Splenic infarction without splenic vessel thrombosis is an infrequent presentation in clinical practice. The case discussed here is a 45-year-old male with a history of alcohol abuse, who presented to the hospital with pain abdomen epicentered in the left upper quadrant. On evaluation, the patient was found to be having portal hypertension complicated with alcoholic hepatitis, acute necrotizing pancreatitis, gastric, and paraesophageal varices. The presence of splenic infarction without concomitant splenic vessel thrombosis in this patient merits a discussion of relevant investigations and their findings thereof.

Heterotaxy syndrome is an uncommon disease, with an incidence ranging from 1 in 6000 to 1 in 20,000 live births.[1] This syndrome is characterized by major cardiac vascular malformations, congenital asplenia, polysplenia, and abnormal arrangement of the chest and abdominal organs. Radiological investigations such as radiographs, sonography, and computed tomography scan play a pivotal role in ascertaining the correlation between clinical symptoms of the patient and the extent of anatomical aberration in the form of thoracic or visceral “situs” abnormalities. The case in this report is a rare variant of heterotaxy, which cannot be stratified into any of the existing subsets for heterotaxy syndromes. The relevant investigations thereof and their relevant findings have been discussed in detail.

Objective: Mesenteric lymphadenitis reflects the mesenteric lymph node (MLN) response to an underlying infection of uncertain etiology, usually viral. In children, enlarged MLNs are common findings detected during abdominal ultrasound, whether done for nonspecific pain abdomen or for unrelated clinical presentations. This study was conducted to determine the significance of mesenteric lymphadenopathy in asymptomatic children as compared to those with symptoms of acute abdominal pain or chronic abdominal pain (CAP). Methodology: A prospective hospital-based study was conducted among 72 children aged between 2 and 15 years. These children were referred from the outpatient/pediatric ward department for 1 year, for evaluation by abdominal ultrasonography. Children were grouped into three categories based on their clinical presentations as asymptomatic (controls), those with CAP, and those with acute abdomen. The sonographic findings were tabulated against each, with accounting of parameters such as size, number of enlarged nodes, and site of nodes. Pearson’s Chi-square test was used to analyze ordinal variables between groups. About 95% confidence interval was selected with a P = 0.05 taken as statistically significant. Results: Significant enlarged MLNs were comparable in prevalence in all groups. The incidence of significant mesenteric lymphadenopathy in the CAP group was even less than in the control group. The Chi-square statistic was 2.5612. The P = 0.633718. The result is not statistically significant at P < 0.05. This indicates that MLNs on ultrasonography have no significant association with the clinical presentation in children. Conclusion: Our study indicates that reporting of enlarged mesenteric nodes on transabdominal sonography in children is not statistically significant with the clinical symptomatology.

Introduction: Cholesteatoma has been described as an accumulation of desquamated keratin debris in a pocket of squamous epithelium over a matrix within the middle ear cleft. A prospective study was carried out to establish a correlation between preoperative high-resolution computed tomography (HRCT) temporal bone findings with intraoperative findings in cases of cholesteatoma. Methods: Fifty patients of chronic otitis media, active squamous type, i.e. clinically suspected cholesteatoma, scheduled to undergo tympanomastoid exploration were selected. The positive and negative findings of the scan were documented as per the parameters to be analyzed. The important intraoperative surgical findings were then analyzed with preoperative HRCT findings. Results: Agreement between surgical and HRCT findings ranged from 86% (facial canal erosion) to 100% (external bony canal involvement). HRCT had higher detection rate as compared to surgery for scutum erosion (40% vs. 36%), tegmen erosion (6% vs. 4%), facial canal erosion (28% vs. 14%), lateral semicircular canal erosion (6% vs. 2%), incus erosion (78% vs. 64%), sinus tympani involvement (14% vs. 4%), attic involvement (44% vs. 42%), mastoid involvement (88% vs. 80%), and aditus widening (54% vs. 44%). The higher detection of scutum erosion, tegmen erosion, facial canal erosion, lateral semicircular canal erosion, and incus erosion is probably due to partial volume averaging. Conclusion: The findings of the present study showed that HRCT is an essential and indispensable tool for preoperative evaluation of cholesteatoma. It was highly sensitive and adequately specific for a significant number of findings. These findings are pivotal in planning the surgery and preparing for necessary anticipatory reconstructive procedures.