RESUMEN
Situs inversus is a condition in which abdominal and thoracic organs are laterally transposed. The organs which are supposed to be on the right side of the abdomen are on the left and vice versa. It is a rare congenital condition; however, the exact incidence is difficult to determine as most of the cases go unnoticed until they undergo an imaging study. We report a case of a 30-year-old female presenting with situs inversus in association with a choledochal cyst and a horseshoe kidney. She underwent imaging evaluation for non-specific abdominal pain. Her routine clinical examination revealed a soft abdomen without any tenderness. Routine laboratory tests were within normal limits. Since there was abdominal pain, ultrasonography of the whole abdomen was advised. It revealed the presence of abdominal organs on the opposite side as normally seen. The common bile duct was dilated, and lower poles of the kidneys were fused. The cardiac apex was found to be on the right. It was followed up with a computed tomography scan which confirmed situs inversus. The common bile duct was dilated without any obstructive pathology in the pancreatic head or periampullary region. Lower poles of the kidneys were found to be fused together in front of the retroperitoneal vessels through an isthmus. Based on these findings, a diagnosis of situs inversus in a case of a choledochal cyst and a horseshoe kidney was made. Situs inversus is a rare entity. Its association with choledochal cysts and horseshoe kidneys has never been reported in the literature to the best of our knowledge.
RESUMEN
Persistent sciatic artery (PSA) is an exceptionally rare congenital vascular anomaly with profound clinical implications. This condition occurs when the primitive sciatic artery, responsible for fetal lower limb blood supply, fails to regress during embryonic development. PSA persists into adulthood, representing an intriguing vascular variation that can present as gluteal aneurism and thrombosis. We present the case of a 72-year-old female patient admitted with abdominal pain and blackening of her right foot. Clinical examination revealed dry gangrene affecting the toes, limb edema, and absent peripheral pulses in the right lower limb. Septic shock and electrolyte imbalances prompted immediate resuscitation and antibiotic therapy. Diagnostic investigations, including Doppler ultrasonography, CT angiography, and 2D echocardiography, identified a right-sided PSA. With limb ischemia being irreversible, a below-knee amputation was performed. This case highlights the clinical presentation, diagnostic workup, and management of a rare PSA, emphasizing the importance of prompt recognition and intervention in complex vascular anomalies.
RESUMEN
Ecchordosis physaliphora (EP) is a notochordal remnant tissue rarely encountered during routine clinical practice. These lesions usually do not produce any significant symptoms as they are slow-growing and mostly small in size. Symptoms are due to mass effects on adjacent structures when they are large or extra-tumoral hemorrhage. Because of histological similarity with chordoma, diagnosis is challenging, and this differentiation is essential as the disease course and treatment differ significantly. Imaging plays a crucial role in identifying and distinguishing these lesions. We report the case of a 16-year-old male who presented with intermittent headache and neck pain for six months. His routine clinical examinations were within normal limits. On neurological assessment, there was no focal neurodeficit. Evaluation of cranial nerves did not reveal any evidence of palsy. Routine hematological tests were also normal. A computed tomography (CT) scan of the brain revealed a mass in front of the pons. Magnetic resonance imaging (MRI) for further evaluation revealed a T1 hypointense and T2/fluid-attenuated inversion recovery hyperintense lesion in the pre-pontine cistern. There was no enhancement in the mass either in the post-contrast CT or MRI scans. There was no bony erosion and clivus was normal. Based on the location and characteristic imaging features, a diagnosis of EP was made. There may be several other lesions that may present as a mass in the pre-pontine region. Histopathological tests may find it difficult to distinguish between lesions that originate from notochord remnants. Imaging studies play a vital role in confirming the diagnosis and help in planning treatment and follow-up.
RESUMEN
The transradial approach is the most preferred method for cardiac catheterization. The radial route approach has many advantages, including fewer puncture site-related complications and early mobility and discharge. The vascular complications include radial artery spasms, occlusions, dissections, perforations, and compartment syndrome. Although pseudoaneurysms are a well-known complication of femoral access (0.2%-3%), pseudoaneurysms are very infrequent (0.05%) after radial artery access. Very few cases of radial pseudoaneurysms have been reported to date. We present a rare case of an 82-year-old man on dual antiplatelet and anticoagulant therapy who underwent coronary angiography via the radial route. The patient developed a pseudoaneurysm requiring surgical intervention.