Ozan Karatag

Dural sinus filling defect: intrasigmoid encephalocele.

Filling defects of dural venous sinuses are considered to be a challenging problem especially in case of symptomatic patients. Many lesions have to be ruled out such as sinus thrombosis, arachnoid granulations and tumours. Encephalocele into dural sinus is also a rare cause of these filling defects of dural sinuses. Here, we report an extremely rare case with spontaneous occult invagination of temporal brain tissue into the left sigmoid sinus and accompanying cerebellar ectopia.

Seminal Vesicle Hypoplasia With Contralateral Renal Agenesis

Renal agenesis is a rare condition of unknown etiology frequently seen together with ipsilateral seminal vesicle and vas deferens anomalies because of common embryologic development. However, no cases of contralateral seminal vesicle hypoplasia accompanying renal agenesis have previously been reported. We describe a case of contralateral seminal vesicle hypoplasia accompanying renal agenesis incidentally detected in a 27-year-old presenting to the urology clinic with pelvic pain.

Tegmen height: preoperative value of CT on preventing dural complications in chronic otitis media surgery☆ , ☆☆

OBJECTIVE The objective was to examine tegmen height in patients with iatrogenic dural exposure in chronic otitis media (COM) surgery. METHODS Computed tomographic (CT) scans of 50 patients who underwent COM surgery were retrospectively examined. Twelve patients with dural exposure were admitted to the dura group. The control group of 38 patients had no dural exposure. Tegmen heights in both groups were compared. RESULTS There was no statistically significant difference between opposite ears (P>.05). Significant difference was found in tegmen height between healthy and operated ears in unilateral COM patients (P=.001). CONCLUSION Preoperative CT assessment of tegmen height is an important parameter in assessing risk of exposing dura during surgery.

Cervical necrotizing fasciitis associated with descending necrotizing mediastinitis

We report a case of potentially fatal cervical necrotizing fasciitis and descending necrotizing mediastinitis due to deep neck infection in a 66-year-old male patient with no history or evidence of immunocompromising disorders. On admission, he had painful neck movements and the skin over his neck was red, hot and tender. A computerized tomography (CT) scan of his neck and chest showed evidence of air collection in soft tissues. He was treated with broad-spectrum intravenous antibiotics and early massive cervical drainage. Prompt diagnosis by CT of the neck and chest enabled an early surgical treatment of cervical necrotizing fasciitis. Although acute mediastinitis is a fatal infection involving the connective tissues that fill the interpleural spaces and surround the median thoracic organs, an extensive cervicotomy combined with appropriate antibiotics can prevent the need for mediastinal drainage.RiassuntoDescriviamo il caso di una fascite cervicale necrotizzante potenzialmente fatale con mediastinite necrotizzante discendente causata da un’infezione profonda del collo in un maschio di 66 anni, in assenza di anamnesi o evidenza di patologie immunodepressive. All’ingresso presentava dolore al movimento del collo e la cute del collo era arrossata, calda e dolente. Una TAC di collo e torace mostrava enfisema nei tessuti molli. È stato trattato con antibiotici ad ampio spettro e.v. e drenaggio cervicale massivo precoce. Una diagnosi tempestiva con una TAC del collo e del torace ha consentito un trattamento chirurgico precoce della fascite necrotizzante cervicale. Nonostante la mediastinite acuta sia un’infezione fatale che interessa il tessuto connettivo interposto tra i foglietti pleurici e che circonda gli organi mesotoracici, una cervicotomia estensiva associata ad un’adeguata terapia antibiotica può prevenire la necessità di un drenaggio mediastinico.

Spleen and muscle metastasis in renal-cell carcinoma

A 64-year-old male patient was admitted with a mass complaint in the right breast. He had a history of right nephrectomy seven years previously due to a renal-cell carcinoma (RCC). Routine biochemistry, complete blood count, and urinalysis results were within normal ranges. There was neither a chronic disease history of cardiovascular or respiratory system, nor pathological findings. At the physical examination, mass in the right breast was characterized as hard and fixed. Abdominal ultrasonography showed no pathology except a simple cyst in the left kidney. Breast ultrasonography revealed a solid and hypoechoic mass, measuring 35x10 mm, in the muscle tissue. Due to history of malignity, the patient underwent abdominal and thoracic computed tomography (CT). Abdominal CT showed three hypervascular masses in the spleen (Figure 1). In addition, a mass with 25x23 mm size, located in pectoral muscles was observed in thoracic CT (Figure 2). Histopathological examination was performed with a preliminary diagnosis of metastasis and primary muscle tumor. The pathology result was reported as metastasis of RCC. Renal-cell carcinoma constitutes approximately 85% of all kidney malignancies (1). It is more common in males and elderly individuals and is rarely diagnosed in early stages. The main reasons for this are the lack of specific symptoms, non-palpable masses (unless it reaches large size) and lack of specific screening test (1). Lesions in early stages are often detected incidentally during radiological imaging. Smoking is a definite risk factor, and the risk often decreases after quitting smoking. Obese individuals have also two-fold increased risk for RCC. In additi-

Neglected areas on thorax computed tomography evaluation in patients with chronic obstructive pulmonary disease: Paravertebral muscles and para-aortic adipose tissue

This study, investigated the para‐aortic adipose tissue cross‐sectional area, a novel predictor of cardiovascular diseases and degenerative changes in the paravertebral muscles, in patients with chronic obstructive pulmonary disease (COPD).

Malignant fibrous histiocytoma in a patient presenting with urinary system symptoms

Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.

Gaucher's disease in a patient presenting with hip and abdominal pain

Gauchers disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gauchers disease.

The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

Thorax Computed Tomography Findings in Patients with Erectile Dysfunction

Objective: Diabetes mellitus, smoking, dyslipidemia, and obesity play an important role in the etiology of erectile dysfunction, particularly in cases with vascular insufficiency. These risk factors also target the lungs due to their systemic effects. Materials and Methods: Patients with penile vascular insufficiency determined at Doppler ultrasonography and undergoing thoracic computerized tomography for various reasons were included in this study. A history of acute thoracic trauma, pneumonic consolidation, or pelvic surgery and trauma were regarded as exclusion criteria. Results: Thirty-seven male patients with identified vascular insufficiency (age 54.48 ± 13.62 years) were enrolled. Mass lesions with a malignant morphology were present in two patients. The most common mediastinal/vascular pathology was atherosclerosis, while the most common parenchymal lesion was emphysematous aeration. Other findings included parenchymal fibrotic bands, atelectasis, interstitial thickening, bronchiectasis, air trapping, aortic aneurysm, a dilated pulmonary artery, hiatal hernia, and pericardial effusion. Conclusion: Erectile dysfunction may be an early sign of cardiovascular diseases. Care must be taken in terms of existing or potential pulmonary pathologies in these patients due to their sharing common risk factors with systemic effects.