Browsing by Author "Ram C. Shukla"

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A Correlation between Antral Follicle Count and Anti-Müllerian Hormone in Healthy Indian Women of Reproductive Age
(Jaypee Brothers Medical Publishers (P) Ltd, 2022) Shivi Jain; Ram C. Shukla; Madhu Jain; Usha Singh; Tej B. Singh
Aim: To determine which of the two parameters between antral follicle count (AFC) and anti-Müllerian hormone (AMH) had better correlation with age in healthy females, and also to estimate the strength of correlation between AMH and AFC. Materials and methods: This was a prospective, cross-sectional study comprising 1,181 fertile women of age 20–40 years, who were divided into four age groups, i.e., group I (20–24 years), group II (25–29 years), group III (30–34 years), and group IV (35–40 years). AFC and AMH were measured on third day of menstrual cycle. Pearson correlation and linear regression analysis were used. Statistical Package for Social Sciences, trial version 20, was used for the statistical analysis. A p-value of <0.05 was considered statistically significant. Results: The correlation coefficients between AFC and age, AMH and age, AMH and AFC were r = −0.403, r = −0.824 and r = 0.328; p <0.001, respectively. A strong positive correlation (r = 0.986, p <0.001) was noted between AMH and age in group I, while strong negative correlations (p <0.001) were noted in other groups. The correlations between AFC and age (r = −0.177) and AMH and AFC (r = 0.175) were significant (p <0.05) only in group IV. Age accounted for 16.3% variation in AFC and 67.8% variation in AMH. Conclusion: AMH correlated better with age than AFC. There was a weak correlation between AMH and AFC. Clinical significance: The counselling of a woman about her reproductive potential should be based on both AFC and AMH taken together, apart from chronological age, to avoid false sense of security or unnecessary alarm. © The Author(s). 2022.
Ambulatory venous pressure studies and its correlation with CEAP grading of varicose veins
(Edizioni Minerva Medica, 2020) Ajay K. Khanna; Shivanshu Singh; Satyendra K. Tiwary; Soumya Khanna; Shripad B. Deshpande; Ram C. Shukla; Puneet Kumar
BACKGROUND: Venous hypertension in the lower limb is predisposing factor for the chronic venous insufficiency and resultant skin changes. In a normal limb, during ambulation, there is a fall in lower limb venous pressure as the calf muscle pump and unidirectional valvular activity propel the blood from the lower limbs to the heart. Failure of this mechanism results in ambulatory venous hypertension predisposing to chronic venous insufficiency. The current study aimed at studying the lower limb ambulatory venous pressure in varicose veins, its co-relation with clinical severity of the disease according to the clinical grading of clinical-etiological-anatomical-pathophysiological (CEAP) classification and whether these measurements can help in assessing the anatomical sites of incompetence. METHODS: A prospective study was carried out at a University Teaching Hospital in Northern India. Ambulatory venous pressure was measured in 67 limbs. Limbs were classified according to the CEAP grading. Four groups were divided as follows: group 1, CEAP-0 (7 limbs); group 2, CEAP-1, 2 (24 limbs); group 3, CEAP-3, 4 (21 limbs); and group 4, CEAP-5, 6 (15 limbs). Following the duplex scan, limbs were also grouped according to the anatomical sites of incompetence. For pressure measurement, dorsal foot vein was cannulated with a 20-gauge cannula and connected to a physiograph through a pressure transducer filled with heparinized saline. Patient performed a standard 10 tip-toe exercise and following parameters were assessed: resting pressure in the sitting and standing position, mean ambulatory venous pressure, maximum fall in pressure, percentage decrease in pressure, 50%, 75%, 90% recovery time, initial recovery rate, recovery in first 4 seconds, pressure relief index. RESULT S: Median ambulatory venous pressure showed a progressive increase from group 1 (18.0 mmHg) to group 2 (51.5 mmHg) to group 3 (69.0 mmHg) and group 4 (91.0 mmHg). Median recovery times for 50%, 75% and 90% recovery of pressure after cessation of exercise were significantly lower while the percentage recovery in first 4 seconds was significantly higher in the ulcer group. Median pressure relief index showed a significant stepwise decreasing trend from group 1 to group 4 (2790.0 mmHg-sec in group 1to 534.0 in group 2 to 534.0 in group 3 to 40.0 in group 4; P<0.001). The prevalence of ulceration increased significantly with increasing median ambulatory venous pressure and decrease in time required for 90% recovery and median pressure relief index. None of the parameters showed significant variation among all the groups divided based on anatomical sites of incompetence. CONCLUSIONS: Ambulatory venous pressure measurement correlates with the clinical grading of the CEAP classification of varicose veins. Ambulatory venous pressure measurements do not help in determining the anatomical sites of incompetence. Pressure relief index, the recovery time intervals and the mean ambulatory venous pressure are the important parameters that can help in identifying and grading the severity of the disease. © 2020 EDIZIONI MINERVA MEDICA.
Carcinoma of the gallbladder: Role of sonography in diagnosis and staging
(2000) Manoj Pandey; Bimal P. Sood; Ram C. Shukla; Nakul C. Aryya; Shailesh Singh; Vijay K. Shukla
Purpose. In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology. Patients and Methods. Patients with proven gallbladder cancer presenting to a single surgical unit between 1991 and 1995 were identified through a records search. All patients underwent sonographic examination followed by fine- needle aspiration (FNA), biopsy, or laparotomy for establishing the diagnosis. Results. A mass in the gallbladder and gallbladder wall thickening (> 12 mm) were cardinal sonographic findings of carcinoma. Liver infiltration was correctly identified in all patients who had it. Sonography was highly accurate for detecting mass lesions, gallstones, liver infiltration, metastasis, and ascites. However, visualization of lymph nodes, common bile duct infiltration, and peritoneal dissemination was poor. Conclusions. Sonography was found to be a good diagnostic tool for carcinoma of the gallbladder; however, its sensitivity was poor for staging nodal spread of the disease. (C) 2000 John Wiley and Sons, Inc.
Cholecystosonographic evaluation of the prevalence of gallbladder diseases: A university hospital experience
(Elsevier Inc., 1996) Manoj Pandey; Ajay K. Khatri; Bimal P. Sood; Ram C. Shukla; Vijay K. Shukla
Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gall-bladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.
Congenital thyroid hemiagenesis with thyroid nodules—Role of TI-RADS to prevent long term thyroid replacement therapy
(Elsevier Ltd, 2016) Ashish Verma; S.K. Bhartiya; S.P. Basu; V.K. Shukla; Ram C. Shukla
Background Hemi-agenesis of thyroid is a rare congenital condition with the clinical significance lying only in cases where the remnant tissue is affected by a pathology mandating removal of the gland. Henceforth, the hemi-thyroidectomy technically becomes a total thyroidectomy with a need for long term thyroid replacement therapy. Case summary We present a series of three cases noted over a period of two years where preoperative imaging evaluation confirmed the developmental abnormality. Further presence of a thyroid nodule in each of these cases posed a specific clinical situation whereby characterization of nodule appeared mandatory for a rational management involving life-long thyroid replacement therapy due to an ‘apparent total thyroidectomy’, if the remnant gland is removed. Ultrasound TI-RADS is a new system for evidence based sub-classification of thyroid nodules enabling both the surgeon and patient to take a streamlined decision about the overall approach for management. Conclusion Prospective nodule characterization based on the thyroid image reporting and data system (TI-RADS), enables the surgeon to decide the treatment strategy sparing the patient of the cost and morbidity associated with long term thyroid replacement therapy. © 2016
CT-Based Definition and Structured Reporting of Abdominal Lymph Node Stations
(Georg Thieme Verlag, 2022) Ishan Kumar; Srishti Sharma; Adity Prakash; Priyanka Aggarwal; Ram C. Shukla; Ashish Verma
Background Meticulous evaluation of abdominal lymph nodes on computed tomography (CT) is a fundamental task in radiological practice especially in oncological reporting. Although various reporting systems exist to define abdominal nodal stations for malignancies of individual abdominal organs, a complete and uniform framework for radiological reporting of abdominal lymph nodes does not exist in the literature. Purpose The goal of this review was to provide a step-wise reporting template and precise definitions of the radiological anatomy of abdominal lymph nodes and to generate a CT-based illustration of the lymph node stations of the abdomen. Conclusion This CT-based illustration and reporting template will help the radiologists to aptly describe the extent of the lymph nodal diseases and will help in comparison with posttherapy scans. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Demystifying the Radiography of Age Estimation in Criminal Jurisprudence: A Pictorial Review
(Thieme Medical Publishers, Inc., 2024) Vritika Bhardwaj; Ishan Kumar; Priyanka Aggarwal; Pramod Kumar Singh; Ram C. Shukla; Ashish Verma
Skeletal radiographs along with dental examination are frequently used for age estimation in medicolegal cases where documentary evidence pertaining to age is not available. Wrist and hand radiographs are the most common skeletal radiograph considered for age estimation. Other parts imaged are elbow, shoulder, knee, and hip according to suspected age categories. Age estimation by wrist radiographs is usually done by the Tanner-Whitehouse method where the maturity level of each bone is categorized into stages and a final total score is calculated that is then transformed into the bone age. Careful assessment and interpretation at multiple joints are needed to minimize the error and categorize into age-group. In this article, we aimed to summarize a suitable radiographic examination and interpretation for bone age estimation in living children, adolescents, young adults, and adults for medicolegal purposes. © 2024 Thieme Medical Publishers, Inc.. All rights reserved.
Doppler ultrasound scoring to predict chemotherapeutic response in advanced breast cancer
(2007) Anand Kumar; Seema Singh; Satyajit Pradhan; Ram C. Shukla; Mumtaz A. Ansari; Tej B. Singh; Rohit Shyam; Saroj Gupta
Background: Doppler ultrasonography (US) is increasingly being utilized as an imaging modality in breast cancer. It is used to study the vascular characteristics of the tumor. Neoadjuvant chemotherapy is the standard modality of treatment in locally advanced breast cancer. Histological examination remains the gold standard to assess the chemotherapy response. However, based on the color Doppler findings, a new scoring system that could predict histological response following chemotherapy is proposed. Methods: Fifty cases of locally advanced infiltrating duct carcinoma of the breast were studied. The mean age of the patients was 44.5 years. All patients underwent clinical, Doppler and histopathological assessment followed by three cycles of CAF (Cyclophosphamide, Adriamycin and 5-Fluorouracil) chemotherapy, repeat clinical and Doppler examination and surgery. The resected specimens were examined histopathologically and histological response was correlated with Doppler findings. The Doppler characteristics of the tumor were graded as 1-4 for <25%, 25-50%, >50% and complete disappearance of flow signals respectively. A cumulative score was calculated and compared with histopathological response. Results were analyzed using Chi square test, sensitivity, specificity, positive and negative predictive values. Results: The maximum Doppler score according to the proposed scoring system was twelve and minimum three. Higher scores corresponded with a more favorable histopathological response. Twenty four patients had complete response to chemotherapy. Sixteen of these 24 patients (66.7%) had a cumulative Doppler score more than nine. The sensitivity of cumulative score >5 was 91.7% and specificity was 38.5%. The area under the ROC curve of the cumulative score >9 was 0.72. Conclusion: Doppler scoring can be accurately used to objectively predict the response to chemotherapy in patients with locally advanced breast cancer and it correlates well with histopathological response. © 2007 Kumar et al; licensee BioMed Central Ltd.
Early postnatal color Doppler changes in neonates receiving delivery room resuscitation with low 5 min Apgar score—a pilot study
(Springer Nature, 2021) Ishan Kumar; Shweta Singh; Ashok Kumar; Priyanka Aggarwal; Ram C. Shukla; Ashish Verma
Aims and objectives: To evaluate the Doppler changes in the intracranial arteries of neonates exposed to perinatal hypoxic insult and compare it with normal neonates. Materials and methods: Color Doppler of bilateral anterior and middle cerebral arteries was performed within 6 h of birth in 26 healthy neonates and 50 neonates who received delivery room resuscitation (DRR) for perinatal depression and had a 5 min Apgar score <7. Comparisons of resistive index (RI) and peak systolic velocity (PSV) were made between the (a) control group (b) patients with low 5 min Apgar score <7 who without clinical features of neonatal encephalopathy at 24 h (c) neonates with perinatal depression with a clinical evidence of disturbed neurological function at 24 h of birth and examination consistent with mild, moderate, or severe encephalopathy using modified Sarnat and Sarnat’s classification. Results: Significantly higher RI was observed in the neonates with to perinatal depression compared to the normal neonates. Significantly higher RI was seen in the patients with clinical features of neonatal encephalopathy (Group C) compared to group B. RI <0.6 and >0.82 was associated with severe neonatal encephalopathy. Differences in PSV were not statistically significant in the various groups. Conclusion: The study presents the changes in early cerebral Doppler parameters observed in neonates with low 5 min Apgar score following DRR compared to the normal neonates. We also present the relations of Doppler parameters with increasing severity of neonatal encephalopathy according to Sarnat classification. © 2020, The Author(s), under exclusive licence to Springer Nature America, Inc.
Evaluation of Uterocervical Angle and Cervical Length as Predictors of Spontaneous Preterm Birth
(Georg Thieme Verlag, 2022) Pramod Kumar Singh; Resham Srivastava; Ishan Kumar; Sangeeta Rai; Saurabh Pandey; Ram C. Shukla; Ashish Verma
Aim The aim of this article was to evaluate uterocervical angle (UCA) and cervical length (CL) measured at 16 to 24 weeks of gestation using transvaginal sonography (TVS) as predictors of spontaneous preterm birth. Methods In this prospective study, TVS was performed in 159 primigravidas with a singleton, uncomplicated pregnancy at 16 to 24 weeks of gestation to measure the anterior UCA and CL. All the cases were followed until labor to document gestational age at delivery. Results The risk of spontaneous preterm birth was higher in women with obtuse UCA (>95 degrees) with sensitivity of 86.7%, specificity of 93.0%, positive predictive value of 83.0%, negative predictive value of 94.6%, and p -value of <0.001. The difference between the means was statistically significant (p -value < 0.001). UCAs ≥105degrees and 95 to 105 degrees were found to be significantly associated with spontaneous preterm births at <34 weeks and 34 to 37 weeks, respectively. CL <2.5 cm was found to predict spontaneous preterm births at <37 weeks with sensitivity of 31.1%, specificity of 95.6%, and p -value of <0.001. UCA was found to be a better predictor of spontaneous preterm birth with a higher coefficient of variation (56.4%) when compared with CL (16.9%). Conclusions UCA proved to be a novel ultrasound parameter that can serve as a better predictor of spontaneous preterm births in comparison to CL. A strong correlation exists between obtuse UCA and a risk of spontaneous preterm birth. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Hydrocele of the canal of Nuck-Rare differential for vulval swelling
(Georg Thieme Verlag, 2014) Anubha Pandey; Shivi Jain; Ashish Verma; Madhu Jain; Arvind Srivastava; Ram C. Shukla
Patent canal of Nuck is one of the rare developmental entities in females, presenting clinically as an inguino-labial swelling. The usual content of this sac is fluid being secreted by the peritoneal mesothelium. In rare cases, ovary alone or with fallopian tube may prolapsed out into the sac. We report the rationale use of diagnostic algorithm in a case of ovarian hernia into the patent canal of Nuck, to differentiate it from more common clinical mimics. Furthermore, in the present case, a knowledge of the entity and targeted scrutiny, led to a correct identification of the prolapsed ovary, preventing an unwarranted oophorectomy in the garb of neoplasia.
Imaging of trichoptysis - How a radiologist can help?
(Wolters Kluwer Medknow Publications, 2014) Ashish Upadhyay; Ashish Verma; Jeetendra Sharma; Ram C. Shukla; Arvind Srivastava
Trichoptysis is a rare symptom, but pathognomonic of a teratoma having a bronchial communication. Thoracic teratomas are usually located within the anterior mediastinum, but rarely present with trichoptysis, as transpleural erosion of a mediastinal teratoma into lung and hence bronchial tree is exceedingly rare. We report the characteristic radiological and clinical features in one such case with ruptured mature mediastinal teratoma having a bronchial communication leading to trichoptysis. Only nine cases of trichoptysis have been reported in the literature as yet, but a fistulous communication with the bronchial tree on computed tomography, as seen in the present report, has not been demonstrated in any of these preceding reports. Histopathological sample obtained during the surgery further confirmed the presence of a mediastinal teratoma with transpleural broncho-pulmonary communication.
Invasive placental disorders: A prospective US and MRI comparative analysis
(SAGE Publications Inc., 2017) Ishan Kumar; Ashish Verma; Ritu Ojha; Ram C. Shukla; Madhu Jain; Arvind Srivastava
Background Invasive placental disorders are potentially life-threatening. Its diagnosis and evaluation of degree of invasiveness is vital in surgical and treatment planning. Purpose To compare the role of various imaging modalities used in current practice for evaluation of invasive placental disorders, and evaluate the validity of certain imaging signs for prediction of invasive placenta. Material and Methods Twenty-two patients, which were clinically stratified as a risk group for underlying invasive placental abnormality, underwent Doppler sonography and magnetic resonance imaging (MRI). Abnormal placental invasiveness was assessed using various Doppler sonography and MRI signs described in the existing literature. We systematically evaluated the utility of each of these modalities and signs, and compared the roles played by them separately and in combination. All the cases were correlated with surgical and pathological findings. Results Nine patients had surgical and pathological confirmation of placental adhesive disorders, of which eight were predicted correctly by MRI (true positive) while one was misdiagnosed as normal placenta (false negative). All the nine cases were correctly identified by Doppler sonography. MRI was more accurate in predicting bladder invasion, identifying 5/6 cases. Conclusion Both MRI and Doppler sonography are useful for detection of invasive placental disorders. However, MRI is a better predictor of bladder invasion. © The Foundation Acta Radiologica.
Is rheumatoid factor still a superior test for the diagnosis of rheumatoid arthritis?
(2010) Usha Singh; Anjali Vishwanath; Pramod K. Verma; Nand K. Singh; Ram C. Shukla; Sangeeta Singh; Suman Singh; Gyanendra K. Sonkar
The diagnosis of rheumatoid arthritis (RA) is based primarily on the 1987 revised American College of Rheumatology criteria for RA, which considers mainly the clinical symptoms. But typical clinical symptoms of RA are not manifested completely in early disease course. On the other hand, appreciable advantages have been made in the therapeutic strategy of RA in the last decade and highly effective disease-modifying anti-rheumatic drugs are available now for the control of RA. The treatment strategy for the control of early RA is aggressive. Thus, a highly specific and early diagnostic marker is needed for the detection of RA. Our study is an attempt to see the role of anti-CCP2 antibody (claimed to be highly specific and early diagnostic tool) in the diagnosis of RA. We studied 119 cases of RA in terms of clinical symptoms, disease duration and various autoantibody [including rheumatoid factor (RF), anti-CCP2 antibody, antinuclear antibody, anti-dsDNA] and C-reactive protein status. All the tests were also performed in 26 age and sex-matched healthy controls. Estimation of antibodies was done by quantitative ELISA. IgM RF was positive in 47.89% cases (p value = 0.000), followed by IgG RF (42.01%, p = 0.000) and IgA RF (36.97%, p = 0.000). RF was positive in 64.7% RA cases (p value = 0.000) when all three isotypes were tested together. RF was also detected in one healthy control. In 92 cases, anti-CCP2 Ab was done, hence other data were analyzed further in 92 cases only. Anti-CCP2 Ab was positive (cut-off = 15.0 U/ml) in only 50% RA patients but none of the healthy controls was positive for it. Swelling of joints was seen in 82.6% anti-CCP2 Ab positive cases (p value = 0.092) when compared with anti-CCP2 Ab negative cases (67.4%) while among RF positive cases, only 65.4% ((p value = 0.010) cases had swelling of joints. Out of 39 RA cases presenting with disease duration less than 1 year, only 48.71% patients were anti-CCP2 Ab positive while RF was positive in 61.53% patients. Utility of various combined autoantibody tests revealed that if one does all isotypes of RF (IgG, IgA and IgM) only, then 64.7% RA cases can be diagnosed and if anti-CCP2 Ab is added to it, the sensitivity increases to 75.56%. Thus, our study concludes that anti-CCP2 Ab is not a sensitive test for the diagnosis of RA neither it is useful in early diagnosis of RA, but it increases the sensitivity if added with all RF isotypes. © 2010 Springer-Verlag.
Myelopathy in adult aortic coarctation: Causes and caveats of an atypical presentation
(Wolters Kluwer Medknow Publications, 2016) Chandan Mourya; Ashish Verma; Anand Bansal; Ram C. Shukla; Arvind Srivastava
A 57-year-old female presenting with acute-onset paraplegia was referred for magnetic resonance imaging (MRI) of cervico-dorsal spine. On MRI, multiple tortuous dilated vessels were noted in the epidural space with long segment cord compression and imaging features of compressive myelopathy. Associated small acute cervico-dorsal epidural hematoma was also noted in the same region. Computed tomography (CT) angiography was performed subsequently which revealed post-ductal coarctation of aorta with multiple arterial collaterals in the chest wall and spinal canal. An extensive review of English language literature pertaining to the clinical presentations of adult aortic coarctation revealed only few reports of acute compressive myelopathy due to spinal epidural collateral vessels. Further, presentation at such a late age has not been reported before. In the present case, apart from a hypertrophied anterior spinal artery and perispinal collaterals, an anterior epidural hematoma was an additional important factor in the causation of myelopathy.
Performance of NI-RADS on CECT Alone to Predict Recurrent Head and Neck Squamous Cell Carcinoma after Chemoradiotherapy: Added Value of RECIST 11.
(Georg Thieme Verlag, 2022) Ishan Kumar; Syed O. Reza; Sunil Choudhary; Ram C. Shukla; Nilesh Mani; Ashish Verma
Background â The Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting format for the categorization of the degree of suspicion for recurrent head and neck malignancies on positron emission tomography/computed tomography. Purpose â The purpose of our study was to analyze the efficacy of the NI-RADS rating scale and criteria for contrast-enhanced computed tomography (CECT) alone in predicting the local and regional recurrence of malignancies after chemoradiotherapy. Material and Methods â CECT of the patients with head and neck cancers receiving radiotherapy and concurrent chemotherapy as a primary treatment was obtained 3 months after the completion of radiotherapy and NI-RADS scoring was done using components of Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria. Their management was guided according to the recommendations based on their NI-RADS score. Results â Thirty patients with squamous cell carcinoma of the neck were included in this study. The positive or negative status of the recurrent disease was based on biopsy results or follow-up protocol as recommended in NI-RADS rating scale. Fifteen patients had path proven recurrence at the primary tumor site. For primary tumor site, disease persistence rates of 4% for NI-RADS 1, 24% for NI-RADS 2, and 80% for NI-RADS 3 scores were seen. Five patients had recurrent lymph nodal disease. For lymph nodal assessment, NI-RADS categories 1, 2, and 3 revealed nodal disease recurrence rates of 5.3, 25, and 66.7%, respectively. Conclusion â CECT alone may be used to assign the NI-RADS rating scale using RECIST 1.1 criteria to predict the presence or absence of recurrent tumor in patients with neck malignancies. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Retrorectal dermoid cyst in an adult
(2008) Deborshi Sharma; R. Nandini; Deepali Goel; Amrita Ghosh; Ram C. Shukla; Vijay K. Shukla
[No abstract available]
Short-term follow-up HRCT Chest of COVID-19 survivors and association with persistent dyspnea
(Springer Science and Business Media Deutschland GmbH, 2021) Ishan Kumar; Adity Prakash; Manoj Ranjan; Sankha Shubhra Chakrabarti; Ram C. Shukla; Ashish Verma
Background: There is an increasing concern that a proportion of the survivors of COVID 19 might develop fibrotic and/or other non-reversible lung changes. The aim of this retrospective study was to review the imaging findings of HRCT of lungs in a cohort of COVID 19 survivors, coming for short-term clinical follow-up and to assess the relation of the observed HRCT changes with the presence of dyspnea. Results: In total, 40 patients with residual CT findings were included in this study with a mean age of 44.3 years and male: female ratio of 3:2. The presence of residual ground-glass opacities (85%) and reticular opacities (80%) was the most common findings. 25% of the cases had cystic changes in their lung. The presence of dyspnea was significantly associated with male sex and a history of smoking. On HRCT, the presence of cystic changes, involvement of > 10 lung segments, and an HRCT severity score > 7 were significantly associated with dyspnea. Conclusion: Survivors of COVID 19 demonstrate persistent changes in the lung on HRCT. We recommend that a follow-up HRCT should be performed in these patients to identify those with post-COVID sequelae. © 2021, The Author(s).
Spectrum of imaging findings in Klippel-Trenaunay syndrome affecting lower limbs: a report of three cases
(Springer, 2019) Rituparna Das; Ishan Kumar; Ashish Verma; Ram C. Shukla
Background: We present a series of three cases of Klippel-Trenaunay syndrome (KTS) presenting with unilateral lower limb involvement demonstrating a wide range of radiological findings. Case presentation: Case 1: A 61-year-old male presented with varicosities in the right lower limb, which was atrophic with a complete absence of deep venous system in the right limb. Case 2: A 23-year-old woman presented with hypertrophied left lower limb with multiple varicosities showing unusual distribution and intraosseous extension into the distal femur, patella, and tibia. Case 3: A 14-year-old male presented with hypertrophy of the right lower limb overlying macular cutaneous lesions. Capillary malformation was seen underneath the cutaneous lesion and multiple subcutaneous and intramuscular venous malformations were seen. Also noted was persistent embryological vein, i.e., lateral marginal vein of Servelle. Conclusion: The three cases in our series demonstrate common and unusual findings of KTS and highlight the role of CT and MR venography in addition to color Doppler sonography to identify the complete extent of the involvement. © 2019, The Author(s).
The many faces of intracranial tuberculosis: atypical presentations on MRI—a descriptive observational cohort study
(Institute for Ionics, 2023) Ishan Kumar; Shashank Shekhar; Tanya Yadav; Priyanka Aggarwal; Pramod Kumar Singh; Ram C. Shukla; Ashish Verma
Background: Atypical MRI findings of cranial tuberculosis can lead to prolonged delay in diagnosis resulting in high costs to evaluate for alternative diagnoses. The aim of this study was to describe a series of cranial tuberculosis patients with spectrum of MRI features, other than hydrocephalus, parenchymal tuberculomas, and leptomeningeal thickening. The final diagnosis was made based on CSF findings, clinical findings, and/or marked improvement after antitubercular treatment. Results: A total of 39 patients met the inclusion criteria and were diagnosed with vasculitis (n = 15), tubercular abscess (n = 5), miliary tuberculosis (n = 3), tubercular cerebritis (n = 9), sellar and parasellar tuberculosis (n = 7), mass forming tuberculosis (n = 1), choroid plexitis (n = 2), and intraventricular tuberculomas (n = 1). Conclusion: A significant number of patients of cranial tuberculosis can have variable presentations and may be misdiagnosed. This analysis helps to reinvestigate the spectrum of MRI findings. © 2023, The Author(s).