman's cervix begins to dilate (widen) and efface (thin) before her pregnancy has reached term. Cervical incompetence may cause miscarriage or preterm birth during the second and third trimesters.
In a woman with cervical incompetence, dilation and effacement of the cervix occur without pain or uterine contractions. In a normal pregnancy, dilation and effacement occurs in response to uterine contractions. Cervical incompetence occurs becauese of weakness of the cervix, which is made to open by the growing pressure in the uterus as pregnancy progresses. If the responses are not halted, rupture of the membranes and birth of a premature baby can result.

In this patient there is a clearly apparent dilatation of internal os (involving about 1.7 cms of cervical canal). This patient also had a anterior type 2 placenta previa.

MY NEW HTC TOUCH 2

2008-12-25T12:30:00.003+05:30

ENDOMETRIAL POLYP

2008-12-23T20:02:00.004+05:30

An endometrial polyp or uterine polyp is a big lump in the inner lining of the uterus. They may have a large flat base (sessile) or be attached to the uterus by an elongated pedicle (pedunculated).Pedunculated polyps are more common than sessile ones. They range in size from a few millimeters to several centimeters. If pedunculated, they can protrude through the cervix into the vagina. Small blood vessels may be present, particularly in large polyps.

A Case of Open Lip Schizencephaly

2008-12-20T11:35:00.000+05:30

These are the pictures from transcranial ultrasound of a neonate presenting with intractable seizures.

The scan shows an anechoic band or cavity, extending from the cortical surface to the lateral ventricle , representing the fluid-filled cleft.

This is the typical feature of type II schizencephaly.

Another differentials worth consideration are

1. Arachnoid cyst.

2. Porencephaly.

3. Porencephalic cyst.

MRI is the modality of choice for evaluating patients with schizencephaly. MRI better delineates the gray matter lining the cleft, which is the pathognomonic finding in schizencephaly. MRI also provides superb cortical anatomy detail and multiplanar capability. Primary findings related to the cleft and secondary findings associated with schizencephaly are identified using MRI.
The ability of MRI pulse sequences to differentiate gray matter and white matter permits demonstration of gray-matter heterotopias in the subcortical white matter beneath the cleft, abnormalities involving the cortex (eg, pachygyria or polymicrogyria), and other secondary findings also identified by using CT scans.
Homolateral absence of the sylvian vasculature, small medullary pyramids, a low position of the fornix, and thinning of the corpus callosum are findings related to absent cerebral cortex and are better demonstrated by MRI than with other studies.

SCHIZENCEPHALY: An Overview

Schizencephaly is an uncommon disorder of neuronal migrational characterized by a cerebrospinal fluid–filled cleft, which is lined by gray matter. The cleft extends across the entire cerebral hemisphere, from the ventricular surface (ependyma) to the periphery (pial surface) of the brain.
The clefts may be unilateral or bilateral and may be closed (fused lips), as in schizencephaly type I, or separated (open lips), as in schizencephaly type II.

In closed-lip or type I schizencephaly, the cleft walls are in apposition. In open-lip or type II schizencephaly, the cleft walls are separated. Schizencephaly type II occurs more commonly than type I.
The clefts in schizencephaly are lined either totally or in part by gray matter and extend from the pial surface to the ependyma of the lateral ventricle. The clefts can be located anywhere, but they commonly occur in the parasylvian regions. The clefts can be unilateral or bilateral, and can be either symmetric or asymmetric.
The cavity formed in the open-lip type varies in size from small to large and may communicate with the lateral ventricle. The ventricular system may be enlarged, particularly in patients with the open-lip form of schizencephaly.
Gray-matter heterotopia (collections of gray matter in abnormal locations), polymicrogyria, and arachnoid cysts can be associated with schizencephaly. Heterotopias and polymicrogyria typically line the clefts. Microcephaly has been noted in some patients. The septum pellucidum is absent in 80-90% of patients, and schizencephaly may coexist with septo-optic dysplasia.

Choroid Plexus Cyst in Fetus

2008-12-18T19:44:00.000+05:30

This is a picture of fetal brain showing bilateral Choroid Plexus Cysts in a 24 yrs female presenting at 20 weeks of pregnancy for a routine checkup.
The presence of isolated choroid plexus cysts (CPCs) on a second trimester ultrasound is a common cause of anxiety, although it is almost always an innocent finding
The choroid plexus is the part of the brain that makes cerebrospinal fluid, the fluid that normally bathes and protects the brain and spinal column. In about 1 percent to 2 percent of normal babies -- 1 out of 50 to 100 -- a tiny bubble of fluid is pinched off as the choroid plexus forms. This appears as a cyst inside the choroid plexus at the time of ultrasound. A choroid plexus cyst can be likened to a blister and is not considered a brain abnormality.

Choroid plexus cysts are present in 1 percent to 2 percent of normal fetuses. However, in a very small percentage of fetuses with choroid plexus cysts, there is an associated chromosome disorder called trisomy 18. Fetuses with trisomy 18 have an extra copy of chromosome 18. Frequently, fetuses with trisomy 18 are stillborn. Survivors beyond infancy are rare. They have severe mental retardation and a variety of other problems including abnormalities of almost any organ system such as the heart, brain and kidneys. Fetuses with trisomy 18 have choroid plexus cysts about a third of the time. Therefore, when we see choroid plexus cysts, we are concerned that the fetus may have trisomy 18. Trisomy 18 is rare. It is present in less than 1in 3,000 newborns. Choroid plexus cysts are relatively common in normal fetuses. Most fetuses with a choroid plexus cyst are normal. Furthermore, many of the abnormalities associated with trisomy 18 can be detected by a careful ultrasound. In fact, fetuses with trisomy 18 almost always demonstrate abnormalities on ultrasound in addition to choroid plexus cysts, although some of these abnormalities can be quite subtle. If no additional abnormalities are detected by a thorough late 2nd trimesterultrasound, the likelihood the fetus has trisomy 18 is very low

The fate of these cysts is to resolve in normal fetuses and also in Trisomy 18 fetuses.

DIAGNOSING ECTOPIC PREGNANCY

2008-12-12T11:38:00.000+05:30

Diagnosing an ectopic pregnancy.

A 23 yr old married female presented in the emergency department with complains of acute lower abdominal pain along with minimal spotting. Her last menstrual period was 10 days back but bleeding was scanty and lasted for only one day!.

A trans-abdominal ultrasound was performed immediately.

Picture 1. Trans abdomen scan of pelvis.

This shows an small bulge in the left isthmic region. What it could be?

a) Isthmic Fibroid, or

b) Isthmic ectopic sac.

But an Isthmic Fibroid rarely presents with such an "Acute Picture".

So, in this clinical setting a high degree of suscpicion goes towards "Ectopic Pregnancy"

A UPT was performed immediately which turned out to be "Weakly Positive",following which the patient was taken for an transvaginal scan.

Pictures 2, 3, & 4. Tranvaginal Scan

These scan pictures revealed a small well defined anechoic sac like structure of size 5.2 mm lying within a hypoechoic mass with thin surrounding myometriuim; surrounding vascularity was also found to be raised.

This is among one of the uncommon pictures of an ectopic pregnancy but it is!.

So, a diagnosis of unruptured left isthmic ectopic pregnancy was made.

The Sac was removed laparoscopically and the post -op findings correlated exactly with the ultrasound picture.

Early and correct diagnosis of an ectopic pregnancy is important to avoid any catastrophic event e.g., rupture of ectopic pregnancy.

I am giving below some related notes taken from emedicine.com which you will find useful:-

1. A definite intrauterine pregnancy is present when a gestational sac with a sonolucent center (>5 mm in diameter) is surrounded by a thick, concentric, echogenic ring located within the endometrium and contains a fetal pole, yolk sac, or both.
2. A probable abnormal intrauterine pregnancy occurs when a gestational sac larger than 10 mm in diameter is present without a fetal pole or when a definite fetal pole is present without cardiac activity.
3. A definite ectopic pregnancy is characterized by the presence of a thick, brightly echogenic, ringlike structure outside the uterus, with a gestational sac containing an obvious fetal pole, yolk sac, or both.
4. Pregnancy of unknown location occurs with an empty uterus on endovaginal sonograms in patients with serum beta-HCG levels greater than the discriminatory cutoff value. In this case, an ectopic pregnancy is considered present until proven otherwise. An empty uterus may also represent a recent abortion.
5. Other ultrasonographic findings include an adnexal mass, free cul-de-sac fluid, and/or severe adnexal tenderness upon palpation with the probe. Patients with no definite intrauterine pregnancy and the aforementioned findings are thought to have a high risk for ectopic pregnancy.

An appreciation for the spectrum of ultrasonographic findings in ectopic pregnancy may enable recognition of an early ectopic pregnancy. Findings include the following:

6. Tubal ring: This is an echogenic ringlike structure outside of the uterus. This finding represents an early ectopic pregnancy.
7. Extrauterine mass: The presence of a tender adnexal mass at ultrasonography suggests an ectopic pregnancy. The findings of one study suggest that the presence of any adnexal mass other than a simple cyst is the most significant ultrasonographic finding in the diagnosis of ectopic pregnancy.
8. Interstitial ectopic pregnancy: An interstitial ectopic pregnancy is one that implants at the highly vascular region of the uterus near the insertion of the fallopian tube. These types can grow larger than can those within the fallopian tube because the endometrial tissue is more expandable. Because of the increased size and partial endometrial implantation, these advanced ectopic pregnancies can be misdiagnosed as an intrauterine pregnancy. A clue to the diagnosis of an interstitial ectopic pregnancy is the eccentric location of the gestational sac. It is important to evaluate the amount of uterine myometrium surrounding the gestational sac and echogenic decidual layer. This thickness is called the myometrial mantle. At least 5 mm of myometrium should be present. A finding of less than 5 mm suggests the diagnosis. Another sonographic finding is the interstitial line sign.
9. Heterotopic pregnancy: This is a combined intrauterine and ectopic pregnancy. It is thought to occur in approximately 1 in 3000 pregnancies and is more common in patients taking fertility agents.
10. Extrauterine empty gestational sac: The presence of an extrauterine mass with a thick brightly echogenic band (rind) may represent an ectopic pregnancy.
11. Hemosalpinx: The fallopian tubes may fill with blood or free fluid. One study found hematosalpinx as pathognomonic of ectopic pregnancy.
12. Ruptured ectopic pregnancy: Findings on sonograms include free fluid or clotted blood in the cul-de-sac or intraperitoneal gutters, such as the Morison pouch.

Dyke Davidoff Masson Syndrome

2008-12-07T17:08:00.001+05:30

A 23 yr old boy presented with recurrent episodes of seizures.
The CT Brain reveals
cerebral hemi atrophy on left side
left frontal sinus is well developed as compared with the right which is hypoplastic
the left MCA artery is not opacified with contrast
This lets us think of Dyke-Davidoff-Masson syndrome
It is a condition characterized by seizures, facial asymmetry, contralateral hemiplegia or hemiparesis, and learning difficulties. These findings are due to cerebral injury that may occur early in life or in utero. Insult to immature brain results in neuronal loss and impaired brain growth. The causes in the prenatal period are congenital malformation, infection and vascular insult; in the perinatal period birth trauma, anoxia, hypoxia and intracranial haemorrhage. Postnatal causes are trauma, tumor, infection and prolonged febrile seizures. The radiological features are unilateral loss of cerebral volume and associated compensatory bone alterations in the calvarium, such as thickening, hyperpneumatization of the paranasal sinuses and mastoid cells and elevation of the petrous ridge. Although computed tomography (CT) and MR are complimentary, it is felt that MR represents the imaging procedure of choice with respect to the assessment of the aetiology and extent of cerebral parenchymal involvement in patients presenting with a clinical combination of congenital or early onset of seizures, hemiparesis/plegia, and/or craniofacial asymmetry.

bhopal, dream city

2008-04-22T14:15:00.000+05:30

Escobar Syndrome

2007-01-16T22:13:00.001+05:30

D I S E A S E : Multiple pterygium syndrome, autosomal recessive

autosomal recessive inheritance (Very frequent sign)
scoliosis (Very frequent sign)
symphalangy (Very frequent sign)
talipes-varus/valgus (Very frequent sign)
webbed neck (Very frequent sign)
webbing of joints (Very frequent sign)
cleft hard palate (Frequent sign)
downslanted fissures (Frequent sign)
epicanthic folds (Frequent sign)
high vaulted/narrow palate (Frequent sign)
hypertelorism (Frequent sign)
intrauterine growth retardation (Frequent sign)
microcephaly (Frequent sign)
micrognatia/retrognatia (Frequent sign)
ptosis (Frequent sign)
short stature/dwarfism (Frequent sign)
syndactyly of fingers (Frequent sign)
telecanthus (Frequent sign)
vertebral segmentation anomaly (Frequent sign)
abnormal gait (Occasional sign)
cleft soft palate/bifid uvula (Occasional sign)
congenital cardiac anomaly (Occasional sign)
deafness(conductive) (Occasional sign)
dolicho/scaphocephaly (Occasional sign)
ear anomaly (shape/structure) (Occasional sign)
haemangioma-capillary (Occasional sign)
inguinal hernia (Occasional sign)
low hair line (back) (Occasional sign)
spina bifida occulta (Occasional sign)
squint/paresis of ocular muscles (Occasional sign)
undescended/ectopic testes (Occasional sign)

2007-01-16T22:11:00.000+05:30

Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes

Syndrome	multiple pterygium syndrome
Synonyms	Escobar syndrome
	familial pterygium syndrome
	pterygium colli syndrome
	pterygium syndrome
	pterygium universale
Summary	A rare syndrome of short stature, abnormal facies and webbing of the neck, antecubital, digital, popliteal, and intercural areas. Joint contractures, vertebral fusion defects, and rocker-bottom feet are usually associated.
Major Features	Head and neck: Epicanthal folds and small mandible with pointed receding chin, long philtrum, and syngnathia.
	Ears: Low-set ears.
	Eyes: Downslanting palpebral fissures, blepharoptosis, and puffiness about the eyes in some cases.
	Mouth and oral structures: Downturned angles of the mouth, lip pits, occasional cleft palate, and spoonlike shape of the tongue (lingua cochlearis).
	Neck: Pterygia.
	Hand and foot: Soft tissue syndactyly of the fingers, flexion deformity of the fingers and thumbs, talipes calcaneovalgus, and rocker-bottom feet,
	Extremities: Popliteal pterygia,
	Spine: Fusion of the cervical vertebrae and kyphoscoliosis.
	Bones and joints: Arthrogryposis
	Skin: Neck, axillary, antecubital, popliteal, intercural, and digital pterygia.
	Cardiovascular system: Small heart.
	Respiratory system: Lung hypoplasia.
	Gastrointestinal system: Absence of the appendix and attenuation of the colon.
	Urogenital system: Retroposition of the scrotum and penis, cryptorchidism, male hypogonadism, and hypoplasia of the labia majora.
	Growth and development: Growth and occasional mental retardation.
	Behavior and performance: Peculiar unsteady gait with crouched stance and conductive deafness.
	Heredity: A familial syndrome believed to be transmitted as an autosomal recessive trait. Parental consanguinity was noted in some cases.

WELCOME FRIENDS

2006-12-27T12:08:00.000+05:30

HI EVERYONE OUT THERE
If u want to know about me, then i m a pass out from GMC Bhopal, from the 2000 batch, currently
doing PG [DMRD] from GMC Bhopal
Basically i am a lad from Bilaspur, Chhattisgarh
I m very much fond of making good friends, n i like watching movies and getting out quite often
In the ORKUT community network u can find me as me and the related communities like gandhi medical college, S.K.P.S.H.S.S., Bilaspur , BMHRC, Bhopal & Gandhi medical college 2000 batches
i would love to be in touch with u guys.