Is There a Relationship Between Paratracheal Air Cysts and Upper Lobe Fibrosis?

OBJECTIVE: The purpose of this study was to determine the characteristics of paratracheal air cysts (PACs) and their relationship with upper lobe pulmonary fibrosis. MATERIALS AND METHODS: The routine thoracic computed tomography scans of 3549 patients carried out between January 2014 and April 2015 were retrospectively evaluated. The presence, location, structural characteristics (uniloculated or multiloculated), number of cysts, and anterior-posterior and transverse dimensions of the PAC and its communication with the tracheal lumen were evaluated. The presence of upper lobe fibrosis, emphysema, and bronchiectasis was also evaluated. The relationship between upper lobe fibrosis, emphysema, bronchiectasis, and the presence of paratracheal cysts was evaluated in all patients. An equal number of randomized patients with no paratracheal cysts were selected as a control group. RESULTS: A total of 190 PAC cases were diagnosed, with a prevalence rate of 5.35%: 146 (76.8%) of the cases were men, 44 (23.2%) were female, and the mean (SD) age was 53.79 (16.64) years (range, 12-89 years). The control group included 105 men (57.4%) and 78 women (42.6%), and the mean (SD) age was 53.87 (16.65) years (range, 13-87 years). The groups were similar in terms of age (P = 0.876), whereas the proportion of men in the PAC group was significantly higher (P < 0.001). Most of the PACs were located on the right side (n = 188, 98.9%). The incidence of fibrosis in the paratracheal cyst group was 45.8% (n = 87) compared with 19.5% (n = 37) in the control group; this difference was statistically significant (P < 0.001). The prevalence rates of emphysema in the cyst group and the control group were 29.5% (n = 56) and 11.6% (n = 22), respectively, and the difference was statistically significant (P < 0.001). When the groups were compared regarding bronchiectasis (scar and non-scar related), the rate of bronchiectasis in the paratracheal cyst group was 17.9% (n = 34), compared with 3.7% (n = 7) in the control group; this difference was statistically significant (P < 0.001). CONCLUSIONS: Paratracheal air cysts are relatively common, but the etiology is still unclear. We detected increased rates of cyst formation that may result from the traction effect on the tracheal wall in the presence of upper lobe fibrosis.

Twin Reversed Arterial Perfusion (TRAP) Sequence; Characteristic Gray-Scale and Doppler Ultrasonography Findings.

Twin reversed arterial perfusion (TRAP) sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies. The incidence is one in 35.000 births and one in 100 monozygotic twin pregnancies. It is characterized with a recipient fetus exhibiting lethal anomalies including acardia and a pump fetus. Mortality is usually due to heart failure or premature labor caused by polyhydramnios of pump fetus. Herein, we report a case of TRAP sequence that emphasizes the importance of gray-scale and color Doppler imaging in the diagnosis and management of TRAP sequence.

Do the variations in renal pelvic angles play a role in the formation of renal stone? A computed tomography study.

OBJECTIVE: In this study, we aimed to investigate the effect of variations in renal pelvic angle on urinary calculi development. MATERIALS AND METHODS: A total of 2456 unenhanced abdominal CT scans were retrospectively evaluated and 262 kidneys of 131 patients were compared. Patients included in this study were identified and qualified as follows: Having unilateral calculi, having no calculi or a history of calculi in contra-lateral side and having totally normal renal morphology. RESULTS: The mean angle of kidneys with calculi was 55 ± 9°, while the average angle measurement was 61 ± 11° in kidneys without calculi. The mean angle measured from the kidneys with calculi was statistically smaller (p < 0.001). CONCLUSION: Our study suggests that the possibility of calculi development in kidneys, which have more anteriorly localized pelvic angulation tends to be significantly higher in individuals, who did not have any congenital or acquired renal pathology before.

Lumbar Morel-Lavallee lesion after trauma: a report of 2 cases.

Morel-Lavallee syndrome is a posttraumatic soft tissue injury in which the subcutaneous tissue is broken off from the underlying fascia, creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter and, rarely, may also occur in the lumbal region.Morel-Lavallee syndrome can be often diagnosed late because of ommitted diagnosis in emergency services. The emergency physician and radiologist must keep this syndrome in mind because early diagnosis can enable conservative management, whereas delayed diagnosis may lead to surgical exploration. In this article,we present the clinical and radiologic features of 2 cases of lumbar Morel-Lavallee syndrome detected after trauma.

Colloid cyst mimicking intracranial hemorrhage after head trauma.

Trauma patients consist vast majority of the patients who admit to emergency department, and most of them have a head trauma. A 58-year-old patient was taken to emergency department with head trauma, and a hyperdense lesion neighboring to third ventricle was detected. A diagnosis of colloid cyst was made in the patient who was being followed up for hemorrhage. In patients with head trauma, colloid cyst may easly be confused with intracranial hemorrhage due to hyperdensity. The aim of this report is to emphasize the importance of clinical thinking in the differential diagnosis of hyperdense lesion on computed tomography imaging of a patient with head injury.

Whole-exome sequencing identifies homozygous GPR161 mutation in a family with pituitary stalk interruption syndrome.

CONTEXT: Pituitary stalk interruption syndrome (PSIS) is a rare, congenital anomaly of the pituitary gland characterized by pituitary gland insufficiency, thin or discontinuous pituitary stalk, anterior pituitary hypoplasia, and ectopic positioning of the posterior pituitary gland (neurohypophysis). The clinical presentation of patients with PSIS varies from isolated growth hormone (GH) deficiency to combined pituitary insufficiency and accompanying extrapituitary findings. Mutations in HESX1, LHX4, OTX2, SOX3, and PROKR2 have been associated with PSIS in less than 5% of cases; thus, the underlying genetic etiology for the vast majority of cases remains to be determined. OBJECTIVE: We applied whole-exome sequencing (WES) to a consanguineous family with two affected siblings who have pituitary gland insufficiency and radiographic findings of hypoplastic (thin) pituitary gland, empty sella, ectopic neurohypophysis, and interrupted pitiutary stalk-characteristic clinical diagnostic findings of PSIS. DESIGN AND PARTICIPANTS: WES was applied to two affected and one unaffected siblings. RESULTS: WES of two affected and one unaffected sibling revealed a unique homozygous missense mutation in GPR161, which encodes the orphan G protein-coupled receptor 161, a protein responsible for transducing extracellular signals across the plasma membrane into the cell. CONCLUSION: Mutations of GPR161 may be implicated as a potential novel cause of PSIS.

CT and MR Imaging Characteristics of Intravestibular and Cerebellopontine Angle Lipoma.

Intracranial lipoma is an uncommon entity. A rare type of tumor in the internal auditory canal (IAC) and the cerebellopontine angle (CPA) is lipoma. There are a few case reports in the literature related to intravestibular lipoma. Herein, we report a case of lipomas within the cerebellopontine angle and vestibule of the inner ear in a patient with tinnitus and dizziness. The patient was evaluated with a 1.5 T magnetic resonance imaging (MRI) system. MRI and CT showed the masses in the left CPA and the left IAC. These lesions were hyperintense on both T1- and T2 weighted images and showed no enhancement after gadolinium administration. Conservative management was suggested. Histopathological diagnosis is rarely necessary with the widespread use of magnetic resonance imaging. Considering significant morbidity during resection, conservative follow-up is the best approach for CPA and IAC lipoma.

Breast arterial calcifications and carotid intima-media thickness and haemodynamics: Is there any association?

OBJECTIVE: In this study, we aimed to research the relation between breast arterial calcifications (BACs) detected on mammography and two well-known markers of cardiovascular diseases-carotid artery intima-media thickness (C-IMT) and haemodynamics parameters like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI). METHODS: The study group consisted of 50 consecutive BAC (+) women and the control group consisted of 55 BAC (-) women. In all participants, BAC was diagnosed using mammography and C-IMT was measured using B-mode and Doppler ultrasonography. BAC was defined as two linear calcification depositions in a conical periphery or as calcific rings at the mammographic evaluation. Doppler spectrum samples were obtained from 2 cm proximal to the main carotid artery bifurcation. RESULTS: Postmenopausal female patients ranging in age from 40 to 86 included in this study. When the groups were adjusted for age, a statistically significant difference was found between mean C-IMT of BAC (+) and BAC (-) groups (0.81 ± 0.2 vs. 0.69 ± 0.2 mm; p<0.001). No significant differences were observed between BAC (+) and BAC (-) groups in terms of PSV, EDV, RI. CONCLUSION: The findings of the present study suggest that BAC, diagnosed by mammography, is independently associated with C-IMT. C-IMT measurement is suggested as a useful tool to detect early atherosclerotic changes. However, haemodynamic variables (PSV, EDV, RI) were not statistically different between the BAC (+) and BAC (-) groups. Prospective larger cohort studies are needed to further elucidate whether BAC is an independent risk factor for cardiovascular disease.

Role of ultrasonography with color-Doppler in the emergency diagnosis of acute penile fracture: a case report.

Penile fracture is the rupture of tunica albuginea, typically resulting from blunt trauma, intercourse, or penile manipulation. Diagnosis is made clinically. Ultrasound is not used frequently in diagnosis of penile fracture but it provides a fast, non-invasive alternative to more often used MRI and cavernography. We aimed to present diagnostic ultrasound and color Doppler images of a patient with acute penile fracture in conjunction with literature.