Caner Özer

HRCT evaluation of the accessory fissures of the lung

INTRODUCTION The purpose of this study was to classify the accessory fissures of the lung and to assess their frequency by using high-resolution CT. METHODS AND PATIENTS HRCT scans of 115 patients were prospectively reviewed. 1 mm thin sections were obtained at 10 mm intervals with a scan time of 1.9 s. The fissure and its relationship to the segmental bronchovascular structures were then evaluated on transverse sections. RESULTS Forty-four accessory fissures were detected in 35 of 115 patients. The most common accessory fissure was the inferior accessory fissure (12%). The second most common accessory fissure was the left minor fissure (8%). The right superior accessory fissure (5%), the accessory fissure between the medial and lateral segments of the right middle lobe (5%), and the accessory fissure between the superior and inferior segments of the lingula (5%) were seen in equal frequencies. Also, intersegmental accessory fissures, namely the fissure between the anterobasal and laterobasal of both the right (1%) and the left (2%) lower lobes were detected. We found only one subsegmental accessory fissure. DISCUSSION AND CONCLUSION The inferior accessory fissure and the left minor fissure were the most common accessory fissures in our study.

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.

Coexistence of osteopoikilosis and discoid lupus erythematosus: a case report.

Abstract: Osteopoikilosis is an uncommon, benign sclerosing bone dysplasia characterised by typical roentgenographic findings and usually seen in patients with dermatological problems. We report a case of osteopoikilosis and discoid lupus erythematosus presenting with skin and mucosal involvement, an association that has never previously been reported. We also discuss the differential diagnosis and the clinical pathologies accompanying osteopoikilosis in the literature.

Antrolithiasis: a retrospective study.

In this retrospective study, the computed tomography (CT) archives of paranasal sinus examinations were reviewed and three cases of antroliths are presented. The archives of paranasal sinus CT studies of 1957 patients (1023 females, 934 males, mean age 36.5 years) were surveyed. CT studies were performed using 3 mm collimation and interval in the coronal, axial or both coronal and axial planes. Three out of 1957 patients demonstrated antroliths, all in the left maxillary sinus. Associated sinusitis was detected in all three patients. Only one patient was operated. The chemical analysis of the antrolith revealed it to be a calcium oxalate stone. All the relevant literature is reviewed and only 25 other cases of true antrolithiasis were encountered. The clinical and radiological features of antroliths, as well as differential diagnosis were discussed. Antrolithiasis should be considered in any case of sinusitis, that does not respond to appropriate medical therapy.

Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis

Pulmonary toxicity and blood dyscrasias are rare side effects of sulfasalazine. Pulmonary pathology is variable, the most common being eosinophilic pneumonia with peripheral eosinophilia, and interstitial inflammation with or without fibrosis. We here present the case of a 68-year-old female patient treated for 6 months with sulfasalazine for rheumatoid arthritis. On laboratory examination, eosinophil count was 97×103 mm3. Thorocoscopic biopsy was performed . Histopathologic diagnosis was bronchiolitis obliterans organizing pneumonia (BOOP). This is the first case in the literature to present with sulfasalazine-induced BOOP in a patient with seronegative RA.

Two episodes of anuria and acute pulmonary edema in a losartan-treated patient with solitary kidney.

Atherosclerotic renal artery stenosis (RAS) is an increasingly important cause of end-stage kidney disease, and may cause hypertension, progressive renal failure, and recurrent pulmonary edema. Herein, we report two episodes of anuria and acute pulmonary edema associated with losartan treatment in a hypertensive patient with preexisting severe renal artery stenosis in a solitary kidney. After successful percutaneous renal balloon angioplasty procedure, urine flow was started immediately, despite 10 days of anuria. Blood pressure measurements were still at acceptable levels with a low dose Β blocker, and serum creatinine levels were normal even after eight months. PTRA should be done in such patients, even with prolonged anuria. Physicians who recommend angiotensin receptor blockers in patients with RAS, especially in patients wih hypovolemia or a solitary kidney, should be careful about this complication.

Disseminated pneumocephalus secondary to an unusual facial trauma

Pneumocephalus can be secondary to a postintrathecal procedure, sinus fracture, basilar skull fracture, congenital skull defect, neoplasm, gas producing organism, barotrauma, neurosurgery, paranasal sinus surgery, mask or nasal continuous positive-airway pressure. Unusual facial traumas can also be rare causes of pneumocephalus. Here, we present such a case in whom an air compressor tip injury to both eyes led to the disseminated pneumocephalus. We report this rare case with the computed tomography findings and try to explain the possible mechanism of the pnemocephalus.

Primary diffuse tracheobrochial amyloidosis: case report

Respiratory amyloidosis is a rare disease that occurs in three forms: tracheobronchial, nodular parenchymal and diffuse parenchymal involment. Tracheobronchial amyloidosis is characterized by focal or diffuse deposition of amyloid in the submucosa of the trachea and proximal bronchi. Herein, we report a case of diffuse tracheobronchial amyloidosis with plain radiography and thorax computed tomography findings.

Bilateral adrenal cystic neuroblastoma with massive hepatomegaly and intracystic hemorrhage

To The Editor: Cystic neuroblastoma (CNB) is a rare form of this tumor which is characterized by a large cystic lesion and microscopic cysts, and is frequently located in the adrenal gland. It has a little tendency to metastasis and it has an excellent prognosis if early diagnosis can be made [1–10]. Furthermore, bilateral adrenal CNB is an extremely unusual presentation of NB which may represent a second primary tumor or a contralateral metastasis [4]. Most of the patients with CNB are under 1 year of age. Moreover, massive intratumoral hemorrhage, hepatic metastases, and advanced clinical stage are also rare clinical findings. The differential diagnosis of a cystic suprarenal mass is difficult since it occurs not only in CNB, but also in adrenal hemorrhage, enteric cyst, extralobar sequestration, dilatation of upper-pole renal calyces, congenital adrenal cyst, cystic Wilms tumor, and adrenal abscess [2–4]. A 19-day-old girl, being born in another hospital, was admitted to our hospital with the symptoms of paleness, respiratory distress, and abdominal distention. Physical examination revealed tachycardia, tachypnea, hepatomegaly, and a large left-sided abdominal mass. Laboratory findings were as follows: hemoglobin 5.6 g/dl, serum lactate dehydrogenase 1,367 U/L, neuron specific enolase 56 ng/ml, ferritin 220 ng/ml, and urine vanillylmandelic acid 29.5 mg/day. Bone marrow infiltration with tumor cells (8%) was also found. Thorax CT revealed geometric shaped subpleural densities in the lungs consistent with atelectasis. Furthermore, CT scan of the abdomen showed bilateral adrenal cystic mass lesions with intracystic echogenities and fluid levels, suggesting intracystic hemorrhage. Besides hepatosplenomegaly, multiple hypodense lesions conforming to metastases in the liver were also observed (Fig. 1). Radionuclide bone scan was negative. Clinical diagnosis was congenital bilateral CNBwith liver metastases. However, lung metastases were also suspected. Since primary surgery could not be performed, chemotherapy was initiated. On the 8th day of chemotherapy, the patient died of extensive hepatic involvement, which caused respiratory and inferior vena cava compromise. Histopathologic examination revealed neuroblastoma cells at the wall of the almost entirely hemorrhagic cystic masses with favorable histology according to the Shimada classification, and lung, liver, and spleen involvement (Fig. 2). DNAcontent, N-myc expression, and allelic loss of chromosome 1p could not be obtained. Differentiation between adrenal hemorrhage and adrenal CNB is especially important because the treatment of hemorrhage is generally conservative. Although intratumoral hemorrhage is common in CNB, massive symptomatic hemorrhage is a rare finding [1,4,6]. To our knowledge, there have been only three reported cases with bilateral adrenalCNBwith intracystic hemorrhage [4,6,8]. In the newborn, reported by Lee et al. [4] the presence of the liver metastases made differential diagnosis easier as in our case. Since the other two reported cases with bilateral CNB which were diagnosed after the first month of life did not have liver involvement, the differential diagnosis of adrenal hemorrhagewas difficult [6,8]. MR imaging seems to be a good alternative radiological method in this differential diagnosis [6,9]. Most patientswithCNBare diagnosed in the early stage of disease with an excellent long-term prognosis, except patients with stage IV disease, hydrops, or massive hepatomegaly [2,3,10]. Only 9.7% of cases with CNB have metastatic disease at diagnosis [7]. When present, as in our case, the fetal liver is themost common site [5]. Two of three reported children with bilateral CNB had stage IVS, but one patient had stage IV disease. In children with CNB, less aggressive management may be warranted in the absence of stage IV disease. Some authors recommend that prenatally suspected non-metastatic CNB should undergo surgical intervention, unless tumor size decreases within about 1 month after birth [2,9]. While chemotherapy is necessary for advanced disease, as in our case, radiotherapy may be used in patients with unresectable or incompletely resected tumors [4]. One of two reported cases with bilateral CNB of stage IVS, to whom only surgical resection was performed, was lost to follow up,

Heterotopic pregnancy: case report

AbstractHeterotopic pregnancy in a spontaneous cycle is a rare entity with an estimated frequency below one per 30,000 pregnancies. Its incidence evidently has increased in accordance with the widespread use of in vitro fertilization and ovulation induction. We report a case of heterotopic pregnancy in a 40-year-old woman who presented with acute abdominal pain. We also present findings from transvaginal ultrasound imaging.