Ismet Tolu

Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis

The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis.

The role of Onodi cells in sphenoiditis: results of multiplanar reconstruction of computed tomography scanning.

INTRODUCTION Onodi cells are the most posterior ethmoid air cells and extend superolateral to the sphenoid sinus. These cells are also intimately related with the sphenoid sinus, optic nerve, and carotid artery. Radiologic evaluation is mandatory to assess for anatomic variations before any treatment modalities related to the sphenoid sinus. OBJECTIVE To evaluate the effect of Onodi cells on the frequency of sphenoiditis. METHODS A retrospective analysis was performed in 618 adult patients who underwent high-resolution computed tomography between January 2013 and January 2015. The prevalence of Onodi cells and sphenoiditis was evaluated. Whether the presence of Onodi cells leads to an increase in the prevalence of sphenoiditis was investigated. RESULTS Onodi cell positivity was observed in 326 of 618 patients and its prevalence was found to be 52.7%. In the study group, 60.3% (n=73) were ipsilaterally (n=21) or bilaterally (n=52) Onodi-positive, whereas 39.7% (n=48) were Onodi-negative (n=35) or only contralaterally Onodi-positive (n=13). Of the control group, 48.3% (n=240) were Onodi-positive and 51.7% (n=257) were Onodi negative. The co-existence of Onodi cells ipsilaterally was observed to increase the identification of sphenoiditis 1.5-fold, and this finding was statistically significant (p<0.05). CONCLUSION The prevalence of sphenoiditis appears to be higher in patients with Onodi cells. However, it is not possible to state that Onodi cells are the single factor that causes this disease. Further studies are needed to investigate contributing factors related to sphenoiditis.

Post-traumatic leptomeningeal cyst in a child: computed tomography and magnetic resonance imaging findings.

A 3-month-old male infant presented with growing scalp swelling. The growing soft mass was located on the posterior vertex of his head. The swelling was compressible but not tender. Physical examination was normal. There was no neurologic deficit. His health history indicated that he had fallen when he was 1 month old. There was a linear fracture in the occipital bone (Figure 1A) and a cystic lesion was detected on computed tomography (CT) (Figure 1B). The lesion was isointense to cerebrospinal fluid (CSF) in all sequences at magnetic resonance imaging (MRI) (Figure 1C and 1D).

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

Objective The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE). Materials and Methods Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI). Results PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001). Conclusion PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.

Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques

ObjectivesThis retrospective study aims at demonstrating the success rate, effectiveness, and advantages of alcohol as a scolicidal and sclerosing agent for the percutaneous treatment of liver hydatid cysts.MethodsA total of 554 liver hydatid cysts obtained from 347 patients admitted between January 2008 and February 2016 were retrospectively investigated. Of these, 435 (78.5%), 91 (16.4%), and 28 (5%) were classified as Gharbi type 1, 2, and 3, respectively. Type 1 and 2 cysts were treated using PAIR (puncture, aspiration, injection, respiration) and single puncture catheterization methods; type 3 lesions were treated using a modified catheterization technique. Alcohol was used as a scolicidal and sclerosing agent in all procedures.ResultsAfter excluding three lesions (0.5%) because of lack of parenchymal support during catheterization, 274 (49.7%), 250 (45.3%), and 27 (4.9%) of 551 lesions were treated with PAIR, single puncture catheterization, and modified catheterization techniques, respectively. Therefore, a 99.5% of technical success rate was obtained. Major complications in 2 patients (0.5%) and minor complications were observed in 36 patients (10.3%). Mean hospital stay was 1.55±2.3 days (range: 0-23 days). Patients were followed-up for mean 19.6 months (range: 6-83 months), during which recurrences were detected in 19 patients (5.4%).ConclusionsThe use of alcohol as a scolicidal and sclerosing agent during the percutaneous treatment of liver hydatid cysts is associated with a high success rate and low rates of recurrence and complications, and should be considered an important alternative to surgical procedures.

Sphenoethmoid Cell: The Battle for Places Inside of the Nose Between a Posterior Ethmoid Cell and Sphenoid Sinus: 3D-Volumetric Quantification

Background: Sphenoethmoid cells may be above the sphenoid sinus with/ or without con-tact to optical nerve. Although sphenoethmoid cells are theoretically considered to possibly influence the sphenoid sinus volume, we could not find any study in the literature on this issue. Aims: The aim of our study was to detect sphenoethmoid cells and measure the sphenoid sinus vol-ume using multiplanar computerized tomography and also investigate the correlation between the presence of sphenoethmoid cells and the sphenoid sinus volume. Methods: Retrospectively 141 patients who had available paranasal computerized tomography images were included in this study. The sphenoid sinus volumes of each patient were calculated individually for each side, and the relationship between the presence of sphenoethmoid cell and sphenoid sinus volume was investigated. Results: Sphenoethmoid cells were detected at 106 (37.5%) of the total 282 sides in 141 patients. No gender difference was observed. The total sphenoid sinus volume was significantly lower in the group of patients who had bilateral sphenoethmoid cells than in the sphenoethmoid cell negative group. In patients with a unilateral sphenoethmoid cell, a significant decrease in the sphenoid sinus volume was observed only for the side where the sphenoethmoid cell was located. Conclusion: It was observed that the sphenoethmoid cells caused a significant reduction in the sphe-noid sinus volume on the side where they were located. In the case of low sphenoid sinus aeration, the sphenoethmoid cell should be kept in mind. Further studies with an extended patient series are required to explore this issue.

Thoracolumbar intramedullary lipoma without dysraphism causing paraplegia in a pediatric patient

A 6-month-old infant was admitted to our hospital with absence of movement in his legs. During a physical examination, lower extremity muscle strength was found to be 1 out of 5 bilaterally. Also, there was no response to sensory testing. Spinal ultrasonography was performed and showed an intramedullary mass filling the spinal canal containing echogenic linear septations with subcutaneous fatty tissue (Fig. 1). Spinal magnetic resonance imaging (MRI) was performed to more clearly investigate spinal abnormalities. Lumbar MRI showed an intramedullary mass causing expansion of the cord between T10 and L4 and measuring 83 × 17 × 16 mm. The lesion was hyperintense in T1and T2weighted images. There was no enhancement after intravenous contrast administration. Additionally, suppression was seen in fat-suppressed images. Lipoma was diagnosed with typical imaging findings (Fig. 2). No other dysraphism finding was detected in the spinal MRI.

Amyand's Hernia: Ultrasonography Findings.

BACKGROUND Amyands hernia is described as the presence of an appendix vermiformis in the inguinal hernia sac. The incidence of Amyands hernia is approximately 1% of all inguinal hernias. Amyands hernia is diagnosed intraoperatively or preoperatively with radiologic examinations. CASE REPORT Two cases of Amyands hernia, with and without acute appendicitis, are reported here. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Amyands hernia is a rare entity, and physical signs, laboratory results, and symptoms are not always helpful in diagnosis. Preoperative diagnosis of Amyands hernia is not straightforward, and is generally an incidental finding during surgery. Imaging modalities, including ultrasound, can be very useful for making this rare diagnosis.

Primary Retroperitoneal Hydatid Cyst

CASE PRESENTATION A 47-year-old male patient was admitted to our hospital with abdominal pain and abdominal mass on periumbilical region. There were no urologic and gastrointestinal symptoms. On physical examination, a mass was detected in the periumbilical region where mild tenderness was also found. Laboratory findings were normal. Contrast-enhanced abdominal tomography revealed a large retroperitoneal mass with multiloculation suggestive of hydatid cyst (Figure 1, star). The lesion compressed adjacent structures. The pancreas was placed anteriorly and the superior mesenteric artery laterally by the lesion (Figure 1, arrows). Computed tomography examination there were no other lesions on computed tomography examination. The patient was treated with surgery, and hydatid cyst diagnosis was verified with cytological examination. Hydatid cyst is caused by Echinococcus granulosus, and the disease is endemic in some regions. The disease mostly affects the liver and lung; other organ involvement is rarely seen. Retroperitoneal involvement with hydatid disease is very rarely seen, and the prevalence is reported less than 1%. The diagnosis is made with serologic and radiologic methods. Ultrasonography, computed tomography and magnetic resonance imaging are the modalities used in the diagnosis of hydatid disease.