Resat Kervancioglu

ULTRASONOGRAPHIC EVALUATION OF BILATERAL GROINS IN CHILDREN WITH UNILATERAL INGUINAL HERNIA

Purpose: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia. Material and Methods: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically. Results: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters (p<0.0001). Conclusion: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.

Incisional hernia of a normal gallbladder: sonographic and CT demonstration

The subcutaneous herniation of gallbladder through the abdominal wall is very rare, and to our knowledge, only two cases were reported previously in the literature [Clin. Radiol. 42 (1990) 283; J. Clin. Ultrasound 25 (1997) 398]. In both of these cases, the gallbladders were found to be distended. To our knowledge, the present case is the first case report in the literature in which a morphologically normal gallbladder herniated into the subcutaneous tissue.

Fistulous Communication Between a Hepatic Hydatid Cyst and the Gallbladder: Diagnosis with MR Cholangiopancreatography

2Department of Radiology, Medical Faculty, Gaziantep University, Gaziantep, Turkey. ommunication of a hydatid disease with the biliary tree has been described in up to 90% of hepatic hydatid cysts [1]. This is due to the incorporation of biliary radicles into the pericyst [2]. However, frank rupture into the biliary tree occurs in only 5–15% of cases [1]. Although the communication with the intrahepatic bile ducts is common, its occurrence between a hepatic hydatid cyst and the gallbladder is rare [3]. We present an unusual case of a fistulous communication between a hepatic hydatid cyst and the gallbladder. The MR cholangiopancreatography (MRCP) features have been discussed.

Carotid and brachial intima-media thickness, arterial diameter and resistivity indices in aortic regurgitation.

Purpose: To evaluate signs of atherosclerosis in carotid and brachial arteries in patients with aortic regurgitation (AR). Material and Methods: The sonograms of 33 patients (24 M and 9 F, 16-67 years old) with pure AR and 20 control subjects (15 M and 5 F, 19-49 years old) were evaluated. Patients with AR and control subjects completed a questionnaire with SMART risk score based on pre-existing vascular disease and risk factors. AR patients and control subjects were assessed for intima-media thickness (IMT) of common carotid artery (CCA), IMT of brachial artery (BA), CCA diameter, and resistivity index (RI) of CCA and RI of internal carotid artery (ICA). Results: There was no significant difference in the cardiovascular risk score between the patients with AR and control subjects. All measured parameters were statistically significantly greater in AR patients than in control subjects with P values 0.0233 for CCA IMT, 0.0034 for BA IMT, 0.0429 for CCA diameter, <0.0001 for CCA RI, and 0.0002 for ICA RI. Conclusion: AR is associated with signs generally considered to represent atherosclerosis, such as increased CCA and BA IMT, CCA diameter, and CCA and ICA RI.

High prevalence of diffuse parenchymal lung diseases among Turkish tinners.

High Prevalence of Diffuse Parenchymal Lung Diseases among Turkish Tinners: Oner Dikensoy, et al. Department of Pulmonary Diseases, Gaziantep University, Turkey—The objective is to investigate the prevalence of parenchymal lung diseases among tinners. Twenty‐four tinners who signed an informed consent form in the Gaziantep area were the subjects of this study. Demographics, spirometric test results, and high resolution computed tomography (HRCT) scans were obtained for all the tinners. Out of 24 tinners, eleven tinners (46%) had HRCTs consistent with DPLD. Of these 11 subjects, HRCT findings were consistent with respiratory bronchiolitis interstitial lung disease in nine, usual interstitial pneumonia pattern in one, and non‐specific interstitial pneumonia in one. HRCT patterns consistent with DPLDs are significantly prevalent among Turkish tinners. This is the first field study reporting this occupational lung hazard in tinners. Future research is needed to uncover the underlying mechanisms.

Abdominopelvic lipomatosis in a child with indefinite physical findings

A 5-year-old boy had a 2-year history of periumbilical, non-radiating abdominal pain. At repair of an inguinal hernia 6 months previously, histopathological examination of the excised hernia sac showed it to be adipose tissue. Mild abdominal distension was the only physical finding. Abdominal radiography demonstrated radiolucency throughout the abdomen and pelvis and displacement of the intestines superiorly and to the left (Fig. l). US showed a very large, solid hyperechoic mass, which was indistinguishable from adjacent retroperitoneal structures. CT showed a large, fatty mass with stranding and septations filling almost the entire abdomen and pelvis (Fig.2). A 1,540-g mass was resected. Histopathological examination disclosed mature fat with a few fibrous septa consistent with benign, infiltrating abdominopelvic lipomatosis. Pelvic lipomatosis and benign symmetrical abdominal lipomatosis are two distinct clinicopathological entities characterised by collections of non-encapsulated, mature lipocytes [1]. Pelvic lipomatosis is an uncommon and poorly understood condition [2]. It is found in adult overweight patients and the diagnosis is discovered incidentally in the majority of patients. However, about 40% of these patients will develop urinary tract obstruction and renal insufficiency [3]. Most investigators have speculated that a localised inflammatory process may lead to fat deposition [3]. The single paediatric reported case has been debated because the child had Cushings syndrome [4]. Benign symmetrical abdominal lipomatosis mostly occurs in middle-aged men. Although an association with alcohol abuse, metabolic abnormalities, polyneuropathy and certain malignancies has been described, the pathogenesis is unknown [5]. The age of our patient is unusual and he is the first paediatric case of abdominopelvic lipomatosis. Radiological differential diagnosis of a fatty mass includes simple lipoma, lipogenic liposarcoma and lipoblastomatosis. Lipomas are well-defined, non-invasive, benign and encapsulated tumours with a composition similar to that of normal adipose tissue. Pathologically, the masses of diffuse infiltrating lipomatosis resemble simple lipoma except for their extensive infiltrative distribution, which precludes complete resection [6]. Lipogenic liposarcomas are distinguishable from benign fatty masses because they contain higher density tissues [6]. Lipoblastomatosis is a rare benign mesenchymal tumour of embryonal fat that occurs almost exclusively in infants and children. On CT scans, the tumour has a variable appearance, ranging from a predominantly fatty mass to heterogeneous mass containing soft-tissue densities [1].

A thyroglossal duct cyst with calcification

Abstract We report a thyroglossal duct cyst with calcification, the second case in the world literature. The ultrasound and CT findings are described and we highlight the differential diagnosis.

Congenital systemic arteriovenous fistula between the distal thoracic aorta and hemiazygos vein in a child

Congenital thoracic arteriovenous fistulas have been rarely described [1, 2, 3, 4, 5,6]. Therefore, a congenital systemic arteriovenous fistula arising from the thoracic aorta and draining into azygos or hemiazygos vein is extremely [1, 3, 4,6]. Such lesions are usually accompanied by a continuous murmur. The extent of clinical manifestations is related to the size, duration, and the precise location of the collaterals. Although physical diagnosis may be easy with careful examination if lesions are located superficially, angiography is important in delineating the anatomy, and to decide on the appropriate management of the patient. In this report, a rare case of congenital systemic arteriovenous fistula between the descending aorta and hemiazygos vein is presented. A 15-month-old girl was referred to our paediatric cardiology unit for cardiac evaluation following incidental detection of an intensive continuous murmur in the left paraspinal region. There was no family history of congenital heart disease. Her height was 80 cm (75th– 90th percentile), and weight 9 kg (10th–25th percentile). The physical examination was normal except for a murmur. The pulse rate was 120/min and blood pressure 90/50 mm Hg with normal heart sounds. A chest X-ray film showed a normal heart size and pulmonary vascularity. Normal function and structure were detected by transthoracic echocardiography. A contrast-enhanced CT scan with 2.5 mm slice thickness and increments of the thorax demonstrated a tortuous vascular malformation coursing from the descending thoracic aorta to the hemiazygos vein at the left paravertebral localisation in the posterior mediastinum (Fig. 1). Angiography of the distal descending thoracic aorta revealed a thoracic arteriovenous fistula. Selective angiography of the fistula was performed and we observed that the fistula was draining into the hemiazygos vein. The fistula coursed posteriorly into the hemiazygos system before draining into the azygos vein and vena cava superior (Fig. 2). The calculated ratio of the pulmonary blood flow to systemic flow was 1.2. Since the patient was asymptomatic, no therapy was advised. Bacterial endocarditis prophylaxis was recommended. Thereafter, she was discharged and followed up for a year and there was no additional symptom except continuous murmur. Arteriovenous fistula is characterised by abnormal shunting of blood between the arterial and venous systems without the presence of a normal intervening capillary bed. Since the capillary bed represents the source of resistance to blood flow in the circulatory system, arteriovenous collaterals are low resistance, high flow lesions [2]. A congenital systemic arteriovenous fistula arising from the thoracic aorta and draining into the azygos or hemiazygos vein is extremely rare [1, 3, 4,6]. To our knowledge, our case is the second in the literature [1]. Soler et al. [6] postulated that this particular type of malformation could be attributed to abnormal fistulous communications between embryological arterial and venous channels that were originally normal. The clinical features of arteriovenous collaterals depend on their location and involved blood vessels. Although diagnostic investigation may be necessary, clinical examination is essential. A physician can hear a distinctive continuous murmur in the affected region using a stethoscope. If the fistula is large enough, heart failure may develop. Therefore, careful clinical followup is essential. Since the degree of left to right shunt was low in our patient, fistula closure was not indicated. In fact, Saito et al. [4] reported that regression of an O. Baspinar (&) Æ H. Kazaz Department of Paediatric Cardiology and Cardiovascular Surgery, Gaziantep Üniversitesi Tip Fakültesi Pediatri ABD, 27310 Gaziantep, Turkey E-mail: osmanbaspinar@hotmail.com Tel.: +90-342-3606060 Fax: +90-342-3603928

Massive upper gastrointestinal bleeding from an accessory splenic artery mimicking isolated gastric varices

Knowledge of anatomical variations of coeliac trunk and its branches is important for surgeons and interventional radiologists planning surgical and radiological interventions. We describe a case of a 42-year-old male with an accessory splenic artery (ASA) originating from the left gastric artery (LGA) running in the wall of gastric fundus and mimicking isolated gastric varices, which was observed during endoscopy. Bleeding from this artery was massive and was managed with endovascular coil embolisation. Coeliac angiography of the patient with upper gastrointestinal bleeding showed that the coeliac trunk divided into 3 arteries: the LGA, the splenic artery, and the right hepatic artery. Additionally, the variations of ASA and the left hepatic artery arising from LGA, and the left and right inferior phrenic arteries arising from ASA were identified. This case is the first to be presented in the literature with ASA originating from LGA that was situated in the gastric wall where inferior phrenic arteries arose from the ASA.

The evaluation of potential donors hepatic vascular anatomy in liver transplantation with multislice computed tomography

The purpose of this study is to assess the role of multislice computed tomography angiography in the evaluation and determination of variations in hepatic arterial, portal and hepatic venous anatomy in potential liver donors before transplantation. Total 48 healthy liver donor candidates (11 female and 37 male) who applied for liver transplantation donation between March 2010 and July 2013 were included in our study. Donors scanned with 0.625-mm thickness, 64 detector computed tomography (CT) scanner. Unenhanced CT and CT angiography in arterial, portal and hepatic venous phases were performed. From axial images two dimensional multiplanar reformats and with maximum intensity projection and volume rendering techniques three dimensional images were obtained. Hepatic vascular system anatomy and variants were demonstrated. In 34 cases of 48 donor candidates arterial branching were detected compatible with the classic hepatic artery anatomy (Michels type I). Hepatic arterial variations were viewed in 14 cases. In four cases Michels type II and III cases Michels type III variations were present. Michels type IV in one case and Michels type V variations in one another case were detected. Five cases had rare anomalies not classified by Michels (left hepatic artery originating before the gastroduedonal artery and the common hepatic artery arising directly from the aorta). In twenty-five patients from donor candidates, normal main portal venous bifurcation branching (type I); in twenty-three patients, portal venous variations were detected. While middle and left hepatic veins separately drained into vena cava inferior in 32 donor candidates, main hepatic vein and left hepatic vein was being draining in the form of common trunk in 16 of the donors. Segment V and/or VIII veins which were larger than 5 mm and drained to the middle hepatic vein was detected in 12 patients. Fourteen of donor candidates had accessory inferior hepatic vein, 5 patients had accessory superior hepatic veins greater than 5 mm. Multislice CT is a reliable and useful non-invasive technique; in potential liver donors to provide artery, portal and hepatic venous structures mapping and to determine fairly common vascular variations that may complicate surgery before liver transplantation.