Mahmut Oğuz

Vein of Galen and sinus thrombosis with bilateral thalamic infarcts in sickle cell anaemia: CT follow-up and angiographic demonstration.

A 2-year-old boy with known sickle cell disease presented in acute coma. CT revealed bilateral thalamic infarcts and incomplete sinus thrombosis. Angiography confirmed thrombosis of the straight sinus and vein of Galen.

Biliary tuberculosis mimicking cholangiocarcinoma: treatment with metallic biliary endoprothesis.

A 58-yr-old patient who presented with obstructive jaundice was evaluated with ultrasonography (US), computed tomography (CT), and percutaneous transhepatic cholangiography (PTC). Diffuse irregular stenosis of the extrahepatic bile ducts and periductal ill-defined soft tissue density along the hepatoduodenal ligament was determined. The patient was originally misdiagnosed with cholangiocarcinoma and, because the extent of disease process made surgical bypass impossible, was treated with a percutaneously inserted metallic stent. Histopathological examination of the endoluminal biopsy revealed ductal tuberculosis (TB). Most of the previous reports in the literature indicated that biliary obstruction was due to enlarged tuberculous lymph nodes compressing the bile duct. To our knowledge, only three cases of biliary stricture due to tuberculous involvement of the bile ducts were reported previously. This case illustrates the importance of tissue diagnosis in all cases of obstructive jaundice to avoid missing rare but curable diseases.

Hepatic endometrioma: a case report and review of the literature.

Abstract. Extrapelvic endometriosis is not uncommon but hepatic endometrioma is extremely rare. Ultrasound, CT and MR features of hepatic endometrioma are discussed and the literature is reviewed in this report.

Biliary–enteric fistulas: report of five cases and review of the literature

Abstract. Internal biliary fistulas (IBF) are seen rarely. Because the symptoms and signs of IBF are not specific and the diagnosis is not suspected, these patients are commonly investigated with plain abdominal films (PAF), ultrasonography (US), upper gastrointestinal series (UGIS), barium enema (BE), and computed tomography (CT), but not always with endoscopic retrograde cholangiopancreatography (ERCP). The purposes of this article are (a) to attract attention of radiologists to presumptive findings of IBF, so as not to misdiagnose this unsuspected and rare disease, and (b) review of the literature while presenting radiologic features of our cases. Five cases of IBFs in which extrahepatic biliary tree communicating with duodenum (four cases) and colon (one case) are reported. Diagnostic work-up of cases were done by PAF, US, UGIS, BE, and CT. Aerobilia, which cannot be explained using other means, ectopic gallstone and small bowel dilatation, nonvisualization of the gallbladder despite no history of cholecystectomy, and thick-walled shrunken gallbladder adherent to neighboring organs were suggestive findings of IBF in our study. Knowledge of imaging findings suggestive of IBF and a high index of suspicion increase the diagnostic rate of IBFs.

Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82 (65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients’ survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective.

Color doppler ultrasonography of renal vascular resistance in sickle cell disease: Clinical implications

The major complications in sickle cell disease (SCD) are microcirculation lesions and impairment of renal function. The aim of this study was to evaluate renal vascular resistance by means of color and duplex ultrasonography (CDU) and its relationships with hematological and clinical features in patients with SCD. Forty patients with SCD (mean age 22.4±7.0) and 14 age- and sex-matched healthy subjects (mean age 25.7±9.5) were included in the study. CDU of the main renal, segmental, and interlobar arteries was performed in both kidneys in all patients and controls. Peak systolic, end diastolic, and mean velocities through the entire cardiac cycle were obtained with further calculation of resistive (RI) and pulsatile (PI) indices. All the patients were investigated in stable state condition and had not been transfused within a month before investigation. Patients had a 6-month follow-up. Patients with SCD had higher RI and PI values than control subjects (p<0.0001,p<0.0001, respectively). Patients with high RI values (RI>0.70) had more pronounced disturbances of blood parameters (allp<0.05) than patients with normal RI values (<0.70). The significant positive correlation between RI and ISC number, MCHC level (r=0.52,p<0.001 and r=0.42,p<0.01), as well as RBC and Hgb level, correlated inversely with RIs (r=−0.39,p<0.01 and r=−0.42,p<0.01). During the follow-up, in nine patients (33.3%) with high RIs and one (5.5%) with normal RIs developed painful crises. In conclusion, renal vascular resistance, assessed by CDU is raised in SCD patients as compared with age-matched, apparently healthy persons. These changes are more pronounced in those with more severe manifestations of disease and correlated with hematological and clinical features of sickle cell disease.