Vasculopathic changes in the cerebral arterial system with neurobrucellosis.

Brucellosis is a zoonotic disease characterized by multisystem involvement. Nervous system involvement is rare, with a reported incidence of 3%-13%. Brucellosis can also be manifested in the form of vasculopathy. Cerebral vasculopathy due to brucellosis is a very rare entity, with only a few cases reported in the literature. We present a patient with neurobrucellosis who had involvement of cerebral vasculature demonstrated by angiography.

Endovascular angioplasty-stenting as a definitive treatment for isolated spontaneous common carotid artery dissection. A case report.

Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature. - ÖZET - Izole spontan common carotid arter (CCA) diseksiyonu nadirdir. Literatürde sadece birkaç adet, medikal veya cerrahi tedavi uygulanan, CCA diseksiyonu olgusu bildirilmistir. Bildirimizde, bir yil önce izole spontan CCA diseksiyonu tanisi almis ve medikal tedavi altinda iken yeni minor strok geçiren 39 yasinda erkek olguyu sunuyoruz. Olgunun yeni magnetik rezonans görüntülemesinde (MRG), sol posterior frontal ve pariyetal loblarda yeni iskemik lezyonlarin ortaya çiktigi görüldü. Renkli Doppler ultrasonografi (RDUS) incelemesinde eski incelemesine gore darligin arttigi izlendi. Karotis anjiografide de internal karotis arter baslangicinda jet ve türbülans akima neden olan kritik darlik saptanmasi üzerine endovasküler tedavi planlandi. Femoral girisimle koruyucu filtre kullanilarak self ekspandibl stent yerlestirildi ve postdilatasyon balon uygulandi. Islemden 24 saat sonra alinan difüzyon MRG incelemesinde yeni iskemik alan görülmedi. Birinci ve 3. ay kontrollerinde, nörolojik muayenesinde yeni bulgu saptanmadi. RDUS incelemelerinde stentin açik oldugu görüldü. Karotis artere stent yerlestirimesi cerrahiye alternatif bir tedavi olup daha az invazivdir. Stent uygulamasi, spontan ve travmatik internal karotis arter darliklarinda kullanilmis, ancak izole spontan CCA diseksiyonunda kullanilmamistir. Olgumuz nadir görülen izole spontan CCA diseksiyonu olgularindan biri olup stent yerlestirilerek tedavi edilmistir. Sonuç olarak, medikal tedaviye ragmen tekrarlayan semptomlari olan izole spontan CCA diseksiyonu olgularda tromboemboli kaynaginin kontrol altina alinmasi ve yeterli karotis akiminin saglanmasi için stent yerlestirilmesi gerekebilir.

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.

Duplex sonography of the carotid arteries in patients with pure aortic regurgitation: pulse waveform and hemodynamic changes and a new indicator of the severity of aortic regurgitation.

PURPOSE: To determine the changes of multiple hemodynamic parameters and pulse wave contour in pure aortic regurgitation (AR) and to present a new indicator of the severity of AR (shrink ratio of proximal common carotid artery). MATERIAL AND METHODS: The sonograms of 42 patients (31 M, 11 F; 16-68 years) with pure AR and 18 control subjects (15 M, 3 F; 20-47 years) were assessed for velocities and indices, and change of pulse wave contour (bisferious pattern, zero level and retrograde diastolic flow) in each carotid artery. Shrink ratio (maximum diameter-minimum diameter/maximum diameter) of each proximal common carotid artery was calculated. RESULTS: Bisferious waveforms seen in patients with AR grade 1, grade 2, and grade 3-4 were 66%, 83%, and 88%, respectively. Diastolic reversed flow was determined in 7 (39%) of 18 patients with AR grade 3-4. Three patients (25%) with AR grade 2 and 4 patients (22%) with AR grade 3-4 had zero level diastolic flow in the common carotid artery. Statistically significant changes of decreased end-diastolic velocity, increased peak systolic velocity/end-diastolic velocity, resistivity index, and pulsatility index were revealed, especially in AR grade 3-4 compared to controls. Significantly increased shrink ratio was seen only in AR grade 3-4. CONCLUSION: Increased shrink ratio or changes in hemodynamics or pulse waveform can be used in recognition of AR.

Assessment of mastoid air cell size versus sigmoid sinus variables with a tomography-assisted digital image processing program and morphometry.

We assessed the mastoid air cell size and variables of the sigmoid sinus in healthy ears and ears with chronic otitis media (COM). Thirty-eight patients with unilateral COM [15 with cholesteatoma (COM/+) and 23 without cholesteatoma (COM/-)], and 20 subjects with healthy ears, were included in the study. Assessment was performed using a quantitative digital image processing computed tomography (CT) program, and the volume of the mastoid bone was measured using the morphometric method of Cavalieri. In both COM/+ and COM/- patients the sigmoid to suprameatal spine distance and mastoid size were greater on the healthy side than on the diseased side ( p<0.05). The distance and area were significantly greater in the healthy control subjects than in either the healthy or the diseased ears of the patients with COM ( p<0.05). In the healthy ears of COM patients, there was significant correlation between the sigmoid to suprameatal spine distance and air cell size and mastoid volume ( p<0.05). In the diseased ears of COM patients, this correlation was absent ( p>0.05). The sigmoid sinus shape was of the half-moon type (62%), protrusive type (22%) and saucer type (16%). The digital image processing CT program allowed us to estimate the individual area of the air and soft tissue filled mastoid air cells. The mastoid size in both intact and disease ears of COM patients was smaller than in the healthy controls. The mastoid size may be determined genetically. However, environmental factors such as infection may also affect the mastoid size. Therefore, both genetic and environmental factors may be related to COM as far as the size of the mastoid air cells is concerned.

The normal menisci: in vivo MRI measurements.

The aim of this study was to determine dimensions of the normal menisci in 174 healthy subjects by using MRI. The menisci were divided into three zones (anterior horn, mid-body, posterior horn). The height and width of the both menisci were measured. For the medial meniscus; the height and width of the anterior horn were 5.32 mm and 7.78 mm, the height and width of the mid-body were 5.03 mm and 7.37 mm, and the height and width of the posterior horn were 5.53 mm and 11.71 mm, respectively. For the lateral meniscus, the height and width of the anterior horn were 4.33 mm and 8.88 mm, the height and width of the mid-body were 4.94 mm and 8.37 mm, and the height and width of the posterior horn were 5.36 mm and 9.70 mm, respectively. Three cases (1.7%) of discoid lateral meniscus were encountered. The results of this study should help to establish standard measurements, and to differentiate between normal and pathologic conditions of the menisci of the knee joint.

Conservative management of intrahepatic perforation of the gallbladder secondary to acalculous cholecystitis.

Gallbladder (GB) perforation is a rare complication of acute acalculous cholecystitis. This complication mostly manifests as acute free perforation into the peritoneal cavity, subacute pericholecystic abscess, or chronic perforation with cholecystoenteric fistula. Perforation of the GB into the liver is extremely rare, and was reported only in adults, of whom all were treated surgically. The authors present an intrahepatic GB perforation secondary to acute acalculous cholecystitis, and its successful conservative management in a 13-year-old boy.

Anatomic variations of the paranasal sinus area in pediatric patients with chronic sinusitis.

Endoscopic endonasal surgery has been performed in children. Therefore, we need to know the precise anatomy and anatomic variations of the lateral nasal wall. This is important in order to achieve better surgical results and avoid complications. We also need to know the relationship between the anatomic variations and sinonasal disease. For the purpose of this study we assessed the anatomic variations of the lateral nasal wall and the association of these variations with chronic sinusitis in children. Forty-seven children with chronic sinus disease were included in the study. There were 25 female and 22 male patients with ages ranging from 2 to 16 years (mean 10.5+/-3.8 years). On coronal and axial computed tomographic (CT) scans, the anatomic variations of the lateral nasal wall and sinusitis were assessed. A pneumatized middle concha (MC) was the most common anatomic variation, followed by pneumatization of the superior concha (SC), Haller cell and agger nasi cell. Secondary MC, large ethmoidal bulla, maxillary sinus hypoplasia, Onodi cell, and uncinate process pneumatization were relatively rare. Maxillary sinusitis was the most common sinus infection, followed by ethmoidal, sphenoidal and frontal sinusitis in that order. There was no significant relationship between the sinusitis and anatomic variations except for some minor associations. In conclusion, anatomic variations in the lateral nasal wall are common in children. Local, systemic or environmental factors appear to be more important in pediatric sinusitis than the anatomic variations. Due to the absence of a definitive relationship between the anatomic variations and sinus disease, aggressive surgical interventions should be avoided while performing endonasal endoscopic surgery in the children.

Unthreatened late pregnancy with a huge mucinous cyst adenoma of the left ovary: report of an unusual case.

Benign cystadenomas or cystic teratomas are most frequently diagnosed in pregnancy. In the latter half of pregnancy ovarian tumors are particularly difficult to diagnose. In this report we present a case of a huge mucinous cyst adenoma of the ovary diagnosed in the 26th week of pregnancy. To our knowledge this is the first report of a case of unthreatened late pregnancy with a huge mucinous cyst adenoma of the ovary.

Important anatomic variations of the sinonasal anatomy in light of endoscopic surgery: a pictorial review.

Advances in surgical techniques and instrumentations, utilization of the imaging tools, and understanding the regional anatomy have served to make functional operations with less complications in the paranasal sinus area. In the context of this article, some of these anatomical structures and their variations were reviewed through images. These structures were as follows: course of the anterior ethmoidal artery; roof of the ethmoid; lamina papyracea; uncinate process; optic nerve; and internal carotid artery.

The Chiari III malformation: an unusual and asymptomatic variant in an 11-year old child.

Chiari III malformation is an extremely rare condition, and is characterized by the hindbrain herniation into a low occipital or high cervical encephalocele together with the pathologic and imaging features of the Chiari II malformation. In this report, an unusual variant of the Chiari III malformation was diagnosed in an 11-year-old girl. She had an encephalocele operation when she was a newborn, and has been asymptomatic since then. The clinical and imaging findings of this case were presented.

Significance of the auditory tube angle and mastoid size in chronic ear disease.

The aim of this study was to determine whether a relationship exists between mastoid size and auditory tube angle (ATA) and chronic ear disease. A radiological and clinical study was undertaken of the temporal bones of 36 subjects. There were 24 patients with unilateral chronic otitis media (COM) and 12 healthy controls (HC): the contralateral healthy ears of the COM patients were also used as control (CLHC). From each CT scan the distance between Henle spine and the sigmoid sinus (H-SS) and the ATA was assessed. The angle between a longitudinal line bisecting the transverse length of the external auditory canal and the longitudinal axis of the AT was calculated. A direct correlation between H-SS and ATA, both in COM and HC (p < 0.01), was observed, but not in CLHC (p > 0.05). There was no significant difference in the ATA results between COM and CLHC, or between COM and HC (p > 0.05), however there was a significant difference between CLHC and HC (p = 0.02). H-SS distances were not significantly different between COM and CLHC, or COM and HC, or CLHC and HC (p > 0.05). An association between ATA and mastoid size in both healthy and diseased ears was observed. The anatomical relationships of the AT, mastoid and middle ear, which form a functional unit, are not significantly important in chronic ear disease.

Eosinophilic granuloma of the temporal bone.

Histiocytosis X or Langerhans cell histiocytosis (LCH) is a disease that possesses three less distinctive and overlapping states called eosinophilic granuloma (EG), Hand-Schuller-Christian (HSC) disease and Letterer-Siwe (LS) disease. EG is the least severe and localized form of all LCHs and possesses the best prognostic result. A high index of suspicion is required to diagnose the EG, especially when an ear disease is refractory to medical treatment. Early detection is important to manage the EG properly and to minimize the complications or sequels of treatment. Definitive diagnosis of histiocytosis is made by histopathological means and immunohistochemical detection of S-100 and CD1 antigens in the tissue samples. And differential diagnosis of the subgroups is made according to the clinical manifestations such as visceral organ or bone involvement. Surgical excision, radiotherapy and chemotherapy, either alone or in combination, are the main treatment options.

Huge primary mucinous cystadenoma of the retroperitoneum mimicking a left ovarian tumor.

Primary mucinous cystic tumors of the retroperitoneum are rarely encountered and have been reported in approximately 25 cases in the literature. The histogenesis of primary mucinous cystadenomas is not clear. Most authors suggest that it develops through mucinous metaplasia in a pre-existing mesothelium-lined cyst. Surgery is the only treatment. In this report we present an additional case of primary retroperitoneal mucinous cystadenoma in a 44-year-old female.

Hydatic cyst located intermuscular area of the forearm: MR imaging findings.

Hydatid cyst of the skeletal muscle is rare and can pose various diagnostic problems. The authors report the case of a patient with primary hydatid cysts localized to intermuscular area of the forearm, emphasizing the diagnostic value of MRI. To the best of our knowledge, this localization of the hydatic cyst has not been reported to date.

Ureteral displacement due to a migrated intrauterine contraceptive device.

Perforation of the uterus is rare but potentially fatal. During puerperium when the uterus is small and its wall is thin, the risk of perforation increases. We report a rare complication from an intrauterine contraceptive device (IUD) which caused deviation of the right ureter in a 31-year-old woman who presented with complaints of insomnia and abdominal pain. Our case shows that perforation of the uterus by an IUD can cause a silent urological complication. The possibility of ureteral involvement and displacement should be kept in mind in a woman in whom a missing IUD is encountered.