Ebru Düşünceli

Post-traumatic intrasplenic pseudoaneurysms with delayed rupture: color Doppler sonographic and CT findings.

Post‐traumatic intrasplenic pseudoaneurysms are very rare in children. Since pseudoaneurysms may expand a splenic hematoma and cause delayed splenic rupture, early diagnosis and treatment are crucial. In this report, we describe the case of a 12‐year‐old boy with a delayed splenic rupture caused by a splenic hematoma containing 2 pseudoaneurysms. Abdominal sonography showed free intraperitoneal fluid and a mildly enlarged spleen with a large heterogeneous area occupying the upper half of the organ. Two anechoic lesions (15 and 4 mm) were seen inside the hematoma near the splenic hilum. Color Doppler sonography demonstrated turbulent arterial flow within the lesions, suggesting pseudoaneurysms. On CT, the lesions enhanced simultaneously with the splenic artery in the arterial phase of contrast enhancement. CT also showed an intrasplenic arterial branch leading to the larger of the 2 pseudoaneurysms.

Lupus mastitis is not a surgical disease.

Abstract:  A 23‐year‐old woman with a 2‐year history of discoid lupus (SLE) presented with a right lateral upper quadrant breast mass. Physical examination revealed a 5 cm irregular, hard lesion suggestive of a breast malignancy. Ultrasound‐guided fine needle aspiration biopsy of the mass confirmed the diagnosis as lupus mastitis. Differential diagnosis of a breast mass in a patient with SLE must include the possibility of lupus mastitis. Surgical resection is usually not necessary, and medical treatment can be implemented successfully.

Is there an association between mastalgia and fibromyalgia? Comparing prevalence and symptom severity.

To determine the prevalence of mastalgia in patients with fibromyalgia (FM) and the prevalence of FM in patients with mastalgia in order to investigate coexistence, and to compare the pain patterns in the case of mastalgia or FM alone versus the two in combination. Fifty consecutive patients with mastalgia and 50 consecutive patients with FM were assessed and examined both for the existence and severity of mastalgia and FM. A high proportion of patients with mastalgia (36%) fulfilled the criteria for FM and 42% had mastalgia in the FM group. Two distinctive entities mastalgia and FM, being both unexplained pain syndromes, seem to frequently coexist. Patients with mastalgia or FM should be thoroughly questioned considering each of the diseases so that in case of coexistence an appropriate therapy might be implemented for a successful pain management.

Myoid hamartoma of the breast: a very rare entity.

A34-year-old woman was admitted to our clinic with a right upper quadrant breast mass. There was no family history of breast cancer and general risk assessment didn’t reveal any increased risk. A previous breast ultrasound was consistent of a heterogenous breast mass that was suspicious for breast carcinoma. On physical examination the mass was 6 cm, rubbery in content, and freely movable on palpation. With the suspicion of malignancy we performed a mammogram which showed a circumscribed mass with a thin capsule and ‘‘breast within a breast’’ appearance that was suggestive of a breast hamartoma (Fig. 1). Ultrasound examination demonstrated a heterogeneous hypoechoic lesion with minimally lobulated contour and a thin capsule (Fig. 2). Core biopsy of the mass revealed fibrous and adenomatoid pathology. Although the suspicion for malignancy was very low at that moment, given the fact that sometimes hamartomas may contain malignant tissue we offered lumpectomy to the patient.

Placement of an Inferior Vena Cava Filter in a Patient with Azygos Continuation Complicated by Pulmonary Embolism

A 53-year-old man presented with dyspnea, hemoptysis, and a painful, swollen left leg. During physical examination the left leg was tender. He had a history of inguinal hernia 1 month previously. Tests for thrombophilia, including protein C, protein S, antithrombin III, homocysteine, antiphospholipid antibody, and tumor markers, were all within normal limits. Thus, a thrombotic tendency was not detected. Duplex sonography of the lower extremities demonstrated multiple acute thrombi in the left deep venous system. The deep and superficial veins of the right leg were all patent. A contrast-enhanced CT scan showed extensive thrombosis in the right and left main pulmonary arteries, and lack of contiguity between the prerenal and the hepatic segments of the IVC. An enlarged azygos vein (Fig. 1) and a retroaortic left renal vein were also identified. The pulmonary and cardiac pattern did not show any congenital anomalies. A diagnosis of infrahepatic IVC interruption with azygos continuation was made. The patient was given anticoagulation therapy with intravenous unfractionated heparin and oral warfarin. He was discharged after a short hospitalization. However, 6 months later he returned to the hospital complaining of bilateral leg swelling and pain. Duplex sonography showed multiple thrombi in the deep venous structures of both lower extremities. Placement of an IVC filter for prophylaxis against PE was suggested because deep venous thrombosis (DVT) had progressed despite adequate anticoagulant therapy. A right transfemoral inferior vena cavogram performed with 6 Fr pigtail catheter to determine the level of the renal veins prior to filter placement, demonstrated the enlarged azygos vein draining into the superior vena cava (SVC) (Fig. 2). The right common femoral vein was used as a route for placement of a TrapEase filter (TrapEase, Cordis Europa, Roden, The Netherlands). A guidewire was directed, under fluoroscopic guidance, beyond the orifices of the renal veins into the enlarged azygos vein. The hemiazygos and paravertebral collateral veins were not enlarged. The TrapEase filter carrier was then passed over the guidewire, and the filter was discharged at the level of the third lumbar vertebra (Fig. 3). A final venogram revealed continued patency of the azygos vein following placement of the filter. In the 6 months since the placement of the filter, there has been no clinical evidence of pulmonary emboli. On follow-up abdominal radiographs, there has been no evidence of filter migration.

Effect of Carotid Artery Stenting on Ophthalmic Artery Flow Patterns

The purpose of this study was to assess the effect of carotid artery stenting on ophthalmic artery blood flow using transorbital color and spectral Doppler sonography and review the changes in relation to cerebral hemodynamics.

Axillary Cystic Hygroma

lowish nodule but may contain focal gray or pink areas They rarely exceed 2 cm in diameter Microscopic examination revealed mature adipose tissue separated by a branching network of small vessels. Vessels often appear as lobulated collections at the tumor periphery and may be plugged with hyaline thrombi, which are highly suggestive of the diagnosis. In 1974, Lin and Lin proposed strict pathologic criteria for the diagnosis of angiolipoma such as gross evidence of tumor formation with or without capsule, microscopic evidence of mature lipocytes consisting of at least 50% of the tumor, and microscopic evidence of angiomatous mesenchymal elements varies, and the degree of vascular proliferation ranges from less than 5% to more than 90% of the lesion. This subgroup of highly angiomatous lesions has been termed cellular angiolipoma when 90% of the lesion is highly cellular, vascular tissues. The diagnosis may be difficult in cases of cellular angiolipoma with low-grade angiosarcoma or Kaposi’s sarcoma because of the spindle cell areas associated with collapsed and patent blood vessels in these cases.

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sjögren's Syndrome: A Case Report

Sjögrens syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.