L. Oktay Erdem

Radiological characteristics of pulmonary hydatid disease in children Less common radiological appearances

OBJECTIVE To evaluate the chest roentgenogram and CT characteristics of pulmonary hydatid disease (PHD). MATERIAL AND METHODS Forty-seven (27 male and 20 female, aged between 3 and 11 years) consecutive pediatric patients with surgically proven pulmonary hydatid cysts were enrolled for the study. Posteroanterior and lateral chest roentgenograms, CT of the chest, and laboratory findings (latex agglutination, Casoni skin test, and eosinophil count) were obtained from all of the patients. The radiological features (localization, internal architecture, number, diameter) were determined. RESULTS On CT examination, a total of 79 cysts were determined. On chest roentgenogram, 57 of 79 cysts were detected in all patients. Single cysts were seen in 33 patients, while multiple cysts were seen in 14. Median CT density of the cysts was 21 Hounsfield units (HU) (0-80). There were six giant cysts (>10 cm of cyst diameter). The crescent sign, water lily sign, and air-fluid level were seen in two, five and eight of the cysts, respectively. Apart from the classically described features of pulmonary hydatid cysts of the lung, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was detected in three cysts. All of the liquid content of the cyst was expelled to the bronchial system (dry cyst sign) was observed in seven cysts. There were two infected cysts. Heavily calcified curvilinear cyst wall was present in one cyst. Pericystic reaction in the lung tissue was observed in five patients. Other features included pleural effusion (n=2), mediastinal shift (n=6) and atelectasis (n=7). CONCLUSIONS Chest roentgenogram is helpful for diagnosis of intact cysts but, it is impossible to define entire morphology of the complicated cysts. CT imaging recognize certain details of the lesions and discover others that are not visible by conventional radiography. In conclusion, CT examination should be done to elucidate cystic nature of the lung mass and for accurate localization in the preoperative period. In addition, inverse crescent sign should be recognized as feature of pulmonary hydatid cysts on CT.

Ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge

Ceftriaxone is known to induce precipitates that mimic a gallstone on sonograms in the gallbladder of children and adults. Terms such as ‘biliary pseudolithiasis’ are now used to denote the reversible, benign character of this complication upon discontinuation of ceftriaxone therapy. 1–3 The first sonographic demonstration of precipitates forming in the gallbladder during ceftriaxone therapy was reported by Schaad et al . in 1986. 3 In subsequent reports, biliary sludge or biliary pseudolithiasis, has frequently been reported with this antibiotic. 1,2,4 Ceftriaxone-induced urinary calculi are rarely observed. Six cases of ceftriaxone urinary calculi have been published. 1,4–7 In this study, we report a case who developed ceftriaxone-induced biliary pseudolithiasis and urinary bladder sludge, which were completely resolved after the ceftriaxone treatment ceased. To our knowledge ceftriaxone-induced urinary bladder sludge has not been reported previously. In this case, we report the first documented case of ceftriaxone-induced urinary bladder sludge.

Gallbladder and urinary tract precipitations associated with ceftriaxone therapy in children: a prospective study

Abstract The incidence and outcome of gallbladder and urinary tract complications in children receiving ceftriaxone therapy were evaluated prospectively. The subjects were given intravenous ceftriaxone, 100 mg/kg/day, in two divided doses infused over 20–30-minute periods, for 5–14 days. Serial abdominal ultrasonography revealed gallbladder and urinary tract precipitations in five of 35 children, three of whom had gallbladder pseudolithiasis, one gallbladder sludge and one gallbladder pseudolithiasis and urinary bladder sludge. The children who had gallbladder sludge and gallbladder pseudolithiasis with urinary bladder sludge had abdominal pain, nausea and vomiting. Three children remained symptom-free. The gallbladder precipitations were found after 4–9 days of ceftriaxone therapy, and resolved completely 7–19 days after the end of treatment. The urinary tract precipitation was found on the 5th day after cessation of ceftriaxone therapy and resolved 7 days later. Ceftriaxone-associated gallbladder pseudolithiasis, gallbladder sludge and urinary bladder sludge usually resolve spontaneously and physicians should be aware of these complications so as to avoid unnecessary therapeutic procedures.

Radiologic aspects of abdominal hydatidosis in children A study of 31 cases in Turkey

OBJECTIVE To determine the location and radiological characteristics in children with abdominal hydatid disease (HD). MATERIALS AND METHODS Thirty-one children (average age: 7.2 years) with abdominal HD were studied. The number, location, diameter and internal architecture of the cysts were assessed with abdominal ultrasonography (US) and computed tomography (CT). Density measurements and enhancement patterns were determined on CT. RESULTS Twenty-one children had hepatic HD. The remaining 10 children had both hepatic and extrahepatic cysts. There were splenic cysts in five children, peritoneal cysts in two children and combined splenic and peritoneal cysts in three children. The most common site of the cysts was the liver (64%), followed by the spleen (20%) and the peritoneal cavity (16%). The seven intraabdominal cysts, which were not detected by US, were 20 mm or less in diameter. CONCLUSION CT may demonstrate additional small intrahepatic or unsuspected extrahepatic cysts. Although rare, splenic or peritoneal hydatidosis should be included in the differential diagnosis of a cystic splenic or peritoneal lesion. Familiarity with atypical locations of HD may be helpful in making a prompt, accurate diagnosis. We think that in particular patients, especially those who had diagnostic problem and who are under surgical planning, CT should be performed additionally.

Internal Jugular Phlebectasia: Usefulness of Color Doppler Ultrasonography in the Diagnosis

Jugular phlebectasia (JP) is an entity that has been increasingly recognized in recent years. It is a rare entity. This paper reports three new cases presenting with swelling on the right side of the neck, and reviews all cases of internal JP published in English literature up to 2001. This article also discusses the usefulness of color Doppler ultrasonography for the diagnosis of internal jugular venous ectasia.

Case Report: Intrapancreatic Lipoma and Morgagni Hernia: A Previously Unrecognized Association

Focal fatty masses of the pancreas include pancreatic lipoma, teratoma, liposarcoma, and focal fatty infiltration (1). Intrapancreatic lipomas are very rare conditions which have been reported in 14 cases (2–9). Morgagni hernias are rare diaphragmatic hernias which usually contain omental fat and bowel (10). The liver and stomach are found less commonly in the hernia contents (11). Herein, we reported the first case of an incidentally found intrapancreatic lipoma in association with a Morgagni hernia that contained the left lobe of the liver and stomach diagnosed by computed tomography (CT) in an adult patient. Related literature is also discussed.

Splenic Vein Aneurysm Demonstrated by Magnetic Resonance Angiography

Splenic vein aneurysm (SVA) is an extremely rare vascular abnormality (1, 2). We report a SVA in a rheumatoid arthritis (RA) patient which was demonstrated by Doppler sonography, contrast-enhanced computed tomography (CT), and magnetic resonance angiography (MRA). The present case is the tenth SVA patient reported in the English literature. Furthermore, this is the first case of a SVA which was demonstrated by MRA. The literature regarding this entity is discussed and the characteristic MR angiographic appearance of a nonthrombosed splenic vein aneurysm is presented.

Intratesticular Varicocele Concomitant With Spermatocele

Varicocele is an abnormal dilatation of the veins of the pampiniform plexus. Intratesticular varicocele, characterized by dilated intratesticular veins, is an extremely rare disorder. This is the second reported case of intratesticular varicocele demonstrated by using power Doppler sonography. Spermatocele is a common benign retention cyst most often located in the caput epididymis. This is the first intratesticular varicocele case concomitant with spermatocele. The authors believe that power Doppler sonography and gray-scale sonography are effective, rapid methods in the diagnosis of intratesticular varicocele and spermatocele.

Unusual Sonographic Appearance of Scrotal Calculi Without Hydrocele

Scrotal calculi are rare benign lesions of the scrotum. Scrotal calculi associated with hydrocele are occasionally reported, but to the best of the authors’ knowledge, scrotal calculi without hydrocele have not been previously reported. In this study, three cases of scrotal calculi without hydrocele are presented.

A Technique Developed by a Morbidly Obese Patient to Eat More Despite an Adjustable Gastric Band

A woman who had undergone gastric banding is described. In her non-compliance, she developed a subxiphoid pressure maneuver to empty her stomach and permit further intake.