Disappearing Inferior Vena Cava in A Pediatric Patient with Down Syndrome and Hereditary Thrombophilia.

Absence of the infrarenal segment of the inferior vena cava is an extremely rare anomaly. The reasons for such a developmental failure are unclear. Most researchers believe that the cause lies in embryonic dysgenesis affecting separate segments or the entire inferior vena cava. Others suggest that absence of the inferior vena cava is not embryonic in origin, rather the result of intrauterine or perinatal thrombosis. We report a case here that during a period of six months, inferior vena cava first occluded, then become redundant in a baby girl with several chromosomal and gene defects, including Down syndrome and hereditary thrombophilia, admitted to our hospital due to the swelling and redness of the right lower extremity. From this observation, we propose that the absence of the inferior vena cave was not of embryonic origin but due to thrombosis.

Atypical Feeding and Drainage of Dural AV Fistula.

Dural arteriovenous fistulas (DAVF) are frequent causes of pulsatile tinnitus. Color Doppler sonography may play a useful, complementary role to CTA/MRA and digital subtraction angiography (DSA) in the assessment of these anomalies' characteristics, such as an ipsilateral increased flow volume and a low resistive index. In this article, we report a case of DAVF first detected with Color Doppler sonography that displayed an uncharacteristic venous drainage pattern.

Rare Variants of Carotid-Vertebrobasilar Anastomoses.

Carotid-vertebrobasilar anastomoses generally disappear during embryogenesis. However, if a problem exists during regression, these arteries persist in adult period and are named as persistent arteries. Their persistence in adult patients is sometimes pathological and may result in the development of an aneurysm or a compressive syndrome. These anastomoses are frequently associated with proximal or distal arterial pathology. Herein, we present three rare variants of carotid-vertebrobasilar anastomoses: a persistent trigeminal artery, persistent hypoglossal artery, and a persistent otic artery. These variants should be kept in mind to avoid errors both in clinical reporting and surgical procedures.

Inferior vena cava anomalies and variations: imaging and rare clinical findings.

PURPOSE: The aim of this paper is to summarize imaging findings of some frequent and infrequent inferior vena cava (IVC) anomalies and variations. CONCLUSIONS: IVC anomalies should be suspected in patients presenting with pulmonary emboli, chronic pain, and deep vein thrombosis. To correctly characterize and classify IVC anomalies and variations is of crucial importance for proper planning of surgical interventions and thus for avoiding serious complications. KEY POINTS: • IVC anomalies should be suspected in patients with pulmonary emboli, pain, and venous thrombosis. • Awareness of IVC anomalies and variations is crucial for clinical and surgical procedures. • Unawareness of these anomalies may lead to severe and deadly complications.

Cardiac Hydatid Cysts: Computed Tomography and Magnetic Resonance Imaging Findings of the 5 Cases.

OBJECTIVE: In this article, we aimed to review the computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac hydatid disease. CONCLUSIONS: Regarding the diagnostic work-up of cardiac hydatid disease, CT and MRI are complimentary techniques. Whereas CT effectively depicts wall calcifications, MRI reveals the exact anatomic location and nature of the internal and external structures and is the technique used for the early diagnosis, assessment, and follow-up of patients with cardiac hydatid disease.

Idiopathic recurrent transverse myelitis with syringomyelia: a case report.

Idiopathic transverse myelitis is a monophasic demyelinating disease of the central nervous system (CNS) and its recurrence is a rare entity. Existence of syringomyelia in the spinal cord in inflammatory CNS disease is not usually encountered. This case study describes a 45-year-old man who was admitted with features of a cervical demyelinating disease. The history of the patient indicated that this could be a recurring attack. Cervical MRI and laboratory examination of the patient showed evidence of recurrent transverse myelitis. The patient was managed with medical therapy. The follow-up cervical MRI of the patient 2 years later indicated syringomyelia in the cervical cord.

The midterm effects of diabetes mellitus on quadriceps and patellar tendons in patients with knee arthrosis: a comparative radiological study.

We sought to evaluate the effects of diabetes on the physical properties of the patellar and quadriceps tendons using radiological techniques. Twenty-seven diabetic and 34 nondiabetic patients with primary osteoarthritis of the right knee were studied. All patients had anteroposterior and lateral knee radiographs. The lengths of the patella and the patellar tendon were measured. The width and thickness of the patellar tendon were determined by ultrasound (US) examination at midpoint. The increase in the thickness of the patellar tendon sheath was graded qualitatively. The length of the quadriceps and patellar tendons, and the thickness and width of tendons in mid-length were measured by magnetic resonance imaging (MRI). Buckling of tendons and increase in intensities were also evaluated. The mean age in the diabetic group was 57.6 +/- 10.1 years, and the mean age in the control group was 52.6 +/- 9.1 years. The mean duration of diabetes was 104.1 +/- 67.1 months. X-ray, US, and MRI measurements did not reveal any differences between the two groups. Quadriceps buckling was more prevalent in diabetic patients (P=.025). In both groups, the width of the patellar tendon was greater in men than in women (P=.001). In conclusion, we found no significant structural changes in the patellar and quadriceps tendons in diabetic patients in midterm. On MRI examination, the quadriceps tendons had more buckling in diabetic patients.

Nonoperative treatment of acute appendicitis in children.

BACKGROUND/PURPOSE: Appendicitis is considered by many surgeons to be a surgical emergency for which necessary to avoid perforation of the appendix. Although it has also been treated nonoperatively using antibiotic therapy, experience in such treatment in children with acute appendicitis (AA) is extremely limited. In addition, previous studies on nonoperative treatment (NT) showed it to be a cause of morbidity and mortality. The authors hold that not all appendicitis cases respond to NT because only some of the cases recover. In the present study, 16 of 95 cases with AA were selected for NT according to physical and ultrasound examinations. The clinical and ultrasonographic findings of the cases are presented. METHODS: The medical records of all children with appendicitis treated between August 2003 and March 2006 were retrospectively reviewed. Patients who had history of abdominal pain for less than 24 hours with localized abdominal tenderness and hemodynamic stability underwent NT. Children were treated with parenteral antibiotics (ampicillin with sulbactam, 100 mg x kg(-1) x 24 h(-1), divided into 3 doses daily, and ornidasole, 20 mg x kg(-1) x 24 h(-1), divided into 2 doses daily), intravenous fluid, and nothing by mouth for at least 48 hours. RESULTS: A total of 136 patients with appendicitis were treated. Of the cases, 95 (70%) were AA, and 41 (30%) had perforated appendicitis. Sixteen (16.8%) cases of AA were selected for NT (12 boys and 4 girls; age range, 5-13 years; mean age, 9 years). The mean anteroposterior diameter of the appendix at the presentation was 7.11 +/- 1.01 mm (range, 6-9.5 mm). Ultrasound examination was repeated after 48 hours of treatment. The mean diameter of the appendix was 4.64 +/- 0.82 mm (range, 3.6-6.8 mm). The difference was statistically significant (t = 9.63, P < .0001). Nonoperative treatment was successful in 15 (93.7%) of the 16 patients. CONCLUSION: Hyperplasia of the appendiceal lymphoid follicle frequently causes luminal obstruction. Antibiotic therapy probably causes regression of lymphoid hyperplasia because of suppression of bacterial infection and prevents ischemia and bacterial invasion in the early stage of appendicitis. We found that some of the patients who had a history of abdominal pain for less than 24 hours with localized abdominal tenderness and hemodynamic stability could be treated nonoperatively.