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Horizontal hypoechoic tissue seen in the midline anterior to spine representing the isthmus of horseshoe kidney resembles pancreas and is known as the second pancreas sign (Fig. 1) [1].

Increased vascularity seen in the thickened scrotal wall on transverse images on color Doppler ultrasound in patients with acute idiopathic scrotal edema (AISE) resembles a color fountain and is called as the fountain sign (Figs. 1, 2) [1]. AISE, a benign dermatosis characterized by selfresolving scrotal edema and erythema of short duration, accounts for about 3–20% of cases of acute scrotum [2]. AISE primarily affects children, but may also occur in adults [3].

Torsion of the fatty appendage of the falciform ligament, part of the spectrum of conditions known as intra-abdominal focal fat infarction (IFFI), is very rare with less than 20 cases reported on imaging so far. Here we report a case of torsion of the lipomatous appendage of the falciform ligament in a middle-aged female, diagnosed on ultrasound and computed tomography (CT). CT showed classical “hyperattenuating rim” sign in the anterior perihepatic space adjacent to the falciform ligament. We re-emphasize the importance of “hyperattenuating rim” sign on CT in recognizing IFFI in locations other than the pericolic region.

Abstract Colouterine fistula is an extremely rare condition, as the uterus is a thick, muscular organ. Here, we present two different etiologies for this rare condition—diverticulitis and malignancy. A 77-year-old female with colouterine fistula due to diverticulitis presented with complaints of lower abdominal pain localized particularly in the left iliac fossa and fever. Another case was of 73-year-old female with colouterine fistula due to malignancy who presented with abdominal pain, blood in stools, and whitish discharge from vagina. Both cases were evaluated with contrast-enhanced computed tomography (CECT). The presence of air and fluid within the uterus on ultrasound or CT scan, prompts the possibility of colouterine fistula with CECT providing accurate preoperative assessment.

Study DesignA retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population.PurposeThere have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population.Overview of LiteratureCoccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations.MethodsA retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type.ResultsTypes I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females.ConclusionsType I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.

Elastography is a promising way to assess tissue differences regarding stiffness or elasticity, which has been historically assessed manually by palpation. Combined with conventional imaging modalities, shear wave elastography can potentially evaluate the stiffness of a breast lesion and consequently help detect malignant breast tumor from benign ones. The aim of this study was to evaluate the diagnostic role of shear wave elastography in breast lesions in the Indian population. Fifty patients presenting with breast lesions were included in the study. All the patients were subjected to B-mode ultrasound and elastography using shear wave with Virtual Touch Imaging (VTI ) (Siemens Medical Solutions USA, Inc., PA, USA) and Virtual Touch Quantification (VTQ ) (Siemens Medical Solutions USA, Inc., PA, USA) and the obtained data was analyzed using an appropriate statistical test (independent samples t-test). In our study group of 50 patients, 34 were benign and 16 were malignant. VTI showed a sensitivity of 97% and a specificity of 93% with a positive predictive value (PPV) of 97% for benign lesions. VTI showed a sensitivity of 87.5 % and a specificity of 100% with a PPV of 100% for malignant lesions. VTQ showed a sensitivity of 71.4% and a specificity of 100% with a PPV of 100% for benign lesions. VTQ showed a sensitivity of 100% and a specificity of 100% with a PPV of 76.6% for malignant lesions. VTI was more reliable as a diagnostic tool compared to VTQ in benign lesions and both are equally reliable in identifying malignant lesions. Acoustic radiation force impulse (ARFI) plays a significant role as an adjuvant diagnostic tool to B-mode imaging for assessing breast lesions.

A 30-year-old female presented with sudden onset of headache, for two days. She had no nausea, vomiting, memory loss, mental status changes, gait disorder or visual disturbances. She had no other medical illness. She was referred for a non-contrast computed tomography (CT) scan of head, which showed asymmetrically dilated lateral ventricles (left>right) (Figure 1A) with normal third and fourth ventricles. The right and left lateral ventricles measured ~17 and 23 mm at the trigone level, respectively. The septum pellucidum was deviated towards the right side (Figure 1B). No definite hyperdense lesion was seen at the interventricular foramen. Contrast enhanced brain magnetic resonance imaging (MRI) was performed after 20 hours, which showed mild diffuse cerebral edema and hydrocephalus with symmetric dilatation of the lateral ventricles (~1.7 cm at trigonal level) bilaterally, and periventricular interstitial edema. A small ~8-mm well-defined, rounded T1-isointense and T2-hypointense signal intensity non-enhancing lesion was seen in the region of the foramen of Monro and in the anterosuperior aspect of the third ventricle, prompting the diagnosis of colloid cyst (Figure 2). The patient was recommended to undergo surgery but she declined because her symptoms had considerably reduced.