Background: Strain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. Objectives: To assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. Materials and methods: A prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. Results: Significant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. Conclusion: CE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.

Paragangliomas are chromaffin cell tumors that arise from neural crest cells and are extremely rare. Multiple paragangliomas in different locations of the neck and abdomen in the same patient are highly uncommon. We give the instance of a hypertensive male aged 42 years with a history of breathlessness, chest pain, and excessive perspiration for 10 days. Computed tomography of neck and abdomen revealed solid homogenous intensely enhancing masses in the left adrenal of size 64 x 45 x 52 mm [AP x TR x CC (anteroposterior x transverse x craniocaudal)], left paraaortic region of size 41 x 28 x 29 mm [CC x TR x AP (craniocaudal x transverse x anteroposterior)] and at the division of the left common carotid artery of size 17 x 15 x 11 mm (CC x TR x AP). The patient underwent a diagnostic laparotomy and resected tumors were diagnosed as paragangliomas. The possibility of paragangliomas should always be considered when hypervascular masses are encountered in certain locations of the body. Presence of such a lesion must prompt further imaging of the common sites of paragangliomas for the detection of occult synchronous paragangliomas. Routine screening at timely intervals in patients previously diagnosed with paraganglioma may aid in the earlier detection of metachronous tumors.

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.

Background: Cannulation of the internal jugular vein is a common procedure performed in the hospital setting. The development of false aneurysms, emboli, fistulae and hematomas are common complications due to vascular interventions. False aneurysms, or pseudoaneurysms, constitute the majority of these iatrogenic complications. Pseudoaneurysms can be life-threatening and are considered a surgical emergency due to their high relative risk of rupture and bleeding. Case Presentation: This is a case of a 29-year-old female, who presented with symptoms of delayed paralysis of brachial plexus due to transverse cervical artery pseudoaneurysm following iatrogenic trauma. Discussion: The brachial plexus is the primary source of peripheral nervous innervation to the upper extremity, associated muscles of the upper chest and cutaneous supply to the skin and hand. In the region of the thoracic outlet, the brachial plexus comes in close contact with major subclavian vessels supplying the upper extremity. On account of the anatomic proximity between the brachial plexus and transverse cervical artery in the thoracic outlet, a pseudoaneurysm or hematoma in this region can cause compression of the neuroplexus and lead to the gradually progressive neurological deficit over days to weeks as opposed direct penetrating injuries. If left untreated, brachial plexopathy has an unfavorable prognosis Endovascular therapy and surgical management play a crucial role in their treatment. Owing to increased procedural efficacy and its less invasive nature, endovascular repair is being more widely accepted in recent years. Since the exposure of the subclavian artery and difficult vascular control in open surgery poses a challenge in the management of pseudoaneurysms, endovascular treatment is the preferred method of treatment.

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