Measurement of Optic Nerve Sheath Diameter by Computed Tomography in the Pediatric Population: Normal Values.

PURPOSE: To determine the normal values of optic nerve sheath diameter (ONSD) by computed tomography (CT) in the pediatric population. METHODS: The CT scans of pediatric patients aged 1 to 16 years who underwent brain CT for different reasons, who did not have intracranial pathology or increased intracranial pressure, and who had no pathology on CT were included in the study. Four age groups were defined with the following ranges: 1 to 2, 3 to 6, 7 to 10, and 11 to 16 years. ONSD was measured from axial CT images, 3 and 10 mm behind the optic globe. RESULTS: The normative values of ONSD measured on CT imaging in children aged 1 to 16 years were reported. The change in ONSD according to age was investigated. ONSD was found to increase with age at both levels measured. The difference was statistically significant. CONCLUSIONS: Normal values should be known to detect pathologies that may cause an increase in optic nerve diameter. The values reported in this study can serve as a reference for normal optic nerve sheath diameter in the pediatric age group. [J Pediatr Ophthalmol Strabismus. 2024;61(1):38-43.].

[Acute muscle loss and early effects of COVID-19 on skeletal muscle in adult patients: a retrospective cohort study]. / Pérdida muscular aguda y primeros efectos de la COVID-19 en el músculo esquelético de pacientes adultos: estudio de cohortes retrospectivo.

OBJECTIVES: It is known that COVID-19 has multisystemic effects. However, its early effects on muscle tissue have not been clearly elucidated. The aim of this study is to investigate early changes in the pectoral muscle in patients with COVID-19 infection. MATERIALS AND METHODS: The pectoral muscle areas (PMA) and pectoral muscle index (PMI) of 139 patients diagnosed with COVID-19 were measured from chest CTs taken at the time of the first diagnosis and within 6 months after the diagnosis. The effect of the infection on the muscle area was investigated by evaluating whether there was a change between the two measurements. Lung involvement of the infection in the first CT was scored with the CT severity score (CT-SS). In addition, the effects of patients' clinics, CT-SS, length of hospital stay, and intubation history on changes in the muscle area were investigated. RESULTS: When the PMA and PMI values were compared, there was a statistically significant decrease in the values in the control CT group compared to the first diagnosis CT group. The difference was found higher in intubated patients. CT-SS was associated with a decrease in PMI.COVID-19 is one of the causes of acute sarcopenia. Pectoralis muscle is part of the skeletal muscle, and there may be a decrease in the muscle area in the early period of the disease.

The Effects of the Fat Distribution of Body, Skeletal Muscle Mass and Muscle Quality on Acute Pancreatitis Severity: A Retrospective Cross-Sectional Study.

OBJECTIVE: We aim to investigate a possible relationship between acute pancreatitis (AP) and body fat and muscle parameters in computed tomography (CT). METHODS: Computed tomography images of 107 patients with AP were scored in terms of AP severity using the modified CT severity index. Muscle mass, muscle mass index, visceral and subcutaneous adipose tissue area, multifidus muscle/fat attenuation ratio, total psoas index (TPI) and Hounsfield units average calculation (HUAC) values were performed. RESULTS: Total psoas index and HUAC of mild AP cases were significantly higher than those with moderate and severe AP. The TPI of patients with severe pancreatic necrosis were found to be significantly lower than those without necrosis. Hounsfield units average calculation of cases without necrosis were significantly higher than those with severe necrosis in the pancreas. CONCLUSIONS: Our study indicated that lower volume and density of psoas muscle associated with worse CT severity score and larger pancreatic necrosis in patients with AP.

Association between mesenteric panniculitis and non-neoplastic disorders.

PURPOSE: To assess the relationship between MP and coexisting non-neoplastic disorders. METHODS: Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ2, or Fisher's test. RESULTS: 976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036). CONCLUSION: MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.

Tips for Computed Tomography Angiographic Imaging of Pulmonary Embolism.

BACKGROUND: To measure parameters suggesting right heart failure on computed tomography angiography (CTA) taken in pulmonary embolism (PE) and to evaluate their possible contribution to the diagnosis. To investigate the changes in the parameters of PE cases at the 6th month-1 year and to evaluate the importance of these values in prognosis. PE is a disease which may be difficult to diagnose because of its different symptoms and can be fatal. The evaluation of right heart failure findings with CTA is very important in diagnosis and follow-up. METHODS: The mean pulmonary artery (PA) diameter, the ratio of the right ventricle to the left ventricle diameter (RV/LV), contrast material reflux to vena cava inferior and the elapsed time (ET), which was the time required to reach the targeted contrast threshold of 95 patients were measured at the first visit and under treatment. RESULTS: RV/LV, ET and contrast medium reflux at PE group were significantly higher than those without embolism (P=0.009, P=0.001, P=0.014). In the first CTAs of the PE group, these parameters were significantly reduced in the control CTAs (P=0.005, P = 0.013, P=0.016). CONCLUSION: It can be said that the values we measured are important in terms of prognosis of PE by assisting in diagnosis and in evaluating post-treatment recovery.

Measurements in cervical vertebrae CT of pediatric cases: normal values.

PURPOSE: This study aims to determine the normal limits of atlanto-dental interval (ADI), basion-dens interval (BDI), basion-cartilaginous dens interval (BCDI), and prevertebral soft tissue thickness (PVSTT) according to age groups for normal pediatric cases. MATERIALS AND METHODS: CT images of 256 pediatric patients aged between 1 and 15 years were retrospectively evaluated. ADI, BDI, BCDI and PVSTT measurements were performed. RESULTS: Upper normal limit (UNL) values for ADI were 2.65-4.8 mm. UNL values for PVSTT were found to be 6.9 mm at C1 level, 6.7 mm at C2 level, 9.3 mm at C3 level, 14.2 mm at C4 level, 14.1 mm at C5 level, 13.8 mm at C6 level and 12.8 mm at C7 level. The maximum value of BDI in the group with non-ossified os terminale was 12 mm, and in the group with ossified os terminale it was 10 mm. The UNL of BCDI determined for females was 5.1 mm, while the UNL for males was 5.6 mm. CONCLUSION: We propose the obtained values as the UNL values for ADI, BDI, BCDI and PVSTT on CT images in the pediatric population from 1 to 15 years.

Evaluation of pterygoid plate fractures unrelated to Le Fort fractures using maxillofacial computed tomography.

BACKGROUND: This study aims to describe the major pterygoid plate fractures (PPFs) patterns unrelated to Le Fort fractures (LFFs) using maxillofacial computed tomography (CT). METHODS: After obtaining our hospital ethics committee approval (37-05), data for PPF were acquired from the medical records of all the trauma patients who were diagnosed using CT at our hospital from April 2014 to April 2017. RESULTS: Of the 178 patients, 135 (male/female = 86/49; mean age = 37.2 years) had LFF and 43 (male/female = 35/8; mean age = 38.6 years) had PPF without associated LFF. PPF patterns unrelated to LFF included temporal bone (11.6%), sphenotemporal buttress (25.5%), zygomaticomaxillary complex (30.2%), displaced mandible (23.3%), nasal (4.7%), and isolated fractures (4.7%). The etiologies of facial fractures were not significantly different between both sexes (p=0.576). No significant difference between Le Fort and non-Le Fort groups was found for age (p=0.603) and the causes of trauma (p=0.183). CONCLUSION: PPF is most commonly seen with LFF, but it may also be seen alone or with other non-LFF indicating that all PPF are not related to LFF. Axial reformatted CT images can easily display PPF and the degree of displacement of the fragments, and they can be used to guide surgical reduction of the fractures.

The correlation between laboratory markers and computed tomography severity index in acute appendicitis.

A M: This study aimed to evaluate and to investigate the association of some laboratory markers with the stage of the acute appendicitis. MATER AL AND METHODS: The hematological parameters (white blood cell count, red cell distribution width, platellet distribution width, mean corpuscular volume, and mean platelet volume values) and tomography scans of 200 patients who admitted to the emergency department with abdominal pain were retrospectively reviewed. Computed tomography grading about the severity of the cases was carried out by two radiologists, as grade 0 for normal appendix to grade 3 for perforated appencities. The hematological results of the patients were recorded for each severity group and were compared to detect whether there was a change in the hematological parameters as the severity in CT increases. RESULTS: There was no difference in white blood cell count and red cell distribution width levels but mean platelet volume seemed to decrease as the tomography severity index increased. CONCLUS ONS: Our data suggests that the most reliable instrument to detect appendicitis in the emergency environment is the computed tomography. KEY WORDS: Acute appencitis, Computed tomography, RDW, PDW, MPV, MCV.

Normal abdominal aorta diameter in infants, children and adolescents.

BACKGROUND: The normal limits of arterial diameters must be known to diagnose pathologies such as dilatation, stenosis and hypoplasia. Thoracic aorta diameter in childhood has been measured in previous studies, but the number of studies in which normal aortic diameter is determined is very small. The aim of this study was therefore to determine the normal standard diameter of the aorta and iliac arteries in children according to gender and level. METHODS: Pediatric abdominal computed tomography carried out for various reasons was retrospectively re-evaluated between January 2016 and February 2017. Patients were classified according to age into six groups. Vessel diameter, age, gender and vertebra diameter were evaluated. RESULTS: Mean proximal aorta diameter was 8.84 mm for 12-36 months, 10.02 mm for 37-84 months, 12.32 mm for 85-132 months, 14.45 mm for 133-180 months, and 16.51 mm for 181-204 months. Mean distal aorta diameter was 6.67 mm for 12-36 months, 8.07 mm for 37-84 months, 10.79 mm for 85-132 months, 12.14 mm for 133-180 months, and 14.01 mm for 181-204 months. The lumen diameter of the abdominal aorta, both proximally and distally, correlated linearly with age as an independent predictor. Similarly, the lumen diameter of the right and left common iliac artery correlated linearly with age as an independent predictor. There was no statistically significant difference in vascular diameter according to gender in any age groups. CONCLUSIONS: Optimal evaluation of aortic diameter is possible on computed tomography. Measurement outside the normal range is a sign of aneurysm or hypoplasia.

Determination of splenomegaly by coronal oblique length on CT.

PURPOSE: The aims of this study were (a) to determine whether a coronal oblique length (COL) > 12 cm, which is often used to detect splenomegaly (SM) on ultrasound, can be used as a marker of SM on computed tomography (CT), (b) to compare the diagnostic accuracy of COL with other unidimensional linear measurements (ULM) in identifying SM, (c) to determine which ULM most closely correlates with splenic volume (SVol) according to the splenic index on CT, (d) to assess the relationship between SVol and patient's gender, age and body parameters (height, weight), and (e) to determine whether there is a difference between non-contrast-enhanced and contrast-enhanced CT images in identifying SM. MATERIALS AND METHODS: The body parameters and ULM (width, length, thickness, COL) were obtained from patients who underwent CT for various indications from April 2016 to April 2017. SVol and body mass indexes were calculated for each patient. RESULTS: Of the 1078 patients [male/female = 526/552; 47.57 (mean) ± 19.21 (standard deviation) years], 392 patients had SM. The sensitivity, specificity, positive and negative predictive values of COL > 12 cm for diagnosing SM were 44.6, 95.6, 85.3 and 75.1%, respectively (p < 0.001). SVol correlated with all ULM (p < 0.001). In the non-SM group (n = 686), the mean SVol was 331.7 ± 92.2 cm3 and females had smaller spleens than males (p < 0.001). SVol showed correlation with gender, age and height (p < 0.001). CONCLUSION: COL > 12 cm is not superior to other ULM for the detection of SM, but it is very successful in determining normal spleens. The unidimensional measurements and volume of the spleen should be calculated by taking gender and body parameters into account for different ethnic populations. Non-contrast-enhanced CT can also be used to detect SM.

A rib abnormality mimicking pulmonary nodule: a pitfall in the plain chest x-ray.

The ribs show a wide range of normal and pathologic radiographic appearences as well as congenital variations. Intrathoracic ribs are isolated and rare anomalies. They are usually super-numerary, more often right-sided, and involve the middle part of the thorax. We describe a case with intrathorasic rib abnormality mimicking a peripheral metastatic lung nodule in the plain chest x-ray and emphasize the use of coronal and sagittal reformatted images in thorasic imaging. Utilisation of multiplanar reformatted images in chest computerised tomography increase diagnostic quality.

A rare cause of abdominal pain: Catheter in the middle hepatic vein.

Hemodialysis catheters are vital for chronic renal failure patients. Permanent tunneled dialysis catheters may be inserted through the jugular, subclavian, and femoral veins. In this paper, we aimed to present the computed tomography findings of a chronic renal failure patient who had referred our clinic with abdominal pain and dyspnea symptoms. This patient had a formerly inserted hemodialysis catheter for chronic renal failure and her catheter was found to be extending towards the middle hepatic vein with the tip leaning onto the parenchyma. Hemodialysis catheters can provide instant vascular access and can also be used for the consecutive procedures. Permanent hemodialysis catheters are ideal for long-term use when placing an arteriovenous fistula is contraindicated or is no longer possible under conditions like advanced heart failure, peripheral artery disease or short life expectancy. The internal jugular, subclavian, the femoral veins, and the inferior vena cava can be used for catheter insertion. The tip of the catheters inserted in the neck or the thorax must extend to the vena cava superior. Catheter malposition may both lead to fatal outcomes and ineffective dialysis. It is important to obtain chest X-rays after the procedure, particularly to detect catheter malposition.

A rare anatomical variation of the greater saphenous vein. Case report.

The venous system has frequent anatomical variations. A good understanding of the venous anatomy is very important and proper evaluation of the venous system is crucial for the appropriate treatment of venous disorders. There are many variations of the greater saphenous vein at the level of the thigh, knee and leg. All variations of the saphenofemoral junction reported in the literature refer to the drainage of the greater saphenous vein into the common femoral vein. A very rare greater saphenous vein variation at the level of the saphenofemoral junction is defined and discussed in this case report.

The reference intervals of thyroid stimulating hormone in healthy individuals with normal levels of serum free thyroxine and without sonographic pathologies.

INTRODUCTION: The aim of the present study was to investigate the reference intervals for thyroid stimulating hormone (TSH) in healthy individuals with normal levels of serum free thyroxine (fT4) and without sonographic pathologies, and determine the effects of age, gender, and residence on the TSH reference intervals. SUBJECTS AND METHODS: This research was a population-based study conducted in 70 regions. The random sampling method was used to select the 1095 subjects of the study among inhabitants aged 18 and above. Patients who had a previous history of thyroid disease and had been taking medication were excluded from the study as this may have affected their fT4 or TSH levels. In addition, subjects who had serum fT4 without a reference range and abnormal ultrasonography findings were also excluded. A total of 408 subjects were used for establishing the reference intervals for TSH. RESULTS: The data for TSH in the study group were not normally distributed according to the Kolmogorov-Smirnov index. The geometric mean was 1.62 mIU/L, the median was 1.40 mIU/L, and the 95% reference intervals were 0.38-4.22 mIU/L. The median TSH level was higher in females compared to males (p < 0.05). In the female subjects 2.5th percentile of TSH was lower and 97.5th percentile was higher than those of males. The reference intervals of TSH were of lower values in subjects over 50 years old (p < 0.001). DISCUSSION: Studies suggest that determination of the TSH reference intervals may differ due to environmental influences or due to age, gender, and race. It is suggested that the lower limit of normal TSH for the adult Turkish population would be 0.38 mIU/L and the upper limit similar to the traditional value of 4.2 mIU/L. If each clinician uses their population-specific reference interval for TSH, thyroid function abnormalities can be accurately estimated.

Thyroid dysfunctions and sonographic characteristics in northern Turkey: a population-based study.

BACKGROUND AND OBJECTIVES: In this study, it was aimed to investigate thyroid functions, sonographic characteristics of thyroid gland, relation of thyroid functions, and cardiovascular risk factors in adult population living in northern Turkey. DESIGN AND SETTINGS: The study was conducted in 70 areas (12 urban and 58 rural) in the province of Tokat in northern Turkey from 2005 to 2006. PATIENTS AND METHODS: The study included about 530000 inhabitants of 18 years and older. Demographic characteristics and thyroid sonographic findings were noted for each subject, and blood samples were collected for measuring serum lipids and thyroid function tests. RESULTS: A total of 1095 subjects (541 males, 554 females) were included, and their mean age (SD) was 41.4 (17) years. Mean thyrotropin (TSH) and free T4 levels (SD) were 1.5 (1.6) micro IU/mL and 1.2 (0.1) ng/dL, respectively, in males, and 2.2 (6.6) micro IU/mL and 1.2 (0.3) ng/dL, respectively, in females (P < .05). According to mean TSH levels, the prevalence of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism was detected as 1.6%, 0.5%, 2.7%, and 4.9%, respectively. Nodular goiter, multi-nodular goiter, and thyroid heterogeneity were determined as 13.8, 32.1, and 15.6%, respectively. The correlation between cardiovascular risk factors and serum TSH levels was not statistically significant (P > .05). The age was independently and significantly associated with serum TSH levels (P < .0001). CONCLUSION: In terms of high prevalence of thyroid dysfunction and nodular goiter, thyroid diseases must be concluded as a public health problem, and accurate and effective strategies must be identified.

Association between elevated aminotransferase levels and the metabolic syndrome in Northern Turkey.

INTRODUCTION: Elevated aminotransferase levels(ATLs) are alert the physicians for liver-affecting disease and may reflect liver injury. We aimed to determine the prevalence of elevated ATLs and the association of elevated ATLs with the metabolic syndrome (MetS) in a northern province of Turkey. MATERIALS AND METHODS: Elevated ATLs were evaluated among 1,095 individuals of the Tokat Prevalence Study which have been described in detail elsewhere. 1,095 participants had been selected by a simple random sampling method among 530,000 inhabitants in 70 (12 urban and 58 rural) areas in the province of Tokat which is located in the Black Sea Region of Turkey. RESULTS: The prevalence of elevated serum ALT, AST, and ALT and/or AST were found as 11%, 7.2%, and 13.3%, respectively. Increased BMI, fatty liver, and MetS were higher in our general population with elevated ATLs. After exclusion of individuals with hepatitis B or hepatitis C infection, 132 individuals with elevated ATLs (91 male and 41 female) were evaluated. MetS was found in 59 participants and its prevalence was markedly higher in females with elevated ATLs (p < 0.0001). When the males with elevated ATLs were evaluated, the ALT levels of the persons who have no risk of MetS (p =0.007) and the persons who have one risk of MetS (p = 0.001) were lower than the persons with MetS. CONCLUSIONS: Elevated ATLs are common and it's an important cause is MetS in Northern Turkey.

Ultrasonographic evaluation of disc displacement of the temporomandibular joint compared with magnetic resonance imaging.

PURPOSE: We compared high-resolution ultrasonography with magnetic resonance imaging (MRI), as the gold standard, to evaluate lateral and anterior capsule-condyle distances to detect disc displacement of the temporomandibular joint. MATERIALS AND METHODS: This study included 28 patients (19 female and 9 male; age range, 16-51 years; mean age, 32.82 years), and in total, 56 joints were assessed with ultrasonography and MRI. Measurements were obtained for anterior capsule-condyle and lateral capsule-condyle distances in both open- and closed-mouth positions with high-resolution ultrasonography. These findings were also compared with those of MRI taken as reference. Receiver operating characteristic curve analysis was performed to assess our results. We assessed sensitivities, specificities, accuracies, and positive and negative predictive values for both open- and closed-mouth positions. RESULTS: Diagnostic accuracy of ultrasonographic anterior capsule-condyle distance in the closed-mouth position to detect MRI-positive disc displacement (area under receiver operating characteristic curve, 0.689; P = .015) was the highest. CONCLUSIONS: The measurement of the distance between the most anterior point of the articular capsule and the most anterior point of the condyle can be used to assess disc displacement in diseased joints. However, it is necessary to determine the most accurate threshold value and to set cutoff values. These findings need to be confirmed by further research in a large number of patients to test the interexaminer agreement and the reproducibility of this method.