Tumay Bekci

Osteoskeletal manifestations of scurvy: MRI and ultrasound findings

Scurvy has become very rare in the modern world. The incidence of scurvy in the pediatric population is extremely low. In the pediatric population, musculoskeletal manifestations are more common and multiple subperiosteal hematomas are an important indicator for the diagnosis of scurvy. Although magnetic resonance imaging findings of scurvy are well described in the literature, to our knowledge, ultrasound findings have not yet been described. In this article, we report a case of scurvy with associated magnetic resonance imaging and ultrasound findings.

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.

Chemoresponsive liver hemangioma in a patient with metastatic malignant teratoma

l f 8 A 32-year-old previously healthy male patient applied to our hospital for swelling and pain in his testis. Physical and ultrasound examination revealed a mass in the testis; the patient underwent orchiectomy with a prediagnosis of testicle tumor, and pathology revealed a malignant teratoma. In the postoperative period, dynamic contrast-enhanced abdominal CT scanning, which was performed for tumor staging showed three masses (the largest one; 100 × 84 × 62 mm) in the liver and para-aortic lymphadenopathies. On dynamic CT scan, peripheral nodular contrast enhancement was observed in lesions in the arterial phase (Fig. 1a). In late venous phase, contrast enhancement concentrated toward the center (Fig. 1b). Enhancement pattern was consistent with hepatic hemangioma. AFP levels and hepatic enzyme values were normal on laboratory examinations. Because of pathological diagnosis of the malignant teratoma of the testis and para-aortic lymphadenopathy, three cycles of BEP (bleomycin 20 mg/m2, etoposide 100 mg/m2, and cisplatin 30 mg/m2 on days 1-5) were administered. The largest

Primary malignant mucosal melanoma of the nasopharynx: an unusual cause of unilateral hearing loss.

There are many causes of unilateral hearing loss, and making the correct differential diagnosis, especially in elderly patients, is difficult. A primary malignant mucosal melanoma of the nasopharynx is extremely rare and can cause a variety of symptoms. Hearing loss, as a presenting symptom of mucosal malignant melanoma of the nasopharynx, has not yet been defined in the literature. Herein, we report a case of primary mucosal malignant melanoma of the nasopharynx presented with unilateral hearing loss in a 70-year-old man.

Efficiency of B-mode Ultrasound and Strain Elastography in Differentiating Between Benign and Malignant Cervical Lymph Nodes

Purpose The purpose of this study was to evaluate the diagnostic accuracy and efficiency of ultrasonography (US), especially when combined with strain elastography (SE), in differentiating between benign and malignant cervical lymph nodes (LNs). Methods Forty-one LNs were examined by B-mode US, power Doppler US, and SE. The following imaging features were analyzed: shape, echogenicity, echogenic hilum, calcification, intranodal vascular pattern, elasticity scores (5 categories), and strain ratio. The average strain ratio was calculated as the mean strain of the adjacent sternocleidomastoid muscle divided by the mean strain of the target LN. The results of the US and SE features were compared with the histopathologic findings. Results The imaging features that were significantly associated with malignant LNs were an increased short-to-long axis diameter ratio, abnormal or absence of hilum, microcalcification, type 2-3-4 vascularity, 3-4-5 elasticity scores, and a high level of strain ratio (P < 0.05). The cutoff value of the strain index was detected as 1.18. According to this, there was a significant difference (P = 0.004) in the strain index between benign and malignant LNs. Conclusions Strain elastography is useful in differentiating between benign and malignant cervical LNs, thereby informing decisions to perform a biopsy and/or surgery, and facilitating follow-up.

Incidental Persistent Falcine Sinus

This 14-year-old boy was admitted with a two month history of headache. His examination was normal. Magnetic resonance imaging showed a normal brain parenchyma. In addition, an incidental falcine sinus was observed on T2-weighted sagittal images (Figure A). Contrast-enhanced T1-weighted axial images (Figure B) revealed that the sinus connected the junction of the middle and posterior thirds of the superior sagittal sinus and the straight sinus. The posterior third of the superior sagittal sinus was enlarged and the straight sinus was hypoplastic. A magnetic resonance venography confirmed the presence of the persistent falcine sinus between the straight and superior sagittal sinus (Figure C).

Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries

INTRODUCTION The aim of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (MRI) in the diagnosis of ovarian torsion. METHODS We retrospectively identified 84 patients with surgically confirmed ovarian torsion. Seventeen patients with unclear ultrasound findings underwent MRI examination with two different magnetic resonance (MR) systems. RESULTS In ovarian torsion, the mean apparent diffusion coefficient (ADC) value of the torsed ovary was significantly lower than that of the nonaffected ovary in both MR systems (n=17; 0.898±0.539 vs. 1.615±0.469×10(-3)mm(2)/s; P<.001). CONCLUSIONS ADC comparisons were useful for detecting ovarian torsion.

Giant invasive basal skull prolactinoma with CSF rhinorrhoea and meningitis

Therefore, we conclude that the following parameters were he independent predictors of the favorable surgical outcomes in ur study: (1) age at presentation; (2) pontine location of cavrnous malformation; and (3) favorable pre-operative mRS. Also, he location of cavernous malformation and preoperative mRS were ssociated with favorable long-term outcomes. However, the assoiation of outcome to the lesion size or the early surgical timing annot be accurately established. We agree with the authors that correct interpretation of the tatistical results is imperative and should be emphasized. The resent study provides some evidence that the aforementioned linical parameters are predictors of the outcomes for brainstem avernous malformations. Overall this study being a single-center etrospective study with limited number of cases, the statistial results should be interpreted with caution. A prospectively esigned multicentric study might enable robust statistics for efining the accurate outcome predictors for this lesion. Thank you Authors

A unique presentation of renal cell carcinoma: both upper and lower gastrointestinal bleeding.

Renal cell carcinoma (RCC) constitutes 3% of all adult malignancies and may present with various symptoms due to local growth, metastasis, and paraneoplastic syndrome. Gastrointestinal hemorrhage because of RCC is a very rare event and more commonly seen as a recurrence of RCC many years after nephrectomy. Both upper and lower gastrointestinal bleeding due to direct invasion of RCC has not been reported yet in the literature. Herein, we report a case of 78-year-old man with both massive upper and lower gastrointestinal bleeding as a presenting symptom of RCC.

Epiploic Appendagitis as a Rare Cause of Acute Abdomen in the Pediatric Population: Report of Three Cases

Epiploic appendagitis, caused by inflammation of small adipose tissue on the colon wall, is a rare cause of acute abdominal pain in the pediatric population. It is nearly impossible to establish a specific diagnosis merely on the basis of clinical findings; thus, radiological evaluation is always necessary. In this report, we present the cases of three children with abdominal pain who were diagnosed with epiploic appendagitis. All cases were successfully treated with conservative management.