Pancake kidney is a rare congenital anomaly of the genitourinary system, with fewer than 30 cases described in the literature. Cake kidney or fused pelvic kidney is an anomaly in which the entire renal substance is fused into one mass, lying in the pelvis, and giving rise to two separate ureters which enter the bladder in normal relationship. We present a case of pancake kidney who was diagnosed incidentally during a routine infertility work up. Our case did not have any associated genital anomalies.

Persistent hypoglossal artery (PHA) which is a persistent carotid-basilar anastomosis is a rare vascular anomaly. It is usually found incidentally. We present a case of persistent left hypoglossal artery associated with absent bilateral vertebral arteries in a 62 year male patient presenting with vertigo and giddiness for 1 month. This finding was only incidental. There were no associated findings in this patient.

BACKGROUND:A wide variety of tumors may affect pediatric abdomen, which arise from various organs. These may be benign or malignant. OBJECTIVES: (1) To assess the role of computed tomography in the evaluation of pediatric abdominal tumors-in localization and characterization. (2) To illustrate the common pediatric abdominal masses. MATERIALS AND METHODS: 30 patients in the age group 0 to 18 years with suspected abdominal mass underwent non contrast and contrast enhanced computed tomography. The lesions were evaluated in terms of location, organ of origin, CT characters (Including attenuation, enhancement, Presence of necrosis, cystic changes and calcifications) and extensions. Based on the age of the patient and the CT characters, provisional and differential diagnoses were given. These were correlated with the final diagnosis obtained after surgical and histopathological examination and the sensitivity of CT in locating and characterizing various abdominal masses was calculated. RESULTS: Majority of patients in our study belonged to infantile age group (<1 year). Neuroblastomas were the most common tumor in our study followed by Wilms' tumor. Based on organ of origin, adrenal was the commonest organ of origin, followed by kidney and liver. Malignant tumors outnumbered benign tumors by 2:1. Multidetector computed tomography was an excellent imaging modality in localizing and characterizing these tumors. It had a diagnostic accuracy of 96.3% and was 100 % sensitive in detecting calcifications. It thus helped in narrowing differential diagnosis and in most cases helped in providing a provisional diagnosis close to final histopathological diagnosis. It also helped to provide details of extensions and mass effect of these tumors, with local involvements and distant metastases, which in turn were very important in planning further management. CONCLUSIONS: Multidetector computed tomography (MDCT) is a very sensitive imaging modality. It is fast, reliable, significantly accurate method for localizing and characterizing various tumors arising from pediatric abdomen. It helps in narrowing differentials and arriving at a final diagnosis in most cases. It also provides significant information for operative management.

BACKGROUND: The superficial location of the eye, its cystic composition, and the advent of high-frequency ultrasound make sonography ideal for imaging the eye. Ultrasonography is a simple, readily available, non-invasive, non-ionizing, highly accurate, real time and cost effective modality. OBJECTIVES: 1) To evaluate the accuracy of high resolution Bmode ultrasonography in the diagnosis of posterior segment lesions of eye as compared to ophthalmoscopic examination particularly in cases of opaque conducting media. 2) To evaluate sonographic appearances of various posterior segment lesions of the eye. MATERIALS AND METHODS: 1) A prospective study was carried out on 62 cases with suspected posterior segment lesions of eye. All patients clinically suspected to have posterior segment lesions in the presence of opaque conducting media were included in the study. Cases suspected to have isolated anterior segmental and extra ocular lesions were excluded. 2) HRUS was performed with Philips IU22 using high frequency probe (5 to 17 MHz) utilizing contact method. 3) Sonological diagnosis was made based on sonographic features such as location, morphology, echo pattern, color Doppler characteristics, kinetics of the lesion with eye movements and acoustic characteristics of the lesion. 4) Subsequent clinical, lab investigations, surgical and histopathological examinations were carried out as applicable and final diagnosis was made which was correlated with the sonological diagnosis. Sonological diagnosis was also compared with ophthalmoscopic diagnosis. STATISTICAL ANALYSES: The validities and diagnostic accuracies of high resolution ultrasound and ophthalmoscopic examinations were calculated and compared. RESULTS AND CONCLUSIONS: 1) Ultrasound was the initial imaging modality opted in most of the cases as it was readily available, simple and cost effective modality. It establishes the diagnosis in significant number of cases superseding the accuracy of ophthalmoscopic diagnosis with significant difference (p-value < 0.0001). 2) It is particularly well suited in cases of opaque conducting media when direct ophthalmoscopy is not possible. 3) HRUS is a highly sensitive modality and it can reliably differentiate various ocular detachments, vitreoretinal disorders and neoplastic lesions with significant accuracy.

Erdheim-Chester disease (ECD) is a rare, multisystem disorder with a constellation of clinical and radiological findings. We present a case of ECD who came with acute obstructive uropathy and chronic bone pain. Radiological work up in this patient led to a host of findings in various systems, the correlation of which led to narrowing of the differential diagnoses. A 44-year-old male presented with right loin pain and nausea for 1-day duration. A provisional diagnosis of right ureteric colic was made. Routine lab investigations revealed normal total counts and urine analysis. Additional laboratory investigations revealed a raised erythrocyte sedimentation rate (ESR) and Creactive protein (CRP). Radiological Investigations 1. Patient was referred for ultrasound of abdomen which revealed mild to moderate right hydronephrosis with a suspicious hypoechoic area (~ 0.7 x 1.2 cm) in the renal pelvis region raising possibility of a lesion. 2. Contrast computed tomography (CT) study of abdomen was performed which revealed enhancing soft tissue infiltration (+30 to +45 HU) around bilateral kidneys (giving ‘hairy kidney appearance’) (Figures 1, 2 & 3) and adrenal glands with infiltration to renal sinus and constriction of bilateral renal pelves resulting in moderate right and mild left hydronephrosis. Thin streak of excreted contrast was traversing the narrowed segment of renal pelves (Figures 4 & 5). 3. Soft tissue infiltration covering the visualized thoracic and abdominal aorta (giving ‘coated aorta appearance’) (Figures 6 & 7), extending below renal arteries to aortic bifurcation and proximal bilateral common iliac arteries. 4. The adrenal glands were not separately visualized from the above mentioned perinephric soft tissue. 5. Both ureters were normal in course and caliber. No evidence of ureteric calculus. 6. No significant retroperitoneal lymphadenopathy. 7. Few tiny centriacinar nodules with patchy ground glass opacities in postero basal segment of both lungs (left > right) (Figure 8).