Mesut Ozturk

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.

Contribution of 3-T Susceptibility-Weighted MRI to Detection of Intraarticular Hemosiderin Accumulation in Patients With Hemophilia

OBJECTIVE The purpose of this study was to assess the feasibility of 3-T susceptibility-weighted imaging (SWI) for detecting intraarticular hemosiderin accumulation in patients with hemophilia. SUBJECTS AND METHODS Forty-one joints in 24 patients with hemophilia were imaged with conventional MRI and SWI sequences. Two experienced musculoskeletal radiologists and one general radiologist (reader 3) interpreted the images for hemosiderin accumulation. The final decision was determined in consensus by readers 1 and 2 using both conventional MRI and SWI sequences. The diagnostic consistencies of each MRI sequence with the reference and pairwise agreements between interpreters were assessed. RESULTS For conventional MRI sequences, the diagnostic consistencies of the two experienced musculoskeletal radiologists with the reference were substantial (κ = 0.63 and 0.62), whereas the consistency of the general radiologist with the reference was moderate (κ = 0.47). The SWI interpretations of all readers had almost perfect agreement with the reference (κ = 1, κ = 1, κ = 0.97). Interobserver agreement also improved at SWI interpretations. CONCLUSION SWI contributes to more accurate grading of intraarticular hemosiderin accumulation than is achieved with conventional MRI sequences.

The role of ARFI elastography to evaluate microstructrual changes of patients with testicular microlithiasis

Background Testicular microlithiasis (TML) is thought to cause microstructural changes in the parenchyma of the testis, but it is difficult to demonstrate this by ultrasonography. It may be possible to evaluate microstructural changes in the testis by Acoustic Radiation Force Impulse (ARFI) elastography, which measures tissue stiffness. Purpose To assess the tissue stiffness of testicles of children with TML and to compare them with the healthy control group. Material and Methods Between November 2015 and May 2016, 25 pediatric patients with TML and 24 healthy children were enrolled in the study (mean age for TML and control group 6.7 ± 3.17 and 7.9 ± 4.18 years, respectively). Testicular volumes and mean shear wave velocity (SWV) values were calculated and compared with each other in both groups. Results There was no significant difference in average testicular volumes between the TML group and the control group (1.14 cm3, 1.21 cm3, respectively; P = 0.986). Mean SWV of the testicles with TML and normal testicles with control group was 1.18 ± 0.22 cm/s and 0.88 ± 0.11 cm/s, respectively. The SWV of the testicles with TML was higher than the normal testicles and this was statistically significant (P < 0.001). Conclusion This study has shown that tissue stiffness in patients with TML is increased compared to the normal population. ARFI elastography helps the early detection of microstructural changes in TML and can be used for screening and follow-up.

A rare cause of acute abdomen in the ED: Chemotherapy-induced pneumatosis intestinalis

Pneumatosis intestinalis (PI) and portomesenteric venous gas (PVG) refers to the presence of air within the intestinal wall and portomesenteric vessels. Most of the time, it is associated with mesenteric ischemia that requires immediate surgical intervention as it has high mortality rate. It may also be seen secondary to various conditions, including infections, surgeries, and some chemotherapeutic drugs. A 61-year old-male was admitted to our emergency department complaining of abdominal pain after chemotherapy. Radiological evaluation of the patient demonstrated massive PVG and PI. Patient underwent urgent surgery due to the possibility of intestinal ischemia and infarction, but no necrosis was identified Chemotherapeutic drug-induced PI and PVG was the final diagnosis. Although PI and PVG are signs of mesenteric ischemia and intestinal necrosis most the of time, chemotherapeutic drugs may also cause PI and PVG rarely. Recent history of chemotheraphy and absence of any mesenteric vascular occlusion may be the diagnostic clue.

Background Parenchymal Enhancement and Fibroglandular Tissue Proportion on Breast MRI: Correlation with Hormone Receptor Expression and Molecular Subtypes of Breast Cancer

OBJECTIVE To assess the relationship between background parenchymal enhancement (BPE) and fibroglandular tissue (FGT) proportion on breast magnetic resonance imaging (MRI) and hormone receptor expression and molecular subtypes in invasive breast cancer. MATERIALS AND METHODS This retrospective study enrolled 75 breast cancer patients who underwent breast MRI before treatment. T1-weighted images were reviewed to determine the FGT proportion, and contrast-enhanced fat-suppressed T1-weighted images were reviewed to determine BPE. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2-neu (HER2) status, and molecular subtypes of the tumors were compared with the BPE and FGT proportions. RESULTS Women with high BPE tended to have increased rate of ER and PR positive tumors (p=0.018 and p=0.013). FGT proportion was associated with ER positivity (p=0.009), but no significant differences between FGT proportion and PR positivity were found (p=0.256). There was no significant difference between HER2 status and any of the imaging features (p=0.453 and p=0.922). For premenopausal women, both FGT proportion and BPE were associated with molecular subtypes (p=0.025 and p=0.042). FGT proportion was also associated with BPE (p<0.001). CONCLUSION In women with invasive breast cancer, both high FGT containing breasts and high BPE breasts tended to have ER positive tumors.

Spontaneous thrombosis of a giant cerebral varix in a pediatric patient

IntroductionCerebral cortical venous aneurysm also known as cerebral varix is a rare entity that usually occurs in relation to high-flow draining veins of arteriovenous fistulas, arteriovenous malformations, and venous angioma. Isolated cerebral varix is an extremely rare entity.Case reportWe present a 1-year-old male with isolated cerebral varix. During follow-up, the varix thrombosed spontaneously without causing any neurological deficits.ConclusionTo the best of our knowledge, spontaneous asymptomatic thrombosis of an isolated cerebral varix without any clinical finding was reported for the first time in the literature.

Thoracic spinal epidural capillo-cavernous hemangioma causing back pain

A 69-year-old man presented to our outpatient clinic with a 2-year history of backache that was getting worse within the last 2 months. On admission, his neurologic examination was completely normal with no muscle weakness or numbness in the lower extremities. There was no history of trauma, deformity, weight loss, or bladder or bowel dysfunction. A magnetic resonance imaging scan revealed an extraosseous, epidural tumoral mass spanning the T7 through T9 levels, located dorsal to the spinal cord. It was isointense on T1-weighted images and hyperintense on T2-weighted images. Contrast-enhanced axial (Fig. 1) and sagittal (Fig. 2) T1-weighted images demonstrated significant enhancement of the lesion. T7–T9 posterior laminectomy was performed, and a soft reddish well-demarcated lesion was found in the epidural space. Total excision was performed as the lesion had no relation with the nerve roots and bones, making it easily cleavable. The final histopathologic diagnosis was capillocavernous hemangioma. Epidural location of the cavernous hemangioma is rare, and most hemangiomas are the expansion of vertebral lesions into epidural space. Purely epidural cavernous hemangiomas are extremely rare.

Solitary anterior cervical canal neurofibroma causing neck pain.

A 51-year-old man who complained of worsening neck pain for the last 2 months was admitted to our clinic. Neurologic examination was normal. Magnetic resonance imaging revealed an intradural extramedullary well-defined mass lesion extending the left neural foramina and located anterior cervical canal at the level of the C2 vertebra (Figure). The lesion was hyperintense on T2-weighted sagittal images and showed poor enhancement on contrast-enhanced images. Myelopathic signal changes were present owing to the compression of the spinal cord by mass. Surgical resection was performed. The final pathologic diagnosis was solitary neurofibroma. The patient was relieved from neck pain after surgery. Hediye Pinar Gunbey, MD Tumay Bekci, MD Kerim Aslan, MD Mesut Ozturk, MD Lutfi Incesu, MD Faculty of Medicine, Department of Radiology Ondokuz Mayis University 55200 Samsun, Turkey

Caesarean Scar Choriocarcinoma: Ultrasound and Magnetic Resonance Imaging Findings

Primary gestational choriocarcinoma in a uterine caesarean section scar (CSS) is an extremely rare entity, and its timely diagnosis and treatment is crucial in order to prevent related complications and metastatic disease. Herein, we report on a 33-year-old female who was referred to our department with an initial diagnosis of ectopic pregnancy. Transabdominal ultrasound and magnetic resonance imaging (MRI) demonstrated a nodular mass on CSS. The final histopathological diagnosis was CSS choriocarcinoma.

Angiolipoma of the Breast: Multi-modality Imaging Findings.

than 200 ng/mL, sustained elevations of serum prolactin levels that are not explained by secondary causes, the presence of symptoms with pituitary compression. Once a prolactinoma is discovered, dopamine agonists could both normalize the level of prolactin and decrease the size of pituitary tumor. Surgery and radiotherapy are reserved for patients with intolerance to medication or associated with cranial complications.