Evaluation of brain perfusion in Alzheimer disease with perfusion computed tomography and comparison to elderly patient without dementia.

BACKGROUND/AIM: The aim of this study was to evaluate perfusion computed tomography (PCT) findings in patients with Alzheimer disease and to compare them with those of patients without dementia. MATERIALS AND METHODS: PCT was performed in 35 patients: 20 with Alzheimer disease (mean age, 69.7 ± 5.5 years) and 15 control subjects (mean age, 67.5 ± 3.5 years). Control subjects were elderly individuals with no cognitive problems who were admitted with headaches. All PCT examinations were performed on a 4-slice CT unit. The PCT analysis software program was used to calculate regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional time-to-peak (rTTP) values in the bilateral frontal, temporal, and occipital cortices, and bilateral lentiform nucleus. RESULTS: rCBF values in the bilateral frontal and temporal cortices and bilateral lentiform nucleus were significantly lower in the patients with Alzheimer disease than in the control subjects. There were no significant differences in rCBV values between Alzheimer disease and the control group. rTTP values in all cortical areas and bilateral lentiform nucleus were significantly higher in the patients with Alzheimer disease than in the control subjects. CONCLUSION: PCT is a rapid and reliable imaging modality for evaluating brain perfusion in Alzheimer disease.

Value of sonographic anterior-posterior renal pelvis measurements before and after voiding for predicting vesicoureteral reflux in children.

PURPOSE: Voiding cystourethrography (VCUG) is the gold standard for diagnosing vesicoureteral reflux (VUR), but it is important to minimize the use of VCUG because of the urinary catheterization and radiation exposure required. Ultrasound (US) observations suggest that pelvicalyceal dilatation varies according to the degree of bladder fullness in children with urinary tract infection. The aim of this study was to assess whether anterior-posterior (AP) measurements of the renal pelvis on US before and after voiding can be used as a screening tool while predicting the presence of VUR in children. METHODS: The subjects were toilet-trained children older than 4 years who required VCUG. Two groups were established based on the VCUG results: a VUR group of 40 kidney units (each unit defined as calyces and ureter) that exhibited different severities of reflux, and a control group of 68 kidney units unaffected by VUR. Prior to VCUG, US AP measurements of the renal pelvis of each kidney unit were recorded when the urinary bladder was full and again after bladder emptying. The change in AP measurement from before to after voiding was compared between the two groups. RESULTS: The mean change in AP measurements from before to after voiding in the VUR group was significantly greater than that in the control group (p = 0.003). CONCLUSIONS: Comparing US AP measurements of the renal pelvis before and after voiding is useful for identifying children who are suspected to have VUR and thus require immediate VCUG.

Tailored treatment approach for emphysematous pyelonephritis.

OBJECTIVE: We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP). PATIENTS AND METHODS: The clinical data of 24 EP patients diagnosed between 2000 and 2009 were retrospectively reviewed. The management strategies were discussed according to the severity of condition at presentation. RESULTS: The mean age of the patients was 61.8 years. Diabetes mellitus was detected in 21 (87.5%) of them. Escherichia coli was the predominant pathogen. There were 6 patients (25%) who recovered with antibiotic treatment only (mild). Percutaneous drainage in addition to antimicrobial chemotherapy was necessary in 13 cases (54%) (moderate). The remaining 5 patients (21%) were treated by nephrectomy (severe). CONCLUSIONS: EP is a serious infection that can display a fatal progression despite ablative treatment but there are also some cases with mild or moderate severity that can be successfully treated without nephrectomy.

Hepatobiliary fascioliasis: imaging characteristics with a new finding.

PURPOSE: The aim of this study was to present the imaging characteristics of patients with hepatobiliary fascioliasis and describe a new imaging finding. MATERIALS AND METHODS: Imaging and clinical findings of five patients diagnosed with hepatobiliary fascioliasis were retrospectively evaluated. All patients were examined by abdominal ultrasonography (US) and computed tomography (CT); two were additionally evaluated by abdominal magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). Diagnosis was confirmed by serology and parasitology tests in all patients. RESULTS: Presenting complaints were abdominal pain in four patients, with fever in one of the four. All patients also had eosinophilia and abnormal liver function tests. In all patients, US examinations showed multiple hypoechoic nodules or parenchyma heterogeneity. CT examinations showed linear or branching, and nodular hypodense lesions in the liver. As a new imaging finding, hyperdense materials were identified in the dilated bile duct in one patient. MRI showed T1 hypo and T2 hyperintense areas of liver parenchyma in two patients, with peripheral enhancement in one of them. Filling defects and dilation of the intra-extrahepatic bile ducts were identified by US and MRCP in two patients. In these two patients Fasciola flukes were removed by ERCP. Medical treatment (triclabendazole) was successful in all patients. CONCLUSION: Hepatobiliary fascioliasis is a rare disease which may have typical imaging findings in the liver and bile ducts as seen in our patients. Imaging characteristics with clinical findings may have a diagnostic clue especially in endemic areas.

Localisation using mini c-arm fluoroscopy of needles ingested by a woman with schizophrenia: a case report.

INTRODUCTION: Our aim was to specify the use of mini C-arm fluoroscopy in a woman with schizophrenia who was suffering from abdominal pain because of ingested needles. CASE PRESENTATION: Here we report the case of an 18-year-old Turkish woman with schizophrenia who was admitted to the emergency department with signs of an acute abdomen as a result of ingestion of multiple needles. This is the third case in the literature for which mini C-arm fluoroscopy has been used to localize metallic sewing needles. CONCLUSION: When intentional ingestion occurs, surgery is rarely required. It is hard to localize ingested sewing needles and mini C-arm fluoroscopy is a good alternative when metal detectors are not available for localization of metal sewing needles. We recommend this approach because it helps to avoid unnecessary exploration, shortens the duration of surgery and provides outstanding results.

Primary renal lymphoma: report of four cases.

BACKGROUND: Although secondary renal involvement from systemic lymphoma is very frequent, primary renal lymphoma is a rare entity. It is characterized by aggressive histopathology, very early extra-renal infiltration and poor prognosis. CASE REPORTS: Here, we report 4 cases of primary renal lymphoma presenting with unilateral renal masses, which after radiological and clinical examination were assumed to be renal cell carcinoma. 3 patients were diagnosed with Non-Hodgkin's lymphoma by nephrectomy and one patient was diagnosed by open renal biopsy. Histopathological subtypes were diffuse large B cell lymphoma in 2 cases and non-Hodgkin's lymphoma of small B cell type in the others. While 3 of the patients were treated with systemic chemotherapy, the fourth patient refused chemotherapy. 2 patients (no. 2 and 3) were still in complete remission and were followed regularly in the second and first year after diagnosis, respectively. CONCLUSIONS: Since it is difficult to diagnose primary renal lymphoma, most patients with this kind of tumor undergo radical nephrectomy, and diagnosis of primary renal lymphoma is delayed. The authors believe that both the delayed diagnosis due to anatomical difficulties and the histological aggressive characteristics of this disease are equally responsible for the poor outcome in the case of primary renal lymphoma.

Spinal MRI findings of guillain-barré syndrome.

Guillain-Barré syndrome is a relatively common, acute, and rapidly progressive, inflammatory demyelinating polyneuropathy. The diagnosis is usually established on the basis of symptoms and signs, aided by cerebrospinal fluid findings and electrophysiologic criteria. Previously, radiologic examinations have been used only to rule out other spinal abnormalities. We report a case of systemic lupus erythematosus associated with Guillain-Barré syndrome with marked enhancement of nerve roots of the conus medullaris and cauda equina on MR imaging. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.

Metastatic pulmonary calcification in a patient with chronic renal failure.

Metastatic pulmonary calcification characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. We present a case of a 47-year-old man with chronic renal failure presented with dyspnea, high-resolution computed tomography of the chest revealed multiple, centrilobular, calcified nodules and patchy areas of ground-glass opacity throughout both lungs, consistent with metastatic pulmonary calcification. Calcification was also seen in the bronchi and trachea.

Rhabdomyolysis and acute myoglobinuric renal failure in a patient with bilateral pheochromocytoma following open pyelolithotomy.

Rhabdomyolysis is an unusual manifestation of pheochromocytoma. Early diagnosis and prompt management are crucial, as it may have life-threatening consequences. This is the case of a 19-year-old man with bilateral pheochromocytoma complicated with rhabdomyolysis and acute myoglobinuric renal failure after surgery for nephrolithiasis. A massive catecholamine release during the procedure manifested itself as a hypertensive crisis, producing severe vasoconstriction and thereby provoking ischemia of the patient's muscle tissue. This insult resulted in rhabdomyolysis and acute myoglobinuric renal failure. After making sure that all necessary medical precautions were performed, including blood pressure stabilization with alpha receptor blockade and adequate fluid replacement, the patient successfully underwent a bilateral cortex-sparing medullar adrenalectomy. The operation specimen was reported as pheochromocytoma.

Accuracy of sonography for detecting renal stone: comparison with CT.

PURPOSE: To determine the diagnostic accuracy values of sonography in the detection of renal stones using noncontrast CT as the gold standard. In addition, we correlated the accuracy of sonography with stone size, the kidney affected (right versus left), and body mass index (BMI). METHODS: Fifty patients underwent 2 separate sonographic examinations performed by 2 radiologists. CT scans were evaluated by another 2 radiologists, and the diagnosis was made by consensus. We compared the sonograms and CT scans and the sonographic detection of stones in the left and right kidneys. All sonographic findings were correlated with the BMI groups. RESULTS: The sensitivity of sonography for any stone in a patient was 52-57% for the right kidney (radiologist 1 and 2) and 32-39% for the left kidney (radiologist 1 and 2). The overall accuracy of sonography in detecting a stone in the right kidney by radiologists 1 and 2 was 67% and 77%, respectively. The corresponding accuracy values for the left kidney were 53% and 54%, respectively. CONCLUSION: Sonography is of limited value for detecting renal stones. The sonographic detection of a renal stone is dependent on the side of the kidney involved but is independent of BMI.

Venous variants and anomalies on routine abdominal multi-detector row CT.

OBJECTIVE: This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). MATERIALS AND METHODS: One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. RESULTS: In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. CONCLUSION: The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation.

Computed tomographic findings of trichuriasis.

In this report, we present computed tomographic findings of colonic trichuriasis. The patient was a 75-year-old man who complained of abdominal pain, and weight loss. Diagnosis was achieved by colonoscopic biopsy. Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon. Although these findings are nonspecific, they may be one of the findings of trichuriasis. These findings, confirmed by pathologic analysis of the biopsied tissue and Kato-Katz parasitological stool flotation technique, revealed adult Trichuris. To our knowledge, this is the first report of colonic trichuriasis indicated by computed tomography.

Percutaneous transhepatic thrombolysis in the treatment of acute portal venous thrombosis.

Acute portal vein thrombosis (PVT) is a rare clinical condition that can cause portal hypertension and bowel infarction. Early diagnosis and treatment of PVT is crucial for the restoration of portal venous flow and reduction of morbidity and mortality. We report a successful treatment of acute PVT which was seen following splenectomy, utilizing catheter directed transhepatic thrombolysis. No complication was encountered related to the procedure. Thrombolytic therapy via transhepatic route proved to be a safe and effective method in the treatment of PVT.