Background Primary spinal hydatid disease (HD) is uncommon disease with significant morbidity. The diagnosis of this entity is not simple, unless the patient comes from an endemic area or has a history of HD elsewhere. Only few case reports and case series of this entity are available in the published literature. We report a series of three cases of primary spinal HD who had characteristic MR appearance and were managed successfully. Case presentation We report a series of 3 cases, two presenting with paraparesis and one with right lower limb weakness and hesitancy of micturition. MRI demonstrated multiloculated cystic lesion involving thoracic spine in two patients and lumbar spine in third patient. All the three patients were showing intraspinal extension with compression of neural structures. MRI features were characteristic of hydatid disease. All the three patients were managed surgically with gross total excision of the cysts followed by albendazole chemotherapy. Histopathology was consistent with hydatid cyst. Patients with dorsal spine disease showed improvement in motor weakness, but third one with lumbar spinal disease had to use foot splint for walking. None of the patient showed features of recurrence on follow-up. Conclusion Radiologist should be familiar with the typical and atypical manifestations of the disease and should keep it in the differential diagnosis of cystic spinal lesions. Radical surgical excision along with postoperative adjuvant albendazole chemotherapy is the mainstay of treatment.

Background Mammography is currently the modality of choice for mass screening of breast cancer, although its sensitivity is low in dense breasts. Besides, higher breast density has been identified as independent risk factor so it has been conceptualized that women with dense breasts should be encouraged for supplemental screening. In this study, we aimed to estimate the distribution of volumetric breast density using fully automated Volpara software and to analyze the level of agreement between volumetric density grades and Breast Imaging Reporting and Data System (BI-RADS) density grades. We also aim to estimate the distribution of breast cancer in different VDG and to find a correlation between VDG and risk of malignancy. Results VDG-c was most common followed by VDG-b and BIRADS grade B was commonest followed by grade C. The density distribution was found inversely related to the age. Level of agreement between VDG and BIRADS grades was moderate (κ = 0.5890). Statistically significant correlation was noted between VDG-c and d for risk of malignancy (p < 0.001). Conclusion Difficulties associated with the use of BI-RADS density categories may be avoided if assessed using a fully automated volumetric method. High VDG can be considered as independent risk factor for malignancy. Thus, awareness of a woman’s breast density might be useful in determining the frequency and imaging modality for screening.

Objective Magnetic resonance spectroscopy (MRS) has emerged as a technique due to its ability to characterize the metabolite constituent of any lesion. We have evaluated magnetic resonance (MR) spectral patterns in different neoplastic brain lesions, using the ability of MRS in grading of gliomas. MRS also helps in differentiating between high-grade glioma and metastases. Method A retrospective observational study in histologically confirmed cases of brain neoplasms in which MRS was performed as a part of preoperative MR imaging. The pattern of metabolite peak was observed and means with standard deviation of different metabolite ratios (choline/creatine, choline/N-acetylaspartate [NAA], NAA/creatine) were calculated for different tumors. Analysis was done to see statistically significant differences in metabolite ratios of different grades of gliomas and to differentiate high-grade gliomas from metastases. Result A total of 61 cases with brain tumor were included in the study. Of which, 20 cases were of gliomas, 11 metastases, 9 meningiomas, 4 dysembryoplastic neuroepithelial tumors, 6 pituitary macroadenomas, 4 trigeminal schwannomas, 3 craniopharyngiomas, 2 acoustic schwannomas, and 2 medulloblastomas. Statistically significant differences in ratios of metabolite peaks were noted between different grades of gliomas and for high-grade glioma versus metastases. Conclusion MRS compliments the MR imaging and stands out as problem-solving method to distinguish neoplastic lesions in selected cases and also has a role in grading of gliomas and in differentiation of types of malignancies.

A boy in his middle childhood presented with intermittent episodes of headache with vomiting for 6 months. Plain CT of the head and MRI of the brain revealed fourth ventricular cysticercal cyst with acute obstructive hydrocephalus. Endoscopic excision of the cyst was done along with endoscopic third ventriculostomy and septostomy with external ventricular drain placement. Although we were able to decompress the cysticercal cyst, unfortunately, the cyst got slipped from the grasper leaving the grasped cyst wall in the tooth of the grasper. Through this case report, we want to highlight that such a complication could also happen during neuroendoscopic cysticercal cyst removal and how we dealt with it. Our patient was discharged neurologically intact and was symptom free on follow-up.

Background Single coronary artery (SCA) is a rare anomaly, usually diagnosed incidentally during coronary artery angiogram. Individuals with this anomaly mostly remain asymptomatic while some present with symptoms such as chest pain, dyspnoea and even sudden death. The origin and the proximal course of anomalous coronary artery are the main prognostic factors. Several classification systems have been proposed based on the site of origin and anatomical distribution of anomalous artery. Coronary computed tomography angiography has become the reference method for such an assessment noninvasively. Herein, we report a series of two cases of SCA diagnosed on CT angiography. In one case it was single left coronary artery associated with other congenital cardiac anomalies, whereas in other it was single right coronary artery and was an isolated anomaly. Case presentation Our first case was of a 19-year-old female who presented with chest pain and dyspnoea. Transthoracic Echocardiography (TTE) features were suggestive of Tetralogy of Fallot (TOF) with infective endocarditis. Cardiac CT angiography revealed the presence of a large SCA arising from left aortic sinus with absence of normal origin of right coronary artery (RCA). This artery was dividing into and supplying different coronary arterial territories with pre-pulmonic course of RCA. The patient underwent Aortic valve replacement with pulmonary Commissurotomy and improved in post-operative period. Our second case was of a 50-year-old man with complaints of breathlessness and normal ECG and Echocardiography examination findings. Coronary CT angiography revealed the presence of SCA arising from right aortic sinus and supplying the territories of both RCA and Left coronary artery (LCA). The patient was managed conservatively with emphasis on aggressive control of risk factors. Conclusions SCA is a rare anomaly and may lead to catastrophic life threatening complications. The accurate delineation of the origin and course of the anomalous vessel is of paramount importance while planning surgical intervention. Management usually involves a multi-disciplinary approach with cardiologists and cardiac surgeons aiming for deciding an individual plan based on presentation and anatomy of each case.