Aims:In emergency settings, computed tomography (CT) accurately detects surgical pathology and reduces unnecessary hospital admissions. This study compared the diagnostic performance of multidetector computed tomography (MDCT) of the abdomen with and without oral contrast (OC) in patients with non-traumatic acute abdominal pain. Materials and methods:This one-year study, conducted at Maulana Azad Medical College and its affiliated hospitals in New Delhi, enrolled 50 patients aged 18 years or older, who were randomly assigned to two groups. Group I underwent MDCT with intravenous (IV) contrast alone, while group II received both oral and IV contrast. Bowel findings were qualitatively assessed, and radiological diagnoses were correlated with surgical, pathological, or clinical outcomes. The mean CT completion time was 1.69 hours for group I and 2.5 hours for group II, representing a 49-minute reduction when OC was omitted. Results:The final MDCT diagnosis matched the clinical diagnosis in 23 of 25 cases (92%) in group I and 24 of 25 cases (96%) in group II, with no statistically significant difference (p = 0.99). The positive predictive values were 92.0% and 96.0%, respectively. Two false positive results occurred in group I, while group II had one false positive case. No cases required repeat scanning. Conclusion:Patients with acute abdominal pain can be effectively evaluated with MDCT using IV contrast alone, particularly for acute appendicitis and pancreatitis. Clinical significance:Eliminating routine OC use in acute abdominal pain may reduce emergency department length of stay and CT completion time without compromising diagnostic accuracy. How to cite this article:Kumar A, Satyam S, Prakash A, et al. Rethinking Routine: Oral Contrast-free MDCT in Acute Abdominal Pain Assessment. Euroasian J Hepato-Gastroenterol 2025;15(2):127-135.

Ovarian leiomyomas (OLMs) are rare benign ovarian tumors, representing only 0.5%-1% of all benign ovarian neoplasms and exceptionally uncommon in children. Fewer than 100 cases are reported worldwide, with < 10 in the pediatric and adolescent age group. We report a 2-year-old girl presenting with incidental abdominal fullness. Imaging revealed a right adnexal mass, and intraoperatively, the tumor was found to completely replace the right ovary. Right oophorectomy with omentectomy and peritoneal washings was performed. Histopathology showed spindle-shaped smooth muscle cells with minimal atypia, and immunohistochemistry confirmed OLM with positivity for smooth muscle actin and desmin. The child had an uneventful recovery and remains well at 9 months of follow-up. This represents the youngest case worldwide and the first reported from India.

Objectives: To evaluate the diagnostic utility of computed tomography texture features in differentiating odontogenic cysts and tumors. Methods: This cross-sectional pilot study included 30 patients with odontogenic cysts and tumors. Lesions were manually segmented using MRIcron software. Histogram, gray-level co-occurrence matrix, and run-length matrix features were extracted. Independent t-tests, logistic regression modeling, and receiver operating characteristic curve analysis were performed for statistically significant features. Results: Histogram mean, median, and mode values were significantly higher in cystic lesions compared to tumors (p < 0.05). Combined logistic regression modeling demonstrated a diagnostic accuracy of 66.7% with an area under the curve of 0.826, sensitivity of 0.875, and specificity of 0.643. Individual features demonstrated limited discriminatory ability when analyzed independently. Conclusions: CT texture analysis demonstrated promising diagnostic potential when combined feature models were applied. These findings support the role of texture analysis as a non-invasive adjunct tool for lesion characterization, warranting validation in larger cohorts.

Extrapulmonary tuberculosis (TB) contributes significantly to the disease burden in Southeast Asia, yet maxillofacial involvement is rare and often misdiagnosed due to nonspecific features such as swelling, ulceration, or trismus. Conventional microbiology shows low sensitivity in these paucibacillary lesions, emphasizing the role of rapid molecular tests such as Cartridge-Based Nucleic Acid Amplification Testing (CBNAAT). This case series outlines the diagnostic challenges of maxillofacial TB in an endemic region. Nine patients (aged 9–33 years) presented with chronic lesions in maxillofacial region. Imaging commonly demonstrated osteolysis, cortical breach, periosteal reaction, or soft-tissue abscess. Mantoux testing, cytology, and Ziehl–Neelsen staining were often inconclusive, whereas CBNAAT or culture confirmed Mycobacterium tuberculosis in most cases. All patients received standard anti-tubercular therapy with significant clinical and radiographic improvement. Maxillofacial TB should be considered in persistent jaw lesions. Early molecular testing enhances diagnosis and supports timely, effective therapy.

Voice related complications are a major cause of morbidity in patients undergoing thyroidectomy in the postoperative period in the modern world. EBSLN being a primary tensor of vocal cords via cricothyroid muscle is important to produce high pitched sound above 150 Hz and it is essential for professional voice users. This nerve is prone to injury during surgery because of its proximity to the upper pole of the thyroid and complex anatomical relationship with the superior thyroid vessels. We aimed to study the occurrence of injury to EBSLN during surgery via acoustic voice analysis and comparing it with the pre-operative values. Patients of benign thyroid swelling with Bethesda type I to III and normal thyroid function tests were taken up for surgery. Pre- and post-operatively acoustic voice analysis was done in a soundproof room. Fundamental frequency (F0), amplitude perturbation (shimmer), fundamental frequency perturbation (jitter), and harmonic/noise ratio (HNR) were calculated and analysed. Intraoperatively, EBSLN was identified in Joll’s triangle and preserved. The acoustic voice analysis was performed on the postoperative day one and seven, and compared with the pre-operative values. The mean age of patients was 35.73 ± 9.13 years. Most common age group 36–45 with male to female ratio being 1:9. Cystic colloid goitre was seen in 85

Background:To evaluate the role of FDG PET/CT in diagnosing and monitoring rhinocerebral mucormycosis (RCM) and its added value over conventional imaging.Patients and Methods:We conducted a prospective observational study of 47 adults with biopsy-confirmed rhinocerebral mucormycosis between July 2022 and September 2024. All patients underwent FDG PET/CT, and findings were compared with MRI/CT and correlated with microbiological or histopathologic results. PET/CT was used to assess disease extent, identify residual or recurrent disease, and monitor treatment response.Results:Of the 47 patients (43 men, 4 women; mean age 49.4 +/- 12.2 y), 3 were imaged preoperatively and 44 postoperatively. PET/CT detected metabolically active disease in 35 patients, including 6 (12.8%) with lesions not well visualized on MRI/CT. Preoperative SUVmax was higher than postoperative (8.12 vs 6.12), reflecting disease burden reduction after surgery. PET/CT confirmed disease resolution in 12 patients who remained recurrence-free on follow-up. In 32 patients, PET/CT identified residual or recurrent disease, influencing further surgical and medical management. Representative images demonstrate PET/CT detection of active lesions missed on MRI/CT.Conclusions:FDG PET/CT delineates disease extent, guides therapeutic decisions, and confirms treatment response. Incorporating PET/CT into routine clinical management may improve outcomes by enabling timely, targeted interventions.

BACKGROUND:To evaluate the role of FDG PET/CT in diagnosing and monitoring rhinocerebral mucormycosis (RCM) and its added value over conventional imaging. PATIENTS AND METHODS:We conducted a prospective observational study of 47 adults with biopsy-confirmed rhinocerebral mucormycosis between July 2022 and September 2024. All patients underwent FDG PET/CT, and findings were compared with MRI/CT and correlated with microbiological or histopathologic results. PET/CT was used to assess disease extent, identify residual or recurrent disease, and monitor treatment response. RESULTS:Of the 47 patients (43 men, 4 women; mean age 49.4 ± 12.2 y), 3 were imaged preoperatively and 44 postoperatively. PET/CT detected metabolically active disease in 35 patients, including 6 (12.8%) with lesions not well visualized on MRI/CT. Preoperative SUVmax was higher than postoperative (8.12 vs 6.12), reflecting disease burden reduction after surgery. PET/CT confirmed disease resolution in 12 patients who remained recurrence-free on follow-up. In 32 patients, PET/CT identified residual or recurrent disease, influencing further surgical and medical management. Representative images demonstrate PET/CT detection of active lesions missed on MRI/CT. CONCLUSIONS:FDG PET/CT delineates disease extent, guides therapeutic decisions, and confirms treatment response. Incorporating PET/CT into routine clinical management may improve outcomes by enabling timely, targeted interventions.

Endoscopic middle ear surgery can be utilized to visualize and excise retraction pockets without the need for extensive bone work and removal of lateral bone. To evaluate the role of endoscope in the management of squamosal type of chronic otitis media. A total of 25 adults subjects (male = 12, female = 13) in the age group of 18–55 years suffering with chronic otitis media were operated by transcanal endoscopic approach. High resolution computed tomography of temporal bone was done to help identify the anatomy and underlying extent of disease. All patients were operated by transcanal endoscopic technique. The study concluded that the endoscope gives a better visualization of the middle ear and its hidden areas. The extensive bone work and associated cavity related problems can be avoided and normal anatomy can be preserved with the help of endoscopic ear surgery.

Sinus tympani is one of the hidden space in the retrotympanic area of middle ear which is commonly invaded by cholesteatoma and known for recidivism. Conventional surgical approaches sometimes fail to access deep sinuses and eradicate the disease. The aim of our study was to measure endoscopic depth of Sinus tympani in Indian Population. Total of 30 patients underwent mastoid exploration and intraoperatively depth of Sinus Tympani was measured using a 0.5 mm calibrated probe with 30 degree rigid Hopkins endoscope. Endoscopic depth in the present study ranges between 2.5 and 5.5 mm. It was higher in right ear in case of females however no significant difference were seen in males and females on left side. It is difficult to clear disease from Sinus Tympani because of its inaccessible location. Sinus Tympani can also show variations in terms of its depth further making difficult to clear disease.

Abstract Objective To compare the image quality of normal anatomical structures and radiation dose on low-dose (LDCT) and standard-dose (SDCT) temporal bone CT in children. Methods The study included 45 LDCT (80 kV and 130 mAs) and 45 SDCT (120 kV and 170 mAs) scans in children, 1–15 years of age. LDCT and SDCT scans were analyzed on H60s and H70h reconstruction kernels, respectively. Two readers assessed the image quality for 25 anatomical structures, using a 5-point scale. A score of 3 and above was considered “sufficient” and 2 and below was considered “insufficient” image quality. Image noise, contrast, age and size-specific effective doses were calculated. Results Despite an increase in image noise on LDCT, image quality remained sufficient for most structures owing to increased image contrast. The median effective dose on LDCT, calculated with age-specific conversion factor, decreased by 72.9% and that calculated with size-specific conversion factor decreased by 81.8% compared to the dose on SDCT. Conclusion LDCT provides comparable image quality for evaluation of temporal bone with significant reduction in radiation dose in children.

BACKGROUND:Emerging infectious diseases, often zoonotic, demand a collaborative "One-Health" surveillance approach due to human activities. The need for standardized diagnostic and surveillance algorithms is emphasized to address the difficulty in clinical differentiation and curb antimicrobial resistance.OBJECTIVE:The present recommendations are comprehensive diagnostic and surveillance algorithm for ARIs, developed by the Indian Council of Medical Research (ICMR), which aims to enhance early detection and treatment with improved surveillance. This algorithm shall be serving as a blueprint for respiratory infections landscape in the country and early detection of surge of respiratory infections in the country.CONTENT:The ICMR has risen up to the threat of emerging and re-emerging infections. Here, we seek to recommend a structured approach for diagnosing respiratory illnesses. The recommendations emphasize the significance of prioritizing respiratory pathogens based on factors such as the frequency of occurrence (seasonal or geographical), disease severity, ease of diagnosis and public health importance. The proposed surveillance-based diagnostic algorithm for ARI relies on a combination of gold-standard conventional methods, innovative serological and molecular techniques, as well as radiological approaches, which collectively contribute to the detection of various causative agents. The diagnostic part of the integrated algorithm can be dealt at the local microbiology laboratory of the healthcare facility with the few positive and negative specimens shipped to linked viral disease research laboratories (VRDLs) and other ICMR designated laboratories for genome characterisation, cluster identification and identification of novel agents.

Carotidynia is transient perivascular inflammation of the carotid artery. It is a rare condition of head and neck associated with atypical neck pain, often unilateral. Patients with carotidynia often presents with atypical symptoms that makes the diagnosis of this rare entity difficult. In this article, we report a case series of 3 patients that presents with variable symptoms along with different investigative modalities and treatment approaches. Due to rare entity, this condition is often misdiagnosed or necessitates several visits to various specialties before a diagnosis is reached. Thorough clinical examination along with radiology is must to reach to a diagnosis. Patient should be counselled regarding the benign nature of the disease that can be easily controlled by low dose steroids.

Sinonasal Organized hematoma (SOH) is a rare, benign condition that can mimic the malignancy of sinonasal region. It typically involves the maxillary sinuswith extra sinus involvement being a rare presentation. . We present two cases of SOH with unususal presentations, posing diagnostic challenges. One case had the organised hematoma over the hard palate, While the other case had an organised hematoma in the nasal cavity. Both the cases underwent thorough preoperative evaluation, including physical examination and radiology.. . Surgical management was employed in both cases. Early diagnosis and appropriate intervention are crucial for excellent prognosis. Preoperative diagnosis by clinical suspicion radiology is essential for adopting a more conservative approach.

Paediatric orbital lesions encompass a wide spectrum of benign and malignant entities that can arise from different components of the orbit. Clinical symptoms and signs are often nonspecific, and imaging plays a crucial role in the diagnosis and management. Ultrasonography has a limited role and radiation is a major concern with CT especially in the paediatric population. MRI is the modality of choice that avoids the radiation hazard and provides superior soft tissue contrast. The lesions can be localized using the ‘compartment’ approach which helps to narrow the list of differentials. MRI also provides critical information for management such as presence of perineural spread and intracranial extension. This article depicts the spectrum of Magnetic Resonance imaging findings encountered in paediatric ocular and orbital lesions.

AbstractNasopharyngeal carcinoma (NPC) is an epithelial carcinoma originating from lining of the nasopharyngeal mucosa usually at the fossa of Rosenmuller (pharyngeal recess). An early detection on endoscopy can be rewarding, however, often difficult as the tumor at the pharyngeal recess is hidden from the endoscopic view. Magnetic resonance imaging and positron emission tomography–computed tomography form the backbone of detection and spread of the carcinoma into local and distant regions. These modalities help further characterize the precise locoregional infiltration and lymph nodal involvement which aids in the planning of the surgery/chemoradiotherapy. They also help in the follow-up evaluation and further management strategies. Many research and treatment groups namely American Joint Committee on Cancer, National Comprehensive Cancer Network, American Society of Clinical Oncology, American College of Radiology, Radiological Society of North America, European Society of Radiology (iGuide), Indian Radiological & Imaging Association/Indian College of Radiology and Imaging, National Cancer Grid, etc. have devised guidelines for the optimal assessment and treatment of NPC. The present document aims at providing a comprehensive review of the clinicoradiological recommendations for the diagnosis and management of NPC based on these guidelines as well as personalized experience of the contributors.

Lipomatosis of nerve, earlier known as fibrolipomatous hamartoma is a rare condition which predominantly affects peripheral nerves, cranial nerve involvement being extremely uncommon. Preoperative consideration of this entity is of paramount importance as its inadvertent complete surgical resection may inevitably result in significant neurological deficit. We report a case of trigeminal lipomatosis in a young patient with trigeminal neuralgia.

Cholesteatoma is a benign inflammatory pathology that affects the middle ear as well as other pneumatized areas of temporal bone and can be highly aggressive in its spread pattern. It is characterized histologically by keratinizing squamous epithelium lining a cystlike structure filled with desquamated keratin. The epithelium, also known as the matrix, is surrounded by the perimatrix consisting of inflammatory cells and fibroblasts. The surrounding bone erosion has been ascribed to multiple factors such as induced pressure effect and release of inflammatory mediators that recruit osteoclastic activity. If not treated in time, destruction can advance and extend to surrounding structures that include the labyrinth, petrous apex, mastoid, and external auditory canal (EAC), and can further lead to facial nerve paralysis and intracranial complications.

Purpose Our aim was to assess the sinonasal magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) in coronavirus disease (COVID)-associated mucormycosis (CAM) and to correlate these with histopathology and patient outcome in terms of duration of hospital stay and survival at 10 weeks. Methods Twenty patients with histopathologically confirmed sinonasal CAM underwent MRI (including postcontrast T1-weighted and diffusion-weighted imaging). Histopathological findings (presence of coagulative necrosis, granulomatous reaction, and fungal burden) were recorded and all patients were followed up at 6 and 10 weeks. Statistical analysis was done using chi-square test and Fischer's exact test. Results Enhancement patterns seen in our subjects included homogeneous, heterogeneous, and lack of contrast enhancement (LOC), with LOC being the most common (65%). Diffusion restriction was found in 90% patients. Statistically significant correlation was found between LOC pattern and presence of coagulative necrosis (p-value = 0.007), extent of fungal hyphae (p-value = 0.047), and duration of hospital stay (p-value = 0.004). Restricted diffusion was also seen to correlate with a high fungal load (p-value = 0.007). Conclusion Our study describes the MRI findings of AIFRS in CAM and highlights the imaging features which may be surrogate markers for coagulative necrosis and fungal burden.