Zülküf Akdemir

Giant thyroid abscess related to postpartum Brucella infection.

Thyroid gland infection, although rare, may be a life threatening disease. Thyroid abscess, arising from acute suppurative thyroiditis (AST), is a rare clinic condition depending on widespread use of antibiotics. Infection may involve one or both lobes and abscess formation may not be apparent until late stage of the progress of illness. Thyroid left lobe is more often affected than the right one. Brucellosis, especially obvious in endemic areas, is a widely seen zoonosis around the world. Although brucella infection can affect many organs through various complications, thyroid gland infection is rare. We aimed to present ultrasonography (USG) and magnetic resonance images (MRI) of a case with an acute thyroiditis which rapidly developed and grew fast on the left half of the neck during the first postpartum month. As far as we know from literature reviewing, our case is the first case report of a thyroid abscess arising from brucella infection which is developed in first postpartum period with images of ultrasonography and MRI.

Herlyn-Werner-Wunderlich Syndrome: Merits of Sonographic and Magnetic Resonance Imaging for Accurate Diagnosis and Patient Management in 13 Cases

STUDY OBJECTIVE To review the main sonographic and magnetic resonance imaging manifestations of Herlyn-Werner-Wunderlich syndrome, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, and to discuss the value of techniques for its diagnosis and treatment. PARTICIPANTS Thirteen patients with Herlyn-Werner-Wunderlich syndrome referred to our department with acute abdomen were identified for the period from 2009-2012. DESIGN Retrospective chart review. SETTING Two tertiary academic centers. INTERVENTIONS None. MAIN OUTCOME MEASURES The evaluation of the clinical features, ultrasonography and magnetic resonance imaging findings, and the treatment protocols. RESULTS Ultrasonographic evaluation of didelphic or double uterus in 10 and bicornuate-bicollis uterus in 3 patients with hematocolpos or hematometrocolpos associated with agenesis of the ipsilateral kidney revealed the diagnosis. In 10 patients, magnetic resonance imaging provided extra information. In 1 patient, a 25-week pregnancy was additionally detected and follow-up was suggested. Seven patients underwent surgical excision of the septum and drainage of the obstructed vagina. Total hysterectomy and hemicolpectomy were performed in 1 patient with 2 children suffering from severe chronic pelvic pain due to pelvic inflammatory disease. CONCLUSIONS Despite its rarity, accurate diagnosis and morphologic description of Herlyn-Werner-Wunderlich syndrome with radiologic modalities are of importance in relieving the clinical complaints by enabling the suitable surgical treatment to be identified.

Giant Vulvar Epidermoid Cyst in an Adolescent Girl

Introduction. Vulvar cyst in adolescent girls is very uncommon. Epidermoid cyst can be seen in many sites including face, trunk, and extremities but its occurrence in vulva is uncommon. This is the first case of epidermoid cyst of vulva reported in an adolescent girl. Case. A 17-year-old, adolescent girl admitted to our gynecology outpatient clinic with a complaint of painful and palpable mass in her vulva. On examination, a giant mass located in left vulva and labia majora with 11 cm in diameter was seen. The magnetic resonance imaging (MRI) showed a well-defined cystic mass without contrast enhancement. The surgery was advised to the patient and the pathologic examination of mass revealed vulvar epidermoid cyst. Discussion. Vulvar cysts generally grow slowly and the main etiologies are vulvar trauma and surgical interventions including episiotomy and female circumcision in some culture. The exact treatment is total surgical excision and pathologic examination. MRI is an important imaging modality for detection of extension to deep perineal tissue and localization of mass in vulva especially in giant ones. Conclusion. Although vulvar mass in adolescents is rare, the epidermoid cyst with benign origin should be kept in mind.

A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman with Radiologic Findings.

The incidence of all malignant tumours during pregnancy is extremely rare and esophageal carcinoma ranges from 0.07 to 0.1% of all malignant neoplasms. The physiological changes during pregnancy frequently mask the complaints and symptoms related to the disease. The physical and physiological clinical conditions limit the diagnostic approaches. Therefore, the stage of cancer at the time of diagnosis is usually advanced. The management with cancer surgery and chemotherapy regimens must be modified in pregnant women in order to minimize fetal and maternal risks. Here, we report a very rare case of metastatic esophagus cancer in a 39-year-old woman with 28 weeks of pregnancy and aim to show the ultrasound (USG) and magnetic resonance imaging (MRI) findings with treatment and follow up management.

Synovial Hemangioma in the Knee: MRI Findings

Synovial hemangiomas are rare benign tumors of vascular origin. A 23-year-old boy presented with knee pain and swelling. The boy had developed symptoms 18-months earlier. He was diagnosed with synovial hemangioma based on magnetic resonnance imaging examination and histopathologic findings of the arthroscopic biopsy tissue. We present the magnetic resonance imaging and histopathologic findings of synovial hemangioma of the knee.

Contribution of Ultrasound Strain Elastography to the Differentiation of Benign and Malignant Thyroid Lesions: Randomized Controlled Study

Objective: We aimed to investigate the contribution of strain elastosonography to the distinction of benign and malignant thyroid nodules. Materials and Methods: The retrospective study included 135 patients who were detected with thyroid nodules on ultrasonography and then underwent fineneedle aspiration biopsy (FNAB). Semi-quantitative strain elastographic evaluation was performed and mean strain ratio was calculated for each nodule. The elastograms were classified using the Tsukuba fivepattern visual scoring system. Accordingly, the lesions with scores 1 and 2 were accepted as soft nodules (benign), score 3 as moderately hard nodules, and scores 4 and 5 as hard nodules (malignant). The nodules were divided as benign and malignant depending on the histopathological results. The FNAB results were compared with elasticity scores. Results: The patients included 18 (13.3%) men and 117 (86.7%) women. Of the 135 lesions, 113 (83.7%) were benign and 22 (16.3%) were malignant. Strain ratio value was statistically higher in malignant lesions compared to benign lesions (p<0.01). When compared with the histopathological results, elastosonography scoring had a sensitivity of 81.8%, specificity of 89.4%, positive predictive value (PPV) of 96.2%, and negative predictive value (NPV) of 64.7%. However, compared with the strain ratio values, elastosonography scoring had a sensitivity of 77.3%, specificity of 87.6%, PPV of 95.2%, and NPV of 54.8% at a cutoff point of 4.850. Conclusion: Elastosonography is highly effective in the differentiation of benign and malignant lesions.

A case report of left paraduodenal hernia diagnosed preoperatively and treated laparoscopically

Paraduodenal hernia is a rare congenital anomaly; however, it is the most common cause of internal herniation. Clinical findings are often indeterminate. Computerized tomography is usually diagnostic; however, the diagnosis is often made intra-operatively. Paraduodenal hernia carries a risk of incarceration leading to bowel obstruction and strangulation; therefore, it should be repaired surgically when diagnosed. Here we present a case of left PDH that was diagnosed preoperatively and repaired laparoscopically.