Kaan Esen

Diabetic striatopathy in a patient with hemiballism

Diabetic striatopathy is a rare and life-threatening manifestation of diabetes mellitus. The disease commonly affects individuals of Asian descent, females, and the elderly. Patients usually present with hemiballism-hemichorea caused by nonketotic hyperglycemia. Hemiballism-hemichorea is defined as involuntary continuous random appearing movement involving one side of the body. This movement disorder may develop secondary to stroke, diabetic striatopathy, neoplasm, infection, Wilson’s disease, and thyrotoxicosis. Despite being rare, prompt recognition of a hyperglycemia-induced hemiballism-hemichorea is essential because the symptoms are reversible with correction of hyperglycemia. Diagnosis is possible based on blood analysis and neuroimaging findings. Laboratory tests reveal raised blood glucose and hemoglobin A1C levels which indicate poorly controlled diabetes. Neuroimaging provides suggestive findings of diabetic striatopathy which are hyperattenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging in the basal ganglia. In this case report, our aim is to present neuroimaging findings in an adult man with sudden onset of hemiballism associated with nonketotic hyperglycemia.

Nonodontogenic mandibular lesions: differentiation based on CT attenuation

Mandibular lesions are classified as odontogenic and nonodontogenic based on the cell of origin. Odontogenic lesions are frequently encountered at head and neck imaging. However, several nonodontogenic pathologies may also involve mandible and present further diagnostic dilemma. Awareness of the imaging features of nonodontogenic lesions is crucial in order to guide clinicians in proper patient management. Computed tomography (CT) may provide key information to narrow diagnostic considerations. Nonodontogenic mandibular lesions may have lytic, sclerotic, ground-glass, or mixed lytic and sclerotic appearances on CT. In this article, our aim is to present various nonodontogenic lesions of the mandible by categorizing them according to their attenuations on CT.

The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings

Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed.

Variations in the origins of the thyroid arteries on CT angiography

ObjectiveTo investigate the anatomical variations in the origins of the thyroid arteries on CT angiography images.MethodsThe presence and the origins of the superior thyroid artery, the inferior thyroid artery, and the thyroidea ima artery were retrospectively evaluated based on carotid CT angiography examinations. The bifurcation level of the common carotid artery with respect to the cervical vertebrae and disc spaces was also determined. A total of 640 patients were included in the study.ResultsThe right and left superior thyroid arteries arose from the external carotid artery in 413 (64.5%) and 254 (39.7%) patients, from the bifurcation of the common carotid artery in 131 (20.5%) and 148 (23.1%) patients, and from the common carotid artery in 90 (14.1%) and 226 (35.3%) patients, respectively. We could not observe the right and the left superior thyroid arteries in 6 (0.9%) and 12 (1.9%) of the patients, respectively. However, the right and left inferior thyroid arteries were not identified in 14 (2.2%) and 45 (7%) of the patients, respectively. The thyroidea ima artery was detected in 2.3% of the patients.ConclusionThe visualization of thyroid arteries on CT angiography images enables the anatomy of the arterial supply system of the thyroid gland to be explored in a noninvasive manner prior to surgery.

Adult presentation of symptomatic left lung agenesis

Pulmonary agenesis is a rarely encountered congenital anomaly, and its average prevalence is about 1 in 100,000 births. Anomalies of the cardiovascular, musculoskeletal, gastrointestinal, or genitourinary systems may accompany in nearly half of the cases. The diagnosis of pulmonary agenesis is usually made during childhood, but the diagnosis may be delayed until adulthood in case of an absence of comorbid anomalies . Herein, we present a case of pulmonary agenesis that was diagnosed during adulthood.

The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus

BACKGROUND The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. MATERIALS AND METHODS The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. RESULTS Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p < 0.001) and right side (p < 0.001). There was a statistically significant relationship between high renal artery origin and renal artery- -diaphragmatic crus contact at the left (p < 0.001) and right side (p = 0.01). The localisation of renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. CONCLUSIONS Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

Appendiceal mucocele due to mucinous cystadenocarcinoma arising from the appendiceal stump: preoperative diagnosis based on the “onion skin sign”

Appendiceal mucocele is defined as enlargement of the appendix due to the intraluminal accumulation of mucoid material. It is an unusual lesion with variable, nonspecific clinical manifestations. Imaging plays an important role in the diagnosis and evaluation of the mucocele. Preoperative diagnosis is mandatory for proper surgical intervention to prevent perforation and spillage of the mucinous material into the peritoneal cavity, which otherwise results in pseudomyxoma peritonei [1–3]. Development of a mucocele in a patient who previously underwent an appendectomy is an extremely rare entity, with only a few case reports in the literature [2–5]. In this paper, we report a case of a mucocele due to mucinous cystadenocarcinoma in a patient with a history of previous appendectomy who presented with acute abdomen-like symptoms. Preoperative diagnosis was made based on the sonographic ‘‘onion skin sign.’’

Hemolytic uremic syndrome and iga nephropathy in a child: coincidence or not?

Sürmeli-Döven S, Delibaş A, Gürses İ, Kayacan UR, Coşkun-Yılmaz B, Esen K, Korkmaz E, Özaltın F. Hemolytic uremic syndrome and IgA nephropathy in a child: Coincidence or not? Turk J Pediatr 2018; 60: 81-85. A previously healthy 18-month old boy, presenting with diarrhea, anemia, thrombocytopenia and acute renal failure was admitted to our hospital. Hemolytic uremic syndrome (HUS) was diagnosed with his clinical and laboratory findings. His stool was negative for Shiga toxin producing E. coli (STEC). During follow-up he developed respiratory distress, hypertrophic cardiomyopathy and seizure. His genetic tests for atypical HUS (aHUS) were negative. His clinical and histological findings indicated hemolytic uremic syndrome and immunglobulin A nephropathy (IgAN). The patient responded to steroid treatment and plasma exchange therapy with peritoneal dialysis. We discuss the probable connection between HUS and IgAN.

Stent-Assisted Coil Embolization of Posttraumatic Dissecting Carotid Aneurysm Causing Ophthalmoplegia

Summary Background Ophthalmoplegia secondary to a traumatic dissecting aneurysm in the cavernous segment of internal carotid artery (ICA) is a relatively rare entity. Anticoagulant or antiplatelet therapy is the preferred treatment option for carotid dissections. However, endovascular interventions are noninvasive and alternative methods to surgery, especially in cases of aneurysms that do not respond to medical therapy. Case Report We report of a 19-year-old man presenting with left-sided, total ophthalmoplegia after a traffic accident. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed a dissection beginning at the cervical segment of internal carotid artery (ICA) together with a dissecting aneurysm in the cavernous segment. A stent was placed in the narrowed and dissected segment of ICA, and the dissecting aneurysm of the cavernous segment was successfully managed with a stent-assisted coil embolization. After the endovascular treatment of the aneurysm, a full recovery of cranial nerve function was achieved. Conclusions Immediate diagnosis and appropriate therapy of dissecting aneurysms is necessary for good clinical outcomes in cases of ophthalmoplegia.

Bilateral thalamic lesions: A pictorial review

Bithalamic lesions are uncommon, however, both focal and systemic disorders may present bilateral abnormalities in the thalamus in different acute and chronic clinical situations. Neuroimaging, in particular magnetic resonance imaging, plays an essential role in diagnostic approach. Imaging features such as signal alterations, diffusion restriction or contrast enhancement are helpful in characterization of these abnormalities. The location of the lesions may provide key information because some pathologies typically involve a certain part of the thalamus. In addition to thalamic findings, neuroimaging findings in other parts of the brain associated with the clinical and laboratory information should be taken into account to make a correct diagnosis.