Appendiceal mucocele: clinical and imaging features of 14 cases.

PURPOSE: Appendiceal mucocele as a cystic dilatation filled with mucinous material is a very rare disease of the appendix vermiformis. Its preoperative diagnosis is still acking behind common use of imaging techniques. METHODS: Retrospective analysis of the patients with a pathological diagnosis of appendiceal mucocele with regard to clinical and imaging features. RESULTS: The study group included 14 patients with a mean age of 51 years (range from 17 to 82 years). Predominant symptoms were pain and feeling of fullness in the right iliac fossa in 9(64%) and 5 (36%) patients, respectively. For imaging purposes, use of computed tomography resulted in preoperative diagnosis of appendiceal mucocele in half of the patients(50%). 93% of the cases underwent appendectomy, and righth emicolectomy was performed in one patient (7%). Mucocele and cystadenoma were detected in 11 (79%) and 3 (21%)patients, respectively. Presence of acute appendicitis and coloncarcinoma were confirmed afterwards histologically in 4 (29%)and one (7%) patients, respectively. CONCLUSIONS: Despite the common use of imaging studies,preoperative diagnosis of appendiceal mucocele is still not possible in most of the cases. During surgical treatment,which is tailored according to imaging and intraoperative findings, precautionary measures to avoid intraperitoneal rupture and dissemination should be taken.

Ultrasonography and magnetic resonance imaging findings of abdominal complications of cystic fibrosis.

UNLABELLED: In this study, our aim is to discuss the imaging findings of the abdominal complications seen in Cystic Fibrosis (CF), with ultrasonography (US) and magnetic resonance imaging (MRI). Our first case, a 22 year-old female showed changes characterized by severe biliary involvement such as cholelithiasis and cholangitis. Our second case was a 36 year-old male with severe hepatic manifestations. In this case signs of severe cirrhosis, portal hypertension and marked splenomegaly were seen. Micro-gallbladder, cholecystolithiasis and diffuse fatty infiltration of the pancreas were seen in both cases. IN CONCLUSION: US and MRI are effective and noninvasive imaging techniques to evaluate the abdominal complications of cystic fibrosis.

Utility of venous compression in deep venous thrombosis evaluation revisited.

OBJECTIVE: Ultrasound venous compression (UVC) is considered the gold standard for confirmation of deep venous thrombosis (DVT) of the lower extremities. The objective of this study was to assess the contribution and significance of venous compression in comparison to color flow duplex (CFD) ultrasonography alone in the diagnosis of DVT. METHODS: Retrospective analysis was performed of all DVT studies during two years period. DVT examinations were performed with a 5.8-7.6 MHz linear broadband transducer following the American Institute of Ultrasound in Medicine guidelines for the performance of DVT examination. The images were categorized as normal, partial thrombus, or complete thrombus. RESULTS: A total of 428 patients comprised the study group. In total, 467 DVT examinations were performed (39 patients had bilateral examinations). Of the lower extremity examinations, 347/467were normal and 120/467 were abnormal. Complete thrombus was evident in 49/120 patients, while 71/120 patients had partial thrombus. We observed the thrombus on gray scale imaging in all 120 positive patients. No patient had venous compression negative for thrombus and CFD positive for thrombus. There was one patient with visualization of thrombus on gray scale imaging and complete venous compression (negative for thrombus). CFD examination of this patient was also negative for thrombus. CONCLUSION: UVC did not provide any additional information for the diagnosis of DVT. If CFD demonstrates the presence of DVT, venous compression is not necessary, although it can further confirm the presence of DVT. No additional DVTs were diagnosed by using venous compression alone (Tab. 2, Fig. 2, Ref. 27).

Ability and utility of diffusion-weighted MRI with different b values in the evaluation of benign and malignant renal lesions.

AIM: To evaluate the ability and the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) with high and low b values to visualize benign and malignant renal lesions, and to determine which b value (b=100, 600, or 1000s/mm(2)) was most useful in differentiating benign from malignant renal lesions. MATERIALS AND METHODS: Fifty-eight patients with 67 renal lesions and 50 normal contralateral kidneys (as control) were enrolled in the study. DW imaging was performed with b values of 100, 600, and 1000s/mm(2). Results of the histopathological evaluation were compared with the DW MRI results. Apparent diffusion coefficient (ADC) values, and the sensitivity and specificity for differentiating malignant renal lesions from benign renal lesions were calculated for each b value. RESULTS: The mean ADC values of normal renal parenchyma with b=100, 600, and 1000s/mm(2) values were (3.14±0.54)×10(-3), (2.52±0.30)×10(-3), and (2.16±0.43)×10(-3)mm(2)/s, respectively. The mean ADC values of benign renal lesions (n=35) with b=100, 600, and 1000s/mm(2) values were (2.88±0.88)×10(-3), (2.58±0.91)×10(-3), and (2.10±0.93)×10(-3)mm(2)/s, respectively. The mean ADC values of malignant renal lesions (n=32) with b=100, 600, and 1000 values were (2.74±0.58)×10(-3), (2.09±0.63)×10(-3), and (1.66±0.51)×10(-3)mm(2)/s, respectively. Using DW imaging malignant renal lesions could be differentiated from benign renal lesions, and also angiomyolipomas and oncocytomas could be differentiated from renal cell carcinoma. CONCLUSIONS: DW MRI with quantitative ADC measurements can be useful in the differentiation of benign and malignant renal lesions. High b values (b=600 and 1000s/mm(2)) had the best specificity and sensitivity.

Scrotal ultrasonography: should it be used in routine evaluation of infertile men?

Several studies have suggested that male infertility and testicular cancer may have common aetiological factors. Scrotal ultrasonography (US) has an important role in the diagnosis of testicular tumours when not palpable by physical examination. In this study, we present two infertile men referred to our clinic. Patients were evaluated by a detailed physical examination, semen analyses and hormonal assessment. Both patients underwent scrotal US examination. Semen analysis of the patients revealed oligoasthenospermia in both patients. Scrotal US revealed hypoechoic masses in the left and right testes of both patients, which were nonpalpable by physical examination. Scrotal exploration and subsequent orchidectomy were performed. Histopathological examination revealed mixed germ cell tumour and Sertoli-Leydig cell tumour in case 1 and case 2 respectively. With these cases, we discussed the role of scrotal US in the routine diagnostic evaluation of infertile men.

Paranasal sinus computed tomography findings in patients treated for lepromatous leprosy.

AIM: Nasal and paranasal sinus involvement is common in lepromatous leprosy and is of considerable epidemiological significance. The aim of this study was to investigate paranasal sinus abnormalities in treated lepromatous leprosy cases and to evaluate the findings in comparison with those of previous studies. MATERIALS AND METHODS: Thirty-eight patients who had been treated for lepromatous leprosy were included. All patients had been treated with dapsone and rifampicine for six months, and followed with dapsone, rifampicine and clofamizine for a minimum of two years. All patients received a clinical examination, a coronal computed tomography (CT) examination of the paranasal sinuses and ethmoidal sinus endoscopy, in order to investigate the involvement of the paranasal sinuses in the leprosy. Ethmoidal sinus biopsies were taken in 18 of the 21 cases of ethmoidal sinus involvement noted on CT scan. RESULTS: Twenty-three patients had sino-nasal symptoms. Endoscopic examination showed different pathologies in 21 of these patients. Abnormalities in the paranasal CT images were observed in 27 patients. The ethmoidal, maxillary, frontal and sphenoid sinuses were affected in 21, 18, three and two patients, respectively. Various degrees of nasal septum perforation were noted in 18 cases. In six of the 18 patients biopsied, the biopsy specimen showed involvement by lepromatous leprosy. CONCLUSION: These findings suggest that although these lepromatous leprosy patients had been treated, persistent infection was still commonly encountered. Paranasal sinus CT examination is a useful method for the evaluation of patient response to treatment and follow up; however, a CT scan alone cannot determine whether the leprosy is active.

Spinal epidural hematoma associated with streptokinase treatment for myocardial infarction.

STUDY DESIGN: Case Report. OBJECTIVE: Thrombolytic therapy has become a routine and valuable care for selected patients with acute myocardial infarction (AMI) and rarely complicates with spinal epidural hemorrhage causing cord compression. SETTING: Elazig, Turkey CASE REPORT: A 72-year-old woman developed spinal epidural hemorrhage following streptokinase and heparin administration for AMI. Back pain and lower extremity neurologic deficits ensued secondary to spinal cord compression by epidural hematoma. Diagnosis of spinal epidural hematoma, extending through T11 to L2 vertebra levels, could be accurately made by magnetic resonance imaging (MRI). Careful follow-up by neurologic examination, reversal of anticoagulant effects, anti-edema treatment with steroids and a low-intensity rehabilitation program maintained a full recovery. Follow-up MRI, 3 months after the accident, revealed complete resolution of the hematoma. CONCLUSION: Physicians should be aware of this rare complication secondary to thrombolytic therapy. A high index of suspicion for hemorrhagic complications is necessary, particularly in elderly patients under thrombolytic treatment regardless of spinal pain, and the patient's lethargic or confused status should be taken into account. MRI is a valuable imaging option that gives information on both localization and extent of lesion and recovery.

An overwhelming pulmonary fungus ball in a systemic lupus erythematosus patient.

Impaired host immunity has been regarded as a predisposing factor in post-primary tuberculosis in adults. Patients with systemic lupus erythematosus (SLE) are usually exposed to high doses of corticosteroids and eventually develop defective cellular immunity that increases the risk for active tuberculosis. SLE-associated pulmonary tuberculosis tends to have a higher incidence of miliary, far-advanced pulmonary disease and therefore establishing the diagnosis can easily be delayed due to generalized, non-specific clinical symptoms such as fever, malaise and weight loss which are also commonly observed in lupus patients. However, cavitary tuberculosis is very rare in patients with SLE. To the best of our knowledge, fungus ball formation in the tuberculosis cavity in a patient with SLE, has not been previously reported. Thus, we present a case of SLE who was found to have a fungus ball within a preexisting tuberculosis cavity. The diagnosis was resolved by computerized tomography of the chest and was confirmed with histopathological examination.

Unilateral absence of cerebellar hemisphere: a case report.

We describe a 38-year-old woman with absence of right cerebellar hemisphere incidentally discovered by MR imaging. No cerebellar abnormality was detected on neurological examination. Tissue probably representing dysgenetic cerebellar tissue with no corticomedullary differentiation was present, connected to the right superior cerebellar peduncle. Ipsilateral enlargement of the pons and cerebral peduncle were additional findings. Although the terms "aplasia" or "agenesis" have been used to describe this entity, intrauterine destruction is the presumed pathogenetic mechanism in our case, and therefore these terms have been avoided. Asymmetry of pons and mesencephalon may be related to compensatory reorganisation or to the impairment of sequential development of nuclei and neural tracts.