Çağlar Uzun

Spontaneous Coronary Artery Dissection in a Male Patient with Takayasu’s Arteritis and Antiphospholipid Antibody Syndrome

We present a case of a 34-year-old male who presented to the emergency ward with fever and abdominal pain. The diagnosis of Takayasus arteritis and also antiphospholipid syndrome was made during an imaging workup of deep-vein thrombosis. A spontaneous coronary artery dissection was revealed in coronary CT angiography requested for chest pain and dyspnea. The patient was treated medically and discharged on close followup. The concurrence of spontaneous coronary artery dissection with antiphospholipid syndrome and Takayasus arteritis has not been reported in the previous literature. The possibility of a spontaneous coronary artery dissection should be considered in patients presenting with both diseases.

Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies

PURPOSE We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODS We analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTS Diagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSION CT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.

Physical Effects of Unilateral Mastectomy on Spine Deformity

Micro‐Abstract As mastectomy is known to effect body posture, we evaluated the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination of 60 women taken before and 12 months after the mastectomy. The results indicated long‐term spinal deformation in women with unilateral mastectomy, suggesting informing patients of the possible change in body posture in the long‐term. Objective: Mastectomy is known to effect body posture after a change in the center of gravity of women due to a missing breast. Although previous studies on short‐term postural changes in mastectomy patients using photogrammetry or Moiré topography suggested ipsilateral inclination of the trunk, our clinical observations during breast reconstruction surgeries indicated a contralateral shoulder elevation in women with unilateral mastectomy. Because the change in body posture can affect spinal alignment, we aimed to evaluate the long‐term physical effects of unilateral mastectomy on spine deformity by radiographic examination. Methods: Posteroanterior chest radiographs of 60 women (mean age 56.3 ± 8.5 years) taken before and 12 months after the mastectomy were evaluated for Cobb angle and the presence or absence of a tilt from the midline in the coronal plane of vertebral body alignment. Results: Cobb angle decreased in 14 and increased in 38 of 60 patients after unilateral mastectomy, and the angular change was found to be independent of the mastectomy side (P < .001). A shift in Cobb angle to the mastectomy side was observed in 11 of 53 patients (P > .05), whereas a statistically significant shift in Cobb angle to the opposite of the mastectomy side was observed in 33 of 53 patients (P < .001). The results of this observational retrospective study indicated long‐term spinal deformation in women with unilateral mastectomy. Two patients with idiopathic scoliosis before mastectomy even developed scoliosis. Conclusion: We recommend informing the patients of the possible change in body posture in the long term, which should be supported or limited with physical therapy.

MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

Age estimation from primary teeth through virtual dental identification

Dental identification from tooth structures can offer a major contribution to forensic science in oral autopsy procedures. Recently, digital virtual examinations have been preferred instead of traditional operations. The aim of this research is to estimate the chronological age from primary teeth using computerised tomography images and to determine the best measurement from the axes of these images. This study was conducted on the dental images of 28 patients of known age (1–195 weeks) using the central teeth measurements that can be displayed on the two image axes. The results show that virtual dental identification from computerised tomography images is a reliable method. The best measurements for age estimation can be obtained from the longest vertical dimension in the sagittal plane, which is the tooth height (R2 =  96.4). Additionally, the best age estimation formula was generated from the tooth height with labio-lingual measurement (R2 = 98.1), where the margin of error of the mean predicted value was equal to ± 1.07 weeks. This age estimation formula can be applied up to two years of age, which is the completion of upper central primary tooth development. In conclusion, virtual dental identification procedures can be applied in cases of forensic odontology investigations.

Trifurcation of the Left Common Carotid Artery.

Summary Background Trifurcation of the common carotid artery is an unusual variation. Case Report We report a case of left common carotid artery trifurcation in a 74-year-old man. The left common carotid artery divided into the internal carotid, external carotid and facial arteries. Herein, the anatomy of the carotid arteries and the Doppler sonography and CT angiography findings of the left common carotid artery trifurcation were described with images. Conclusions The variations of the carotid arteries should be known to avoid and reduce the complications during the invasive procedures.

Additional Diagnostic Value of Inversion Recovery Single-Shot Fast-Spin Echo Sequence in Differentiation Between Hepatic Hemangiomas and Cysts.

Objective The aim of this study was to evaluate the additional diagnostic value of “inversion recovery” single-shot fast-spin echo (IR-SSFSE) sequence using the inversion time at the null point for hepatic hemangiomas as a supplement to standard T2-weighted (T2W) magnetic resonance imaging for the distinction of hemangiomas and cysts. Methods A total of 228 lesions in 56 patients were evaluated in this retrospective study. In addition to routine hepatic magnetic resonance imaging, IR-SSFSE imaging using inversion time value of 600 milliseconds (null point for hepatic hemangiomas) was obtained. Two radiologists independently reviewed T2W images at first and T2W images plus IR-SSFSE sequence 4 weeks afterward and used a 5-point scale to indicate the possibility of detected hyperintense lesion is a cyst or a hemangioma. A receiver operating characteristic analysis and &kgr; statistics were used to evaluate the diagnostic additive value of IR-SSFSE sequence for differentiation of hepatic hemangiomas and cysts, and to determine interobserver agreement, respectively. Results Among 228 lesions, diameters of which ranges from 2 to 125 mm (mean, 13.84 ± 16.24 mm), 56.14% of them (n = 128) were hemangiomas, and 43.86% of them were cysts (n = 100). In the receiver operating characteristic analysis for the differentiation of hepatic hemangiomas from cysts, the calculated area under the curve (AUC) for standard T2W images alone was 0.889 (95% confidence interval [CI], 0.825–0.953) for the first observer and 0.913 (95% CI, 0.861–0.965) for the second observer. When IR-SSFSE sequence was combined to T2W images, AUC was calculated as 0.958 (95% CI, 0.920–0.996) for the first observer and 0.980 (95% CI, 0.956–1.0) for the second observer. The AUC values obtained from standard T2W images and standard T2W plus IR-SSFSE images were significantly different for both observers (P < 0.01). Both observers demonstrate better performance in differentiating hemangiomas and cysts with a combination of IR-SSFSE sequence and T2W imaging than with T2W imaging alone. Adding IR-SSFSE sequence as a supplement to standard T2W images improved the sensitivity and the &kgr; values. Conclusions Inversion recovery single-shot fast-spin echo sequence using the inversion time to null signal from the hepatic hemangiomas as a supplement to standard T2W images is useful for distinguishing hemangiomas from hepatic cysts without the need for intravenous gadolinium chelate administration.

Polyacrylamide gel augmentation mammoplasty: Breast Images

A 36-year-old female with a history of polyacrylamide (PAA) gel augmentation mammoplasty complained of persistent bilateral mastalgia. Subsequently, a breast ultrasound examination was performed in December 2013. PAA gel was observed as large, multiple septa containing hypo-/anechogenic collections in intraglandular, retroglandular, and intrapectoral location. In March 2014, MRI was performed to further evaluate the extent and nature of this complication. It showed that the gel dissected the fibers of bilaterally enlarged pectoralis muscle which confirmed the suspicion of falsely gel injection into the muscle (Figure 1). A follow-up ultrasound examination in January 2015 showed no significant difference (Figure 2). Polyacrylamide gel is a hydrophilic, sterile, and gelatinous solution which consists of water (95%-97.5%) and acrylamid monomers (2.5%-5%). Polyacrylamide gel injection was first applied in China, Soviet Republic, South America, and Eastern Europe and provided a nonsurgical way of breast augmentation. However, a wide range of complications associated with this procedure like mastalgia, infection, fibroglandular atrophy, gel migration have been reported. In addition to these complications, a PAA gel injection can obscure breast malignancies by causing dystrophic calcifications. While this method has been forbidden in some countries like in China or Russia, it is still used in others like in Turkey.

Left ventricular inferoapical diverticulum associated with normal coronary arteries

Isolated congenital left ventricular (LV) diverticulum, which is characterized by the local failure of the ventricular muscle, is a rare cardiac abnormality with a reported prevalence of 0.4%. Clinically, it has been reported to follow an asymptomatic course in the majority of cases; however, it may cause heart failure, thrombus formation, arrhythmia, rupture or chest pain in some patients. Due to its asymptomatic course, it is difficult to diagnose an isolated LV diverticulum. Our patient was admitted to hospital with the complaint of typical chest pain and no any electrocardiogram ischemic changes. Transthoracic echocardiogram showed a diverticulum in the inferoapical wall. Coronary computed tomography angiography was performed, which revealed LV diverticulum at inferoapical region and normal coronary anatomy.

İntralüminal duodenal divertikül: Baryumlu grafi ve MRKP bulguları

Abstract: In this case, an intraluminal duodenal diverticulum, causing recurrent abdominal pain, is presented together with the duodenography and magnetic resonance cholangiopancreatography imaging findings. On magnetic resonance cholangiopancreatography and T2-weighted images, a fluid collection protruding into the duodenal lumen surrounded by a hypointense rim, the shape of which changed with peristalsis, was considered to be diagnostic for intraluminal duodenal diverticulum.