Meltem Ceyhan Bilgici

Sonographic diagnosis of ascariasis causing small bowel obstruction

Acute right lower quadrant pain is a common, but nonspecific presenting symptom of a wide variety of diseases in children. Sonography (US) can play a significant role in the accurate and early diagnosis of right lower quadrant pain. In this article, we report a case of small bowel obstruction due to intestinal ascariasis diagnosed at bedside US and confirmed by MRI and describe a new US sign of intestinal ascariasis.

Structural brain alterations of Down's syndrome in early childhood evaluation by DTI and volumetric analyses.

AbstractObjectivesTo provide an initial assessment of white matter (WM) integrity with diffusion tensor imaging (DTI) and the accompanying volumetric changes in WM and grey matter (GM) through volumetric analyses of young children with Down’s syndrome (DS).MethodsTen children with DS and eight healthy control subjects were included in the study. Tract-based spatial statistics (TBSS) were used in the DTI study for whole-brain voxelwise analysis of fractional anisotropy (FA) and mean diffusivity (MD) of WM. Volumetric analyses were performed with an automated segmentation method to obtain regional measurements of cortical volumes.ResultsChildren with DS showed significantly reduced FA in association tracts of the fronto-temporo-occipital regions as well as the corpus callosum (CC) and anterior limb of the internal capsule (p < 0.05). Volumetric reductions included total cortical GM, cerebellar GM and WM volume, basal ganglia, thalamus, brainstem and CC in DS compared with controls (p < 0.05).ConclusionThese preliminary results suggest that DTI and volumetric analyses may reflect the earliest complementary changes of the neurodevelopmental delay in children with DS and can serve as surrogate biomarkers of the specific elements of WM and GM integrity for cognitive development.Key Points• DS is the most common genetic cause of intellectual disability. • WM and GM structural alterations represent the neurological features of DS. • DTI may identify the earliest aging process changes. • DTI-volumetric analyses can serve as surrogate biomarkers of neurodevelopment in DS.

A rare cause of acute abdominal pain: Herlyn-Werner-Wunderlich syndrome.

Abstract Twin partial hydatidiform molar pregnancy with a viable fetus is an uncommon occurrence. Presentations of molar pregnancies include vaginal bleeding, unusually elevated &bgr;-human chorionic gonadotropin level, and preeclampsia. Previous descriptions of twin molar and fetus pregnancies in the literature have been described in the outpatient obstetric setting. We present a case of partial molar pregnancy with a viable fetus detected with emergency ultrasound in a pediatric emergency department.Herlyn-Werner-Wunderlich (HWW) syndrome is a rare müllerian duct anomaly with uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. Patients with this syndrome generally present after menarche with pelvic pain and mass and, rarely, primary infertility in later years. Strong suspicion and knowledge of this syndrome are mandatory for an accurate diagnosis. A 14-year-old female patient presented with acute retention of urine and abdominopelvic pain. Her condition was diagnosed with the use ultrasonography and magnetic resonance imaging as a case of HWW syndrome. She was treated with vaginal hemiseptal resection. The HWW syndrome should be considered among the differential diagnoses in girls with renal anomalies presenting with pelvic mass, symptoms of acute abdominal pain, and acute urinary retention.

Role of Point Shear Wave Elastography in the Determination of the Severity of Fibrosis in Pediatric Liver Diseases With Pathologic Correlations

Our aims in this study were as follows: (1) to determine the cutoff value that can distinguish between advanced liver fibrosis and normal liver tissue for two different elastographic techniques; (2) to determine the cutoff value that can distinguish mild liver fibrosis from normal liver tissue for the techniques; and (3) to assess tissue stiffness in nonalcoholic fatty liver disease (NAFLD).

A case of tuberculous peritonitis in childhood.

Currently, tuberculosis remains a major public health problem worldwide. Peritoneal tuberculosis occurs in approximately 1% of all of tuberculosis cases and is rarely observed in children. Diagnosis and treatment delays caused by mimicking many other intra-abdominal diseases can lead to increases in morbidity and mortality. Here, we present a case of a four-year-old child with tuberculosis peritonitis who was diagnosed by laparoscopic biopsy and histopathological examination and recovered with antituberculosis therapy. Peritoneal tuberculosis should be considered in younger patients and adults with fever, abdominal pain and weight loss in endemic areas.

A very rare cause of neck pain: primary Ewing sarcoma of the axis.

We report the case of a 7-year-old boy who presented with a 1-month history of neck pain, left-sided torticollis, and no neurological deficit. Computed tomography and magnetic resonance imaging revealed an expansile lesion in the axis, with epidural and prevertebral soft tissue components. Histopathologic examination of the biopsy specimen revealed primary vertebral Ewing sarcoma. This is the first case of primary vertebral Ewing sarcoma that has presented with torticollis. It is essential for physicians to be familiar with this condition and the associated imaging findings because early diagnosis of such cases is the key to better prognosis.

Incidental Persistent Falcine Sinus

This 14-year-old boy was admitted with a two month history of headache. His examination was normal. Magnetic resonance imaging showed a normal brain parenchyma. In addition, an incidental falcine sinus was observed on T2-weighted sagittal images (Figure A). Contrast-enhanced T1-weighted axial images (Figure B) revealed that the sinus connected the junction of the middle and posterior thirds of the superior sagittal sinus and the straight sinus. The posterior third of the superior sagittal sinus was enlarged and the straight sinus was hypoplastic. A magnetic resonance venography confirmed the presence of the persistent falcine sinus between the straight and superior sagittal sinus (Figure C).

Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries

INTRODUCTION The aim of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (MRI) in the diagnosis of ovarian torsion. METHODS We retrospectively identified 84 patients with surgically confirmed ovarian torsion. Seventeen patients with unclear ultrasound findings underwent MRI examination with two different magnetic resonance (MR) systems. RESULTS In ovarian torsion, the mean apparent diffusion coefficient (ADC) value of the torsed ovary was significantly lower than that of the nonaffected ovary in both MR systems (n=17; 0.898±0.539 vs. 1.615±0.469×10(-3)mm(2)/s; P<.001). CONCLUSIONS ADC comparisons were useful for detecting ovarian torsion.

Epiploic Appendagitis as a Rare Cause of Acute Abdomen in the Pediatric Population: Report of Three Cases

Epiploic appendagitis, caused by inflammation of small adipose tissue on the colon wall, is a rare cause of acute abdominal pain in the pediatric population. It is nearly impossible to establish a specific diagnosis merely on the basis of clinical findings; thus, radiological evaluation is always necessary. In this report, we present the cases of three children with abdominal pain who were diagnosed with epiploic appendagitis. All cases were successfully treated with conservative management.

Does Type 1 Diabetes Mellitus Affect the Shear Wave Velocity of the Thyroid Gland of Children Without Autoimmune Thyroiditis

Objective The aim of this study is to evaluate the shear wave velocity (SWV) of the thyroid gland with acoustic radiation force impulse elastography in children with type 1 diabetes mellitus (T1D). Materials and Methods Between November 2015 and April 2016, 35 T1D patients who were referred to our hospitals endocrinology outpatient clinic (mean age, 11.88 ± 4.1 years) and 30 children (mean age, 11.3 ± 3.08 years) in the control group were enrolled in the study. Five acoustic radiation force impulse elastography measurements from each lobe of the thyroid gland in m/s were recorded. Diabetes age, hemoglobin A1c, and C-peptide levels were recorded in T1D patients. Statistical analyses were performed using SPSS version 21 (IBM Corporation, Armonk, NY). Results The mean SWV of the thyroid gland in T1D patients and the control group was 1.11 ± 0.21 and 1.29 ± 0.23 m/s, respectively. The mean SWV of the thyroid gland in T1D patients was lower than that in the control group and this was significant (P = 0.002). The mean SWV of the thyroid gland was not correlated with hemoglobin A1c level, body mass index, or the insulin dose in T1D patients. Conclusions The present study showed that T1D affects the thyroid gland stiffness even in patients without autoimmune thyroiditis. Acoustic radiation force impulse elastography may be a useful method in determining early changes in thyroid gland in T1D and may be used as a screening tool.