Aylin Hasanefendioglu Bayrak

MDCT Findings of Denim-Sandblasting-Induced Silicosis: a cross-sectional study

BackgroundDenim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis.MethodsSixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images.ResultsSilicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients.ConclusionsThe duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

The frequency of intracranial arterial fenestrations: A study with 64-detector CT-angiography

Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

Evaluation of interlobar and accessory pulmonary fissures on 64-row MDCT

We aimed to describe the prevalence, morphology, and completeness of the oblique, horizontal, and accessory fissures on 64‐row multidetector computed tomography (MDCT) scans. Three hundred and eighty‐seven patients were included in this study. The lungs were scanned from apex to diaphragm using 1‐mm collimation. Images were evaluated on a Philips workstation using the PACS system. Prevalence of the interlobar and accessory fissures and also incompleteness of the interlobar fissures was evaluated on axial, coronal, and sagittal planes. The frequencies of right oblique fissures, right horizontal fissures, and left oblique fissures were 99.7%, 94.8%, and 100%, and the percentage of incompleteness was 69.7%, 86.9%, and 48.3%, respectively. Accessory fissures were detected in 164 of the 387 patients (42.4%). Pulmonary fissures are well visualized on MDCT because of its capacity in evaluating the whole thorax with thin sections and at various planes. Fast‐image acquisition in MDCT also accounts for less motion artifacts and high‐image quality. Clin. Anat. 23:552–558, 2010.

Diameters of normal thoracic vascular structures in pediatric patients

PurposeTo determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference.MethodsContrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated.ResultsThere was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent.ConclusionsDiameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.

Factor X Deficiency Presenting with Bilateral Chronic Subdural Hematoma

Factor X deficiency is a rare coagulation defect that can result in several hemorrhagic manifestations including central nervous system hematomas in infants and children. In this case report, we present computed tomography (CT) and magnetic resonance (MR) imaging findings of bilateral chronic subdural hematomas due to factor X deficiency. Cranial CT and MR imaging in a hypoactive 7-month-old male infant with right hemiparesis revealed bilateral chronic subdural hematomas at different stages. Laboratory findings showed a severe factor X deficiency, with a level of 0.7%. After fresh frozen plasma replacement, the patient was operated and the large hematoma on the left side evacuated. The patient recovered uneventfully and remained asymptomatic during the 1-year follow-up.

Percutaneous transluminal angioplasty in pediatric patients with Takayasu arteritis: comparison of initial and long- term results of interventions on aorta and non-aortic vessels.

Takayasu arteritis (TA) is a chronic inflammatory condition of the aorta and other major vessels that usually results in stenosis, occlusion, dilatation, or the formation of aneurysm. The studies on long-term results of percutaneous transluminal angioplasty (PTA) in pediatric patients with TA are limited (1-3). Furthermore, there is no study that compared PTA results of large and medium vessels. Herein we report 15 pediatric TA cases treated with PTA for stenotic lesions of the aorta, renal arteries, celiac truncus and superior mesenteric artery. The aim of this study is to compare initial and longterm results of PTA in largeand medium-sized vessel. Between August 1992 and January 2007, 15 pediatric TA cases with significant stenosis (≥60% stenosis of vessel diameter) of the aorta and/or non-aortic vessel involvement were treated with PTA. Fifteen cases (9 girls, 6 boys; age range 2.5 months18 years; median age, 12 years) were included. Informed consent was obtained from all parents. Although unilateral access was preferred, in two cases, bilateral femoral artery access was used with kissing balloon technique to reduce trauma to the common femoral artery (Table 1). For PTA procedures of the aorta, while inflating the balloon in aorta, renal arteries were protected by keeping the guide-wire in them (3). In cases with severe stenosis (case 6 and case 12), “graded dilatation” was performed to reduce the risk of rupture (Table 1). It means dilatation by gradually increasing balloon diameter. If residual stenosis was less than 40% during the immediate post-PTA arteriogram, the procedure was considered technically successful. Clinical results were based on symptoms, pulses and blood pressure values and were judged as cured, improved or failed. The procedure was considered clinically successful if the clinical results were rated as cured or improved (3). During follow up period, symptomatic patients with suspicious imaging findings were evaluated with diagnostic angiography whether the presence of recurrence (stenosis rate ≥50%). The paired sample t-test, independent samples t-test and the Pearson’s Chi-square test (Epi Info 2000 CDC, Atlanta, USA) were used for deciding about significance of differences for mean preand post-PTA stenosis, technical success of the procedures, rate and time of recurrences, primary patency rate (continued patency without subsequent intervention) and secondary patency rate (continued patency after any necessary intervention) between two groups. During the initial PTA procedures, 13 of the 15 stenotic aorta segments, and 23 of the 26 stenotic non-aortic vessel segments were successfully dilated (Fig.1, 2). In case 4, poor clinical result was observed due to technically unsuccessful dilatation of both the aorta and renal arteries. Case 1 died as the result of an arrhythmia due to hypertrophic cardiomyopathy within 24 hours of PTA. All the remaining cases were clinically successful (Table 1). The follow-up period was 4-168 months (mean: 53.7±65.88 months). Repeated procedure was performed in 6 recurrent cases (Table 1). Overall, 12 of the 15 stenotic segments of the aorta and all the non-aortic vessels were successfully dilated. Due to the small number of cases, statistical evaluation was not performed for clinical results: however, the outcomes are presented in Table 1. The comparison of PTA results between groups are listed in Table 2.

Cervical spinal meningioma mimicking intramedullary spinal tumor.

Study Design. Case report. Objective. To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. Summary of Background Data. Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. Methods. A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1–C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. Results. At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. Conclusion. Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.

Occult bleeding of small bowel: endovascular embolization and literature review

Blackwell Publishing Asia Melbourne, Australia CDD hines Journal of Digestive Diseases 1443-9611 751-2980