Publications by authors named "Kanika Khandelwal"

18 Publications

  • Page 1 of 1

Review of multi-modality imaging update and diagnostic work up of Takotsubo cardiomyopathy.

Clin Imaging 2021 Dec 3;80:334-347. Epub 2021 Sep 3.

Department of Radiology, Mayo Clinic, Rochester, MN, USA.

Takotsubo cardiomyopathy (TC) is an acute but reversible non-ischemic heart failure syndrome. It is characterized by a transient form of ventricular dysfunction typically manifesting as basal hyperkinesis with hypokinesia and ballooning of left ventricle mid-cavity and apex. Imaging helps in both diagnosis and follow up. Echocardiogram is the first-line modality to assess the typical contractile dysfunction in suspected patients with catheter angiography showing normal coronary arteries. Cardiac MRI is currently the modality of choice for the non-invasive initial assessment of TC and for follow up imaging. The current review focusses on historical background of TC, its pathophysiology, diagnostic work up and differential diagnosis and provides multimodality imaging work up of TC including role of echocardiogram, invasive catheterization, nuclear imaging, cardiac computed tomography and cardiac MRI including basic and advanced MRI sequences.
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http://dx.doi.org/10.1016/j.clinimag.2021.08.027DOI Listing
December 2021

Problem-solving with MRI in acute abdominopelvic conditions, part 2: gynecological, obstetric, vascular, and renal diseases.

Emerg Radiol 2021 Dec 21;28(6):1173-1183. Epub 2021 Jul 21.

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

The purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal disease. In the part 2, the authors focus on MRI features of female pelvic gynecological diseases, pregnancy- related complications, abdominal vascular complications, and renal diseases.
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http://dx.doi.org/10.1007/s10140-021-01961-yDOI Listing
December 2021

Problem-solving with MRI in acute abdominopelvic conditions, part 1: gastrointestinal, hepatobiliary, and pancreatic diseases.

Emerg Radiol 2021 Dec 11;28(6):1161-1172. Epub 2021 Jul 11.

Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.

The purpose of this article is to review the benefit and added value and advantages of magnetic resonance imaging (MRI) compared with other cross-sectional imaging in patients presenting with abdominopelvic emergencies. During the past decade, there has been increased utilization of MRI in the emergency department with widespread availability of MR scanners, improvement in rapid imaging techniques, and methods to overcome motion-related artifacts. This has benefited patients at higher risk of radiation, particularly children and pregnant women, and patients with contraindications to iodinated contrast including allergy and renal dysfunction. Still the challenges are: on site MR scanner in the emergency department, after-hour services, as well as availability of time slot to rapidly scan emergency patient. MRI has additional advantages over other imaging modalities due to its high contrast resolution, which allows it to better characterize tissue and fluid collections, and may avoid the need for intravenous contrast. Radiologists must be familiar with the role and added value of MRI, spectrum of imaging findings, and problem-oriented modified MR protocols in abdominal and pelvic emergencies. In part 1, we will discuss the utility of MRI in gastrointestinal, hepatobiliary, and pancreatic diseases. In part 2, the authors will focus on the key MR imaging features of female pelvic gynecological diseases, pregnancy related complications, abdominal vascular complications, and renal diseases.
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http://dx.doi.org/10.1007/s10140-021-01960-zDOI Listing
December 2021

Steroid-Induced Sinus Bradycardia.

Cureus 2021 May 16;13(5):e15065. Epub 2021 May 16.

Internal Medicine, Mayo Clinic Health System, Austin, USA.

Steroids are one of the most commonly used drugs and known to be associated with several side effects. There have been case reports about the associated sinus bradycardia with pulse dose corticosteroids administration both IV and oral. We present a case of asymptomatic sinus bradycardia associated with oral prednisone 40 mg. A 69-year-old male was admitted to the ICU for sepsis and subsequently was found to have gastrointestinal (GI) bleed. He developed an acute gout attack during hospitalization and was treated with prednisone 40 mg. Over the next 24 hours, the patient's heart rate dropped to 30s to 40s beats/minute while other vitals have remained stable. He was monitored on telemetry and review of the rhythm strips, as well as a 12-lead electrocardiogram (EKG), that showed sinus bradycardia; no pauses or atrio-ventricular (AV) nodal blocks were identified. The patient was not on any beta blocker or other therapies commonly associated with sinus bradycardia. His steroids were stopped while all other medications were continued. His heart rate slowly started to improve over the next 24 hours. He was not found to have any further episodes of bradycardia. Our case is unusual as we noted transient asymptomatic bradycardia with oral prednisone 40 mg dose. While bradycardia is reversible and may go unnoticed, it is important for the clinician to be aware of this adverse effect and include it in the list of potential differentials for bradycardia.
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http://dx.doi.org/10.7759/cureus.15065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205859PMC
May 2021

A Case of Hepatic Portal Venous Gas: Hypothesis of a Transient Direct Communication between a Penetrating Antral Gastric Ulcer and Mesenteric Varices.

Case Rep Gastrointest Med 2017 26;2017:8185132. Epub 2017 Feb 26.

Division of Gastroenterology and Hepatology, Tufts Medical Center, Tufts School of Medicine, Boston, MA, USA.

Hepatic portal venous gas (HPVG) is a rare radiological sign that usually signifies an acute intra-abdominal process, most commonly bowel ischemia and sepsis. Few reports described an association with underlying gastric pathologies. We report a 60-year-old patient who presented with melena and chills and was discovered to have a gastric ulcer that appeared to have penetrated into a mesenteric varix. This, in turn, likely caused development of HPVG associated with fungemia. Treatment with a proton pump inhibitor and bowel rest was sufficient to resolve symptoms and the HPVG.
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http://dx.doi.org/10.1155/2017/8185132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346356PMC
February 2017

Pediatric cutaneous leishmaniasis in an endemic region in India.

Am J Trop Med Hyg 2014 Nov 6;91(5):901-4. Epub 2014 Oct 6.

Department of Dermatology, Sardar Patel Medical College, Bikaner, Rajasthan, India; Department of Molecular Biology, Indian Council of Medical Research, New Delhi, India; Department of Pathology and Microbiology, Ohio State University, Columbus, Ohio

Cutaneous leishmaniasis (CL) is endemic in the Bikaner region situated in the Thar Desert of Rajasthan, India. This study describes clinicoepidemiological data of pediatric CL in pre-school children (0-5 years of age) from this region during 2001-2012. In total, 151 patients with 217 lesions were reported during the study period. The mean age of the study group was 3.29 ± 1.43 years (0.25-5 years), with many (41.7%) cases being in the age group of 2-4 years. Face was the most common site involved, and morphologically, the lesions were either plaque type or papulonodular. Smear for parasitologic examination was positive in 84 (70%) of 120 cases, and histopathologic examination confirmed CL in 10 (55.55%) of 18 cases. Parasite species identification conducted for 13 randomly selected patients by polymerase chain reaction identified Leishmania tropica as the causative species. Intralesional sodium stibogluconate was the most commonly used treatment and found to be well-tolerated. Other therapies that were effective included oral rifampicin, oral dapsone, radiofrequency heat therapy (RFHT), and combinations of the three therapies.
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http://dx.doi.org/10.4269/ajtmh.13-0737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228883PMC
November 2014

Inverted cortico-medullary differentiation of renal hemosiderosis.

Saudi J Kidney Dis Transpl 2014 Jan;25(1):170-1

Department of Nephrology, Max Super-speciality, Shalimar Bagh, New Delhi, India.

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http://dx.doi.org/10.4103/1319-2442.124559DOI Listing
January 2014

Bilateral adrenal infarction in Crohn's disease.

Indian J Endocrinol Metab 2013 Sep;17(5):933-5

Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada.

Adrenal infarction is an uncommon cause of adrenal insufficiency. We herein present unique occurrence of bilateral adrenal infarction detected on imaging in a young female with known history of Crohn's disease. The patient responded well to steroids and is on follow up. To our knowledge, this is the first case reported in English literature of adrenal infarct associated with Crohn's disease as extraintestinal manifestation.
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http://dx.doi.org/10.4103/2230-8210.117227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784888PMC
September 2013

Aortic intramural hematoma and hepatic artery pseudoaneurysm: unusual complication following resuscitation.

Am J Emerg Med 2014 Jan 21;32(1):107.e1-4. Epub 2013 Sep 21.

Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. Electronic address:

We present a case of a 71-year-old woman with an unusual complication of aortic intramural hematoma and hepatic artery pseudoaneurysm following cardiopulmonary resuscitation and thrombolysis done for sudden cardiopulmonary arrest and pulmonary embolism. Patient was on Warfarin treatment for a prior history of pulmonary embolism and experienced recurrent cardiac arrests, which finally resolved after intravenous administration of thrombolytic agents. However, follow-up computed tomographic angiography revealed descending aortic intramural hematoma with intramural blood pool and concomitant liver laceration with hepatic artery pseudoaneurysm. The patient received transcatheter embolization for the hepatic injury with careful follow-up for the aortic injury and was later discharged in a stable condition. Follow-up with subsequent computed tomographic angiography at a regular interval over 1 month shows near complete resolution of the intramural hematoma. The purpose of this report is to describe the rare complication of cardiopulmonary resuscitation and thrombolysis in the form of concomitant injuries of the aorta and liver. Although the use of thrombolytic agents in patients with pulmonary embolism and cardiac arrest is still a matter of debate, this case report supports the concept that thrombolysis has a role in restoring cardiopulmonary circulation, especially in recurrent cardiac arrests resulting from pulmonary embolism. On the other hand, this case also highlights the increased association of the bleeding-related complication as a result of vigorous efforts of cardiopulmonary resuscitation. Aggressive management with interventional radiology for hepatic pseudoaneurysm and conservative management of the aortic intramural hematoma resulted in favorable outcome for our patient.
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http://dx.doi.org/10.1016/j.ajem.2013.08.012DOI Listing
January 2014

Clinco-epidemiologic study of cutaneous leishmaniasis in Bikaner, Rajasthan, India.

Am J Trop Med Hyg 2013 Jul 28;89(1):111-5. Epub 2013 May 28.

Department of Dermatology, Sandar Patel Medical College, Bikaner, Rajasthan, India.

Cutaneous leishmaniasis is endemic to the Thar Desert of Rajasthan, Bikaner, India. The present study describes clinico-epidemiologcial data of all cases of cutaneous leishmaniasis CL in this region during 2001-2011. A total of 1,379 patients with 2,730 lesions were reported during the study period. Ages of patients ranged from 3 months to 86 years, and there was a predominance of infections in males. Most patients were from urban areas and lower middle socioeconomic groups. Lesions were dry, ulcerated nodules or plaques of different sizes commonly over face and upper limb. Skin smears were positive for parasites in 958 (69.5%) patients, and the remaining 45.8% (193 of 421) patients were positive by skin biopsy. Histopathologic analysis of the skin showed mixed granulomas consisting of macrophages, lymphocytes, epitheloid, and plasma cells. Species identification was conducted for 45 randomly selected patients by polymerase chain reaction, the infective species was Leishmania tropica. Most patients were treated with intra-lesional injections of sodium stibogluconate.
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http://dx.doi.org/10.4269/ajtmh.12-0558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748465PMC
July 2013

Radiology-pathology conference: malignant solitary fibrous tumor of the seminal vesicle.

Clin Imaging 2013 Mar-Apr;37(2):409-13. Epub 2012 Jun 8.

Division of Abdominal Radiology, University of Ottawa, Ottawa, Canada.

Mesenchymal neoplasms are rarely encountered in the seminal vesicle. Only four cases of the seminal vesicle solitary fibrous tumor have been reported in English literature, all of which were benign in nature. We are describing the clinicoradiological and pathological features of a locally aggressive malignant solitary fibrous tumor arising from the seminal vesicle, which posed the therapeutic challenge for the surgical management in a 52-year-old male patient. To our knowledge, this is the first reported case of the malignant solitary fibrous tumor arising from the seminal vesicle.
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http://dx.doi.org/10.1016/j.clinimag.2012.04.027DOI Listing
September 2013

Long-term efficacy of radiofrequency ablation in treatment of common and palmo-plantar warts.

Australas J Dermatol 2013 Nov 6;54(4):307-9. Epub 2012 Nov 6.

Department of Skin, STD and Leprosy, SP Medical College, Bikaner, Rajasthan, India.

Current treatments for warts induce significant local tissue damage and do not prevent recurrence. We evaluated the efficacy of localised radiofrequency heat (RFH) therapy in inducing the long-term resolution of common and palmo-plantar warts in a placebo-controlled randomised single blind trial. Our data show that RFH therapy is a safe, cosmetically acceptable and long-term effective treatment for warts.
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http://dx.doi.org/10.1111/j.1440-0960.2012.00966.xDOI Listing
November 2013

Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts.

J Cutan Aesthet Surg 2011 Sep;4(3):188-91

Departments of Dermatology, Venereology and Leprosy, SP Medical College, Bikaner, Rajasthan, India.

Background/aim: Intralesional bleomycin gained increasing popularity in the recent past for treatment of warts particularly in palmo-plantar and periungual regions as other modalities are not very effective. Hence we evaluated the role of intralesional bleomycin in periungual and palmo-plantar warts to know its efficacy in Indian patients.

Settings And Design: This was a placebo-controlled study.

Materials And Methods: Fifty patients of multiple palmo-plantar and periungual warts were included in this study and categorized in groups A and B of 25 each. Alternate patients were included in groups A and B and treated respectively with intralesional bleomycin (1 mg/mL solution) and normal saline as placebo, fortnightly for maximum up to two injections. Patients were followed up weekly for 1 month, fortnightly up to 12 weeks, and then quarterly for 1 year. If warts persisted after 12 weeks of starting treatment, it was considered a failure. Statistical analysis was done by the chi-square test using M-stat software.

Results: Group A and B patients were having 85 warts and 72 warts, respectively. The cure rate in group A and B patients was 96.47% (82/85 warts) and 11.11% (8/72 warts), respectively, after one or two injections within 12 weeks. The difference in the cure rate between two groups was statistically highly significant (<0.0001). In group A patients, a haemorrhagic eschar was formed which gradually healed in 8-12 weeks without atrophy or pigmentation; this phenomenon was not seen in group B. Only moderate pain was observed by most of the patients during injection in both groups.

Conclusion: The intralesional injection of bleomycin is highly effective, safe, and non-toxic in periungual and palmo-plantar warts.
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http://dx.doi.org/10.4103/0974-2077.91250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263129PMC
September 2011

Perinephric extramedullary hematopoiesis.

Kidney Int 2012 Feb;81(3):326

Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1038/ki.2011.360DOI Listing
February 2012

Malignant peripheral nerve sheath tumor of kidney.

Iran J Kidney Dis 2011 Nov;5(6):373

Department of Nephrology, University of Ottawa, Ottawa, Canada.

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November 2011

A patient presenting with diffuse cutaneous leishmaniasis (DCL) as a first indicator of HIV infection in India.

Am J Trop Med Hyg 2011 Jul;85(1):64-5

Department of Dermatology, Sardar Patel Medical College, Bikaner, Rajasthan, India.

Opportunistic parasitic infections such as leishmaniasis are common in human immunodeficiency virus (HIV)-infected patients and are usually acquired several days after initial diagnosis of HIV infection. Here, we report on a patient who presented with diffuse cutaneous leishmaniasis (DCL) caused by Leishmania tropica as the first and only clinical manifestation of HIV infection. To the best of our knowledge, this is the first case that illustrates that DCL could be the first clinical indicator of HIV infection. Cutaneous leishmaniasis (CL) and DCL are becoming frequent opportunistic infections in HIV-infected individuals throughout the world. To date, all documented cases of CL and HIV coinfections have been reported in patients who were known cases of HIV and who subsequently developed CL. In this report, we present a case that illustrates that DCL could be the first clinical indicator of HIV infection.
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http://dx.doi.org/10.4269/ajtmh.2011.10-0649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122345PMC
July 2011

Unresponsive cutaneous leishmaniasis and HIV co-infection: report of three cases.

Indian J Dermatol Venereol Leprol 2011 Mar-Apr;77(2):251

Department of Dermatology, SP Medical College and PBM Group of Hospitals, Bikaner, Rajasthan, India.

Cutaneous leishmaniasis (CL) is a vector borne disease caused by various species of Leishmania parasite. CL is endemic in the Thar desert of Rajasthan state and Himachal Pradesh in India. Immune suppression caused by human immunodeficiency virus (HIV) infection is associated with atypical clinical presentation of CL which responds poorly to the standard treatment and causes frequent relapses. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which failed to respond to conventional intralesional/intramuscular sodium stibogluconate (SSG) injections. Initially, we did not think of HIV infection because CL is endemic in this region. When patients did not respond to SSG injections, we performed enzyme-linked immunosorbent assay (ELISA) tests for HIV and they turned out to be HIV positive. Our report showed that CL is emerging as an opportunistic infection associated with HIV/AIDS and may be the first manifestation in HIV positive patients in an endemic area.
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http://dx.doi.org/10.4103/0378-6323.77484DOI Listing
January 2012
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