Fatih Alper

Detection of myocardial bridging with ECG-gated MDCT and multiplanar reconstruction.

OBJECTIVE The aim of this study was to evaluate the incidence of myocardial bridging in 626 patients examined with MDCT angiography of the coronary arteries. MATERIALS AND METHODS Six hundred twenty-six patients who were referred to Florence Nightingale and Atatürk University Hospitals were involved in this study. These patients had atypical chest pain, symptoms suggestive of coronary artery disease, or no significant cardiac complaint. Patients were in sinus rhythm and were premedicated with metoprolol tartrate (5 mg/mL IV bolus) to decrease the heart rate and nitroglycerin (5 mg sublingual 1 min before the examination) to dilate the coronary arteries. MDCT was performed on two different 16-MDCT scanners. RESULTS Among the 626 patients, 22 cases (3.5%) of myocardial bridging were detected. Fifteen cases of myocardial bridging (2.4%) were located at the middle third of the left anterior descending coronary artery (LAD), five (0.8%) were at the distal third of the LAD, and two (0.3%) were at the proximal third of the LAD. In these patients, the length of tunneled artery was between 6 and 22 mm, with a mean of 17 mm, and the depth of tunneled artery was between 1.2 and 3.3 mm, with a mean of 2.5 mm. CONCLUSION We found the incidence of myocardial bridging in this patient group to be 3.5%. This result is in agreement with some of the angiographic studies in the literature. Our study showed that MDCT is a reliable and noninvasive tool for diagnosing coronary myocardial bridging. After evaluating resource axial images, it is necessary to also evaluate the sagittal multiplanar reconstruction images for myocardial bridging.

Importance of Anatomical Asymmetries of Transverse Sinuses: An MR Venographic Study

Time-of-flight (TOF) magnetic resonance venography (MRV) is often used to examine the intracranial dural sinuses, particularly in the evaluation of dural sinus thrombosis. The goal of the study was to evaluate the use of TOF MRV in assessing the normal anatomy of dural sinuses and their variations as sources of potential pitfalls in the diagnosis of venous sinus thrombosis. Cerebral TOF MRV obtained in 105 persons with normal MR studies were reviewed to determine the presence, aplasia and hypoplasia of the transverse sinuses. Twenty-one (20%) aplasias of the left sinus, 41 (39%) hypoplasia of the left sinus, 33 (31%) symmetric, 6 (6%) hypoplasia of the right sinus, and 4 (4%) aplasias of the right sinus cases were determined in the asymmetry in sizes of transverse sinuses. These results suggested that transverse sinus flow gaps or aplasias can be observed in approximately 24% of normal population on MR imaging. The rate of these gaps in normal subjects must be kept in mind because it can be a source of misdiagnosis in cases of suspected dural sinus thrombosis.

An epidemic of silicosis among former denim sandblasters.

Sandblasting denim using silica has emerged as a new cause of silicosis in Turkey. Following the discovery of several cases of silicosis in (young) workers who used this process, the frequency and main occupational risk factors of silicosis among former denim sandblasters in the region of Erzurum (Turkey) were evaluated. Demographic characteristics and information on working conditions were obtained by questionnaire and interview. In addition, spirometry testing was performed and chest radiographs were evaluated according to International Labour Office (ILO) classification of pneumoconioses in 157 former denim sandblasters. All subjects were male, with a mean (range) age of 23 (15–44) yrs. They had worked for a mean (range) of 36 (1–120) months, starting employment at a 17 (10–38) yrs of age. Most subjects (83%) had respiratory symptoms, especially dyspnoea (52%) but also chest pain (46%). Radiological evidence of silicosis (ILO score 1/0 or higher) was present in 77 (53%) out of 145 subjects with interpretable chest radiographs. These subjects had lower forced expiratory volume in one second and forced vital capacity. The risk of silicosis correlated with seniority (i.e. working as a foreman), exposure duration and number of places of work. Considering the high prevalence rate of silicosis in such workplaces, further problems are inevitable in the future unless effective measures are taken.

Angulation, Length, and Morphology of the Styloid Process of the Temporal Bone Analyzed by Multidetector Computed Tomography

Purpose: To investigate the angulation, length, and structural variations of the styloid process (SP) by multidetector computed tomography (MDCT). Material and Methods: MDCT scans were performed in 283 cases (127 M and 156 F, age range 18–77 years). The length of the SP and its angulation on the transverse and sagittal planes were measured. Structural variations of the SP were observed by means of three-dimensional (3D) and multiplanar reconstruction (MPR) images. Results: The length of the bony SP on both sides varied from 0 to 62 mm (mean 26.8±10.0 mm). Angulation ranged between 55° and 90.5° (7 2.7±6.6) in the transversal plane and between 76° and 110° (93.5±6.9) in the sagittal plane. Morphologically, the SP showed a considerable amount of variation. A solitary SP was present in 168 individuals (59.4%). In 9 individuals (3.1%), the SP was duplicated (4 unilateral and 5 bilateral). Sixty-one persons (21.6%) showed an incomplete ossified SP (42 unilateral and 19 bilateral), whereas in 7 individuals (2.5%) a bony SP was absent entirely (7 unilateral). In 38 individuals (13.4%), the stylohyoid ligament was ossified (16 entirely, 22 partial). In all individuals, 3D and MPR images showed the SP in its entire length. Conclusion: MDCT with 3D CT and MPR of SP may show further detailed information related to SP. Not only the length of the SP, but also its 3D orientation, should be in focus in anatomical and clinical studies.

Intussusception in Adults

Abstract To review clinical, radiological and histopathological findings of adult intussusception and its management, 18 adult patients who had been treated surgically because of intussusception were reviewed. Of the patients, 5 (27.8%) had idiopathic intussusceptions, while the other 13 (72.2%) had a definable intraluminal pathology. The site of the intussusception was more common in the small bowel (83.3%) than the colon (16.7%). Ultrasonography and computed tomography were successful in demonstrating “target lesion” in 80% and 75% respectively. Patients with idiopathic intussusception were treated with simple reduction, while the others underwent segmental resection because of the possibility of malignant tumour. In contrast to intussusception in childhood, intussusception in adults usually has a definable lead point and resection of the involved bowel, rather than simple reduction, is indicated.

The spectrum of radiographic findings in primary hyperparathyroidism

The aim of this study was to assess the spectrum of radiographic findings in primary hyperparathyroidism (PHPT). The study group consisted of 16 women and 7 men whose Ca levels were at least two or three times higher than normal. The average age was 55.3 in women and 49.4 in men. We detected carcinoma in 1, hyperplasia in 1, multiple adenomas in 4, single adenoma in 17 patients. The most common finding in the skeletal system was the decreased bone mineral density (BMD) and the complete loss of the lamina durae dentium. BMD was found lower in women than in men. This result attributed the increased number of postmenopausal patients in our study group. The second most common finding in our study group was subperiosteal bone resorption. Brown tumors (BTs) were located at maxilla in one, widespread in one, mandibula in two, long tubular bones in four patients. Renal stone disease was found in five, spastic colon in two, gastric ulcer in one, mitral valve calcification in one patients. We demonstrated no pathologic changes consistent with PHPT in remaining seven patients.

CT findings in silicosis due to denim sandblasting

The purpose of this study was to describe the findings of CT performed on denim sandblasters with silicosis. Fifty consecutive male patients with silicosis were evaluated. Their clinical data and pulmonary function tests (PFT) were obtained. The CT findings were recorded and the correlations between CT nodular profusion score and the other parameters were assessed. The diagnoses of the patients were classified as accelerated silicosis (n = 43) and acute silicosis (n = 7). The most common CT finding was centrilobular nodules. Twenty-three patients had complicated silicosis based on pleural involvement and presence of progressive massive fibrosis (PMF). Lymphadenopathy (LAP) was positive in 50% of the patients, with calcification in 24%. The CT grade was highly correlated with the clinical data such as exposure duration and PFT. Our findings suggest that the clinical manifestation of silicosis in denim sandblasters is severe. Although the duration of exposure is shorter the rate of complicated silicosis patients with pleural involvement was unexpectedly higher in the cases. Because the most common radiological appearance was nodules and the CT grading of the nodules was highly correlated with the clinical data, nodule grading may be used in the management of such cases.

Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review.

Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral. Although this entity is frequently asymptomatic and firstly detected on the chest radiography, it may be difficult to distinguish a partial eventration from the other diaphragmatic lesions or mediastinal pathologies on the chest radiographs. US may present valuable information about diaphragm integrity with eventration content or the other diaphragmatic pathologies. Although the other imaging modalities such as fluoroscopy, computed tomography, and MR imaging may be performed as adjunct techniques in cases of the diagnosis still in doubt, they are frequently unnecessary after US. Our goal is to present imaging features and management of this entity together with a literature review.

Anaphylaxis due to a rupture of hydatid cyst: Imaging findings of a 10-year-old boy

Anaphylactic shock as a result of trauma is very rare. We report the clinical and radiologic findings of a 10-year-old boy who developed systemic anaphylaxis due to traumatic rupture of hepatic hydatid cyst into a pericystic blood vessel. In regions where hydatid disease is endemic, rupture of a hydatid cyst might be taken into consideration in patients who have post-traumatic anaphylactic shock. Likewise, this pathology should be kept in mind when evaluating an immigrant from an endemic area in nonendemic regions.

Spinal widespread intradural extramedullary hydatidosis.

Spinal hydatid cyst is an uncommon but serious condition. Intradural presentation is extremely rare. The case reported herein describes an unusual recurrent hydatidosis with progression of recurrence and spreading into intradural extramedullary field.