A rare triad of Wolffian duct anomaly known as Zinner syndrome includes unilateral renal agenesis with ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. It is often diagnosed in third and fourth decades of life. Patient presents with dysuria, perineal pain, infertility and painful ejaculation. The aim of this case report is to show the importance of the radiological imaging on diagnosis of Zinner syndrome. MRI being the modality of the choice for the confirmation of the diagnosis is vital in further management of the syndrome.

Introduction: Obstructive jaundice is one of the most common hepatobiliary diseases. Though USG is very good screening and diagnostic tool for obstructive jaundice its role is limited in gaseous abdomen, recent meal and patient’s body habitus. ERCP has very high accuracy in diagnosis of biliary disease especially choledocholithiasis and CBD stricture. Since ERCP is minimal invasive procedure with certain morbidity and mortality risk MRCP is standard technique for overall assessment of obstructive jaundice. This study aims to compare diagnostic accuracy of MRCP in diagnosing benign and malignant cause of obstructive jaundice taking HPE and ERCP as Gold standard. Method: This was a retrospective study reviewing MRCP findings of clinically diagnosed obstructive jaundice from 2018 to2021 at Patan Hospital, Kathmandu Nepal. Study was conducted after ethical clearance of the institutional review committee. Result: Among 66 patient Sensitivity, Specificity, PPV and NPV of MRCP for biliary obstruction due to malignant pathology were 89.50%, 93.60%, 85.00% and 95.70% respectively. Similarly for benign etiology, Sensitivity, Specificity, PPV and NPV accounted for 93.60%, 89.50%, 95.70% and 85.00% respectively. The overall diagnostic accuracy was 92.40%. Choledocholithiasis  was the most common benign cause of obstructive jaundice 31 (46.97%) cases, while periampullary carcinoma was the most common malignant cause eight (12.12%). Conclusion: MRCP is highly sensitive and specific test in the evaluation of benign and malignant biliary pathology. Being noninvasive and can have good diagnostic value despite use of contrast. So minimally invasive procedure ERCP can be reserved for therapeutic or diagnostic biopsy purpose only.

Introduction: Magnetic resonance imaging (MRI) plays an important role in distinguishing malignant from benign adnexal mass which are indistinguishable from ultrasonography. This can help in early diagnosis and treatment of indeterminate adnexal lesions. This study aims to evaluate the features suggestive of malignant features and  accuracy of ovarian adnexal reporting and data system (O-RADS) MRI score in distinguishing benign from malignant lesions when compared with histopathology which is gold standard. Method: This was a retrospective study of MRI pelvis carried out in patients with indeterminate adnexal lesions who had MRI pelvis done from 2018 to 2022 at Patan Hospital, Lalitpur, Nepal.  Ethical approval was obtained from the institutional review committee of Patan Academy of Health Sciences. MRI diagnosis based on O-RADS MRI score was compared with histopathology diagnosis and sensitivity, specificity was calculated. Chi square test was computed and p-value less than 0.05 was considered statistically significant. Result: Among 175 patients, 135 had benign and 40 had malignant lesions. Malignancy was common in middle aged patients (41-60years).MRI features of malignancy were multilocular, solid cystic lesion with contrast enhancement, septations and diffusion restriction. Significant statistical association of O-RADS MRI score was found with histopathology diagnosed malignancy.  92.5% of malignancy had O-RADS MRI score of 4 and 5.The sensitivity and specificity of MRI diagnosing indeterminate lesion was 92.5% and 91.85% respectively. Conclusion: O-RADS MRI scoring is significantly associated with histopathology proven adnexal malignancy hence helps in accurately diagnosing indeterminate adnexal lesions and stratisfying the risk of malignancy.

Introduction: In an ectopic pregnancy, most patients present with 5 to 9 weeks of amenorrhea, mild pelvic pain and vaginal spotting which triggers the evaluation of ectopic pregnancy. The presence of an extrauterine gestational sac containing a yolk sac or embryo is the most specific sonographic finding whereas an echogenic tubal ring in the adnexa is the most common finding.1  This study aimed to find the accuracy of ultrasound findings versus clinical presentation, intraoperative findings and histological findings. Methods: This is a retrospective study. All patients with histopathological diagnoses of ectopic pregnancy were included in the study and data regarding clinical diagnosis, ultrasound diagnosis and intraoperative diagnosis were retrieved and compared with their histopathological diagnosis. Result: There were 216 cases of ectopic pregnancy with an overall incidence of ectopic pregnancy was 0.88%. The sensitivity with ultrasound diagnosis was 99.52% and specificity 11.11% with positive and negative predictive values were 96.2 % and 50 % respectively and overall diagnostic accuracy of 95.83%. The sensitivity was 97.6% and specificity was 11.1% for clinical diagnosis of ectopic pregnancy. The sensitivity was 100% for intraoperative diagnosis of ectopic pregnancy with a positive predictive value is 95.83%. Conclusion: Clinical diagnosis, intraoperative findings and ultrasound findings were highly sensitive to detecting ectopic pregnancy in the study population. The overall diagnostic accuracy was highest for the ultrasound finding.