Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Periacetabular vascular anatomy in high-riding dysplastic hips: a CT angiographic study.

BACKGROUND: Developmental hip dysplasia (DDH) is shown to have osseous and neural abnormalities but literature is sparse with investigation of vascular structures. Therefore, we aimed to evaluate periacetabular vascular structures. METHODS: By computerised tomography angiography (CTA), 13 highly dislocated hips of 11 patients' iliac bone to external iliac and obturatory artery and vein proximities were measured and compared with the same measurements of 20 healthy hips of 12 patients. Numbering from superior to inferior, a total of 7 axial images were created on the 2D CTA coronal images with 1 cm apart, the 4th being at the level of acetabular dome. RESULTS: The mean age of the patients was 53 (18-72) years. Dysplastic hips tended to have curved (53%) and healthy hips tended to have straight iliac arteries (p = 0.037). As compared to healthy hips, external iliac veins were significantly closer to the bone at all levels, but the external iliac arteries were closest at 1st to 4th levels (p < 0.001) in dysplastic hips. The course of the obturatory arteries was similar in both groups (p = 0.147). CONCLUSIONS: The external iliac artery and vein is in close proximity to the iliac bone which dangers acetabular screw, acetabular reaming or retractor placement in highly dislocated hips. The surgeon should be aware of this proximity in operations of these hips to avoid vascular complications.

A novel deletion involving exon 13 of factor VIII gene in a newborn with splenic hematoma.

Splenic hematoma is an exceptionally rare event in newborn period that usually occurs in concomitant birth trauma and bleeding disorder. This report presents a newborn case with severe hemophilia A, who had a splenic hematoma presented on the second day of life with severe anemia, abdominal distention, abdominal and scrotal ecchymosis. The patient was successfully treated medically with factor VIII concentrates without splenectomy. Molecular analysis of the factor VIII gene revealed a hemizygous deletion in exon 13.

Evaluation of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method in living individuals: A retrospective CT study.

The evaluation of the medial clavicular epiphysis via CT plays an important role in the determination of age, particularly the 19th and 22nd ages. Several authors have recommended the use of the Schmeling and Kellinghaus methods in conjunction in the evaluation of the medial clavicular epiphysis. The aim of this retrospective study was to evaluate thin section CT scan images of the medial clavicular epiphysis according to the Schmeling and Kellinghaus method, and to discuss the obtained data in the light of the literature. The thoracic CT scan images (0.6mm section thickness) of 601 patients (202 female and 399 male) aged between 10 and 35years obtained by 16-detector CT were evaluated by two examiners. The stage 2 was seen between 13 and 23years of age; stage 3 was seen between 16 and 27years of age. However, 100% of the female cases with stage 3c were ⩾18years of age, and 100% of the male cases with stage 3c were ⩾19years of age. Stage 4 was first observed at 20years of age in both sexes, and stage 5 was first observed at 25years of age in both sexes. We believe that stage 3c may be used, particularly in the determination 18-year age limit for both sexes. The outcomes of our study are consistent with those of our previous study and other studies in the literature, which is important for the confirmation of the reliability of the method.

Misdiagnosed epigastric mass: Ectopic liver.

We discuss an ectopic liver misdiagnosed as an abdominal mass and the importance of magnetic resonance imaging (MRI) in liver positional anomalies. A solid midline mass midline adjacent to the liver was found in a 45-year-old female at an external center during an ultrasound investigation conducted for occasional abdominal pain of many years. The patient was referred to us for MRI. MRI revealed a solid epigastric lesion adjacent to the liver but unrelated to the liver parenchyma. The mass was of similar intensity as the liver in all sequences and in postcontrast dynamic phases following hepatospecific contrast material administration. We also observed contrast material excretion into the solid lesion from the biliary ducts in the hepatobiliary phase. The lesion was diagnosed as ectopic liver tissue with these findings. LEVEL OF EVIDENCE: 5 J. Magn. Reson. Imaging 2017;45:761-763.

Effect of rheumatoid arthritis on strength, dexterity, coordination and functional status of the hand: the relationship with magnetic resonance imaging findings.

OBJECTIVE: To evaluate the effect of rheumatoid arthritis (RA) on strength, dexterity, coordination and functional status of the hand and to determine the relation with magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: Thirty eight patients with RA and thirty three controls were included in the study. There were five drop-outs in RA group. Pain was assessed by visual analog scale. Painful and swollen joints of the dominant hand were recorded. Hand deformities of the patients were noted. Hand grip strength and pinch strength of the dominant hand were evaluated. Hand disability was assessed by Duruoz hand index (DHI) and the Purdue pegboard test was used for assessment of coordination and dexterity. MRI of the dominant wrist and hand was performed in RA group. MRI scans were evaluated for synovitis, tenosynovitis, bone erosion and bone edema. RESULTS: Demographic characteristics were similar between groups. While DHI scores were significantly higher (p=0.000), Purdue pegboard test scores were significantly lower in RA group in comparison to control group (p=0.000). Bone edema and synovitis scores were significantly higher in patients with longer disease duration (p=0.025, p=0,006 respectively). There were significant negative correlation between grip strength, pinch strength subgroups and tenosynovitis scores (p=0.001, p=0,001). When the Purdue pegboard scores were lower, tenosynovitis scores were significantly higher (p=0.019, p=0,013, p=0,043). There was a significant positive correlation between DHI score and tenosynovitis score (p=0.003). CONCLUSION: This study showed that RA has significant negative impact on hand function and dexterity and the parameters used in the evaluation of hand function are mainly associated with tenosynovitis scores. Since tenosynovitis is a common pathology in RA, MRI can be used as a supportive method in early diagnosis of tenosynovitis and may be useful in identification of patients requiring aggressive treatment.

Scintigraphic and tomographic evaluation of biological activities of prefabricated free and vascularized bone allografts.

BACKGROUND: We performed an experimental study on rabbits to compare the biologic activities of free and vascularized cortical and corticocancellous solvent-dehydrated bone allografts by scintigraphy and three-dimensional computed tomography (CT). METHODS: Twenty New Zealand white rabbits (2500-3000 g) were divided into 2 groups each consisting 10 animals. In group 1, solvent-dehydrated human cadaveric cranium allografts (corticocancellous bone) were used. The grafts were divided into 20 pieces, approximately 10 × 10 × 5 mm. On the right ears, grafts were placed on dissected vascular bundles. On their left ears, allografts were implanted into subcutaneous pockets without dissecting any vascular bundle. The same procedure was performed in group 2 with solvent-dehydrated human cadaveric fibula bone allografts (cortical bone). No infection or any animal death occurred during 12 months of observation. At the end of the 12th month, implanted bone allografts were evaluated by 3-phase bone scintigraphy to observe the circulation and viability of the grafts and three-dimensional CT scans to measure their dimensions. RESULTS: Radioactive uptake by scintigraphy of grafts placed on vascular bundle was higher than grafts placed in pockets. t-Test was calculated for region of interest of right ear (vascularized) to left ear rate (nonvascularized) according to graft type. Rate for corticocancellous bone graft was 1.187 ± 0.179 (P = 0.038) and cortical bone graft was 1.055 ± 0.052 (P = 0.038). There was correlation between region of interest generated from arm and neck regions and graft regions (P = 0.001). Regarding the dimension measurement made by three-dimensional CT, all the grafts grew whether they were on vascular bundle or not. Mann-Whitney test was used to determine whether differences between preoperative and postoperative volumes of grafts and growth of all grafts were significant (P = 0.007 for vascularized cortical bone and P = 0.005 for others). Kolmogorov-Smirnov test was performed to evaluate the distribution of growth rate. Vascularized medullar-cortical and nonvascularized medullar bone grafts expanded more than nonvascularized cortical bone (P = 0.001, P = 0.005, P = 0.001, respectively). CONCLUSIONS: Vascularized bone allograft combines the advantages of autogenous and allogenous grafts. Both scintigraphic and tomographic results overlapped that corticocancellous and cortical bones developed more on vascular bundle. Even though radioactive uptake was statistically higher in vascularized bone allografts, we determined that this small difference did not affect the overall late vascularity of the bone allografts. In conclusion, regardless their types or placement on vascular bundle, prefabricated bone allografts had similar metabolic function after 1 year of integration.

Clinic and ultrasound findings related to pain in patients with knee osteoarthritis.

The aim of this study was to determine clinical and US factors associated with pain in patients with knee osteoarthritis (OA). The study included 143 patients. Patients were divided into two groups: group 1 consisted of 94 patients with unilateral or bilateral knee pain ≥3 cm during physical activity for at least 48 h prior to inclusion, measured by the visual analog scale from 0 to 10 cm. Group 2 consisted of 49 patients with knee OA without knee pain at least 1 month prior to inclusion. In both knees, range of motion was measured by goniometry and anteroposterior, and lateral knee radiographs were taken during weight-bearing. OA grading was performed in accordance with the Kellgren-Lawrence criteria by a specialist in radiology experienced in this field. A knee ultrasound (US) examination was performed in all patients by a blinded radiologist. Women were more often symptomatic than men (p < 0.005). Patients in group 1 tended to have a higher body mass index (BMI; p<0.001). Radiographic grades III (52.1%) and II (37.2%) were most frequently found in group 1, whereas I (30.6%), II (46.9%), and III (22.4%) were found in group 2. When radiographic grades in both groups were compared, group 1 had greater radiographic grades than group 2 (p<0.001). US findings in group 1 were effusion of the suprapatellar pouch (72.3%), Baker's cyst (42.6%), protrusion of the anterior horn of the medial meniscus associated with medial collateral ligament displacement (9.6%), and loose body (9.6%). In group 2, the only US finding was Baker's cyst (6.1%). Regression analysis revealed that BMI, degree of knee flexion, and thickness of the quadriceps tendon were factors that were related with pain in the knee. Increased BMI, decrease in the degree of knee flexion, and decreased quadriceps tendon thickness are factors that increase the risk of pain in knee OA.