Severe Posterior Reversible Encephalopathy in Pheochromocytoma: Importance of Susceptibility-Weighted MRI

Pheochromocytoma is a rare cause of hypertension in children. Hypertension is one of the common reasons of posterior reversible encephalopathy. Intracerebral hemorrhage is a serious and unexpected complication of hypertensive encephalopathy due to pheochromocytoma, and very rarely seen in the childhood. Intracerebral hemorrhages should be searched if there are hypertensive reversible signal changes on the brain. Susceptibility weighted imaging (SWI) is a more sensitive method than conventional MRI when demonstrating cerebral microhemorrhagic foci. This is the first report of SWI findings on intracerebral hemorrhages in basal ganglia, brain stem and periventricular white matter due to hypertensive encephalopathy in a child with pheochromocytoma.

Idiopathic postpartum intussusception: a rare cause of acute abdominal pain

To present a case with acute abdominal pain due to idiopathic intestinal intussusception diagnosed by ultrasound and computed tomography [CT] during the early postpartum period. A 21-year-old female patient was admitted to our hospital with abdominal pain, nausea and emesis after a normal vaginal delivery. Laboratory tests done at admission were within normal limits except for leukocytosis. Physical examination revealed abdominal distention, guarding and rebound tenderness. Abdominal ultrasound and oral contrast-enhanced CT showed a complex mass in the hypogastrium, with a typical configuration of intussusception. Emergent laparotomy revealed ileoileal invagination approximately 70 cm to the ileocecal valve but no lead point. A partial ileal resection was performed. This case shows that when intussusception is suspected, an abdominal ultrasound should be performed even in patients with atypical symptoms. CT may be used to confirm the diagnosis

Primary Hepatic Actinomycosis

To present a case of primary hepatic actinomycosis. A-40-year-old man was admitted to the general surgery clinic with a 1-month history of abdominal pain and weight loss. Liver transaminase, bilirubin levels and white blood cell counts were increased. Abdominal ultrasound and CT revealed cystic lesions with necrotic debris involving the posterior segment of the right lobe of the liver and the medial segment of the left lobe. The patient underwent surgery under general anesthesia. On exploration, three cavities were found within the liver containing necrotic material. Surgical debridement and drainage was performed. Histopathological examination revealed actinomycotic colonies with a surrounding suppurative granulomatous reaction. The patient was treated with penicillin for 3 months. This case showed that histological examination of biopsy or surgical material or anaerobic cultures was needed for definitive diagnosis and that hepatic actinomycosis should be included in the differential diagnosis of solitary or multiple hypodense liver lesions

Recurrent Retroperitoneal Cystic Lymphangioma

Retroperitoneal cystic lymphangioma is a rare congenital malformation. The majority of lymphangiomas are present at birth and nearly all present before the age of two years. We report a case of giant cystic retroperitoneal lymphangioma in a patient who first presented with symptoms at the age of 7, underwent surgery, and who then suffered a recurrent mass 11 years later.

Pediatric idiopathic pulmonary hemosiderosis diagnosed by sputum analysis: plain radiography and computed tomography findings

Idiopathic pulmonary hemosiderosis [IPH] is an uncommon disorder, which is characterized by recurrent hemoptysis, iron deficiency anemia and diffuse parenchymal infiltration on chest radiographs in pediatric patients. We wish to present clinical and radiological [plain radiography and CT] findings of this rare pathology. Clinical Presentation and Intervention: A 14-year-old girl was admitted to the pediatric emergency department with complaints of cough, dyspnea, fatigue and bloody sputum for 6 months. She had been hospitalized 3 times during this period and received antibiotics and blood transfusion. Chest X-rays revealed prominent perihilar and bibasilar consolidation. CT showed a ground glass pattern and consolidated areas with increased density. Sputum analysis yielded hemosiderin-laden macrophages. With presumptive diagnosis of IPH, prednisolone was administered. Her symptoms improved on the 5th day of treatment and 1 month later, plain chest radiography demonstrated marked improvement. Although IPH is a rare condition, the diagnosis of IPH should be considered, among others, in a patient with hemoptysis and bilateral infiltration in the chest X-ray. This may prevent antibiotic misuse and risk of death due to severe hemorrhage

Correlation of hand bone mineral density with the metacarpal cortical index and carpo:metacarpal ratio in patients with rheumatoid arthritis

This study proposed an assessment of the correlation of hand bone mineral density measured by dual energy x-ray absorbtiometry (DXA) with the carpo:metacarpal (C:MC) ratio and metacarpal cortical index (CI) in patients with rheumatoid arthritis (RA). The correlation of total hand BMD, CI and C:MC ratio with BMD at other sites, the Health Assessment Questionnaire (HAQ) and Larsen scores were also examined. The hand and axial BMD of 30 female patients were also compared with 29 age-matched healthy female controls. Total hand BMD values of patients were significantly lower than the control group. There was no significant difference between groups in axial measurements. CI correlated moderately with the second metacap (II.MC) midshaft and total hand BMD. The C:MC ratio correlated with II.MC midshaft and total hand BMD. Total hand BMD correlated moderately with the AP spine (L2-L4) and femoral neck BMD. Larsen scores showed weak negative correlation with II.MC midshaft BMD and CI. Grip strength correlated weakly only with total hand BMD. The results indicated that CI may reflect cortical bone mass of the hand accurately and did not predict bone density of the spine or hip in patients with RA. The C:MC ratio is a useful method for evaluating progression of wrist involvement and may be related to the loss of hand bone mineral density associated with disease process.