A Sciatic Neuralgia Case of an Entrapment Neuropathy Mimicking Piriformis Syndrome Due to Soft Tissue Hemangioma.

BACKGROUND: Lumbosacral pain is commonly seen in daily clinical practice. In fact, entrapment of the part of the sciatic nerve after the sacral foramen causes some of these pains, which should not be overlooked. The sciatic nerve may be compressed during its course after the sacral foramen for a variety of reasons. We aimed in this article to review extra-spinal compressive sciatic neuropathy reasons and abnormal magnetic resonance imaging (MRI) by presenting a sciatic neuralgia case of an entrapment neuropathy mimicking piriformis syndrome due to soft tissue hemangioma. CASE PRESENTATION: A 30-year-old male patient was admitted with complaints of lumbosacral pain spreading to the leg that had been worsening over the previous 10 days. With the preliminary diagnosis of labral damage and piriformis syndrome, the patient was referred to the radiology clinic for a hip MRI. In the hip MR images, a mass lesion suggestive of heterogeneously enhanced soft tissue hemangioma after the injection of paramagnetic contrast material was observed in the proximal left thigh. The soft tissue hemangioma extends towards the obturator foramen and compresses the sciatic nerve proximal to the femur after the sciatic foramen. CONCLUSION: The diagnosis of lower extremity entrapment neuropathy is frequently misdiagnosed. In these cases, MRI becomes more important for accurate diagnosis. The radiologists' knowledge of the sciatic nerve in MRI, regional anatomy during the course of the sciatic nerve, and abnormal nerve imaging findings will aid in the diagnosis.

The Effectiveness of Prostate Imaging and Reporting and Data System Version 2 in the Diagnosis of Prostate Cancer with Screening Parameters Correlation.

PURPOSE: Prostate cancer is the most commonly diagnosed cancer and the second most common reason for cancer-related mortality in men. The purpose of cancer screening is to detect the disease at an early stage to help effective treatment. This study aimed to investigate the effectiveness of MRI and PI-RADS in the diagnosis of prostate cancer and examine the relation between screening parameters with prostate cancer. METHODS: The PACS system was analyzed and MRI images between September 2016 and April 2018 were listed. The state of patients regarding having pathology results were obtained. PSA values were listed. The prostate volume and the prostate density was calculated. PI-RADS assessment was used for each prostate lesion. RESULTS: Data of 138 patients were included in the study. The mean age was 63±8.9. The mean prostate gland volume was 63.8±39.3ml, the mean PSA value was 12.51±25.22 and the mean PSA density was calculated as 0.319±0.945. A statistically significant difference was found between age and prostate volume and cancer. The age of the cancer cases was higher than those who did not have cancer (p<0.05). A negative correlation was found between prostate volume and cancer status. The prostate volume of non-cancer cases was higher compared to cancer cases (p=0.0001). 55 patients had no malignancy. It was observed that 56.4% of cancer patients had significant cancer. The frequency of using PI-RADS scores was 4% for P1, 36% for P2, 14% for P3, 28% for P4, and 18% for P5. Clinically significant cancer was present in 57.9% of patients with PI-RADS score4 and 69.6% of patients with PI-RADS score5. It was found that diagnostic values were significantly high for prostate cancer screening in patients with PI-RADS scores4 and 5 (Sensitivity 76.4%, Specificity 73.5%, Negative predictive value 82.4%, Positive predictive value 65.6%). CONCLUSION: PI-RADS and MRI can be useful for the diagnosis of the clinically significant prostate cancer in patients at risk for prostate cancer. It is a non-invasive, repeatable method for prostate cancer screening and diagnosis. In prostate screening PSA reliability may be questioned. Additional methods are needed for the diagnosis. For this reason MRI and PI-RADSv2 is an effective predictor of prostate cancer in patients with high PSA levels.

The radiologic roadmap for treatment of an acute appendicitis patient who tested positive for coronavirus disease 19.

Objective: In this study, we aimed to emphasize the role of radiological imaging in determining the treatment of a patient, who tested positive for COVID-19 and diagnosed with acute appendicitis during the pandemic. Methods: A 31-year-old patient presented to the emergency department due to abdominal pain. Ultrasound examination, thoracic and pelvic CT scan were performed. Results: Non-complicated appendicitis can be treated conservatively with antibiotics. Treatment can be maintained by starting with IV antibiotics and bridging therapy with oral antibiotics. Conclusion: This studysummarize how radiological follow-up can be used to decide on the suitability of the patient for appropriate medical treatment as an alternative to surgery in a patient, whose gold standard treatment is emergency surgical intervention, which is frequently encountered in the emergency department during the COVID-19 pandemic. Healthcare workers need to be protected to ensure the continuity of the health system. On the other hand, patients requiring emergency healthcare should also be provided with appropriate treatment. Healthcare professionals should choose the most appropriate treatment method, protecting themselves and their patients as much as possible.

Right lower quadrant pain: not always appendicitis but epiploic appendagitis of appendix.

Epiploic appendagitis is a condition that mimics acute abdomen, causing inflammation of epiploic appendages. This paper aimed to present a case of "epiploic appendagitis of the appendix", which is a rare cause of right lower quadrant pain. A 45-year-old male patient with abdominal pain was referred to the radiology clinic for abdominal CT. The pain localized to the right lower quadrant and no signs of peritoneal irritation were present on physical examination. On images of abdominal CT the diameter of the appendix measured as 7 mm. The wall thickness was within normal limits and no mucosal enhancement noted. Appendiceal air was present in the lumen. An oval lesion of fat density with a hyperdense rim was seen adjacent to the anterior part of the appendix. It was causing striations and heterogeneous appearance in the surrounding mesenteric fat tissue with central areas of high attenuation. The findings noted down as "hyper-attenuating ring sign" and "central dot sign". These pathognomonic CT findings were consistent with epiploic appendagitis and the case reported as epiploic appendagitis of the appendix. After conservative non-surgical medical treatment symptoms of patient revealed. To prevent unnecessary surgery, it is important to exclude conditions requiring emergency surgical intervention with imaging. The most effective technique recommended for imaging is CT with IV opaque. Increasing awareness and knowledge of radiologists regarding epiploic appendagitis of the appendix will rule out the possibility of potential misdiagnosis in imaging and will avoid the resultant unnecessary surgery.