Halil Donmez

Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms

PURPOSE The aim of this study is to compare the diagnostic performance of 16-row computed tomographic angiography (MDCTA) with digital subtraction angiography (DSA) for the detection and characterization of intracranial aneurysms in patients with nontraumatic subarachnoid hemorrhages (SAH). MATERIALS AND METHODS One-hundred and twelve consecutive patients with suspected intracranial aneurysm underwent both 16-row MDCTA and DSA. The MDCT angiograms were interpreted in a blinded fashion by using combination with VRI, MIP and MPR techniques. Sensitivity specificity and accuracy were calculated for the CTA and DSA. The results were compared with each other. The DSA readers interpretation was accepted as the reference standard. RESULTS A total of 164 aneurysms were detected at DSA in 112 patients, no aneurysms were detected by DSA and MDCTA in 16 patients. Eight aneurysms were missed by MDCTA. The overall sensitivity, specificity, and accuracy of MDCTA on a per-aneurysm basis were 95.1%, 94.1%, and 95%, respectively. According to the size of the aneurysm less than 3mm; sensitivity, specificity and diagnostic accuracy of MDCTA were 86.1%, 94.1%, 88.6%, respectively. CONCLUSION This study suggests that MDCTA is equally as sensitive as DSA in the detection of intracranial aneurysms of greater than 3mm, and it also reveals 100% detection rate for ruptured aneurysms.

Empty Sella may be the Final Outcome in Lymphocytic Hypophysitis

Introduction. Lymphocytic hypophysitis (LH) is an autoimmune disorder associated with the infiltration of the pituitary gland by lymphocytes leading to different degrees of hypopituitarism. Females are affected more frequently than males and the disease is usually associated with pregnancy or postpartum period. Case. We present a case of LH who was first diagnosed with diabetes insipidus and hyperprolactinemia. In the follow-up, the patient developed growth hormone, gonadotropin, and thyroid stimulating hormone deficiency. The typical appearance of increased stalk thickness and diffuse homogenous contrast enhancement of pituitary on magnetic resonance imaging resulted in empty sella by time. Conclusion. The present case demonstrates the natural course of LH over a 13-year period in which the empty sella was the final outcome.

Endovascular Treatment of Lower Limb Penetrating Arterial Traumas

Purpose:The purpose of this study was to evaluate the effectiveness of percutaneous arterial embolization in patients with penetrating peripheral arterial trauma.Materials and Methods:Twelve patients with penetrating peripheral arterial trauma were treated with percutaneous arterial embolization between 2002 and 2007. All injuries were secondary to penetrating stab wounds. Active bleeding (eight patients), recurrent bleeding episodes (one patient), persistent pain and mass (one patient), leg edema, claudication, swelling (one patient), local hyperemia, and pain (one patient) were the presenting symptoms. Microcatheter systems were used for catheterization. We used n-butyl cyanoacrylate mixture as the embolizing agent in all patients.Results:On angiograms the inferior gluteal artery (one patient), internal pudendal artery (one patient), perforating branch of the profundal femoral artery (six patients), superficial femoral artery (one patient), peroneal artery (two patients), and anterior tibial artery (one patient) were found to be injured. In all patients, the source of arterial bleeding could be reached, and a safe embolization was achieved. Nontarget embolization due to backflow of n-butyl cyanoacrylate mixture was detected in two patients and inguinal hematoma at the puncture site occurred in one patient.Conclusions:We conclude that embolization—particularly n-butyl cyanoacrylate embolization—is technically feasible in patients with penetrating peripheral arterial trauma.

Popliteal artery branching patterns detected by digital subtraction angiography.

PURPOSE To describe the popliteal and distal branching patterns detected by digital subtraction angiography. MATERIALS AND METHODS The popliteal branching patterns were analyzed in 535 extremities (270 right, 265 left). Of these, 226 limbs were evaluated bilaterally, while 83 were evaluated unilaterally. The branching patterns were classified according to the level of branching and the presence of hypoplasia or aplasia of the distal branches. RESULTS Four hundred and seventy-two (88.1%) limbs had a normal level of popliteal artery branching. Type IA was the most frequently encountered pattern. High division of the popliteal artery was seen in 30 (5.6%) limbs. Type IIA was the most frequently encountered pattern among these limbs. Type IIC was not seen. We encountered a new pattern characterized by high division of the peroneal artery with a trifurcation pattern and an anterior tibial artery with a proximal medial course and a distal lateral course. We called this pattern Type IID. Thirty-three (6.1%) limbs exhibited hypoplasia/aplasia of the distal branches. Type IIIA was the most frequently encountered pattern among these limbs. CONCLUSION Variations that occur in nearly 10% of patients should be understood because they may affect the choice of management strategy.

Direct CT Venography for Evaluation of the Lower Extremity Venous Anomalies of Klippel-Trénaunay Syndrome

OBJECTIVE Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trénaunay syndrome. CONCLUSION MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image.

Childhood Stroke: Results of 130 Children From a Reference Center in Central Anatolia, Turkey

BACKGROUND Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke. METHODS The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed. RESULTS Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis. CONCLUSION Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.

Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma

Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma.

Hyperbaric oxygen therapy for radiation‐induced brain necrosis in a patient with primary central nervous system lymphoma

A 45‐year‐old man who developed brain radionecrosis in the right frontal and left temporoparietal lobes after receiving whole brain radiotherapy and stereotactic radiosurgery for primary central nervous system lymphoma. Since high dose steroid treatment failed and he declined to undergo surgery, he was referred to hyperbaric oxygen (HBO) therapy. Both clinical and radiological findings improved after HBO therapy. Steroid requirements were also reduced. HBO therapy may have a potential value in treatment of brain radionecrosis. J. Surg. Oncol. 2009;100:732–735.

Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route

We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.

Giant gastroduodenal artery pseudoaneurysm due to polyarteritis nodosa as a cause of obstructive jaundice: imaging findings and coil embolization results.

Polyarteritis nodosa (PAN) is a rare vasculitis that affects the small and medium artery walls focally and is characterized mainly by polymorphonuclear leukocyte infiltration and fibrinoid necrosis. The female-to-male ratio is 1/2.5. It is thought that immune complexes are active in the starting mechanism; however, the triggering antigen has not been found yet. Ischemic necrosis of the arterial wall, thrombosis of the lumen, aneurysm formation, and hemorrhage associated with aneurysm rupture might occur in the course of time, with progression of the inflammatory reaction. Multiple-system involvement is a wellknown feature of the disease, and presentation varies with the system involved [1–7]. The gastrointestinal system (GIS) involvement is seen in 50% of the cases and hepatic and jejunal arteries are affected frequently [1, 7]. Although the disease causes various hepatobiliary complications [2, 6], to our knowledge, obstructive jaundice as a complication of PAN has not been mentioned previously in the literature. In this report, imaging findings and endovascular therapy results of a patient who has intrahepatic hemorrhage, obstructive jaundice, and a giant gastroduodenal artery pseudoaneurysm are presented.