Suat Eren

Remarkable anatomic anomalies of coronary arteries and their clinical importance: a multidetector computed tomography angiographic study.

Objective: An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies. Materials and Methods: Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Atatürk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean ± SD, 59 ± 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist. Results: The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%). Conclusions: An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.

Alveolar Echinococcosis: Spectrum of Findings at Cross-sectional Imaging

Alveolar echinococcosis is a rare parasitic disease caused by the fox tapeworm Echinococcus multilocularis, which is endemic in many parts of the world. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiologic imaging and in serologic analyses. Because echinococcal lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Echinococcal lesions may produce widely varied imaging appearances depending on the parasites growth stage, the tissues or organs affected, and the presence of associated complications. Although the liver is the initial site of mass infestation by E multilocularis, the parasite may disseminate from there to other organs and tissues, such as the lung, heart, brain, bones, and ligaments. In severe infestations, the walls of the bile ducts and blood vessels may be invaded. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. Ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging with standard and diffusion-weighted sequences, and MR cholangiopancreatography all provide useful information and play complementary roles in detecting and characterizing echinococcal lesions. Cross-sectional imaging is crucial for differentiating echinococcosis from malignant processes: CT is most useful for depicting the peripheral calcifications surrounding established echinococcal cysts, and MR imaging is most helpful for identifying echinococcosis of the central nervous system.

Comparison of peritoneal tumor imaging using conventional MR imaging and diffusion-weighted MR imaging with different b values

PURPOSE The aim of this study was to evaluate the utility of DW MRI with two different b values in identifying peritoneal tumors in oncology patients. MATERIALS AND METHODS Nineteen patients with known malignancy underwent abdominal and pelvic MRI before surgery. MRI included free-breathing DWI with b values of 400 and 800 s/mm2, T1-weighted fat-suppressed spoiled gradient-echo, T2-weighted fat-saturated turbo spin-echo, and 5-min delayed gadolinium-enhanced imaging. Two observers reviewed images for peritoneal tumors at ten anatomic sites within consensus. The results of laparatomy and histopathological evaluation were compared with MRI results. Sensitivity, specificity, and accuracy of identifying peritoneal metastases were calculated for conventional MRI, combined DWI with a b value of 400 s/mm2 and conventional MRI, and combined DWI with a b value of 800 s/mm2 and conventional MRI by consensus of two observers. RESULTS One-hundred and twenty-five peritoneal metastasis sites were confirmed by surgical and histopathological findings. Conventional MRI alone identified 72 peritoneal metastases (sensitivity, 0.58; specificity, 0.87; accuracy, 0.67). Combined DWI with a b value of 400 s/mm2 and conventional MRI revealed 106 peritoneal metastases (sensitivity, 0.85; specificity, 0.88; accuracy, 0.85). Finally, combined DWI with a b value of 800 s/mm2 and conventional MRI revealed 103 peritoneal metastases (sensitivity, 0.83; specificity, 0.94; accuracy, 0.86). CONCLUSION DWI with a high b value provides complementary information that can improve the detection of peritoneal tumors when combined with conventional MRI. We recommend combined MRI and DWI with a high b value for increasing the sensitivity and accuracy of the preoperative detection of peritoneal tumors.

A rare cause of intestinal obstruction in the adult: Morgagni's hernia

Morgagnis hernia is a rare congenital diaphragmatic herniation and is usually diagnosed in childhood. It is quite rare in adults, and intestinal obstruction as a complication due to intrathoracic intestinal herniation rarely occurs. We present the plain radiography and computed tomography findings of an adult patient with acute abdomen symptoms due to Morgagnis hernia.

Congenital diaphragmatic eventration as a cause of anterior mediastinal mass in the children: imaging modalities and literature review.

Congenital eventration of the diaphragm, as a cause of mediastinal mass, is an unusual condition and it may be unilateral or bilateral. Although this entity is frequently asymptomatic and firstly detected on the chest radiography, it may be difficult to distinguish a partial eventration from the other diaphragmatic lesions or mediastinal pathologies on the chest radiographs. US may present valuable information about diaphragm integrity with eventration content or the other diaphragmatic pathologies. Although the other imaging modalities such as fluoroscopy, computed tomography, and MR imaging may be performed as adjunct techniques in cases of the diagnosis still in doubt, they are frequently unnecessary after US. Our goal is to present imaging features and management of this entity together with a literature review.

Diagnosis and management of hydatid liver disease in children: a report of 156 patients with hydatid disease

BACKGROUND/PURPOSE There are many published reviews on adult hydatid disease and a guideline published by World Health Organization Informal Working Group (WHO-IWGE) in 2010. However, there are very few reports on hydatid liver disease in children with limited numbers of patients, and no comments were offered on childhood hydatid liver disease in the WHO-IWGE 2010 guideline. The aim of this study is to present our 17-year experience with 156 pediatric patients with hydatid liver disease and provide a treatment algorithm for children. METHODS The clinical records of 156 children with hydatid liver disease treated from January 1994 to January 2011 were retrospectively reviewed. Patient sex, age at diagnosis, symptoms, disease location, cyst numbers and sizes, treatment choices, medical treatment duration, surgical methods, and complications were recorded. Treatment of liver hydatidosis included 3 different schedules: (1) small (<5 cm) liver cysts treated with albendazole (ABZ) only, (2) cysts (>5 cm) located at the liver surface treated with surgery combined with ABZ, and (3) all (>5 cm) liver cysts embedded deep in the liver parenchyme treated with percutaneous drainage and ABZ. Albendazole was given (10 mg/kg twice a day) and continued for 6 months after initial therapy. RESULTS There were 92 boys and 64 girls with an average age of 9.2 years (range, 1.1-15 years). A total of 376 cysts were detected in 156 patients. The follow-up period ranged from 1 to 10 years (median, 6.5 years). Complications were classified according to the Dindo classification. After the first 6 months of therapy, grade I complications occurred in 12.1% of patients, grade II complications in 7.4%, and grade IIIb complications in 7.3%. There were no grade IIIa, IVa, or IVb complications. At 1 year, grade II complications were recorded in 9.6% of 15 patients, and grade IIIb complications, in 1.2% of patients. During the 17 years reviewed, there were no mortalities (0% grade V complications). CONCLUSIONS Based on this experience, we believe that suitable treatment should be chosen based on factors such as cyst number, cyst location (on the surface or deep in the organ), proximity to vascular structures, whether the cyst is complicated, and additional organ involvement or not. In addition, although the results of our study mostly agree with the results in the WHO-IWGE 2010 report, there are some noticeable differences between these 2 studies. Hence, we believe that the WHO-IWGE 2010 recommendations should be updated by incorporating the childhood observations.

An investigation of the association between coronary artery dominance and coronary artery variations with coronary arterial disease by multidetector computed tomographic coronary angiography.

Purpose: Depending on the perfusing interventricular septum of the arteries, there are 3 types of circulation dominance: right, left, and balanced. In this study, coronary artery branches supplying the ventricular septum were investigated in vivo in a large group of patients by multidetector computed tomography (MDCT) coronary angiography. In addition, the association of coronary artery variations with coronary arterial disease was investigated. Materials and Methods: The study included 325 consecutive patients (214 men and 108 women, with a mean age of 59 ± 14 years) who underwent MDCT coronary angiography. Multidetector computed tomography was performed with a 16-detector-row computed tomographic scanner. The type of dominance, coronary arterial diseases, and coronary artery variations were recorded. Results: In our study, the types of coronary circulation were right, left, and balanced in 227 (70%), 40 (12.5%), and 58 (17.5%) patients, respectively. Dominance of right circulation was detected in 150 of 217 (69%) of men and in 77 of 108 (71%) of women; dominance of left circulation was found in 26 of 217(12%) of men and in 14 of 108 (13%) of women; balanced/codominance circulation was found in 41 of 217 (19%) of men and in 17 of 108 (16%) of women. However, no significant differences were detected between the sexes for the type of coronary circulation. Coronary artery disease was determined in 68 patients (20.9%) by MDCT, and coronary artery variations were also determined in 34 patients (10.4%). Both the number and the rate of coronary artery variations were significantly higher among the patients with left artery dominance. Conclusions: Knowledge of coronary artery variations and pathologies is important in planning the treatment and in interpretation of findings of cardiovascular diseases. Our study indicated that, although right dominance circulation is more common in general population, both the coronary diseases and coronary artery variations are more common in individuals with left dominance circulation.

A childhood case of primary hepatic actinomycosis presenting with cutaneous fistula

Primary hepatic actinomycosis is extremely rare in children. Although the infection has the capability of extension to surrounding tissues or organs, involvement of the abdominal wall is infrequently reported even in adults. We present a childhood case of primary hepatic actinomycosis infiltrating the anterior abdominal wall and spontaneously draining through the skin.

Efficacy and safety of rectal thiopental: Sedation for children undergoing computed tomography and magnetic resonance imaging

Abstract Purpose: We evaluated the clinical safety, effectiveness, efficiency and potential side effects of rectally administered thiopental in 30 children undergoing computed tomography (CT) and magnetic resonance imaging (MRI).

An asymptomatic ruptured hepatic hydatid cyst case presenting with subdiaphragmatic gas in a traumatic patient

Hydatid disease presents as hydatid cysts primarily in the liver and lungs. Although hepatic hydatid cysts (HHCs) may be asymptomatic for many years, they may be symptomatic due to expansion, rupture, and pyogenic infection. Rupture of the HHC into the biliary tract is one of the most serious complications and is frequently related to overenlargement of the cyst or major trauma. Patients with this disease usually have jaundice or fever. We report an asymptomatic HHC ruptured after minor trauma. While the ruptured cyst was presented as the subdiaphragmatic gas on the chest radiography, it was detected as a large cyst with multiple daughter cysts on ultrasound, computed tomography scan, and magnetic resonance imaging.