ABSTRACT
Monomelic amyotrophy, known as Hirayama disease, is a rare neurological condition that mostly affects young men. It is characterized by distal muscle atrophy and asymmetric weakness in the upper limbs, which are typically brought on by dynamic cervical spinal cord compression. We report a rare case of Hirayama disease in 2024 who is a 27-year-old male patient presented with weakness of right upper limb for the past 3 months and wrist drop involving right hand for the past three weeks. Clinical examination, lab investigation, nerve conduction study and flexion MRI of cervical spine was done. MRI findings, particularly focal atrophy and asymmetrical spinal cord flattening at the C4-C6 level, were key in confirming the diagnosis and guiding treatment decision. Imaging findings played a pivotal role in the diagnosis and management of Hirayama disease in this patient. His condition improved due to early intervention with immunosuppressive therapy, physiotherapy and regular follow up.

ABSTRACT
Avascular necrosis (AVN) of the talus and osteochondritis dissecans (OCD) are uncommon conditions affecting the ankle joint, each with distinct pathophysiologies and clinical implications. The talus’s unique vascular anatomy renders it susceptible to AVN, especially in the setting of trauma or compromised vascular supply. OCD, conversely, is typically linked to repetitive microtrauma leading to subchondral bone fragmentation and cartilage instability. Their simultaneous occurrence is exceedingly rare and presents diagnostic as well as therapeutic challenges. We report the case of a 46-year-old female who presented with progressive pain and tenderness over the ventral aspect of the ankle, aggravated by weight-bearing activities. Imaging with radiography, computed tomography (CT), and magnetic resonance imaging (MRI) revealed features consistent with avascular necrosis of the anterior talus and a displaced osteochondral fragment over the medial talar dome, suggestive of OCD (Stage IV – Berndt and Harty classification).

ABSTRACT
Hydatid disease is a parasitic infection caused by Echinococcus granulosus or, less commonly, Echinococcus multilocularis. It remains a significant public health concern in endemic areas, particularly in the Mediterranean region. Due to its non-specific clinical presentation and the often inconclusive nature of standard laboratory tests, diagnosis can be challenging. The liver is the most commonly affected organ, involved in approximately 70% of cases, while pulmonary involvement occurs in about 25%, due to larvae bypassing hepatic filtration. Renal involvement is relatively uncommon, accounting for 2–4% of all hydatid cyst cases, with isolated kidney involvement being extremely rare, seen in only 1.9% of cases. Here, we report a rare case of an isolated renal hydatid cyst in a pediatric patient, in whom the diagnosis was delayed due to its atypical presentation.

ABSTRACT
Ultrasound is the preferred method for identifying the cause of sudden scrotal pain and diagnosing related conditions. A pyocele refers to a collection of pus in the scrotal sac, which can occur as a result of a testicular abscess, infection of the testis or epididymis, or after trauma. In this case, a young man from rural India developed a pyocele following an injury. An ultrasound scan revealed that the pyocele had ruptured, with the pus spreading throughout one side of the scrotum. While rupture of the protective layer around the testicle (tunica) is commonly seen with a hematocele (blood collection), it is rarely associated with a pyocele. This case report explains the possible causes of a pyocele, how it appears on imaging, how it is treated, and the complications that can occur. It also discusses other conditions that may look similar.

ABSTRACT
Branchial cleft cysts are congenital anomalies arising due to incomplete involution of the branchial apparatus, most commonly involving the second cleft. They typically present as painless, cystic masses in the lateral neck with characteristic imaging features. However, atypical presentations in unusual anatomical locations can pose diagnostic challenges. We report the case of a 14-year-old female who presented with a painful swelling in the left upper neck. Ultrasonography and MRI revealed a heteroechoic, septated cystic lesion in the upper cervical region, deep to the parotid gland, with features overlapping multiple cystic neck pathologies. Differential diagnoses included lymphatic cyst, necrotic lymph node, cystic schwannoma, and salivary gland neoplasm. The lesion was aspirated and surgically excised. Histopathological examination confirmed the diagnosis of a second branchial cleft cyst, showing squamous epithelial lining with lymphoid aggregates and reactive lymphadenitis. This case highlights the diagnostic difficulty of branchial cleft cysts with atypical radiologic presentation, and underscores the critical role of radiology-pathology correlation in reaching a definitive diagnosis.

ABSTRACT
Abstract: Deep cerebral venous thrombosis (CVT) is a rare cause of stroke causing a diagnostic dilemma on imaging. Its presentation can be variable and is often radiologically characterized by bilateral gangliothalamic involvement, which can mimic other pathologies. We present a case of a 15-year-old male who developed deep cerebral venous thrombosis, manifesting as a bithalamic hemorrhagic lesion on imaging. This case underscores the importance of considering venous thrombosis in the differential diagnosis of bilateral thalamic abnormalities, such as acute viral hemorrhagic fever, especially in young patients presenting with atypical stroke symptoms.

ABSTRACT
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a morbid adverse effect characterized by the exposure of the alveolar bone. It presents with distinctive radiological features that not only guide diagnosis but also help detect complications, as illustrated in our patient. The purpose of this presentation is to demonstrate the radiological semiology through our case to familiarize radiologists with this pathology and briefly remind them of the pathophysiological mechanisms behind this side effect.