Massive upper gastrointestinal bleeding from an accessory splenic artery mimicking isolated gastric varices.

Knowledge of anatomical variations of coeliac trunk and its branches is important for surgeons and interventional radiologists planning surgical and radiological interventions. We describe a case of a 42-year-old male with an accessory splenic artery (ASA) originating from the left gastric artery (LGA) running in the wall of gastric fundus and mimicking isolated gastric varices, which was observed during endoscopy. Bleeding from this artery was massive and was managed with endovascular coil embolisation. Coeliac angiography of the patient with upper gastrointestinal bleeding showed that the coeliac trunk divided into 3 arteries: the LGA, the splenic artery, and the right hepatic artery. Additionally, the variations of ASA and the left hepatic artery arising from LGA, and the left and right inferior phrenic arteries arising from ASA were identified. This case is the first to be presented in the literature with ASA originating from LGA that was situated in the gastric wall where inferior phrenic arteries arose from the ASA.

Hoffa's recess in the infrapatellar fat pad of the knee on MR imaging.

The infrapatellar fat pad of Hoffa is a structure that is located in the space between the back side of the patellar ligament and the real capsule. It is routinely visualized on magnetic resonance (MR) images of the knee. The purpose of this study was to determine the prevalence and shape of a fluid-like indentation at the inferior posterior margin of the infrapatellar fat pad of the knee (recess) and to look for a relation between the liquid image in the fat pad and joint effusion. Three hundred and fifty consecutive MR imaging examinations of the knee were evaluated for the presence, location, size and shape of a recess in the infrapatellar fat pad and existence of joint effusion. The study population consisted of 145 females and 205 males aged between 5 and 80 years old (mean age 37.5 years). The recess in the infrapatellar fat pad was revealed on MR imaging in 54 of 350 knees (15.43%) and had a variable shape, consisting of 35 linear or ovoid (64.81%), five pipe-shaped (9.26%) and 14 globular (25.92%). Additionally, one ganglion cyst was observed in the infrapatellar fat pad. Globular and pipe-shaped recesses may be confused with cystic infrapatellar fat pad pathologies such as ganglion cyst, meniscal cyst, loose body or nodular synovitis. The existence of an infrapatellar fat pad may not be related to the presence of joint effusion.

Carotid and brachial intima-media thickness, arterial diameter and resistivity indices in aortic regurgitation.

PURPOSE: To evaluate signs of atherosclerosis in carotid and brachial arteries in patients with aortic regurgitation (AR). MATERIAL AND METHODS: The sonograms of 33 patients (24 M and 9 F, 16-67 years old) with pure AR and 20 control subjects (15 M and 5 F, 19-49 years old) were evaluated. Patients with AR and control subjects completed a questionnaire with SMART risk score based on pre-existing vascular disease and risk factors. AR patients and control subjects were assessed for intima-media thickness (IMT) of common carotid artery (CCA), IMT of brachial artery (BA), CCA diameter, and resistivity index (RI) of CCA and RI of internal carotid artery (ICA). RESULTS: There was no significant difference in the cardiovascular risk score between the patients with AR and control subjects. All measured parameters were statistically significantly greater in AR patients than in control subjects with P values 0.0233 for CCA IMT, 0.0034 for BA IMT, 0.0429 for CCA diameter, <0.0001 for CCA RI, and 0.0002 for ICA RI. CONCLUSION: AR is associated with signs generally considered to represent atherosclerosis, such as increased CCA and BA IMT, CCA diameter, and CCA and ICA RI.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the maxillary sinus mimicking malignancy: a case report of an unusual location (is that a true neoplasm?).

The inflammatory myofibroblastic tumor (IMT) is a space-occupying lesion of unknown etiology and a distinctive but controversial lesion. This type of tumor is recently considered neoplastic rather than inflammatory. It is usually occurring during childhood, composed of fascicles of bland myofibroblastic cells admixed with a prominent inflammatory infiltrate consisting of lymphocytes, plasma cells, and eosinophils. IMT of the maxilla is very rare. The diagnosis of IMT can be made on the basis of histopathology and immunohistochemistry. Herein, we presented a patient who had IMT of the maxillary sinus that was initially misinterpreted as a malignant neoplasm upon clinical and radiographic examinations. We discussed the diagnostic and therapeutic procedures and may consider it a true neoplasm.

Ultrasonographic evaluation of bilateral groins in children with unilateral inguinal hernia.

PURPOSE: The presence of hernia was investigated prospectively by US in both groins of children with clinically suspected or apparent unilateral inguinal hernia. MATERIAL AND METHODS: One hundred and twenty-eight (103 boys, 25 girls) were classified into three groups according to age: 0-2, 3-5 and 6-15 years. The widest diameter of the inguinal canal was measured in the longitudinal plane while the children were in the supine position and at rest. The patent processus vaginalis (PPV) values of 4 mm and higher were accepted as hernia. The groins diagnosed clinically and/or ultrasonographically as hernia were explored surgically. The clinical and US findings were compared with surgical results. The relations between hernia diameters and the age groups, sex, right/left and inguinal/scrotal hernias were analyzed statistically. RESULTS: In 128 children, 138 groins were treated with surgery. One hundred and eleven cases were unilateral hernia (73 right, 38 left) and 10 were bilateral. Seven cases were found to be normal. Ten cases with clinically unilateral hernia were bilateral at US and surgery. One hundred and thirty-one of 138 groins were correctly diagnosed by US. The accuracy, specificity and sensitivity of US were 94.9%, 85.7% and 95.4%, respectively. The accuracy of physical examination was 87.7%. There were no significant differences between hernia diameters and the age groups, sex and right/left side except the difference between inguinal and scrotal hernia diameters (p<0.0001). CONCLUSION: US can be used routinely in the pre-operative diagnosis of inguinal hernia in children. PPV values higher than 4 mm, with a high accuracy indicate hernia.

A thyroglossal duct cyst with calcification.

We report a thyroglossal duct cyst with calcification, the second case in the world literature. The ultrasound and CT findings are described and we highlight the differential diagnosis.

CT findings in pulmonary hydatid disease.

PURPOSE: The purpose of this study was to present the CT findings of complicated pulmonary hydatid cysts on the basis of the CT appearances. MATERIAL AND METHODS: Preoperative CT examinations of 19 cases with hydatid cysts were evaluated retrospectively for the number and various features of the cysts and secondary changes in adjacent structures. The results were compared with surgical findings. RESULTS: While 7 patients had multiple pulmonary hydatid cysts, 12 patients had solitary cyst. The total number of the cysts was 29. Eleven of them were intact cysts. Two of the 18 complicated cysts were only ruptured, while the remaining 16 complicated cysts were ruptured and infected. The endocyst was separated from a pericyst in a local area in one ruptured cyst. Air-bubbles were seen within 14 infected cysts. Nine of the infected cysts had characteristic appearances of hydatid disease. The other 2 infected cysts showed soft tissue density. CONCLUSION: CT can provide the specific diagnosis of pulmonary hydatid cysts by demonstrating the number and features of the cysts, characteristic appearances of complicated cysts, and secondary changes in adjacent structures. Whether there are characteristic signs or not, the demonstration of air-bubbles within the cyst, together with ring enhancement, are strong indicators for infected hydatid cysts.

Scrotal gray-scale and color Doppler sonographic findings in genitourinary brucellosis.

PURPOSE: Brucellosis is an enzootic disease that is frequently transmitted from Brucella-infected animals and their products to humans through the gastrointestinal tract. Genitourinary complications are seen in 2-10% of cases. We used sonography to investigate such complications in patients from a Brucella-endemic area. METHODS: Between 1992 and 1996, 246 patients were clinically and serologically diagnosed as having brucellosis and were examined by sonography. RESULTS: Genitourinary complications were identified by sonography in 26 patients. Fifteen of these patients had unilateral epididymo-orchitis, 6 had diffuse orchitis, and 5 had a focal hypoechoic testicular lesion. An increase in the vascularity of the lesions was seen in the 14 patients who also underwent color Doppler examination. Spectral waveform analysis showed a decrease in the resistance index in 9 patients. After medical treatment, all but 1 of the lesions disappeared within 2 months; the last lesion persisted for 6 months. CONCLUSIONS: In areas in which brucellosis is endemic, when scrotal abnormalities are seen with gray-scale or color Doppler sonography, the possibility of genitourinary tract complications of brucellosis should be considered. Simple Brucella tests may prevent unnecessary surgery.