Simay Kara

Accuracy of Skeletal Age Assessment in Children From Birth to 6 Years of Age With the Ultrasonographic Version of the Greulich-Pyle Atlas

Objectives. For the evaluation of skeletal age, the methods of Greulich‐Pyle and Tanner‐Whitehouse are generally used in clinical practice. Our investigation was undertaken to determine whether the ultrasonographic version of the Greulich‐Pyle atlas is capable of assessing skeletal age. If so, we aimed to describe the standards for the ultrasonographic version of the Greulich‐Pyle atlas for each year during the first 6 years of life. Methods. Ninety‐seven subjects underwent left hand and wrist radiography and ultrasonographic examination for bone age assessment during a 1.5‐year study. Estimated bone ages derived from the plain radiography and “hand and wrist ultrasonography charts” interpreted by use of the Greulich‐Pyle atlas were compared statistically. Results.The estimated bone ages from plain radiography and hand and wrist ultrasonography charts interpreted by use of the Greulich‐Pyle atlas were significantly correlated; 71.1% of male patients had the same age in both methods, and in 84.4% of patients, the difference was less than 6 months. In 65.5% of female patients, both methods revealed the same age, and in 88.5% of them, the difference was less then 6 months. Conclusions. The ultrasonographic version of the Greulich‐Pyle atlas can be used to estimate bone age even in ultrasonography departments. This method is highly correlated and a valid alternative to plain radiography for bone age estimation. This enables estimation of skeletal age in ultrasonography departments easily without exposing the patient to radiation.

Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma

OBJECTIVE Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of chest X-rays in showing the rib fractures is limited particularly in those involving the cartilage part of the rib. We investigated the possible rib fractures, those overlooked on chest X-rays, with the use of ultrasonography in minor blunt chest trauma. METHODS A total of 37 patients, with minor blunt chest trauma showing no evidence of a rib fracture on chest X-rays, were examined with ultrasonography performed with a 7.5-MHz linear transducer. Logistic regression analysis was done to outline the clinical predictors of these insidious rib fractures. RESULTS A total of 15 (40.5%) patients showed rib lesions, whereas 22 (59.5%) patients had no evidence of rib lesions. Fracture of the rib associated with a subperiosteal hematoma was the most common finding in ten (66.7%) patients followed by the fracture of the rib alone in four (26.7%) patients, and subperiosteal hematoma alone in one (6.7%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (P=0.617), gender (P=0.552), type of etiology (P=0.954), duration of pain (P=0.234) and site of trauma (P=0.740) did not appear as significant predictors for these rib fractures. However, the involved part of the rib showed a significant correlation with either age (P=0.042) or duration of pain (P=0.033). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of patients with chondral rib fractures. CONCLUSIONS Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on chest X-rays in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration of pain.

Bilateral elastofibroma dorsi: proper positioning for an accurate diagnosis

Elastofibroma dorsi is a rare, slow-growing, ill-defined soft tissue tumor of the chest wall, most commonly located beneath the rhomboid major and latissimus dorsi muscles. It is usually unilateral, and bilateral involvement occurs in only 10% of patients. We report herein a case of a 56-year-old woman with bilateral elastofibroma dorsi. The patient was found to have bilateral involvement of the tumor following a physical examination with proper positioning. An elastofibroma should be considered in the differential diagnosis of tumors deeply located at the periscapular area. Meticulous physical examination may reveal a nonpalpable coexisting tumor with deep subscapular location and help the accurate diagnosis of bilateral elastofibroma dorsi, hence preventing a secondary operation.

Cricoarytenoiditis in rheumatoid arthritis: radiologic and clinical study.

The cricoarytenoid (CA) joint involvement in rheumatoid arthritis (RA) is not uncommon. In this study, clinical assessment, laryngeal endoscopy, and high-resolution computed tomography (HRCT) were used in 15 patients with RA to evaluate the diagnostic criteria of CA joint involvement. Symptoms owing to CA joint involvement were present in 66.6% of the patients. The frequency of involvement was 13.3% on laryngeal endoscopy but 80.0% with HRCT assessment. The most common HRCT findings were CA prominence (46.6%), density and volume changes (46.6%), and CA subluxation (39.9%). In some of the patients, soft tissue swelling (20%) near the CA joint and narrowing in the piriform sinus (33.3%) were also observed. Radiologic abnormalities related to CA joint involvement generally precede clinical symptomatology. Therefore, HRCT evaluation may be a useful method in the assessment of CA joint involvement in RA patients to exclude possible causes of laryngeal signs and symptoms.

Imaging in the diagnosis of symptomatic forearm muscle herniation

Abstract Muscle herniation can be defined as protrusion of a portion of muscle through an acquired or congenital defect of enclosing fascia. Although it is usually a cosmetic problem, it can lead to local pain and tenderness after prolonged exertion. In this report, we present a case of flexor digitorum superficialis muscle herniation in a 58-year-old man. The radiographic, ultrasonographic and magnetic resonance imaging findings are described with dynamic examination, permitting demonstration of muscle herniation through the fascial defect during muscle contraction.

A case of brucellar septic arthritis of the knee with a prolonged clinical course.

Brucellosis is a systemic infectious disease with a broad spectrum of clinical manifestations. Arthritis is frequently observed in its course and may be one of the main presenting clinical features of the disease. We report a case of brucellar monoarthritis of the knee with a prolonged clinical course despite efficient antibiotic treatment.

Myometrial involvement of tumor-like cystic endosalpingiosis : a rare entity

Endosalpingiosis is characterized by the presence of benign glands lined by tubal‐type epithelium involving the pelvic and lower abdominal peritoneum and pelvic and para‐aortic lymph nodes in women. Rarely, cystification can occur, resulting in a neoplasm‐like mass associated with clinical manifestations, an intraoperative abnormality, or a striking finding on gross examination. Here we report the transvaginal ultrasound, magnetic resonance imaging and histopathological appearance of an unusual case of cystic endosalpingiosis involving the right ovary and full thickness of the wall of the uterine fundus in a patient who presented with a 6‐month history of menorrhagia and pelvic pain. Clinicians should be aware of this type of uterine benign manifestation so as to refrain from overtreatment. Copyright

Diagnosis and management of vaginal mullerian cyst in a virgin patient

Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 × 20 mm in the vagina. She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with the surrounding structures.

Change in retrobulbar circulation during menstrual cycle assessed by doppler ultrasound

Our purpose was to study the hemodynamic changes in the ophthalmic, central retinal and posterior ciliary arteries during the normal menstrual cycle and to relate the vascular changes to menstrual cycle. A total of 23 healthy women underwent serial color Doppler ultrasonography at least six times during a normal menstrual cycle, twice each in follicular, ovulatory and luteal phases. Pulsatility and resistance index and peak systolic velocity of the each arteries were assessed with color Doppler imaging. There was no statistical difference in any of the parameters during the menstrual cycle. This was supposed to be because generalized hormonal effects on heart rate, blood pressure, blood volume, cardiac output and on the diameter of the vessel cancel each other and this effect maintains the same ocular blood flow and perfusion during the menstrual cycle.

Kimura's disease in a Caucasian male treated with cyclosporine

45 Correspondence Kimura’s disease in a Caucasian male treated with cyclosporine A 45-year-old Caucasian man was admitted to the Department of Dermatology with the complaint of erythematous lesions on the fingers and elbows present for 10 years. The physical examination revealed nontender, nonfluctuant, firm and fixed nodules localized in the right postauricular region, left parotid gland and submental region measuring 34 × 25 mm, 26 × 15 mm and 42 × 35 mm, respectively (Fig. 1). No warmth or redness was noted on the overlying skin. There were erythematous plaques on the metacarpophalangeal and interphalangeal joints in both hands and also in the right elbow. He was otherwise healthy. He had no fever, weight loss nor was he sweating. He was treated with systemic steroid two times in the past four years. The masses showed regression, but recurrence occurred when the dose was tapered. The patient’s eosinophil count was above normal (36%), and IgE level was markedly raised 1130 IU/ml. He tested negative cytomegalovirus, Epstein-Barr virus, toxoplasma serologies and stool parasitic infection. Bone marrow biopsy revealed moderate increase in eosinophilic lineage without atypia. A computed tomographic scan of the neck showed multiple lymph nodes located at the bilateral servical chain and heterogeneous areas in both of the parotid glands. Histopathological examination revealed dense mononuclear cell infiltration with eosinophils and numerous vascular structures. There was no atypia in the dermis (Fig. 2). Immunohistochemical staining for CD68, CD34, LCA and S100 were positive. Stains and cultures for bacteria, fungi, and mycobacteria were negative. Based on clinical findings, histology, peripheral eosinophilia, high IgE level, and negative serological testing for parasitic agents, a diagnosis of KD (Kimura’s disease) was made. Cyclosporine at an initial dose of 5 mg/kg/day was started. One month later, the lesions showed complete regression. We began tapering the dose by 1 mg/kg/day each month. The remission was not long lasting, the lesions began to appear again when the dose was 2 mg/kg/day. The therapy was stopped at the end of the fifth month. The exact pathophysiology of KD is unknown. The presence of eosinophils in the inflammatory infiltrate and the peripheral blood suggests that KD represents a self-limited allergic 1