Ramazan Aydin

Comparison of muscle-to-nodule and parenchyma-to-nodule strain ratios in the differentiation of benign and malignant thyroid nodules: which one should we use?

OBJECTIVE The aim of this study is to investigate the diagnostic accuracy of muscle-to-nodule strain ratio (MNSR) in the differentiation of benign and malignant thyroid nodules and to see if there was a difference between MNSR and parenchyma-to-nodule strain ratios (PNSR) in diagnosis. METHODS A total of 106 consecutive patients (88 women and 18 men; age range 19-79 years) with thyroid nodules were prospectively examined using ultrasound and sonoelastography before the fine-needle aspiration biopsy. The mean MNSR and PNSR were calculated for each nodule and the elasticity score was determined according to four-point scoring system. RESULTS According to the four-point scoring system, 44 of the 83 benign nodules had a score of one or two while 22 of the 23 malignant nodules had a score of three or four (p<0.001). Using ROC analysis, the best cutoff point for MNSR 1.85 and for PNSR 3.14 was calculated. The sensitivity and specificity for the MNSR were 95.6%, 92.8%, respectively; for the PNSR were 95.6%, 93.4%, respectively, when the best cutoff points were used (p<0.001). The κ value for the PNSR and MNSR methods was 0.87, which indicated an almost perfect agreement (p<0.001). CONCLUSIONS Sonoelastography has a high diagnostic accuracy in the differentiation of benign and malignant thyroid nodules. There was no significant difference between MNSR and PNSR in the differentiation of benign and malignant thyroid nodules. Therefore, we think that MNSR could safely be used in situations where PNSR could not be used.

Round ligament varicosities: a rare cause of groin swelling in pregnancy

Round ligament varicosities (RLVs) are rare, and only occur in pregnancy. The swelling due to RLVs mimics an inguinal hernia and generally resolves spontaneously after delivery. Distinguishing between varicosities and hernias is critical to avoid unnecessary surgeries on pregnant women. We aimed to determine the significance of RLVs during pregnancy and to review and describe their clinical and sonographic characteristics. All patients were diagnosed by gray scale and color Doppler ultrasonography, managed conservatively, and RLVs regressed spontaneously postpartum.

Isolated torsion of the fallopian tube with hydrosalpinx mimicking a multiloculated ovarian cyst: Whirlpool sign on preoperative sonography and MRI

Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging findings on preoperative ultrasonography, color Doppler ultrasonography, and magnetic resonance imaging that was misdiagnosed as a multiloculated ovarian cyst at a local hospital.

Paratracheal air cysts: Prevalence and correlation with lung diseases using multi-detector CT

The purpose of this study was to determine the prevalence of paratracheal air cysts (PACs), their correlation with different lung diseases and their connection with the trachea by chest multi detector computed tomography (MDCT).

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.

Detection of Duct Ectasia of Mammary Gland by Ultrasonography in a Neonate with Bloody Nipple Discharge

Bloody nipple discharge, a rare finding in infants, is associated most often with benign mammary duct ectasia and commonly resolves spontaneously. Ultrasonography is a useful diagnostic imaging method to detect the cause of discharge. The rarity of this symptom in infants and its association with breast carcinoma in adults can lead to unnecessary investigation and treatment. Here, we describe ultrasonographic and color Doppler ultrasonographic findings of a 20-day-old boy with bilateral bloody nipple discharge that resolved spontaneously without treatment after 15 days. We conclude that bloody nipple discharge is usually a benign and self-limited process in infancy, and that it is advisable to avoid unnecessary invasive investigations initially.

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.

Gray-scale and color Doppler ultrasound imaging findings of an ovarian inguinal hernia and torsion of the herniated ovary: a case report.

Inguinal hernia is extremely rare among girls. The hernia sac may sometimes involve intestinal structures, but ovaries in the sac are uncommon. Early diagnosis of a possible ovarian torsion is essential because potential amenable benefits can be achieved with surgery. A baby girl was admitted to our pediatric emergency unit with the complaints of swelling and erythema of the left groin. Then gray-scale ultrasonography and color Doppler ultrasonography was performed immediately at the emergency radiology room. In our case, ovarian torsion was diagnosed by gray-scale ultrasonography and color Doppler ultrasonography. After the diagnosis of ovarian torsion, the patient underwent surgery. It is possible to diagnose inguinal emergencies by high-resolution ultrasonography and color Doppler ultrasonography.

Normal pressure hydrocephalus versus atrophic dilatation to distinguish and predict the benefits of surgical intervention with a phase-contrast MRI technique.

AIM To compare mean cerebrospinal fluid (CSF) volume in the aqueduct by using phase-contrast magnetic resonance imaging for the patients with idiopathic normal pressure hydrocephalus (INPH) and atrophic dilation (AD) to investigate the efficacy of this technique in predicting surgery. MATERIAL AND METHODS The MR images of a total of 80 individuals, consisting of 30 patients considered to have INPH, 20 patients with AD not proportional with cerebral sulci, and 30 control cases without a hydrocephalus clinical picture, were evaluated retrospectively. The minute mean aqueductal CSF flow rates of the three groups were compared using the Kruskall-Wallis analysis of variance, and the inter-group statistical comparisons were made using the Mann-Whitney U test. RESULTS The mean aqueductal flow rates were 46.56 ± 25.06 ml/min for the INPH group, 9.28 ± 4.68 ml/min for the AD group, and 8.68 ± 3.40 ml/min for the control group. The mean flow rate of the INPH group was significantly higher than those of the control and ADH groups (p < 0.001). CONCLUSION The mean CSF flow rate may be useful in the diagnosis and differential diagnosis, and the prediction of the potential benefits of surgical intervention for patients considered to have INPH.

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.