Yuksel Balci

An Unusual Cause of Intestinal Obstruction: Abdominal Cocoon

OBJECTIVE abdominal cocoon is characterized by total or partial encasement of the small bowel by a thick fibrotic membrane, leading to mechanical obstruction. Here, we report two cases of abdominal cocoon; both patients presented with symptoms of intestinal obstruction. CONCLUSION We describe the CT and sonographic features of this disease, emphasizing the role of MDCT, and discuss the preoperative diagnostic clues.

Variations in the origins of the thyroid arteries on CT angiography

ObjectiveTo investigate the anatomical variations in the origins of the thyroid arteries on CT angiography images.MethodsThe presence and the origins of the superior thyroid artery, the inferior thyroid artery, and the thyroidea ima artery were retrospectively evaluated based on carotid CT angiography examinations. The bifurcation level of the common carotid artery with respect to the cervical vertebrae and disc spaces was also determined. A total of 640 patients were included in the study.ResultsThe right and left superior thyroid arteries arose from the external carotid artery in 413 (64.5%) and 254 (39.7%) patients, from the bifurcation of the common carotid artery in 131 (20.5%) and 148 (23.1%) patients, and from the common carotid artery in 90 (14.1%) and 226 (35.3%) patients, respectively. We could not observe the right and the left superior thyroid arteries in 6 (0.9%) and 12 (1.9%) of the patients, respectively. However, the right and left inferior thyroid arteries were not identified in 14 (2.2%) and 45 (7%) of the patients, respectively. The thyroidea ima artery was detected in 2.3% of the patients.ConclusionThe visualization of thyroid arteries on CT angiography images enables the anatomy of the arterial supply system of the thyroid gland to be explored in a noninvasive manner prior to surgery.

The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus

BACKGROUND The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. MATERIALS AND METHODS The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. RESULTS Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p < 0.001) and right side (p < 0.001). There was a statistically significant relationship between high renal artery origin and renal artery- -diaphragmatic crus contact at the left (p < 0.001) and right side (p = 0.01). The localisation of renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. CONCLUSIONS Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma

Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumors. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass. The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl.

Primary pulmonary langerhans cell histiocytosis associated with smoking in an adolescent boy

Pulmonary Langerhans cell histiocytosis (PLCH) is a well known entity in adults but is exceedingly rare in children. It is better described in adults than in children. Smoking is a major etiological factor in adulthood. We report a case of a previously healthy 16-year-old male with a history of cigarette smoking, who presented with cough with sputum, breathlessness, easy fatigability and loss of appetite for two weeks. He was first diagnosed with bronchiectasis according to the cystic pulmonary changes demonstrated by computed tomography. After appropriate treatment, there was no sign of clinical improvement. A lung biopsy confirmed Langerhans cell histiocytosis (LCH). The definitive diagnosis was isolated pulmonary LCH. PLCH should be considered in the etiology of cystic lung diseases. Isolated pulmonary LCH is rare so such cases are needed to be reported and followed-up to understand the treatment response and course of this illness.

Metachronuous Synovial Sarcoma After Treatment of Mixed Germ Cell Tumor in a Child of Complet Gonodal Dysgenesis

Patients with complete XY gonadal dysgenesis (GD) show a high predisposition to germ cell tumors (GCT). Patients with coexistence of GCT and GD have been reported previously. Here we present a 15-year-old girl with mixed GCT and GD who also developed an intra-abdominal synovial sarcoma one year after the treatment. This is the first report, to our knowledge, of synovial sarcoma associated with XY GD.

Diagnostic Value of Ultrasound Elastography Characterization of Solid Breast Lesions

Objective: In this study, the contribution of ultrasound (US) elastography in the characterization of solid breast masses was investigated. Methods: Seventy-five patients (1 male and 74 female, aged between 19 and 80 years) were enrolled. A total of 75 solid breast lesions, for which a biopsy was planned, were evaluated using B-mode US and US elastography during the same session. Using B-mode US, the lesions were classified according to the Breast Imaging Reporting and Data System (BI-RADS); Tsukuba elasticity score was determined and strain ratio was calculated for all lesions. Subsequently, a core biopsy of the lesions was performed. BI-RADS results, Tsukuba elasticity scores, and strain ratio were compared with the histopathological results. Results: Of 75 lesions, 47 were benign (62.66%) and 28 were malignant (37.33%). According to the Tsukuba scoring method, the mean score of benign and malignant lesions was 2.31 and 3.96, respectively. The mean strain ratio was calculated to be 4.97±2.94 (0.96–13.20) for malignant lesions and 2.27±1.41 (0.5–5.84) for benign lesions. In statistical analysis, the mean strain ratio of the malignant lesions was significantly higher than that of the benign lesions (p<0.05). BI-RADS classification had the highest sensitivity (89.3%), and the Tsukuba scoring method had the highest specificity (93.6%). Elastographic assessment altered the result in 6 of 8 patients (75%) that B-mode US was non-diagnostic Conclusion: The combination of B-mode US and US elastography can significantly improve the accuracy of diagnosis and characterization of breast lesions, thereby reducing the unnecessary biopsy rate.