The association of ocular blood flow with haemorheological parameters in primary open-angle and exfoliative glaucoma.

PURPOSE: To evaluate the ocular blood flow velocities and haemorheological parameters in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG) and exfoliation syndrome (XFS) and to compare their results with those of healthy controls. METHODS: Twenty-five patients with POAG (group 1), 25 patients with XFG (group 2), 25 patients with XFS (group 3) and 25 healthy controls (group 4) were included in the study. Ocular blood flow velocities of ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs) were measured using colour Doppler imaging (CDI). Haemorheological parameters (erythrocyte elongation and aggregation index, aggregation amplitude, aggregation half-life, plasma viscosity, haematocrit) were measured in venous blood samples of all patients. RESULTS: The peak systolic velocity (PSV) and end-diastolic velocity (EDV) values were lower and resistive indices (RI) were higher for the OA, CRA and SPCA of glaucomatous (groups 1 and 2) patients compared with those of controls (group 4) (PSV: OA, 40.4 ± 11.3 versus 52.6 ± 12.8 cm/second, p < 0.001; CRA, 12.9 ± 2.9 versus 15.3 ± 4.2 cm/second, p = 0.02; SPCA, 21.7 ± 6.6 versus 26.6 ± 8.3 cm/second, p = 0.013) (EDV: OA, 10.3 ± 4.3 versus 14.2 ± 5.1 cm/second, p < 0.001; CRA, 3.7 ± 1.1 versus 4.5 ± 1.3 cm/second, p = 0.025; SPCA, 5.2 ± 1.8 versus 7.7 ± 3.2 cm/second, p = 0.001) (RI: OA, 0.75 ± 0.05 versus 0.66 ± 0.07, p < 0.001; CRA, 0.73 ± 0.08 versus 0.68 ± 0.10, p = 0.223; SPCA, 0.70 ± 0.10 versus 0.63 ± 0.11, p = 0.004). There were no statistically significant differences between the haemorheological parameters of glaucomatous and non-glaucomatous patients. The reduction in ocular blood flow velocities in groups 1, 2 and 3 were not associated with changes in haemorheological parameters. CONCLUSION: Our results suggest that impairment of the retrobulbar blood flow in POAG and XFG is not associated with alterations in haemorheological parameters.

Unusual causes of left renal vein compression along its course: MDCT findings in patients with nutcracker and pelvic congestion syndrome.

PURPOSE: The aim of this study was to describe the multidetector computed tomography (MDCT) findings of unusual locations of left renal vein compression in patients with nutcracker and pelvic congestion syndrome. MATERIALS AND METHODS: We retrospectively searched our picture archiving and communication system database for the patients with left renal vein compression. We excluded the patients with well-known forms of nutcracker syndrome. We found four patients and retrieved the CT images of them with left renal vein compression secondary to unusual causes. All patients underwent abdominal MDCT either by 16-MDCT or 64-MDCT. RESULTS: Mean age of the patients was 48 years (range 21-67 years). All patients were female (n = 4). Evaluation of axial and curved planar reformatted images allowed diagnosis of unusual causes of compression. Left renal vein was found to be compressed between aorta and splenic vein, aorta and pancreas, duodenum and aorta or solely by right diaphragmatic crus. CONCLUSION: Contrary to general belief, left renal vein can be compressed along its course between different structures other than aorta and superior mesenteric artery. MDCT findings can demonstrate unusual sites of compression that should be known in patients suspected of nutcracker syndrome.

Multidetector computed tomography diagnosis of fusion of pancreas and spleen confirmed by magnetic resonance imaging.

We report multidetector computed tomography findings of fusion between the spleen and the distal pancreas with magnetic resonance imaging findings, which has not been reported before. Diagnosis of splenopancreatic fusion can be important in patients who will undergo splenectomy or distal pancreatectomy to avoid possible complications.

CT findings of lymphoma with peritoneal, omental and mesenteric involvement: peritoneal lymphomatosis.

PURPOSE: We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement. MATERIALS AND METHODS: We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-Hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings. RESULTS: There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-Hodgkin lymphoma were diffuse large B-cell lymphoma (n=11), small cell lymphocytic lymphoma (n=2), small cleaved cell lymphoma (n=1), T-cell lymphoma (n=1) and Burkitt's lymphoma (n=1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n=12) and nodular (n=3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients. CONCLUSION: Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.

MDCT of the ovarian vein: normal anatomy and pathology.

OBJECTIVE: We intend to show the MDCT findings of normal ovarian (gonadal) vein anatomy and associated disorders, including the "ovarian vascular pedicle" sign, phlebolith, reflux, pelvic congestion syndrome, thrombosis, stenosis, and occlusion. CONCLUSION: Volume-rendered images and curved planar reformatted images can be used to show the ovarian veins. MDCT findings allow the diagnosis of various ovarian vein disorders in patients with abdominal and pelvic pain, pulmonary thromboembolism, and pelvic mass.

Anatomy of the azygos vein examined by computerized tomography imaging.

OBJECTIVE: To examine the anatomy of the azygos vein AV using different parameters. Therefore, the diameter of the AV at its opening into the superior vena cava, the opening level of the AV into the superior vena cava, and the position of the AV, with respect to the vertebral column and carina, were examined by CT. METHODS: Chest CTs of 103 cases (42 female and 61 male) were reviewed at the Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey between July 2004 and February 2005. The CT examinations were performed with a Philips AU E1 spiral CT (Rotterdam, Netherlands) with the following parameters: 120 Hv; 200 mAs; slice thickness: 7 mm; pitch: 1; reconstruction index: 7 mm. The results were statistically analyzed. RESULTS: The diameter of the AV at the opening into the superior vena cava ranged between 4.3 mm and 16 mm. The AV was in the midline in 41 cases. The arching and opening level of the AV was at the fifth thoracic vertebra in most cases. The opening level was most often at the same level as the carina. Hemiazygos veins were detected in 90 patients. CONCLUSION: The parameters measured in this study may be useful in surgical procedures of the mediastinum and during the interpretation of chest radiographs.

CT and MRI findings of sclerosing angiomatoid nodular transformation of the spleen: spoke wheel pattern.

Sclerosing angiomatoid nodular transformation of the spleen is a recently described benign pathologic entity that is characterized by round shaped vascular spaces that are lined by endothelial cells, and the spaces are circumscribed by granulomatoid structures. Microscopically, all the reported cases had multiple angiomatoid nodules in a fibrosclerotic stroma. Each angiomatoid nodule was made up of slit-like, round or irregular shaped vascular spaces that were lined by endothelial cells and interspersed ovoid cells. We present here the CT and dynamic gadolinium-enhanced MR findings of a patient with sclerosing angiomatoid nodular transformation. The spoke-wheel pattern that was observed on MRI in this case may be an important imaging clue for making the correct diagnosis of this benign lesion.

CT, MRI, and US findings of incidental segmental distal hepatic vein occlusion: a new form of Budd-Chiari syndrome?

OBJECTIVE: We aimed to describe radiological findings of patients with incidentally diagnosed segmental distal hepatic vein occlusion on computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed CT (n = 8), color Doppler US (n = 6), and MRI (n = 3) findings of 9 patients with incidentally diagnosed segmental occlusion of the hepatic veins from our archive. Computed tomography and US examinations were performed in 4 patients; only CT in 2; US, CT, and MRI in 1; US and MRI in 1; and CT and MRI in 1 patient. Liver contour, presence, and location of hepatico-hepatic shunts were evaluated. RESULTS: Middle hepatic vein (n = 6) was the most commonly segmentally occluded vein, followed by left hepatic vein (n = 3). Mean length of segmental occlusion was 1.9 cm (range, 1.2-4.2 cm). Hepatico-hepatic shunts were found close to hepatic vein confluence in all but 1 patient. Segmental distal hepatic vein occlusion can cause antegrade (n = 5) or retrograde (n = 1) flow in the affected vein on color Doppler examination, depending on presence of intraparenchymal hepatico-hepatic shunt. In the patient with retrograde flow, occluded segment was very short, and no intraparenchymal shunt was visible. Patients were asymptomatic, and no change in liver morphology (including caudate lobe hypertrophy) was noted. CONCLUSIONS: We propose that segmental Budd-Chiari syndrome can be a valid terminology for asymptomatic patients with segmental hepatic vein occlusion most likely developing as a sequela of subclinical Budd-Chiari syndrome. Acquaintance of practicing radiologists to this phenomenon may be highly useful in the prevention of the diagnostic confusion and potentially unnecessary interventions.

Portomesenteric venous gas: imaging findings with an emphasis on sonography.

OBJECTIVE: Portomesenteric venous gas is a rare condition with an unclear pathogenesis. Most studies in the medical literature mention computed tomography (CT) as the primary imaging tool for this entity. The objective of this study was to outline the advantages and disadvantages of sonography in the evaluation of patients with portomesenteric venous gas. METHODS: We describe 7 patients (3 female and 4 male; age range, 47-83 years) with portomesenteric venous gas. Both CT and sonographic examinations were performed in each patient. Our patient population consisted of 2 patients with superior mesenteric artery occlusion, 3 with ischemia of the colon, small bowel, or both, 1 with gastric ulcer perforation, and 1 with ischemic bowel disease presumably secondary to complications of continuous ambulatory peritoneal dialysis. RESULTS: Portal venous gas was observed in all 7 patients with sonography and in 6 patients with CT. Computed tomography was unable to show gas in the portal venous system in 1 patient. Sonography showed patchy hepatic gas accumulation (likely within small peripheral portal vein branches) with no correlative findings on CT. Computed tomography showed important associated findings, including pneumatosis intestinalis. CONCLUSIONS: In cases with portomesenteric gas, CT is the preferred modality for showing the underlying etiology. However, with its real-time imaging capability, sonography may also be a very valuable imaging modality in the evaluation of this entity.

Doppler sonography of renal obstruction: value of venous impedance index measurements.

OBJECTIVE: Arterial resistive index values have poor sensitivity and specificity for alterations in renal perfusion induced by collecting system obstruction. We aimed to determine whether the intrarenal venous impedance index values could be useful in evaluating renal parenchymal compliance in cases of obstruction and in differentiating acute obstruction from chronic cases. METHODS: Fifteen patients with acute renal colic having unilateral stone disease and another 15 patients having unilateral chronic obstruction due to various causes were evaluated sonographically. The diagnosis was confirmed either by computed tomography or intravenous urography in all cases. Fifteen subjects with normal kidneys were investigated as a control group. All patients were examined prospectively by conventional and Doppler sonography. The impedance indices and peak flow signals of the interlobar arteries and veins of both kidneys were calculated from spectral Doppler waveforms in all 3 groups. RESULTS: The mean venous impedance index on the acutely obstructed side was lower than the index on the unobstructed side: 0.25 +/- 0.07 and 0.53 +/- 0.3 (mean +/- SD), respectively (P = .005). The mean venous impedance index on the acutely obstructed side was less than the indices both on the chronically obstructed side and in the control subjects (P > .0001). In acute cases, the mean arterial resistive index on the obstructed side was higher than the index on the unobstructed side: 0.62 +/- 0.06 and 0.57 +/- 0.06, respectively (P = .001). No statistically significant difference was detected between other parameters evaluated for the test and control groups. CONCLUSIONS: Renal venous impedance index values may be helpful in evaluating renal hemodynamics in obstruction and in differentiating acute obstruction from chronic cases when used in conjunction with the arterial resistive index.