Two isolated giant gastric duplication cysts in thorax in a newborn.

We report a case of a newborn with severe respiratory distress since birth with two giant intrathoracic and separate eneteric duplication cysts in right hemithorax. On day 19, the intrathoracic cysts were removed, and the baby was discharged on his 22nd day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This report is the first case of two isolated, separated and giant right intrathoracic gastric duplication cysts in literature. The diagnostic values of radiological evaluation and surgical and pathological management for precise diagnosis are discussed.

Diagnostic value of plain abdominal radiographs in acute appendicitis in children.

OBJECTIVE: The plain film of the abdomen (PAX) is still utilised in the diagnosis of acute appendicitis (Aap). Aim of this study was to evaluate the value of PAX in the diagnosis of Aap in children, since it continues to be a controversial subject. DESIGN: A retrospective study. SETTING: Department of Paediatric Surgery, Gazi University Medical School. PATIENTS: The histopathological diagnoses and PAX of 213 children (mean age 9-6 years) operated for acute right-lower quadrant pain were evaluated retrospectively. There were 181 patients with Aap and 32 with normal appendix. METHODS: The rate of detection of overall thirteen roentgenographic criteria defined in various reports in medical literature as indicating appendicitis were noted and compared with histopathological diagnoses. The PAX which revealed one or more of these signs in combination was considered to be positive for Aap. Data was analysed statistically and sensitivity, specificity and positive and negative predictive values of PAX in the diagnosis of Aap were determined. RESULTS: Roentgenographic sign(s) were detected in 170 (79%) cases, 18 without Aap. The most frequent were lumbar scoliosis with left-sided convexity (50%) and small intestinal air-fluid levels (32%). In 39 cases, 25 with Aap, no sign(s) was detected. In all of the perforated cases, at least one of the determined criteria was seen. The percentage of roentgenographic signs found in cases with and without appendicitis was different significantly (p<0.01). The negative predictive value of PAX in the diagnosis of acute appendicitis was 32.5% and positive predictive value was 89%. CONCLUSION: PAX could he helpful in diagnosis in children with suspected acute appendicitis.

Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging.

OBJECTIVE: To assess the role of Doppler sonography when used in conjunction with mammography and gray scale sonography in differentiating solid breast lesions and to find out whether lesion size is a limiting factor for Doppler evaluation. METHODS: One hundred twelve lesions (70 malignant and 42 benign) detected with mammography and sonography were prospectively examined with color, power, and pulsed Doppler sonography. Vascularity was analyzed morphologically (vessel location, form, and color tone) and semiquantitatively (by spectral indices) to determine the valuable diagnostic flow characteristics. The lesions were classified by 2 observers as benign or malignant on the basis of each diagnostic technique (namely, a combination of mammography and gray scale sonography, presence or absence of blood flow, morphologic flow analysis, and spectral flow analysis). The results were compared with the histologic diagnosis in 105 lesions and with the clinical and radiologic diagnosis after at least 2 years of follow-up in 7 lesions. RESULTS: The sensitivity and specificity of the mammography-gray scale sonography combination were 98.6% and 76.2%, respectively. Neither morphologic nor spectral Doppler analysis proved to be successful on its own, however, information obtained from investigated morphologic and spectral flow features increased the specificity of mammography and gray scale sonography for lesions 10 mm and smaller (from 88.9% to 100%) and those larger than 10 mm (from 70% to 96.6%). CONCLUSIONS: Our data show that Doppler sonography is a beneficial adjunct to mammography and gray scale sonography for solid breast lesions 10 mm and smaller and those larger than 10 mm.

Breast varices: imaging findings of an unusual presentation of collateral pathways in superior vena caval syndrome.

Imaging findings are presented of an unusual pathway of collateral circulation consisting of bilateral and diffuse dilated breast veins from a patient with long standing superior vena caval syndrome. The main importance of this case is the extent of the collateral development through the breast veins, serving as the major pathway of collateral circulation. Identification of this unusual collateral development, which resembles breast varices, was performed with contrast-enhanced chest CT scans, digital subtraction venography, color Doppler ultrasonography, and mammographic studies. Collateral development was secondary to a long segment idiopathic venous occlusion involving bilateral subclavian and brachiocephalic veins as well as vena cava superior. We conclude that dilated breast veins when detected on any imaging modality should raise the suspicion of central venous obstruction.

Lens of the eye: radiation dose in balloon dacryocystoplasty.

PURPOSE: To evaluate the absorbed radiation dose to the lens of the eye, which is the critical organ in the primary beam during fluoroscopically guided transluminal balloon dilation of the lacrimal drainage system (balloon dacryocystoplasty) for obstructive epiphora and to evaluate the possibility of deterministic radiation effect on the lens. MATERIALS AND METHODS: The radiation dose to the lens of the eye during balloon dacryocystoplasty (which includes pre- and postintervention dacryocystography) was measured in 10 consecutive patients by using thermoluminescent dosimeters on the lids of both eyes as close as possible to the lenses. A C-arm angiographic unit coupled with a digital imaging system was used, with similar exposure and geometric parameters in all cases. RESULTS: The mean radiation dose to the lens of the treated eye was 4.6 mGy +/- 2.2 (dose range, 1.9-9.1 mGy) and to that of the untreated eye was 38.5 mGy +/- 17.5 (dose range, 14.7-67.8 mGy). CONCLUSION: The lens of the untreated eye receives a higher dose than that of the treated eye because of its closer proximity to the x-ray tube in a lateral projection. In the lens, even the highest measured radiation dose (67.8 mGy) still was well below the deterministic threshold for lens opacity and cataract formation.

Spontaneous thrombosis of a vein of Galen aneurysmal malformation: possible effects of contrast media.

A 5-year-old boy with macrocephaly and mental retardation was referred for radiologic evaluation. After cranial CT and MR imaging, the diagnosis of mural type vein of Galen aneurysmal malformation was established by angiography. Two weeks later, preembolization angiography revealed complete thrombosis of the malformation. Although it is a very rare event, vein of Galen aneurysmal malformation may spontaneously thrombose following diagnostic angiography. Possible effects of contrast media on thrombosis were discussed.

Mammographic and ultrasonographic study of changes in the breast related to HRT.

OBJECTIVE: To determine the frequency and degree of change in mammographic densities, and new solid or cystic formations in the breast tissue, during different types of hormone replacement therapy (HRT). SUBJECTS AND METHODS: This prospective study included 118 postmenopausal women, 88 under hormone replacement therapy and 30 control subjects. Four types of hormone therapies were compared for their effects on mammograms and sonograms obtained before and during therapy. Mean duration of follow-up was 16.92 +/- 7.65 months in the treated and 21.56 +/- 11.49 months in the control group. Density changes on mammograms were evaluated subjectively. RESULTS: Density increase was recorded in 34% of the patients receiving HRT and in none of the control subjects (P < 0.01). Highest frequency of density increase was found in the groups treated with estrogen plus cyproterone acetate (46%) and with estrogen plus medroxyprogesterone acetate (43%). Frequencies of density increase in the tibolone users, and in estrogen alone users were 28% and 18%, respectively. Degree of density increase was evidently minimal in tibolone users, compared to others. New cysts occurred in six patients receiving HRT (6%) which was not statistically different from the control group (16%) (P > 0.05). New cyst formation was not related to the degree of density increase. New solid mass formation was not observed. CONCLUSION: Our findings show that mammographic density changes related to HRT are dependent on the selected hormone regimen. Formations of breast cysts or solid lesions do not seem to be related to HRT.

Scrotal arteriovenous malformation and its preoperative embolization.

Arteriovenous malformations of the scrotum are extremely rare. A case of scrotal arteriovenous malformation and its preoperative embolization in a child is presented.

Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography.

OBJECTIVE: The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children. SUBJECTS AND METHODS: This prospective study involved 307 pediatric subjects (169 girls and 138 boys) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were 5 days to 16 years old. All measured organs were sonographically normal. At least two dimensions were obtained for each liver, spleen, and kidney. Relationships of the dimensions of these organs with sex, age, body weight, height, and body surface area were investigated. Suggested limits of normal dimensions were defined. RESULTS: Dimensions of the measured organs were not statistically different in boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area. Height showed the strongest correlation of all. This correlation was a polynomial correlation. CONCLUSION: Determination of pathologic changes in size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs in healthy neonates, infants, and children. Presented data are applicable in daily routine sonography. Body height should be considered the best criteria to correlate with longitudinal dimensions of these organs.

Hepatic color Doppler sonography for hereditary hemorrhagic telangiectasia.

Liver involvement with hereditary hemorrhagic telangiectasis (HHT) is not a rare condition. Its angiographic abnormalities are well known, but reports of the sonographic and, especially, color Doppler sonographic findings are limited. We present a patient with HHT and describe the hepatic color Doppler sonographic findings.

Neovascularization of the testicle through spermatic vessels by omental pedicle flap: a new experimental model.

The aim of this experimental study in rats was to consider the supplementary role of an omental pedicle flap on the neovascularization of the testicle through the spermatic vessels, for which a Fowler-Stephens procedure had been planned. To compare results, 12 animals had only the spermatic vessels ligated, without an additional procedure (Fowler-Stephens procedure [FS group]), and 12 others had omentopexy of the spermatic vessels of the left testes, with ligation of the vessels 4 weeks later (Fowler-Stephens procedure plus omentopexy [FSO group]). In the sham group (n = 8), only omentopexy of the left spermatic vessels was performed. Six rats served as controls. In each rat, both testes were evaluated by color Doppler ultrasonography to assess capsular and intratesticular blood flow, followed by orchiectomy to determine testicular weights, testicular biopsy scores, and mean seminiferous tubule diameters. Data were analyzed statistically. According to the color Doppler ultrasonography, the testicular blood flow in the FSO group was better than that of the FS group, but was less sufficient than that of the sham and control groups. The testicular weights and biopsy scores for the FSO group were statistically greater than those of the FS group, and less than those of the sham and control groups. There was no significant difference in the mean seminiferous tubule diameters of the FSO and FS groups. The contralateral tests of the four groups did not differ significantly for any parameter. In light of the data available, it is suggested that the omental pedicle flap neovascularizes the testicle through spermatic vessels. Given the high incidence of testicular atrophy associated with Fowler-Stephens orchiopexies, it might be beneficial to perform laparoscopic orchiopexy of testicles neovascularized with omental pedicle flaps as the first-stage procedure.