Ahmet Orhan Çelik

Role of mass effect, tumor volume and peritumoral edema volume in the differential diagnosis of primary brain tumor and metastasis

INTRODUCTION The differentiation of metastatic and primary brain tumors with certainty is important since clinical management and treatment of these two types of tumors are radically different. The purpose of the present study was to evaluate the effect of peritumoral edema volume, tumor volume and mass effect of tumor on differential diagnosis of metastatic and primary brain tumors. Also we have planned to investigate if the relationship between edema volume and mass affect can contribute to the differential diagnosis. MATERIAL AND METHODS We retrospectively reviewed MR images of patients with primary (n=40) and metastatic (n=40) intra-axial supratentorial brain tumor. Supratentorial primary solitary brain tumor group was also subdivided as GBM subgroup (n=24) and other than GBM subgroup (n=16) for statistical analysis. Metastasis at suitable localization which can lead to midline shift (due to mass effect) were selected. Tumor volume, peritumoral edema volume and mass-edema index (peritumoral edema volume/tumor volume) were calculated. Displacement of the midline structures (subfalcian herniation) was measured. Metastasis, GBM and other than GBM groups were evaluated for subfalcian shift, shift grade, tumor volume, peritumoral edema volume and mass-edema index by using Kruskal-Wallis test after Bonferroni correction. Mann-Whitney U test was used to analise subfalcian shift, tumor volume, peritumoral edema volume and mass-edema index of primary tumor and methastasis groups since the data was not normally distributed. Shift grade of the two groups was analised with chi-square test. RESULTS Midline shift, tumor volume and mass-edema index were significantly different between metastasis and primary tumor groups (p=0.001, p<0.001, p=0.001 respectively). Midline shift and tumor volume of the primary tumor group were greater than metastasis group while mass-edema index was less. Shift grade of metastasis and primary tumor groups was also significant (p=0.041). A midline shift more than 5mm (grade 2) was more common in primary tumors. There was no significant difference between GBM and other than GBM groups. CONCLUSION Measurement of midline shift, tumor volume and mass-edema index may contribute to the differential diagnosis of brain metastasis from primary brain tumors. Also mass-edema index can be a useful tool for differential diagnosis in the future. But further studies with larger series are needed.

Eagle Syndrome Causing Vascular Compression with Cervical Rotation: Case Report

Summary Background Eagle syndrome is a condition caused by an elongated styloid process. Unilateral face, neck and ear pain, stinging pain, foreign body sensation and dysphagia can be observed with this syndrome. Rarely, the elongated styloid process may cause pain by compressing the cervical segment of the internal carotid and the surrounding sympathetic plexus, and that pain spreading along the artery can cause neurological symptoms such as vertigo and syncope. Case Report In this case report we presented a very rare eagle syndrome with neurological symptoms that occurred suddenly with cervical rotation. The symptoms disappeared as suddenly as they occurred, with the release of pressure in neutral position. We also discussed CT angiographic findings of this case. Conclusions Radiological diagnosis of the Eagle syndrome that is manifested with a wide variety of symptoms and causes diagnostic difficulties when it is not considered in the differential diagnosis is easy in patients with specific findings. CT angiography is a fast and effective examination in terms of showing compression in patients with the Eagle syndrome that is considered to be atypical and causes vascular compression.

A case of concomitant intralobar bronchopulmonary sequestration and situs inversus totalis

Situs inversus is a rare congenital abnormality involving partial or complete transposition of the thoracic or abdominal viscera. In situs inversus totalis, both the thoracic and abdominal viscera are transposed. The incidence of this condition is 0.01% to 0.02%. Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the respiratory tract with an incidence of 0.15% to 1.80%. Intralobar sequestration is uncommonly associated with congenital anomalies.

Rare Primary Lesion of the Costa: Hydatid Cyst

A 50-year old female patient, who had undergone hydatid cyst surgery of bilateral lung and liver, admitted to our hospital with the complaint of swelling and sensitization of the right lower thoracic region. No significant finding was found during her physical examination outside the described region, and biochemical blood tests are normal. Because of her history agglutination test was requested. It was 1/10240 (positive test > 1/128). A lesion containing septations, cystic areas and semisolid areas inside was detected at a depth of 3 cm from the skin during the ultrasound examination [US] performed for this region (Figure 1a). The patient was subjected to computed tomography [CT] and magnetic resonance imaging [MRI] in terms of relationship of these areas with surrounding tissues. A mass appearance in fluid density that caused significant destruction in ribs and extended to the surrounding soft tissues and the right paravertebral region was observed in the right 11th and 12th ribs on the CT images (Figure 1b). A lesion containing a large number of cysts of hypointense in T1 sequences and hyperintense in T2 sequences in this region and showing a circumferential minimal contrast enhancement was observed on the MRI images (Figures 2a2c). The lesion was first thought to be hydatid cyst due to the current imaging findings and history. Surgery performed at Suleyman Demirel University Hospital, Isparta, Turkey in November 2015. Female vesicles in the cyst cavity were surgically evacuated first in a controlled manner. Then, the right 11th and 12th ribs were resected together with soft tissues (Figure 2d). After surgery, albendazole theraphy was continued for six months. 10 mg / kg / day dosage form was recommended as one week break of four weeks. Patient’s symptoms were significantly decreased during follow-up. Also no pathological findings on physical examination.

Aspergilloma Mimicking Metastasis in a Case with Laryngeal Carcinoma

Introduction: Aspergilloma is a fungal ball which is composed of hyphal structure fungus, fibrin, mucus and cellular debris and settled in a pre-existing pulmonary cavity or an ectatic bronchial. It may cause colonization in patients with an immunosuppressive and underlying lung disease. Although chest radiography provides valuable information, it can be scanned more effectively by computed tomography (CT). Monitoring fungal ball within the cavity in CT provides establishing the diagnosis. Case report: However, in this case report, we presented a case with operated laryngeal carcinoma whom we first had considered to have metastasis and who had received a diagnosis of aspergilloma in CT and Positron emission tomography (PET). Conclusion: Imaging findings may remain limited in definitive diagnosis of aspergilloma. Therefore, surgical resection will allow for both pathological diagnosis and treatment.

Relationship of rotator cuff tendon pathology with obesity, chronic diseases and steroid use -

Öz Purpose: To investigate the possible relationship between rotator cuff tendon pathologies detected with magnetic resonance imaging and obesity and chronic diseases. Materials and Methods: Two hundred and sixty seven patients, who underwent shoulder MRI between 2014 January and October 2014 for pain and limitation of motion in the shoulder, were reviewed retrospectively. Tendon pathology was detected in 153 patients and they were included in the study. Tendon pathologies were examined by two radiologists. Tendon pathologies were divided into 3 groups including tendinosis, partially rupture and full thickness rupture. Body mass index (BMI) values were calculated for all patients. The study group were divided into two groups as BMI <25 and ≥25. In addition, presence of diabetes mellitus and hypertension and possible steroid use was noted . Results: The average age of the patients were found to be 57±13 years. Statistically significant correlation was observed between age and all tendon pathology for all patients. A statistically significant positive correlation was observed between BMI and supraspinatus tendon tears ,wheras there was marginal relationship but no statistically significant correlation between BMI the infraspinatus tendon tears. Conclusion: In our study, statistically significant correlation was observed between the supraspinatus tendon pathology with increasing age and increasing BMI. Aging process can not be changed, however prevention of obesity may provide a positive contribution to the conservation of the rotator cuff tendon pathology. Amaç: Omuz manyetik rezonans görüntülemesinde, rotator cuff tendon patolojisi saptanan olgularda, bu patolojilerin obezite ve kronik hastalıklarla olası ilişkisini araştırmak Gereç ve Yöntem: Ocak 2014 ile Ekim 2014 tarihleri arasında ağrı ve hareket kısıtlılığı nedenleriyle omuz manyetik rezonans görüntüleme yapılmış 267 hastanın görüntüleri retrospektif olarak tarandı. Tendon patolojisi 153 hastada saptandı ve bunlar çalışmaya dahil edildi. Tendon patolojileri iki radyolog tarafından değerlendirildi. Tendon patolojileri; tendinozis, parsiyel yırtık, tam kat rüptür olarak 3 gruba ayrıldı. Tüm hastaların vücut kitle indeks (VKİ) değerleri hesaplandı. VKİ değeri < 25 ve ≥25 olacak şekilde hastalar iki gruba ayrıldı. Ayrıca diabetes mellitus ve hipertansiyon varlığı ile olası steroid kullanımı not edildi. Bulgular: Çalışmaya dahil edilen hastaların yaş ortalaması 57±13 yıl olarak saptandı. Tüm hastalar içinde, yaş ile tendon patolojileri arasında istatiksel olarak anlamlı korelasyon izlendi. Supraspinatus tendon yırtıkları ile VKİ arasında istatiksel anlamlı pozitif korelasyon izlenirken; infraspinatus tendon yırtıkları ile VKİ arasında istatiksel anlamlı olmayan marjinal bir ilişki saptandı. Sonuç: Çalışmamızda ilerleyen yaş ve artan VKİ değeri ile supraspinatus tendon patolojileri arasında istatiksel anlamlı korelasyon izlendi. Yaşlanma, değiştirilemez bir süreç iken obezitenin önlenmesi rotator kılıf tendon patolojilerinden korunmada olumlu katkılar sağlayabilir.

Unusual case of spinal epidermoid cyst and a concomitant spinal arachnoid cyst

A 38-year-old woman presented with a 12-month history of subjective weakness and pain in her legs. Thoracolumbar MRI revealed two spinal intradural cystic lesions at T5–6 and T11 levels, respectively. The lesion located at the T5–6 level was heterogeneously hyperintense on T2-weighted images and heterogeneously hypointense on T1-weighted images. This lesion showed high signal intensity on diffusion weighted MRI (DWI) and low signal intensity on apparent diffusion coefficient images (ADC). According to the MRI findings, we reported this tumour as a spinal epidermoid cyst. The pathology result suggested that the lesion was an epidermoid cyst. The second intradural lesion, at the T11 level, showed a hypointense signal on T1 and hyperintense signal on T2 images. However, in contrast to the superior lesion, this lesion was hypointense on DWI and hyperintense on ADC. We evaluated the second lesion as an arachnoid cyst according to the MRI findings.

Radiological Findings of Michel Aplasia.

Introduction: Congenital abnormalities of the inner ear is the most common cause of neurosensory hearing loss. Michel inner ear deformity is a rare developmental anomaly refers to the total aplasia of the inner ear. It is caused by developmental arrest of otic placode early during the third week of gestational age. Case report: We have discussed here that three year old girl diagnosed Michel aplasia with temporal bone computed tomography (CT) and temporal magnetic resonance imaging (MRI) findings.

A novel approach for manual de-torsion of an atypical (outward) testicular torsion with bedside Doppler ultrasonography guidance.

A 17-year-old boy presented with right testicular torsion to the lateral side. Torsion was diagnosed by physical examination; the colour Doppler ultrasonography (CDU) confirmed right testicular torsion with minimal peripheral hydrocele. Transverse and longitudinal examination of the spermatic cord with ultrasound and CDU revealed a counter-clockwise testicular torsion. Manual de-torsion was performed in a clockwise direction (720o) and testicular blood flow and the neutral position of the spermatic cord were confirmed by CDU. We did not encounter a residual twist of the spermatic cord upon surgical exploration. In our experience, ultrasound and CDU may predict the direction of testicular torsion and may allow appropriate management of cases prior to surgery.