Abstract Pituitary lesions are increasingly detected due to widespread use of magnetic resonance imaging (MRI), with incidental findings (“incidentalomas”) now identified in 10–20% of brain imaging studies. MRI remains the gold standard for evaluating sellar and parasellar pathology, offering superior soft-tissue contrast without ionizing radiation. This comprehensive narrative review synthesizes current evidence on the role of MRI in evaluating pituitary lesions, with a primary focus on intrasellar pathologies and post-operative imaging. We highlight technical advances from dynamic contrast-enhanced (DCE) imaging to emerging artificial intelligence (AI) applications. Dynamic contrast-enhanced MRI significantly improves microadenoma detection, with sensitivity exceeding 90% compared to approximately 50% with static imaging. High-field 3 T imaging offers 10–15% improved detection compared to 1.5 T systems. Post-operative baseline imaging optimally performed at 3–4 months minimizes false-positive residual tumor interpretation. AI-based radiomics models demonstrate promising accuracy (AUC 0.85–0.95) for predicting tumor consistency, invasiveness, and recurrence, though prospective validation remains limited. A systematic approach to pituitary MRI interpretation, integrating optimized protocols with emerging AI tools, enhances diagnostic accuracy and guides clinical decision-making.
Duodenal vascular ectasia (DVE) is a rare but important cause of upper gastrointestinal bleeding, particularly in patients with chronic liver disease. Gastric antral vascular ectasia (GAVE) is a more commonly recognized vascular lesion associated with cirrhosis; however, vascular ectasia involving the duodenum is infrequently reported and may pose diagnostic and therapeutic challenges. We report a case of a cirrhotic patient presenting with recurrent upper gastrointestinal bleeding manifested as melena and progressive anemia. Initial evaluation suggested variceal bleeding; however, endoscopic examination revealed the presence of GAVE along with vascular ectasia involving the duodenal bulb and extending into the third part of the duodenum. Histopathological examination of duodenal biopsies demonstrated dilated vascular channels within the lamina propria, consistent with duodenal vascular ectasia. Endoscopic management was initially directed toward GAVE using argon plasma coagulation (APC). Due to persistent anemia and recurrent bleeding, APC therapy was subsequently applied to the duodenal vascular lesions with careful technique to minimize the risk of perforation. Hemostasis was successfully achieved without complications, and the patient showed sustained clinical improvement with stabilization of hemoglobin levels and no further transfusion requirement during follow-up. This case highlights duodenal vascular ectasia as a potential source of gastrointestinal bleeding in cirrhotic patients and demonstrates that argon plasma coagulation can be a safe and effective therapeutic modality when applied cautiously.
The aim of this study was to compare the postoperative analgesic efficacy of the external oblique intercostal (EOI) block with the subcostal transversus abdominis plane (TAP) block. The primary objective was to compare the numerical rating scale (NRS) scores postoperatively. The secondary objectives were to compare the total duration of analgesia and total analgesic consumption in the first postoperative 24 hours. A double blind, randomised study was conducted in a tertiary care academic hospital. Seventy-six patients of either gender, aged between 20 and 70 years, belonging to American Society of Anesthesiologists (ASA) physical status classes I and II, posted for elective laparoscopic surgeries were included. The patients were induced as per the routine general anaesthesia protocol. Post-surgery, prior to extubation, an ultrasound-guided EOI block or subcostal TAP block was performed as per group distribution. The patient was then extubated and shifted to the recovery room. The postoperative NRS score, total duration of analgesia, and total analgesic consumption in the first 24 hours were noted. The postoperative paracetamol requirement and complications were noted. The NRS score was significantly low at 2,4,6,8,10,12,16,18,24 hours postoperatively in patients who received EOM as compared to those who received subcostal TAP block (p value <0.05). The PCM requirement was also low in EOI block patients, but the p-value was not significant (p-value = 0.29). EOI block is an effective and preferred block as compared to the subcostal TAP block, as it provides better postoperative analgesia.
