Shear wave elastography imaging for assessing the chronic pathologic changes in advanced diabetic kidney disease.

OBJECTIVE: The assessment of the grade of renal fibrosis in diabetic kidney disease (DKD) requires renal biopsy, which may be associated with certain risks. To assess the severity of chronic pathologic changes in DKD, we performed a quantitative analysis of renal parenchymal stiffness in advanced DKD, using shear wave elastography (SWE) imaging. PATIENTS AND METHODS: Twenty-nine diabetic patients with chronic kidney disease (CKD) grades 3-4 due to DKD, and 23 healthy subjects were enrolled. Combined conventional ultrasound and SWE imaging were performed on all participants. The length, width, and cortical thickness and stiffness were recorded for each kidney. RESULTS: Cortical thickness was lower in patients with DKD than in healthy subjects (13.8±2.2 vs 14.8±1.6 mm; P=0.002) and in DKD patients with CKD grade 4 than in those with grade 3 (13.0±3.5 vs 14.7±2.1 mm; P<0.001). Cortical stiffness was greater in patients with DKD than in healthy subjects (23.72±14.33 vs 9.02±2.42 kPa; P<0.001), in DKD patients with CKD grade 4 than in those with grade 3 (30.4±16.2 vs 14.6±8.1 kPa; P<0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (15.7±6.7 vs 11.0±4.2 kPa; P=0.03). Daily proteinuria was higher in DKD patients with CKD grade 4 than in those with grade 3 (5.52±0.96 vs 1.13±0.72; P=0.001), and in DKD patients with CKD grade 3b, than in those with CKD grade 3a (1.59±0.59 vs 0.77±0.48; P<0.001). Cortical stiffness was inversely correlated with the estimated glomerular filtration rate (r=-0.65, P<0.001) and with cortical thickness (r=-0.43, P<0.001) in patients with DKD. CONCLUSIONS: In patients with advanced DKD, SWE imaging may be utilized as a simple and practical method for quantitative evaluation of the chronic morphological changes and for the differentiation between CKD grades.

Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis.

BACKGROUND: Percutaneous cholecystostomy is reserved for very high-operative-risk patients suffering from severe acute cholecystitis, who do not respond to conservative treatment. It is associated with high conversion rate to open surgery, when cholecystectomy is held later on. Our objective was to assess whether early timing of percutaneous cholecystostomy decreases conversion rate of delayed laparoscopic cholecystectomy to open surgery. METHODS: The study population included 59 patients who underwent percutaneous cholecystostomy for severe cholecystitis and then proceeded to delayed interval laparoscopic cholecystectomy. The study consisted of a retrospective survey of medical files, based on a prospective enrollment of the data. We assessed conversion rate between two groups based on the time period from onset of symptoms and from admission to hospital until performance of cholecystostomy. RESULTS: Regarding the time from onset of pain to drainage, early cholecystostomy (within 2 days, group I) was associated with 8.3% conversion rate, in contrast to 33.3% in group II (3-6 days from onset of symptoms). Regarding the day of admission to hospital, early drainage revealed 16% conversion rate in contrast to 40.7% in later drainage (p = 0.047, Chi-square test). We found correlation between time interval of symptoms and admission to conversion rate, according to Spearman's correlation coefficient. CONCLUSIONS: Early percutaneous cholecystostomy does decrease conversion rate of delayed laparoscopic cholecystectomy, possibly by halting the propagation of the inflammatory process and its consequences. When decision regarding the necessity to perform drainage of the severely inflamed gallbladder is established, it is suggested to be done as soon as possible.

Angiographic Embolization in Pediatric Abdominal Trauma.

BACKGROUND: Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group. METHODS: Three children with blunt abdominal trauma and one child with iatrogenic renal injury (age 4-13 years) were managed with TAE for lacerated liver (one patient), pelvic fractures (one patient) and renal injuries (two patients). The first two patients, victims of road accidents, had multisystem injuries and were treated by emergency embolization after fluid resuscitation in the Emergency Department (ED). The other two patients had renal injuries: a 4 year old boy with blunt abdominal trauma was diagnosed on initial computed tomography with an unexpected Wilms tumor and was treated with embolization 1 day after admission due to hemodynamic deterioration caused by active arterial tumor bleeding. The following day he underwent successful nephrectomy. The other patient was 13 year old boy with nephrotic syndrome who underwent renal biopsy and developed hemodynamic instability. After fluid resuscitation, he underwent an initial negative angiography, but second-look angiography the following day revealed active bleeding from an aberrant renal artery, which was then successfully embolized. RESULTS: In all four patients, TAE was diagnostic as well as therapeutic, and no child required surgical intervention for control of bleeding. CONCLUSIONS: We propose that emergency transcatheter angiography and arterial embolization be considered following resuscitation in the ED as initial treatment in children with ongoing bleeding after blunt abdominal trauma or iatrogenic renal injury. Implementation of this policy demands availability and cooperation of the interventional radiology services.

Periappendicular Abscess Presenting within an Inguinal Hernia.

The presence of the appendix within an inguinal hernia is a rare finding. We present the case of an elderly woman who developed appendicitis within an inguinal hernia, complicated by a supervening periappendicular abscess. She was successfully treated with a combination of antibiotics and percutaneous drainage.

Sonographic Hair-on-end Sign in Osteosarcoma.

This report is a case of osteosarcoma in a young female whose initial examination was sonography. This examination demonstrated a femoral tumor and included a unique finding corresponding to the radiographic hair-on-end sign of malignant new bone formation.

Assessment of the normal and pathological alignment of the elbow in children using the trochleocapitellar index.

BACKGROUND: The current research is a retrospective study that involves the description of a new trochleocapitellar index (TCI), on basis of anteroposterior (AP) radiographs of normal and fractured paediatric elbows. This index may be useful in assessing the alignment of the elbow with a supracondylar fracture. METHODS: The index was evaluated to define its normal and pathological range in children between the ages of 1-13 years. A total of 212 elbows in 141 children were radiographically evaluated. 70 children without fracture elbows were evaluated by radiographs taken at the time of trauma. 35 children with unilateral fractures that healed in a normal alignment were compared to 33 patients that had a mal-union and three patients with bilateral elbow fractures. The patients were radiographically assessed at the time of fracture as well as after fracture healing as part of a routine clinical assessment. Treatment included observation, cast or internal fixation as needed. RESULTS: The current study establishes that the normal range of the TCI was 0.25-0.8. The average TCI is 0.45. The lower range correlates with a valgus alignment of the elbow while the higher range indicates a neutral alignment. The TCI in fractured elbows that have healed in a clinically normal alignment is different than the contra-lateral elbow's TCI. This might indicate a sub-clinical remaining deformity. CONCLUSIONS: In current practice, paediatric patients with elbow trauma, often undergo bilateral radiographs during emergency room visits. The TCI has high negative and positive predictive values and might be superior to direct angle measurement that is currently in use. The use of the TCI measurement is expected to reduce exposure to irradiation in elbow trauma patients as bilateral comparative films appear to be superfluous when this measurement is used.

Prevalence and Degree of Breast Arterial Calcifications on Mammography: A Cross-sectional Analysis.

OBJECTIVES: The purpose of this study is to establish a database including prevalence and degree of breast arterial calcifications (BAC) in our population of women presenting for mammography. MATERIALS AND METHODS: The mammograms of 1786 women over the age of 40 years were examined for the presence and degree of BAC. Statistical analysis was performed to correlate patient's age and ethnic origin with the presence and degree of BAC. RESULTS: There was statistically significant and strong correlation between the patient's age and presence of BAC. There was also a less strong yet statistically significant correlation between patient age and degree of BAC. Regression analysis showed the likelihood of BAC at various ages. The prevalence of BAC is only 2% of women under 50 years of age; the prevalence of Grade 2-3 BAC is only 1% in women under 60 years of age. CONCLUSION: There is a predictable increase with age in both prevalence and degree of BAC in women. The presence of high degree BAC in women under 60 years of age or any BAC in women under 50 years of age is unusual.

Congenital absence of salivary glands in Down syndrome.

BACKGROUND: Children with Down syndrome have different saliva composition compared to normal children. The presence or absence of the salivary glands has not been previously reported. OBJECTIVE: To examine the presence or absence of the salivary glands in children with Down syndrome. METHODS: 15 children with Down syndrome underwent an ultrasound examination of the salivary glands. The control group consisted of 31 healthy children. The areas of the parotid and submandibular glands on both sides were scanned in an attempt to demonstrate all four glands. The result was reported as 'present' or 'absent'. RESULTS: In four children out of 15 with Down syndrome, one or more salivary glands were absent (26.7%), while in the controls all salivary glands were present. The difference between the groups was statistically significant (p=0.008). There was no significant difference between the groups regarding age and sex. CONCLUSIONS: At least one salivary gland is undetected by ultrasound in some children with Down syndrome.

Posterior mediastinal goiters: Report of two cases and literature review.

Intrathoracic goiters represent substantial enlargement and descent of cervical thyroid tissue into the thoracic cavity, usually in the anterior mediastinum. Rarely, they extend posteriorly, causing obstructive symptoms, sometimes with acute onset. Posterior mediastinal goiters should be differentiated from other mediastinal masses by appropriate work-up, while computed tomography is the most valuable technique. We report two cases of such symptomatic goiters. First reported case was atypically presented with aspiration pneumonia and second was successfully operated. Our overview aims to increase awareness of this rare clinical entity due to possible respiratory compromise. Reasonable surgical management is mandatory.

Bilateral testicular epidermoid cysts.

Testicular epidermoid cysts are the most common benign tumors of the testes, but account for only 1-2% of all testicular tumors. In a young man presenting with a testicular mass, a high index of suspicion must be maintained for the malignant testicular germ cell tumor, which is 50-times more common than testicular epidermoid cyst. Bilateral testicular epidermoid cysts are a very rare condition, with only a few reports in the literature. It is extremely important in this condition to make a correct pre-operative diagnosis on imaging to enable a testis-sparing surgery.

Comparison of early outcome from transperitoneal versus transhepatic percutaneous cholecystostomy.

BACKGROUND/AIMS: To determine whether there is a statistically significant difference in the short-term clinical outcome in patients undergoing percutaneous cholecystostomy based on the anatomic route of gallbladder puncture that is, transhepatic versus transperitoneal. METHODOLOGY: Our population consisted of 132 patients who: 1) presented with acute cholecystitis, 2) were at high risk for surgery because of comorbid conditions, 3) underwent percutaneous cholecystostomy either using computed tomography guidance or ultrasound guidance and whose anatomic route was known: the transhepatic percutaneous cholecystostomy group comprised 59 patients, the transperitoneal group 73 patients. Demographic characteristics and clinical parameters of the groups were compared statistically, as were postprocedure hospital course, complications and time to hospital discharge. RESULTS: The two groups were similar in demographic characteristics. There was a statistically significant tendency for computed tomography-guided percutaneous cholecystostomy to be transhepatic, and for ultrasound-guided percutaneous cholecystostomy to be transperitoneal. There were no differences in short-term postprocedure complications between the two groups. There was a tendency for shorter time to hospital discharge following transperitoneal percutaneous cholecystostomy. CONCLUSIONS: Transperitoneal and transhepatic percutaneous cholecystostomy are similar in short-term safety, with no significant difference in complication rate. The interventional radiologist can feel secure in performing percutaneous cholecystostomy using either approach.

Striated appearance of the testes.

Striated testis is an occasional ultrasound finding in symptomatic and asymptomatic individuals. In older men, the finding of striated testis usually corresponds to a diagnosis of interstitial fibrosis and requires no further action. However, in the appropriate clinical setting, the differential diagnosis of striated testis also includes infection, infarction, trauma, and neoplasm. In this pictorial review, we present the varied sonographic appearances of striated testis within these clinical contexts.

[Parathyroid cyst associated with acute respiratory failure and jugular vein thrombosis].

Parathyroid cysts are much less common than other cystic lesions of the neck. The great majority of parathyroid cysts are endocrine non-functioning. Parathyroid cysts may become symptomatic because of hormonal activity or due to the size and pressure effects. This is a case history of a 43 year-old woman, who presented with dyspnea. A 9 + 8 + 6cm cervical-mediastinal parathyroid cyst causing dyspnea, dysphagia, respiratory failure and jugular vein thrombosis was found.