Aytekin Besim

CT virtual bronchoscopy in the evaluation of children with suspected foreign body aspiration

OBJECTIVE Computed tomography (CT) virtual bronchoscopy is a noninvasive technique that provides an internal view of trachea and major bronchi by three-dimensional reconstruction. The aim of this study was to investigate the usefulness of virtual bronchoscopy in the evaluation of suspected foreign body aspiration in children. MATERIALS AND METHODS Twenty-three children (12 girls, 11 boys) with a mean age of 2.4 years (8 months-14 years) who were admitted to emergency room with a suspicion of foreign body aspiration were included in this study. Chest radiograms, spiral computed tomography scans and virtual bronchoscopy images were obtained. Then, rigid bronchoscopy was performed within 24 h. RESULTS CT virtual bronchoscopy and conventional bronchoscopy revealed the location of the foreign body in seven patients. It was in the right main bronchus in four patients, in the right lower lobe bronchus in one patient, and in the left main bronchus in two patients. There was no discordance between two modalities. CT examination revealed hyperaeration of the ipsilateral lung in four patients, hyperaeration of the ipsilateral lung and mediastinal shift in one patient and bronchiectatic changes in one patient. CT detected no additional finding in one patient with a foreign body in the right main bronchus. In 10 of 16 patients without foreign body, CT examination demonstrated atelectasis, infiltration, peribronchial thickening, and paratracheal lymphadenpoathy. CONCLUSION Helical CT scanning with virtual bronchoscopy should be performed in only selected cases with suspected foreign body aspiration. When the chest radiograph is normal and the clinical diagnosis suggests aspirated foreign body, helical CT and virtual bronchoscopy can be considered in order to avoid needless rigid bronchoscopy.

Evaluation of Coronary Artery Disease by Computed Tomography Angiography in Patients Treated for Childhood Hodgkin's Lymphoma

PURPOSE To detect pathologies in coronary arteries by computed tomography angiography (CTA) in survivors of childhood Hodgkins lymphoma who have been treated with radiotherapy and/or cardiotoxic agents. PATIENTS AND METHODS Patients with HL who have been in remission for at least 2 years after completion of therapy were included. CBC, lipid profile, urine analysis, brain natriuretic peptide, troponin-T, creatinine kinase-myocardial band, ECG, telecardiography, echocardiography, and CTA of the patients were performed. Cardiac vascular abnormalities were noted. Results A total of 119 patients were included in the study. In 19 patients (16%), we found coronary artery abnormalities. There was a significant difference between the patients who received mediastinal radiotherapy and those who did not (P = .02). By multivariate analysis, in patients receiving mediastinal radiotherapy the risk of developing a coronary artery abnormality was found to increase 6.8 times compared with patients who did not receive mediastinal radiotherapy (P = .009). Stent implantation was performed in a 28-year-old patient because of critical stenosis in right coronary. In two patients some irregularities were detected both in CTA and conventional angiography, and they remained in close follow-up. A 22-year-old patient whose CTA showed critical stenosis in his left anterior descending artery refused the conventional angiography. CONCLUSION To our knowledge, this is the first large study using CTA for detection of coronary abnormalities in patients treated for HL in pediatric age group. Coronary CTA is a minimally invasive tool for early diagnosis of coronary artery disease in patients who were treated with mediastinal radiotherapy and/or cardiotoxic chemotherapy.

Spinal intradural hydatid cyst in a child

Hydatid disease is an infestation by the larval stages of Echinococcus granulosus. In man, the liver and lungs are the organs most frequently involved. In the spinal column, hydatid disease usually begins in the vertebral body. Extension into the spinal canal results in spinal cord compression. Intradural hydatid cyst is extremely rare compared with the other types of spinal hydatid lesions (Rayport et al, 1964; Ley & Marti, 1970; Pamir et al, 1984). A 6-year-old boy was admitted to hospital because of progressive paraplegia, which had started 2 months previously. He was said to have lost bladder and bowel control in the last few weeks. Physical examination revealed marked reduction in the motor power of the lower limbs. There was bilateral clonus, a positive Babinskis sign and hyperactivity of the deep tendon reflexes at the lower extremities.

Percutaneous transcatheter ethanol sclerotheraphy of postoperative pelvic lymphoceles

Although percutaneous procedures have been used for the treatment of lymphoceles, transcatheter sclerosing therapy has not been widely applied. We present the results of transcatheter sclerotherapy of lymphoceles with 96% absolute ethanol in 7 patients who had developed lymphocele after pelvic lymphadenectomy for uterine cancer. Seven of the eight lymphoceles (88%) completely disappeared after treatment. The duration of catheter drainage ranged from 4 to 21 days. Although one lymphocele did not resolve completely, it did not require surgery as the patient’s symptoms resolved.

Myocardial Bridging on MDCT

OBJECTIVE The aim of this study is to show the usefulness of MDCT in the diagnosis of myocardial bridging. Although most of the time myocardial bridging is a benign condition, it may be associated with myocardial ischemia and secondary complications. Therefore, it is important to be able diagnose the presence of myocardial bridging. CONCLUSION MDCT is an effective noninvasive method for the diagnosis of myocardial bridging because MDCT can show the length and the depth of the tunneled artery and the diameter and percentage of stenosis in the segments showing myocardial bridging in the systolic and diastolic phases. Moreover, MDCT is efficient in showing the presence of other coronary artery, myocardial, epicardial, and neighboring thoracic abnormalities.

MRI of the facial nerve in idiopathic facial palsy

The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bells palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to as equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment.

Malignant biliary obstruction complicated by ascites: Closure of the transhepatic tract with cyanoacrylate glue after placement of an endoprosthesis

A new technique using cyanoacrylate glue is suggested for closing the transparenchymal tract following metallic endoprosthesis placement in a patient with malignant biliary obstruction complicated by ascites. With this technique, complications related to bile reflux through the transparenchymal tract would be avoided after transhepatic endoprosthesis placement in patients who have ascites. This technique would also be useful for avoiding bleeding following transhepatic portal venous puncture.

Assessment of the Radial Artery and Hand Circulation by Computed Tomography Angiography: A Pilot Study

OBJECTIVES The radial artery (RA) is increasingly being used as a coronary bypass graft. Results of a previous study using Doppler ultrasound and histopathologic examinations indicated that the RA has a higher incidence of preexisting intimal hyperplasia, medial calcification, and atherosclerosis than the internal thoracic artery. The aims of this study were to evaluate the use of computed tomographic angiography (CTA) to display hand collateral circulation, to define the criteria for an abnormal CTA test result, and to demonstrate usefulness of CTA as an alternative to conventional angiography for evaluation of the radial artery. MATERIALS AND METHODS Sixteen patients scheduled for coronary artery bypass grafting entered this study. We performed 32 examinations of forearm and hand arterial anatomy in these patients. CTA was performed in patients with a normal Allen test result, except 1 patient who had a persistent median artery. Soft tissue density forehand roentgenography was performed in all patients before the CTA evaluation. There was no selection of patients in relation to patient characteristics. As a risk factor for radial artery calcification, 6 of the patients had diabetes mellitus, 6 had aortofemoral occlusive disease, and 4 had a history of smoking. RESULTS Bilateral forearm arteries were visualized in all patients. Severe RA calcification was found in 1 patient, and distal occlusion was found in another patient. Focal RA calcification was noted in 2 patients. In the remaining patients no radial artery calcification or occlusion was noted. Anatomic variation of the upper limb arteries was shown in 2 patients; these variations were persistent median artery with absence of the radial and ulnar arteries and high bifurcation of the radial artery from the brachial artery. CONCLUSION CTA is useful and safe for detection of radial artery calcific disease and assessment of the forehand circulation and its anatomic variations. Preoperative imaging of the RA is a means to avoid unnecessary forearm exploration or inadvertent use of a diseased conduit in coronary artery bypass candidates with multiple risk factors such as diabetes mellitus.

Treatment of a TIPS-Biliary Fistula by Stent-Graft in a 9-Year-Old Boy

Abstract We report a 9-year-old male cirrhotic patient with acute occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) due to a biliary-to-TIPS fistula which occurred 9 hr after the TIPS procedure. Immediate TIPS revision was performed and the fistula was treated by placement of an endoluminal stent-graft. At 12-month follow-up color Doppler examination demonstrated a patent shunt.

Endovascular Treatment of an Unusual Arterioportal Fistula Caused by the Rupture of a Giant Hepatic Artery Aneurysm into the Superior Mesenteric Vein in Behçet Disease

JVIR 2000; 11:465- 467 BEHCET disease is a rare, chronic, multisystem disorder with a variety of symptoms. It most often affects men between the ages of 20 and 40 years. Although it occurs worldwide, it oc- curs particularly often in Mediterra- nean countries, the Middle East, and Japan. The etiology of Behcet disease remains obscure. It is considered an autoimmune disease because of the common denominator of vasculitis in most patients. Histologic study of the affected vessels shows leukocytoclastic vasculitis, which leads to thrombosis, obstruction, aneurysm formation, and rupture of vessels. Arteries, capillar- ies, and veins of various sizes are af- fected. Behcet aneurysms may involve the whole arterial tree (1). We report a case of arterioportal fis- tula in a patient with Behcet disease, which resulted from spontaneous rupture of a giant hepatic artery aneurysm into the superior mesenteric vein (SMV).