Aim: To evaluate the utility of susceptibility-weighted imaging (SWI) sequence in stroke imaging and assess supplemental information provided by SWI in an acute stroke scenario. Materials and methods: In this study, the appearance of cerebrovascular stroke on the SWI images were analyzed in 50 patients who presented with acute-onset neurological symptoms. Results: Brain MRI with SWI was performed on 50 patients presenting with acute neurological symptoms. The majority were males, 32/50 (64%) and 18/50 (36%) were females. Most of the patients were in the age group > 60 years (36%), followed by 50-60 years (22%). Most of the patients had bilateral pathology, 20 (40%). The majority of patients had supratentorial lesions 34 (68%). Among 50 patients, the majority of patients had arterial stroke 20 (40%) and cerebral venous sinus thrombosis (CVST) 20 (40%) followed by amyloid angiopathy five (10%), and five (10%) had hypertensive microhemorrhage. Among the 20 patients with arterial stroke, the majority had middle cerebral artery (MCA) thrombosis 10 (50%) and among the 20 patients with venous thrombosis, eight (40%) patients had hemorrhagic infarcts. SWI was better as compared to computed tomography (CT) (P<0.05) in the detection of hemorrhagic transformation of arterial infarct, cerebral hemorrhagic venous sinus thrombosis, hemorrhagic venous infarct, hypertensive microhemorrhage, and cerebral amyloid angiopathy. Conclusion: SWI is a useful imaging sequence that provides additional information on stroke patients. SWI requires only an additional three-four minutes to perform and can be easily incorporated into standard stroke protocol. SWI can identify various features such as hemorrhage, intraarterial thrombus, or concomitant microbleeds that are of prognostic value and affect therapeutic decisions.

No abstract

Cholangiocarcinoma is a rare primary malignancy of the biliary tree, which usually presents late in the course of disease with jaundice, upper right quadrant pain, and cachexia. They frequently metastasise in the lungs, liver, bones, adrenals, peritoneum, and retroperitoneal lymph nodes. The incidence of cutaneous dissemination from cholangiocarcinoma is extremely rare, with the scalp being the commonest distant site of skin metastasis. The authors report the case of a 44-year-old female with Stage IV hilar cholangiocarcinoma, who presented primarily with tender facial swelling, prompting investigation and subsequent diagnosis. To the authors’ knowledge, this case is the first report of a cholangiocarcinoma presenting as facial metastasis. It highlights the need for early characterisation of cutaneous lesions, which are likely to be of neoplastic origin using histology, immunohistochemistry, and PET-CT scans, and reminds that biliary tree neoplasms are possible primary malignancies in cases of skin metastasis, especially in the head and neck region.

No abstract

Cholangiocarcinoma is a rare primary malignancy of the biliary tree, which usually presents late in the course of disease with jaundice, upper right quadrant pain, and cachexia. They frequently metastasise in the lungs, liver, bones, adrenals, peritoneum, and retroperitoneal lymph nodes. The incidence of cutaneous dissemination from cholangiocarcinoma is extremely rare, with the scalp being the commonest distant site of skin metastasis. The authors report the case of a 44-year-old female with Stage IV hilar cholangiocarcinoma, who presented primarily with tender facial swelling, prompting investigation and subsequent diagnosis. To the authors’ knowledge, this case is the first report of a cholangiocarcinoma presenting as facial metastasis. It highlights the need for early characterisation of cutaneous lesions, which are likely to be of neoplastic origin using histology, immunohistochemistry, and PET-CT scans, and reminds that biliary tree neoplasms are possible primary malignancies in cases of skin metastasis, especially in the head and neck region.