Biomedical subjects
Publications and source records attributed to Cetin Atasoy.
We report a case of omental cyst in an 11-month-old infant. The cyst occupied nearly the whole abdomen and mimicked massive ascites on sonography. The correct preoperative diagnosis was achieved through the use of CT, and partial torsion of a huge omental cyst was found at surgery. The diagnostic role of sonography and CT in ascites of unknown etiology is emphasized.
We present ultrasonographic and magnetic resonance imaging findings of intratesticular adrenal rests in a 16-year-old patient with congenital adrenal hyperplasia. Scrotal ultrasonography showed bilateral well-delineated homogenous hypoechoic lesions located around the mediastinum testis, which were highly vascularized on power Doppler ultrasonography. Relative to normal testicular parenchyma the lesions were iso- or hyperintense on T1-weighted and hypointense on T2-weighted images. T2-weighted images also showed a target-like appearance caused by a more hypointense peripheral halo around the lesions. The lesions enhanced remarkably on post-contrast images. This case suggests that radiological evaluation of testes, even in the presence of normal physical examination findings, should be included in periodical follow-up of patients with congenital adrenal hyperplasia. Magnetic resonance (MR) imaging is useful in demonstrating the lesions, because the contrast resolution better than with ultrasonography.
OBJECTIVE: Our objective was to investigate the prevalence of variant main and right portal vein ramification in a large group of patients. SUBJECTS AND METHODS: The study group consisted of 200 patients who underwent consecutive contrast-enhanced abdominal CT examinations performed with an 8-MDCT scanner. Two observers evaluated both thin axial sections and 3D maximum-intensity-projection and volume-rendered images for branching patterns of the main and right portal veins. RESULTS: Conventional main portal vein anatomy was present in 64.5% of the patients. In 9.5% of the patients, the main portal vein trifurcated into the left portal and right anterior and posterior portal veins. In 23.5% of the patients, the main portal vein divided into a common left portal vein-right anterior portal vein trunk and the right posterior portal vein. Three patients (1.5%) had miscellaneous variations. Twenty-two (16.8%) of 131 patients with conventional main portal vein branching had variant right portal vein branching, most of which was a trifurcation, followed by an abnormally proximal origin of the segment VII vein from the right portal vein. CONCLUSION: Variant main portal vein branching seems to be very frequent. Common right anterior portal vein-left portal vein trunk is far more common than trifurcation. Although less frequent, variations also occur in right portal vein branching.
BACKGROUND: Choriocarcinoma mostly metastasizes to lung parenchyma. Its pulmonary tumor embolism and cardiac metastasis are very rarely encountered, of which antemortem diagnosis is even more rare. CASE: To our knowledge, we present the first case of intracavitary cardiac metastasis and pulmonary tumor emboli of choriocarcinoma diagnosed and treated without any surgical intervention. Multi-agent chemotherapy led to almost complete regression of cardiac and pulmonary lesions and normalization of beta-hCG levels. CONCLUSION: Cardiac metastasis of choriocarcinoma must be kept in mind for cases of cardiac mass in reproductive age women, especially when history and clinical presentation are suggestive for gestational trophoblastic disease. As the tumor is highly sensitive, chemotherapy together with biochemical and radiological monitoring constitutes an effective treatment modality if cardiopulmonary functions are not deteriorating.
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PURPOSE: To assess the role of multislice CT angiography in the evaluation of arterial, hepatic and portal venous variations in potential right lobe donors. MATERIALS AND METHODS: Fifty-two potential liver donors (28 females, 24 males), underwent CT angiography in the arterial and portal venous phases with an eight-row CT scanner. Two- and three-dimensional images were obtained from 1.25-mm-thick axial images with multiplanar reformatting, maximum intensity projection and volume rendering techniques. Both axial and two- and threedimensional images were evaluated for possible variants of hepatic vasculature. In twelve operated patients, CT angiography results were compared with the results of surgery. RESULTS: Of 52 patients, 40 had type I, five type III, two type II, three type IX, and two type V hepatic arterial anatomy. In 13 patients (25%), segment IV artery originated from the right hepatic artery. In 26 patients (50%), veins that drained segment V and/or VIII to the middle hepatic vein were larger than 5 mm. Twenty-five patients (48%) had 28 accessory hepatic veins larger than 3 mm; 23 of these drained to the inferior vena cava more than 4 cm caudal to the right hepatic vein-vena cava junction. Three patients (6%) had trifurcation and one patient (2%) had quadrifurcation of the main portal vein. In two patients (4%), the right posterior portal vein arose directly from the main portal vein before its bifurcation. CT angiography findings showed one-to-one correlation with surgery in the 12 operated patients. CONCLUSION: Multislice CT angiography can successfully show the relevant hepatic vascular variations in potential liver donors.
Vascular malformations are infrequent causes of aqueductal stenoses, developmental venous anomaly (DVA) being the rarest among them. DVAs, also known as venous angiomas, are congenital in origin and characterized by dilatation of vessels in the superficial and deep venous system. Although they are usually clinically silent, they can be complicated by hemorrhage, seizures and neurologic deficits. Herein, we report MR imaging findings of a 7-year-old girl whose hydrocephalus was due to an abnormal vein coursing through the aqueduct.
Multidetector CT has had great impact in the evaluation of the liver. Increased speed combined with thin slice collimation improved the spatial and temporal resolution, which in turn provided a higher sensitivity in the detection of focal lesions, particularly for the hepatocellular cancer (HCC) in patients with cirrhosis. There is no consensus as to whether the so-called "double arterial phase scanning" improves the detection rate of hepatocellular cancers, and the majority of the more recent studies suggest acquiring only the late arterial phase images along with the portal venous phase images. However, if the patient is a surgical candidate, the early arterial phase images must also be obtained, because they provide better pre-surgical mapping of the hepatic arteries. In primary and metastatic liver tumors, arterial and portal venous phase images should be acquired with thin collimation and overlapping reconstruction. Maximum intensity projection and volume rendering methods demonstrate the three-dimensional anatomy of the hepatic arteries, portal and hepatic veins successfully, which provide useful information before hepatic resection or intraarterial chemotherapy. In living donor candidates, early arterial and portal venous phase images obtained with thin collimation and overlapping reconstruction are used to reconstruct three-dimensional images with maximum intensity and volume rendering methods. These have a high sensitivity to detect hepatic artery, portal and hepatic vein variations, which could render the surgery difficult or even impossible. Portal venous phase images can also be used to measure total and lobar liver volumes. A virtual hepatectomy plane can be simulated on the three-dimensional model of the liver and hepatic veins, and when necessary, its location can be modified according to the metabolic needs of the recipient and donor. Thin collimation and better temporal resolution may also have beneficial effects in the characterization of liver lesions.
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To investigate the role of three-dimensional computed tomography (CT) in pediatric tracheobronchial diseases. Eleven male, six female patients aged from two weeks to 12 years (mean age, 3.3 years) were referred to spiral CT with a preliminary diagnosis of foreign body aspiration, extrinsic airway compression, acquired tracheoesophageal fistula, post-intubation stenosis, and bronchial erosion by a cavitary lung lesion. Tracheobronchial tree was scanned with 3 mm collimation, 1.5/1 pitch, 1.5 mm reconstruction interval, and standard reconstruction algorithm. Surface-rendered three-dimensional images and virtual bronchoscopic images were created from the axial raw data. Three-dimensional and virtual bronchoscopy findings were compared with findings of bronchoscopy. Virtual bronchoscopy revealed the level of obstruction in five patients with foreign body aspiration, but failed to disclose the nature of the aspirated foreign body and distinguish between a foreign body and mucoid obstruction. Virtual bronchoscopy correctly ruled out foreign body aspiration in four patients. Axial CT images also showed extraluminal findings including atelectasis, air trapping, peribronchial thickening, and infiltrations. In a patient with tracheitis virtual bronchoscopy failed to identify necrotic plaques observed in bronchoscopy. In patients with extrinsic compression, three-dimensional images showed the site and degrees of stenosis, whereas axial images revealed the cause of compression. In one patient, an anomalous tracheal bronchus was demonstrated on three-dimensional and virtual bronchoscopy images. Three-dimensional CT can localize tracheobronchial obstructions accurately. Virtual images may eliminate the need for invasive bronchoscopy in patients with questionable foreign body aspiration. Inability to evaluate the mucosal changes remains an important disadvantage of this technique.
Omental infarction, the end result of impaired perfusion of the greater omentum, is an uncommon cause of acute abdominal pain. Because its clinical symptoms are nonspecific, it is usually confused with more common conditions such as appendicitis or cholecystitis. Consequently, the diagnosis is generally made intraoperatively. However, computed tomography shows characteristic findings and allows a reliable preoperative diagnosis, preventing unnecessary laparotomy. We report two cases of omental infarction, and describe typical CT findings of this rare entitiy.
Vascular complications associated with renal transplants are a significant cause of graft dysfunction or failure. The most common complications are arterial and venous stenoses/thromboses, intrarenal and extrarenal arteriovenous fistulas, and pseudoaneurysms. In this case report, an extremely rare complication following renal transplantation, an extrarenal pseudoaneurysm, is presented with CT, gray scale, and color Doppler US findings.
Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are usually single in occurrence and located in the mandible. Multiple cysts are reported in patients with conditions such as mucopolysaccharidosis and basal cell nevus syndrome. We present the radiologic findings of bilateral impacted maxillary cuspids with dentigerous cysts displacing the maxillary sinuses in a nonsyndromic patient, a condition that, to our knowledge, has not been previously reported.
Neoplasms originating in bladder diverticula are characterized by early transmural invasion and a tendency for higher histopathological grades, which make prompt diagnosis and treatment crucial in these tumors. Filling defects caused by intradiverticular tumors cannot always be visualized in intravenous urography and/or cystography. Cross-sectional imaging methods including ultrasonography, computed tomography and magnetic resonance imaging have been used singly or in combination in neoplasms of the lower urinary tract. We herein present radiological findings in four patients with intradiverticular bladder neoplasms. Although diverticula were readily visualized in all patients, intravenous urography did not detect the neoplasm in two patients. Accurate diagnosis and staging were possible in all patients with both ultrasonography and computed tomography. In one patient magnetic resonance imaging clearly showed the intradiverticular tumor and peridiverticular extension. Cross-sectional imaging methods should be used in the evaluation of bladder diverticula as an adjunct to intravenous urography.
Liver perfusion disorder secondary to hepatic vein occlusion is not often reported. This abnormality might be caused by invasion of the hepatic veins by tumour or compression by a large right adrenal mass. We present an unusual cause of hepatic perfusion disturbance due to right hepatic vein thrombosis resulting from inadvertent hepatic venous catheterization. On contrast-enhanced CT, the tip of a central venous catheter extended into the right hepatic vein, which was thrombosed. A sharply marginated wedge-shaped hyperdense region was demonstrated in the right lobe of the liver, thought to represent a compensatory increase in arterial flow to the affected territory.
SUMMARY: The case presented describes an unusual appearance of thoracic tuberculosis with multiple pleural nodules associated with a parasternal mass as depicted on computed tomography. The patient is a 22-year-old woman who presented with pleuritic chest pain, a left parasternal mass, and weight loss. The pleura of the left hemithorax was studded with multiple low-attenuation, rim-enhancing nodules, and a left parasternal mass with similar imaging features was seen anterior to an enlarged left internal mammary lymph node. There were no pulmonary parenchymal changes nor any mediastinal or hilar lymphadenopathy. Cytologic examination of the specimen obtained with fine needle aspiration of the pleural and parasternal masses yielded granulomatous inflammation. The symptoms remitted with antituberculous chemotherapy and a follow-up CT obtained 6 months later showed complete resolution of the pleural nodules and parasternal mass and considerable regression of the left internal mammary lymph node. Involvement of the pleura with discrete nodules in the absence of parenchymal changes or mediastinal lymphadenopathy is rare in tuberculosis. To the best of the present authors' knowledge, the combination of a tuberculous parasternal mass and multiple pleural nodules as the sole manifestations of thoracic tuberculosis has not been reported previously.
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We report a 58-year-old male patient presenting with a 1-year history of presternal swelling and pain. Plain radiography revealed increased soft tissue density anterior to the body of the sternum, which showed cortical sclerosis. Computed tomography (CT) demonstrated ring-enhancing hypodense soft tissue masses surrounding the sternum, whose anterior and posterior cortices were markedly thickened. On three-phase technetium bone scintigraphy, the left side of the sternum showed increased radiotracer uptake and the central part of the bone was photopenic. The bone marrow of the sternum and peristernal soft tissue lesions were hypo- and hyperintense on T1- and T2-weighted magnetic resonance (MR) images, respectively, and showed marked enhancement postgadolinium. Treatment included both surgical intervention and medical therapy.