Idiopathic Granulomatous Mastitis Associated with Erythema Nodosum.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. CASE REPORT: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with indrawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. CONCLUSION: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Echolucency of carotid plaques and cerebrovascular events.

OBJECTIVES: To assess the relationship between carotid plaque echogenicity and degree of stenosis with acute and chronic stroke. METHODS: A retrospective study of cerebral MRI and carotid B-mode and Doppler ultrasonography in 60 patients with stroke. Plaque echogenicity was graded as echolucent (1), predominantly echolucent (2), predominantly echogenic (3), or echogenic (4). Sonographic findings were compared between patients with acute (group 1) and chronic (group 2) stroke. RESULTS: In group 1 (n = 39 patients), the carotid plaques were grade 1 in 21, grade 2 in 22, grade 3 in 9, and grade 4 in 4 carotid arteries. In group 2 (n = 21), the carotid plaques were grade 1 in 2, grade 2 in 8, grade 3 in 4, and grade 4 in 11 carotid arteries. Plaque echogenicity was lower in group 1 than in group 2 (p < 0.05). Plaque echolucency was associated independently with acute stroke from the degree of stenosis. CONCLUSIONS: Patients with acute infarcts have predominantly echolucent plaques, regardless of the degree of stenosis.

Partial achilles tendon rupture presenting with giant hematoma; MRI findings of 4 year follow up.

In the young population, spontaneous rupture of Achilles tendon is very rare. The big hematoma is also rare finding of the Achilles tendon partial rupture. It is usually seen with complete rupture. We presented imaging findings of 4 years follow up of the spontaneous partial rupture of Achilles tendon presenting with giant expanding hematoma and mimicking complete rupture radiologically. We discussed the alterations of tendon signal intensity and result of conservative therapy after partial rupture with big hematoma in the long term. A 29 year-old man, applied with pain and swelling in the retrocalcaneal region of left ankle. He did not have chronic metabolic disease. He was not active in physical activities. X-ray radiograms were normal. At magnetic resonance images (MRI), there was an intratendinous big hematoma, subcutanous fat planes were edematous around tendon. The diagnosis was partial rupture and giant hematoma. Hematoma was drained. The conservative treatment was applied and his complaints disappeared. After treatment, approximately 4 years later, control MRI showed thickened and hypointense tendon in all images.

Intraventricular glioblastoma multiforme: a pediatric case report.

SUMMARY: Glioblastoma multiforme (GBM) is the most common lethal primary central nervous system tumor in adults. GBM is rarely seen in childhood and adolescence as primary intraventricular tumors. Few cases of solitary intraventricular GBM in adolescence have been reported to date. We report a 16-year-old boy with progressive disorientation, diffuse headache, vomiting, and increased intracranial pressure. Computed tomography and magnetic resonance imaging confirmed that the tumor filled posterior body and occipital horn of the left lateral ventricle and also invaded the surrounding parenchyma. Incomplete removal of the lesion was achieved and a pathologic diagnosis of GBM was carried out. We present a case with an uncommon subtype of glial tumor (GBM) in childhood located in a very rare site. The clinical course, radiologic findings, and possible treatment regimens are reviewed.

Radiological considerations in von Hippel-Lindeau disease: imaging findings and the review of the literature.

BACKGROUND: Von Hippel Lindau disease is an autosomal dominant multisystem/multitumoral cancer disease diagnosed by clinical, radiologic and genetic findings. Its prevalence has been estimated to be of 1/36000 inhabitants. The tumours can be benign or malignant. CASE REPORT: We represent MR findings of a family with ten children. Mother and five siblings had von Hippel-Lindau disease. CONCLUSIONS: Radiologic imaging is very important for the early diagnosis and treatment of asymptomatic patients. Diagnosing it early is important because the tumours in von Hippel Lindau disease are treatable. Also, an early detection allows the patient's survival and quality of life. A multidisciplinary team approach is important in screening.

[Differential diagnosis in cervical lymphadenopathies: efficacy of B-mode, color and power Doppler ultrasonography]. / Servikal lenfadenopatilerin ayirici tanisinda B-mod, renkli ve power Doppler ultrasonografinin etkinligi.

OBJECTIVES: Our purpose was to investigate cervical lymphadenopathies by using color Doppler spectral analysis and power Doppler ultrasonography methods as well as B-mode ultrasound and to classify them as malignant or benign lesions and to compare the results with the histopathological findings. PATIENTS AND METHODS: Sixty-nine lymph nodes of 69 patients were evaluated with color and power Doppler ultrasonography as well as B-mode ultrasonography. The shape and dimensions of the lymph nodes were assessed with B-mode ultrasonography; their vascularization pattern with power Doppler sonography and with color Doppler spectral analysis. Vascular pattern was evaluated according to the vascularization of the lymph node. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. We measured resistive index, pulsatility index, peak systolic velocity, and end diastolic velocity. Results of Doppler analysis were compared with clinical findings and histopathologic results. Nodes were grouped as metastasis, lymphoma, tuberculosis, and reactive benign lymphadenopathies with respect to ultrasonographic results. RESULTS: Forty-four of 69 lymph nodes were found to be malignant histopathologically. In color Doppler analysis, most malign metastatic lymphadenopathies showed peripheral (76.4%), and the rest of them (23.6%) showed peripheral and hilar (mix) vascularization. Most benign lymphadenopathies (88%) and lymphomatous lymphadenopathies (85%) had hilar vascularization. In tuberculous lymphadenopathies, 50% of them showed avascular pattern and the rest of them had variable type of vascularization. A resistive index = or > 0.7 indicated a malignant metastatic lymphadenopathy and a resistive index <0.5 was consistent with benign lesions. In lymphomatous and tuberculous lymphadenopathies resistive index values were between 0.6-0.7. The sensitivity of the resistive index for distinguishing inflammatory from neoplastic lymphadenopathies was 84.6%, the specificity 100% and the diagnostic accuracy 95.7% (p<0.001). CONCLUSION: In addition to B-mode ultrasonography findings, vascularity pattern assessment and spectral analytical measurements with color and power Doppler ultrasonography has an important contribution for the differential diagnosis of cervical lympadenopathies.

Third accessory (supernumerary) intrathoracic right rib.

Intrathoracic ribs are very rare congenital anomaly. We report a case of a third accessory intrathoracic rib located anterior to the normally developed right third rib in a 37-year-old man. Chest X-ray was not diagnostic. Multidetector computed tomography with 3D reconstructions was required for definitive diagnosis. These anomalies are usually clinically silent and detected incidentally by imaging studies. They should be kept in mind in the differential diagnosis of thoracic pathologies.

A rare cause of exophthalmos: cemento-ossifying fibroma.

Cemento-ossifying fibroma is a benign fibroosseous lesion that contains fibrous tissue and calcified tissue resembling bone, cementum or both. It is frequently seen in the mandibula and maxilla, but it may rarely affect the ethmoid sinus. In this report, we presented computed tomography findings of an ossifying fibroma of the ethmoid sinus associated with exophthalmos. A 25-year-old woman presented with complaints of exophthalmos, headache, and nasal congestion of six-month history. Physical examination showed a firm mass on the right side of the nasal septum and right-sided exophthalmos. Eye movements, vision, and the fundus were normal. Axial and coronal computed tomography scans showed a well-delineated, round mass, 4x4.5x3 cm in size, in the right ethmoid sinus, extending from the right orbital rim to the right nasal cavity. Near-total excision of the mass was performed by a lateral rhinotomy and medial maxillotomy approach. Based on histologic and radiological findings, the diagnosis was made as ossifying fibroma.