We present a rare case of a spontaneous indirect caroticocavernous fistula (CCF) in an early adolescent, who exhibited a 1-month history of redness, decrease in vision and proptosis of the right eye without a history of trauma or connective tissue disorder. An MRI of the brain and orbit and a digital subtraction angiography confirmed the diagnosis of Barrow type D CCF. The same was then treated with coiling and a liquid embolising agent using the transfacial venous route, resulting in complete obliteration. Reduction in conjunctival congestion with mild improvement in visual acuity was noted postprocedure. Complete recovery was noted at the 6-month follow-up visit. CCF, though rare in the paediatric population, should be highly considered in the differential diagnosis when the above-mentioned complaints are present. Early diagnosis and intervention have favourable outcomes.

The presence of fat within a lesion in the brain is not only easy to identify on both CT/MRI but also can help narrow the differential. The purpose of this paper is to illustrate the spectrum of common and rare fat-containing lesions in the brain that are encountered in clinical practice. This paper intends to discuss 15 such lesions which are confirmed by MRI findings and histopathological correlation. We divided the spectrum of fat-containing lesions into lesions with adipose cells, lesions with cholesterol-rich content and tumours with lipomatous differentiation/transformation. Knowledge of these common and rare fat-containing lesions is essential for making the right diagnosis or narrowing the differential diagnosis.

Purpose: With the advent of new hepato-biliary interventions, preoperative assessment of coeliac, hepatic, and mesenteric arterial anatomy has now become a necessity for surgeons and interventional radiologists. The primary aim is to avoid or minimize the ischemic complications that could occur during surgeries such as liver transplants, abdominal interventions etc. This study was undertaken to evaluate the variants in coeliac, hepatic, and superior mesenteric arteries based on CECT abdomen. Methods: A prospective study was conducted over a period of 2 years (2020- 2021) on 388 patients who underwent CECT abdomen for evaluation of the above-mentioned variants.Results: 14 types of CM trunk and 11 types of hepatic artery variants were identified in this study. Anatomical variations in CM trunk and CHA were seen in 6.4 % and 7.7 % respectively. The average diameter of the coeliac artery was found to be 6.6 mm, common hepatic artery was 5.04 mm and superior mesenteric trunk was 6.6 mm. In cases with variant coeliac -SMA axis, the average diameter of the coeliac trunk was 5.7 mm while the average arterial diameter of the hepatic artery in CHA variants was 4.38 mm.The pathological variations found in the study were: MALS/ Dunbar syndrome, SMA compression syndrome, aortoarteritis and nutcracker syndrome.Significant correlation was noted between presence of CHA and coeliac -SMA axis variations i.e., the patients with CHA variation were 3.38 times more likely to have coeliac-mesenteric arterial variation.The diameters of common hepatic and coeliac artery was noted to be reduced in cases with anatomical variations (p < 0.05). CONCLUSION - There is an association of coeliac -mesenteric artery variations with common hepatic arterial variations. Another correlation was found between the arterial diameters in cases with variant anatomy versus normal cases in the study population. No significant association between pathological variants like median arcuate ligament syndrome, SMA compression syndrome etc. with normal hepatic /CM trunk variations.Attempt was also made to describe the newly found variations in these target vessels, not previously characterized in the standard classification system.