Mustafa Ozbayrak

Posttraumatic nonischemic priapism treated with autologous blood clot embolization.

INTRODUCTION High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. AIM To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. MAIN OUTCOME MEASURES Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. MATERIALS AND METHODS Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. RESULTS The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. CONCLUSIONS Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.

Isolated Cortical Venous Thrombosis Associated With Intracranial Hypotension Syndrome

The association of intracranial hypotension syndrome with cerebral venous thrombosis is rare. We report our experience with isolated cortical venous thrombosis, which developed after unsuccessful epidural anesthesia. Magnetic resonance imaging showed characteristic imaging findings of intracranial hypotension syndrome, such as dural thickening and brain sagging. We also detected right parietal venous hemorrhagic infarction secondary to right‐sided cortical venous thrombosis. After the treatment of intracranial hypotension via epidural blood patch, heparin was used to treat cortical venous thrombosis.

Riedel Thyroiditis Associated With Massive Neck Fibrosis

iedel thyroiditis, also known as invasive fibrous thyroiditis, is a rare disorder of unknown etiology in which fibrous tissue replaces the normal thyroid gland and extends into adjacent tissues. The differential diagnosis includes carcinoma, lymphoma, and Hashimoto thyroiditis, but the extent of the fibrosis in these disorders is much less, and these entities usually do not extend beyond the thyroid. Sonographic features resemble those of acute or chronic thyroiditis with adjacent soft tissue extension. Here we present the imaging features of Riedel thyroiditis associated with massive neck fibrosis.

A Case of an Idiopathic Massive Osteolysis with Skip Lesions

A patient with a 2-year history of pain in the left arm, and decreased strengths unrelieved by non-steroidal anti-inflammatory therapy, was being referred for repeating radiography. The radiologic examinations have demonstrated a unique pattern of non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges. Multi-site biopsies were being performed and confirmed the diagnosis of massive osteolysis. To our knowledge, this is the first case in which multifocal, non-contiguous osteolysis with skip lesions without associated nephropathy and without a hereditary pattern is being described in one extremity.

Detection of Bladder Cancer Recurrence with Real-Time Three-Dimensional Ultrasonography-Based Virtual Cystoscopy

This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time three-dimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.

Cross-sectional area of the labrum: role in the diagnosis of anterior acetabular labral tears

AbstractObjectiveTo investigate the utility of ultrasound cross-sectional area (CSA) measurements for diagnosing acetabular labral (AL) tears.MethodsThe study included qualitative/quantitative ultrasound examinations of 55 hips in 52 patients with a presumed diagnosis of AL tear and 56 hips in 28 healthy volunteers. MR arthrography examinations were available only for the patients and were reviewed for the presence of AL thickening and tear.ResultsThe CSA of the anterior labrum was significantly larger in patients with an AL tear on MR arthrography than those in healthy volunteers (P < 0.01). The CSA cut-off value in determining labral thickening that maximises accuracy was 34.7 mm2, and sensitivity, specificity and accuracy were 86.7%, 74.1% and 77.5%. Direct signs of AL tear on ultrasound had sensitivity, specificity and accuracy of 34.9%, 91.7% and 47.3%. The CSA cut-off value that maximises the accuracy of the AL tear was 40.6 mm2, and sensitivity, specificity and accuracy were 58.1%, 91.2% and 78.4%.ConclusionsUltrasound detects the thickened labrum frequently observed in MR arthrography studies, especially in patients with dysplastic hips. Although specificity of the method of detecting AL tears is high, sensitivity is low, with an overlap between subjects with AL tear and controls.Key Points• Labral degeneration is frequent in dysplastic hips • Thickened labra are frequently observed on MR arthrograms • Labral thickening can be depicted by quantitative ultrasound measurements • The sensitivity is low with overlap between subjects with AL tear and controls

Atypical pyogenic brain abscess evaluation by diffusion-weighted imaging: diagnosis with multimodality MR imaging.

Abstract Whether a brain abscess is apparent by imaging depends on the stage of the abscess at the time of imaging, as well as the etiology of the infection. Because conventional magnetic resonance imaging (MRI) is limited in its ability to distinguish brain abscesses from necrotic tumors, advanced techniques are required. The management of these two disease entities differs and can potentially affect the clinical outcome. We report a case having atypical imaging features of a pyogenic brain abscess on advanced MRI, in particular, on diffusion-weighted and perfusion imaging, in a patient with osteosarcoma undergoing chemotherapy.

Bilateral breast uptake of radioiodine in a male patient with gynecomastia: A case report.

A 56-year-old male patient with papillary thyroid carcinoma was given radioiodine for the treatment of persistent disease. Post radioiodine whole body scan revealed uptake at the thyroidal region and bilateral uptake at the upper thoracic region. Single photon emission computed tomography/computed tomography (SPECT/CT) confirmed uptake at the left thyroid lobe, and additional symmetrical mammary gland uptake was observed at both breasts. The patient had obesity-related gynecomastia, but he did not have any history of breast cancer, mastitis, hyperprolactinemia, or galactorrhea. Although breast uptake of radioiodine is a common finding in postpartum or lactating women, it is uncommon in male patients. To our knowledge, this is the first case of a male patient with breast uptake of radioiodine documented with SPECT/CT. SPECT/CT is useful in male patients in the differentiation of benign breast uptake with lung metastases or axillary metastases of thyroid cancer.

FDG PET/CT Imaging of an Isolated Recurrence in the Eyelid of a Patient With Follicular Lymphoma.

An 80-year-old woman had a history of follicular lymphoma diagnosed by biopsy of the inguinal lymph node 4 years prior. After systemic chemotherapy, she achieved complete remission. She presented with painless swelling on the left side of the eyelid. She also had suspicious lymph node enlargement in the cervical and axillary regions. FDG PET/CT showed an isolated FDG-avid lesion on the eyelid that was confirmed by biopsy to be compatible with lymphoma recurrence.

Life-threatening retropharyngeal fluid collection after whiplash-type injury of the cervical spine

A 39-year-old man was brought to the emergency department after a car accident. Computed tomography scans of the brain and spine did not reveal any fracture of the craniocervical junction except some thickening of the retropharyngealprevertebral soft tissues, mild increase of the basion-dens interval with basion-axis interval (Fig. 1), and atlantooccipital subluxation (Fig. 2). Also we observed thin linear hyperdensities compatible with subdural hemorrhagia extending through anterior neighborhood of the brainstem and posterior neighborhood of the proximal cervical spinal cord (Fig. 3). The patient developed progressive dyspnea and hoarseness while being monitored in intensive care unit and a magnetic resonance imaging (MRI) scan of the cervical spine was obtained. A retropharyngeal fluid collection extending through the naso-oro-hypopharynx levels was found which also extended into the deep fascial planes of the neck.