[Imaging of pleural diseases: evaluation of imaging methods based on chest radiography]. / Plevral hastaliklarin görüntülenmesi: Akciger grafisi temelinde görüntüleme yöntemlerinin degerlendirilmesi.

The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

The value of magnetic resonance imaging in the diagnosis of penile fracture.

PURPOSE: We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. MATERIALS AND METHODS: Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5 T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectile disfunction. RESULTS: In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. CONCLUSIONS: Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process.

[Computed tomography findings in pulmonary involvement of Wegener's granulomatosis: pictorial review]. / Wegener granülomatozis akciger tutulumunda bilgisayarli tomografi bulgulari: resimlerle bir konu.

Wegener's granulomatosis is a necrotising granulomatous vasculitis which has a variable manifestations in the chest that are best described on computed tomography. Imaging findings may include masses or nodules, which may cavitate; consolidations and ground-glass opacities. Wegener's granulomatosis can mimic pneumonia, malignancy, and noninfectious inflammatory diseases. The purpose of this pictorial essay is to demonstrate the characteristic computed tomography findings of pulmonary Wegener's granulomatosis.

Thoracic Complications in Behçet's Disease: Imaging Findings.

Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.

Multitechnique evaluation of renal hydatid disease.

OBJECTIVE: Hydatid involvement of the kidney accounts for only 2-4% of all cases of hydatid disease. The purpose of this article is to review the imaging features of hydatid disease of the kidney and thus show the role of radiography, excretory urography, sonography, CT, and MRI in the diagnosis of hydatidosis. CONCLUSION: The radiologist should be familiar with the imaging findings of hydatid disease because early diagnosis is important for more appropriate treatment.

Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts.

OBJECTIVES: Symptomatic simple renal cysts can be treated by combination of percutaneous aspiration and sclerotherapy. A number of sclerosing agents including glucose, phenol, iophendylate, polidocanol, minocycline and pantopaque have been used in the past to prevent reformation of cyst. In this study, tetracycline HCL solution is evaluated as a sclerosant for treatment of simple renal cysts. METHODS: Our study treated 76 cysts in 70 patients with symptomatic renal cysts. Aspiration and sclerotherapy was performed on 56 cysts, and 20 cysts aspirated without sclerotherapy as a control group. Treatment was performed under local anesthesia and punctured under ultrasound guidances with an 18-gauge needle. Tetracycline HCL (20%) was injected into the cystic cavity according to cyst diameter. All patients were followed up with an ultrasound examination at 3 months, 6 months, and then at yearly intervals. The reduction rate was estimated by a comparison of the volume of the cyst before and after treatment. A cyst reduction of 50% or greater in diamater was considered as a successful treatment. RESULTS: The average follow-up period was 9.8 months in the sclerotherapy group and 9.9 months in the control group. The success rate was 85.7% in the sclerotherapy group. There was a significant difference in the reduction rate of tetracycline HCL sclerotherapy group and control group. No major complications were encountered.

Pulmonary and cardiac involvement in Behçet disease: 3 case reports.

Pulmonary and cardiac involvement in Behçet disease is rare but can cause life-threatening complications. This report presents computed tomography and magnetic resonance angiography findings in 3 patients with Behçet disease. Imaging findings were confirmed by surgery in 1 patient and by angiography in another. One patient had bilateral pulmonary artery aneurysms, 1 of which had already ruptured and had thrombosed. The other had unilateral pulmonary artery aneurysm and thrombosis accompanied with intracardiac thrombus formation. The third patient had unilateral pulmonary artery aneurysm, thrombus, and coronary artery aneurysm. As in our case, there have been rare reports of coronary artery disease and intracardiac thrombus formation associated with pulmonary vascular involvement. Noninvasive imaging modalities minimize any risk of endothelial damage and can be an alternative to angiography in assessment of pulmonary and cardiac involvement in Behçet disease.

Giant Benign Mediastinal Masses Extending into the Pleural Cavity.

Introduction The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate diagnosis and treatment of the huge mediastinal masses extending into the pleural cavity. Methods Records were reviewed for eight patients who had the diagnosis of huge benign mediastinal masses and who underwent operation; details of the patients and operations were recorded. Results Mean age was 34.5 (range 22 to 44) years, and male-to-female ratio was 2:6. Computed tomography and magnetic resonance imaging (MRI) were used to evaluate the location and extent of the abnormality and to characterize the tissue components of the mass. Most of the tumors were located in the posterior mediastinum. The most frequent presenting symptom was exertional dyspnea. The majority of cases underwent posterolateral thoracotomy, and complete resection was possible in seven patients. Partial resection could only be performed in one. The mean diameter of the resected masses was 15 × 10 cm. Histopathologic examination revealed 3 neurogenic tumors, 2 teratomas, 1 thymolipoma, and 1 ectopic thyroid, and 1 hemangioma. Minor complication was seen in two cases. Conclusion The presurgical thoracic MRI provided correct diagnosis along with radiologic characterization and topography. Surgery must be the preferred treatment in huge benign mediastinal masses.

Primary lymphoma of the gallbladder accompanied by cirrhosis: CT and MRI findings.

A 60-year-old patient with cirrhosis due to chronic hepatitis B was admitted to the hospital for routine controls. An ultrasonographic examination demonstrated a soft tissue mass originating from the gallbladder. A CT scan and after 3 months a dynamic liver MRI were performed for the possible diagnosis. Based on these imaging studies, laparoscopic cholecystectomy was performed. The histopathological examination diagnosed non-Hodgkin's lymphoma.

Comparison of ventilation-perfusion scintigraphy with MR angiography in patients with Swyer-James syndrome.

PURPOSE: The aim of this study was to establish the value of magnetic resonance angiography (MRA) in diagnosing) Swyer-James syndrome (SJS) and to compare MRA and ventilation-perfusion (V/Q) scan results in patients with established SJS. METHODS: The V/Q scans and the MRA findings of 22 lungs of 11 patients with SJS (6 males, 5 females; age range: 17-69 years, mean: 38.4 years) were retrospectively studied. The perfusion scan was performed after the injection of Tc macroaggregated albumin. After 2 days, the ventilation scan was performed by using Tc diethylene triamine penta-acetic acid aerosol. The MRA was performed with a 1.5 T magnetic resonance unit. We compared the MRA and V/Q scan findings of the lungs of the patients. RESULTS: The V/Q scans showed the characteristic pattern of a matched V/Q defect on the affected lungs. The MRA displayed a smaller pulmonary artery and markedly poor peripheral vasculature on the affected side in all patients. The MRA had a sensitivity of 84.6%, a specificity of 100% for the detection SJS. Interobserver variability was minimum as indicated by a weighted kappa statistic of 0.818. CONCLUSION: This study indicates that the MRA is a fast, accurate, without radiation, and noninvasive technique for supporting the diagnosis of SJS. But, V/Q scans showed additional segmental perfusion/ventilation abnormalities on contralateral lung to reveal the segmental involvement of SJS. As a result, the MRA has no more any extra advantages for patient management.

Cystic and cavitary lung lesions in children: radiologic findings with pathologic correlation.

A number of diseases produce focal or multiple thin-walled or thick-walled air- or fluid-containing cysts or cavitary lung lesions in both infants and children. In infants and children, there is a spectrum of focal or multifocal cystic and cavitary lung lesions including congenital lobar emphysema, congenital cystic adenomatoid malformation, pleuropulmonary blastoma, bronchogenic cyst, pulmonary sequestration, Langerhans cell histiocytosis, airway diseases, infectious diseases (bacterial infection, fungal infection, etc.), hydatid cysts, destroid lung, and traumatic pseudocyst. For the evaluation of cystic or cavitary lung lesion in infants and children, imaging plays an important role in accurate early diagnosis and optimal patient management. Therefore, a practical imaging approach based on the most sensitive and least invasive imaging modality in an efficient and cost-effective manner is paramount. We reviewed the conventional radiographs and computed tomography findings of the most common cystic and cavitary lung lesions in infants and children.

Imaging of Cystic and Cyst-like Lesions of the Mediastinum with Pathologic Correlation.

Cystic masses of the mediastinum are a heterogenous group of asymptomatic or symptomatic, congenital, infectious, or neoplastic lesions. For early and correct diagnosis, evaluation, and optimal patient management of cystic mediastinal masses in infants, children, or adults imaging plays an important role. A non-invasive and sensitive imaging modality is an efficient and cost-effective tool. Multidetector computed tomography (MDTC) with volumetric acquisition provides fast acquisition of high resolution images and multiplanar reconstruction. Both 2D and 3D imaging in mediastinal imaging help in surgical planning and assessing resectability of mediastinal lesions. MR imaging has many advantages over other modalities for detecting and identifying cystic, or fluid-filled mediastinal masses, because of its intrinsic high soft tissue contrast and direct multiplanar imaging capabilities. However, histological tissue analysis may be required to differentiate a cystic lesion from other cyst-like or low-attenuation lesions.

Radiologic findings of a traumatic urethral diverticulum with stones in an infertile male patient.

Urethral diverticulum is rarely encountered in male patients. Although postmicturition dribble, pain and infection are usually present, infertility is rarely reported in urethral diverticulum. We present a case with urethral diverticulum associated with infertility, which was diagnosed radiologically.

The value of magnetic resonance imaging in the diagnosis of penile fracture

Purpose We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. Materials and Methods Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectil disfunction. Results In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. Conclusions Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process .