Vascular and Neurological Complications in Sphenoid Sinusitis

Although the cavernous sinus and internal carotid artery are in close proximity to the sphenoid sinus, vascular complications in sphenoid sinusitis are rare due to the intervening mucosa and bone. Variations like dehiscence or aggressive infection can cause vascular complications, leading to cavernous sinus thrombosis, while perivascular inflammation of the internal carotid artery can result in stenosis or occlusion. Untreated or aggressive sphenoid sinusitis can cause neurological complications such as cerebral infarcts, meningitis, subdural empyema, cerebral abscess, and cranial nerve injuries. Magnetic resonance imaging (MRI) of the brain with angiography can depict these complications at an early stage. Additionally, mastoiditis can cause dural venous sinus thrombosis, which, if left untreated, can result in venous infarcts. We report a case of an 11-year-old male with sphenoid sinusitis who developed a left middle cerebral artery (MCA) territory infarct, cavernous sinus thrombophlebitis, subdural empyema, and meningitis. He also developed left transverse and sigmoid sinus thrombosis due to left mastoiditis.

Point Shear Wave Elastography for Assessment of Liver Stiffness in Normal Individuals and in Patients With Non-alcoholic Fatty Liver Disease

Background Non-alcoholic fatty liver disease (NAFLD) is an increasing health issue worldwide, driven by rising rates of diabetes, obesity, and hypertriglyceridemia. Often asymptomatic, NAFLD is diagnosed through blood tests, imaging, and sometimes liver biopsy. Some cases advance to non-alcoholic steatohepatitis (NASH), which can lead to complications like liver cirrhosis and liver failure. While liver biopsy is the standard test for diagnosis, non-invasive methods such as shear wave elastography (SWE) offer a simpler and more reproducible alternative for diagnosing NAFLD. This is crucial for early intervention and preventing the progression of liver damage. Objectives The objectives of the study were to measure and compare liver stiffness in healthy individuals and patients with NAFLD using point shear wave elastography (pSWE), as well as to correlate liver stiffness in NAFLD patients with the ultrasonographic grades of fatty liver. Materials and methods This observational study was carried out at Dr. D. Y. Patil Medical College, Hospital and Research Centre in Pune, India, from December 2022 to April 2024. The study involved 82 participants in total, with 41 patients diagnosed with NAFLD (cases) and 41 healthy individuals with a sonographically normal liver (controls). pSWE was performed on each participant to measure liver stiffness, with results expressed in kilopascals (kPa). The procedure was conducted using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea). Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, USA). Non-parametric tests, such as the Mann-Whitney test and Kruskal-Wallis test, were used to evaluate the significance of differences. A p-value of less than 0.05 was considered statistically significant. Results The mean liver stiffness, measured in kilopascals (kPa), was higher in NAFLD patients (cases) (10±5.1 kPa) than in normal individuals (controls) (4.4±0.7 kPa). This difference was statistically significant, with a p-value of less than 0.001. A positive correlation (rho=0.848, p<0.001) was found between the ultrasonographic grade of fatty liver and liver stiffness in NAFLD patients. Conclusion Our study demonstrated that individuals with NAFLD exhibited significantly higher liver stiffness compared to healthy individuals, as measured by ultrasound SWE. These findings suggest that pSWE could serve as a valuable, non-invasive diagnostic tool for assessing liver stiffness in NAFLD patients. Additionally, pSWE holds the potential for evaluating and monitoring the progression of the disease. However, further research with larger sample sizes is necessary to determine the prognostic significance of liver stiffness in these patients.

IgG4-Related Disease of Mastoid Presenting as Headache: A Case Report

IgG4-related disease (IgG4-RD) is a complex multi-system inflammatory disorder that can affect various organs in the body. This condition is characterized by elevated levels of immunoglobulin G subclass 4 (IgG4) and the presence of specific histopathological features. While neurological involvement is not as common as in other organs, when it occurs, it can lead to hypertrophic pachymeningitis and hypophysitis. Here, we present a case of a 53-year-old male with right-sided hemicranial headache and diplopia. Computed tomography revealed a soft tissue density lesion in the middle ear cavity and mastoid antrum with the destruction of the mastoid septae. Magnetic resonance imaging revealed a lesion in the right middle ear cavity associated with pachymeningitis and right sigmoid and transverse sinus thrombosis. Tissue pathology revealed dense plasma cell-rich chronic inflammation with storiform fibrosis. Immunohistochemistry was positive for IgG4. Hence, a diagnosis of IgG4-related disease causing mastoiditis, pachymeningitis and cerebral venous thrombosis was made. The patient was successfully operated and treated with steroids. IgG4-RD remains a rare but serious condition. It is crucial to identify and treat this condition promptly as it can lead to permanent organ damage. When patients continue to experience middle ear symptoms after an infection has been treated and cancer has been ruled out, it is important to consider inflammatory conditions as a differential diagnosis.

MRI Evaluation and Characterization of Ovarian Lesions Based on Ovarian-Adnexal Reporting and Data System MRI

Background Managing ovarian lesions requires differentiating between benign and malignant cases. The development of a multiparametric MRI approach combining anatomical and functional criteria has led to the creation of the Ovarian-Adnexal Reporting and Data System (O-RADS) MRI scoring system, which enhances diagnostic accuracy. Objectives To study ovarian lesions and their characteristics, along with their risk stratification based on MRI O-RADS. Methods  A prospective study used the O-RADS MRI criteria to categorize ovarian lesions. Clinical findings and MRI results were compared with histopathological outcomes to assess diagnostic accuracy. Results We identified abdominal pain as the most prevalent clinical finding among our cases (64, 91.43%), followed by a lump in the abdomen (33, 47.5%), dysmenorrhea (33, 47.5%), bleeding per vaginal (15, 21.43%), and weight loss (11, 15.71%). A total of 80 ovarian lesions were examined and characterized on the basis of the O-RADS MRI risk stratification system. Among the 80 ovarian lesions, 54 were histopathologically confirmed ovarian lesions (39 (72.22%) were benign, and 15 (27.77%) were malignant). The most common benign lesions were ovarian serous cystadenoma (28.20%) and ovarian mucinous cystadenoma (20.51%), while the most common malignant lesions were serous carcinoma (33.33%) and mucinous carcinoma (20%). Using the O-RADS MRI scoring system, we categorized six lesions (7.5%) as O-RADS 1 (all benign), 34 lesions (42.50%) as O-RADS 2 (32 benign and 2 malignant), 24 lesions (30%) as O-RADS 3 (23 benign and 1 malignant), seven lesions (8.75%) as O-RADS 4 (four benign and three malignant), and nine lesions (11.25%) as O-RADS 5 (all malignant). Our findings revealed significant differences in the size of lesions, the presence of thick septa, high T2-weighted signal intensity within solid tissue, and patterns of solid component enhancement and wall irregularity between malignant and benign lesions. The MRI cut-off score of ≥4 for malignancy demonstrated a sensitivity of 94.59%, a specificity of 97.5%, an accuracy of 97.62%, a positive predictive value of 94.5%, and a negative predictive value of 97.5%. The positive likelihood ratio was 32.7, while the negative likelihood ratio was 0.025. These results affirm the high diagnostic accuracy of the O-RADS MRI scoring system in distinguishing benign from malignant ovarian lesions. Conclusion The O-RADS MRI score is a highly accurate tool for differentiating between benign and malignant ovarian lesions. Its application can significantly enhance the management and treatment outcomes for patients with adnexal masses. The study confirms the scoring system's high sensitivity, specificity, and overall diagnostic accuracy.

MRI Evaluation of Traumatic and Non-traumatic Pathologies of the Ankle Joint and Hindfoot: A Single-Center Observational Study

Background Pathologies affecting the ankle joint and hindfoot can present with a variety of clinical symptoms and etiologies, necessitating accurate diagnostic tools for effective management. Magnetic resonance imaging (MRI) is a valuable imaging modality for assessing these pathologies, providing detailed visualization of bone, joint, tendon, and other soft tissue abnormalities. Objectives To evaluate MRI findings in a diverse cohort of 105 participants with pathologies affecting the ankle joint and hindfoot, focusing on the prevalence and types of bone, joint, tendon, and soft tissue abnormalities. Materials and methods A single-center observational descriptive study was conducted at Dr. D. Y. Patil Medical College and Hospital and Research Centre, Pune, India, over a period from August 2022 to July 2024, involving 105 participants (54.3% male, 45.7% female) with a mean age of 39.04 years. MRI scans were analyzed to assess the prevalence of bone, joint, tendon, and soft tissue pathologies. Clinical profiles, symptom duration, and etiological classifications were documented. Results Analysis of the results obtained from 105 (N = 105) study participants revealed that pain (94.3%, or 99 cases) was the most common symptom, followed by restricted movement (86.7%, or 91 cases), trauma history (75.2%, or 79 cases), and swelling (73.3%, or 77 cases). Traumatic causes (76.2%, or 80 cases) predominated, while inflammatory (48.3%, or 14 cases) and infective (34.5%, or 10 cases) causes were also significant. MRI findings showed marrow edema in 41.9%, or 44 cases, subchondral cysts in 22.9% (24 cases), fractures in 17.1% (18 cases), and erosions in 10.5% of participants (11 cases). Joint involvement was most frequent in the tibiotalar (76.2%, or 80 cases) and subtalar joints (58.1%, or 61 cases). Tendon pathologies included peritendonitis (55.2%, or 58 cases) and tendinosis (23.8%, or 25 cases), with the Achilles tendon being the most frequently affected (39%, or 41 cases). Ligament injuries were predominantly sprains (46.7%, or 49 cases), with less frequent partial (18.1%, or 19 cases) and complete tears (7.6%, or eight cases). Soft tissue findings included subcutaneous edema (76.2%, or 80 cases) and bursitis (24.8%, or 26 cases). Among the study participants who presented with non-traumatic pathologies, inflammatory pathologies (48.3%, or 14 cases) were the most common, followed by infective (34.5%, or 10 cases) and neoplastic (17.2%, or five cases) pathologies. Conclusion MRI effectively identifies a wide range of pathologies in the ankle and hindfoot, with marrow edema, joint effusion, and tendon pathologies being prevalent. The study underscores the utility of MRI in diagnosing and assessing various conditions in the ankle joint complex and highlights the need for accurate imaging to guide treatment decisions. Future research should focus on correlating MRI findings with clinical outcomes to enhance diagnostic accuracy and management strategies.

A Rare Case of Emphysematous Pyelonephritis in a Non-diabetic Patient With Staghorn Calculus

Emphysematous pyelonephritis (EPN) represents a severe and acute infection localized in the renal parenchyma and surrounding perirenal area, typically observed in individuals with predisposing factors such as urinary tract obstruction, diabetes mellitus, or compromised immune function. Here, we present a unique case involving a 23-year-old female patient presenting to the emergency department with complaints of discomfort localized to the right side of her abdomen. Despite the absence of diabetes mellitus, the patient was diagnosed with EPN based on clinical presentation and imaging findings. Prompt and effective management was initiated under the care of the urology department, highlighting the importance of early recognition and intervention in mitigating the potential complications associated with this severe infectious process.

Isolated Partial Absence of the Septum Pellucidum: A Case Report

The septum pellucidum is an important thin, membranous structure in the brain that separates the anterior horns of the lateral ventricles, essential for maintaining brain anatomy and function. Here, we describe a case of a 38-year-old male with a 20-year history of seizures, occurring approximately three to four times annually and lasting 30 minutes to one hour per episode, who presented with a recent seizure three days prior. Magnetic resonance imaging (MRI) of the brain revealed an absence of the septum pellucidum in its posterior portion, mild prominence of both lateral ventricles, and an abnormal course of the crura of the fornix, leading to a diagnosis of partial absence of the septum pellucidum. This case underscores the importance of comprehensive neuroimaging in detecting structural brain anomalies, which is crucial for effective diagnosis, management, and improving patient outcomes, particularly in long-standing seizure disorders.