Insights into chest computed tomography findings in Behcet's disease.

INTRODUCTION: To evaluate the spectrum and frequency of abnormal chest multidedector computed tomography (MDCT) findings in Behcet's disease(BD). MATERIALS AND METHODS: Chest MDCT scans of 44 patients referred to radiology department for chest symptoms those had prior or newly established diagnosis of BD between 2009-2016 were retrospectively reviewed. Abnormal findings within pulmonary artery (PA), lungs, other large vessels, heart, mediastinum, pleura and pericardium were noted. RESULT: Sixteen patients had one ore more computed tomography (CT) findings related to BD. PA involvement was most common (27.2%) presentation revealing thrombosis in 8 and aneurysms in 4 of 12 patients. Mean PA diameter was 29 ± 3.7 mm. Patients with PA involvement had significantly higher PA diameters than those without (p< 0.001). Hypertrophied bronchial artery seen as serpiginous vessels around hilum was a common finding (66.6%). Lung parenchyma findings was rarely isolated and usually associated with PA involvement with subpleural alveolar opacities, focal atelectasis and ill-defined nodular opacities. Cardiac filling defects were accompanying lesions in most of patients with PA aneurysms (75%). CONCLUSIONS: BD is associated with a wide spectrum of simultaneous involvement of discrete anatomical sites. PA enlargement and hypertrophied bronchial artery is a clue for patients with PA involvement. Heart chambers should be checked for filling defects particularly in patients with PA aneurysms.

Effect of Hemoconcentration on Dural Sinus Computed Tomography Density in a Pediatric Population.

Unenhanced brain computed tomography (CT) is inexpensive, easily available, and the first-choice imaging modality for patients presenting with various neurologic symptoms. Venous thrombosis is not rare in childhood, but diagnosis can be difficult. In some cases, only denser vessels can be used to highlight an issue. The aim of this study was to retrospectively evaluate the relationship between X-ray attenuation and hemoconcentration in a pediatric population. This study enrolled 99 pediatric patients who had been referred radiology department for unenhanced brain CT. Images were retrospectively evaluated for measurement of dural sinus densities from four distinct dural sinus locations. Correlation between mean Hounsfield unit (HU) values and hemoglobin/hematocrit (Hb/Htc) levels, as well as age and gender were further analyzed. There was a strong correlation between mean HU and Hb levels (r = 0.411; standard deviation: 0.001) and also between mean HU and Htc levels (r = 0.393; p < 0.001). According to the results of this study, the mean sinus density and H:H (HU:Htc) values were 44.06 HU and 1.19, respectively, in a normal pediatric group. In conclusion, before deciding between a diagnosis of thrombosis and a determination of normal findings during an evaluation of unenhanced CT in a pediatric population, radiologists should consider complete blood count results as well as H:H ratios.

Ultrasound Elastography in Pediatric Congenital Hypothyroid Patients.

OBJECTIVES: Congenital hypothyroidism (CH) is most frequently encountered in newborns as an endocrine disorder characterized by thyroid hormone deficiency, and is one of the most common reasons for preventable mental retardation. This prospective study was designed to detect the pediatric occurrences of CH followed as euthyroid, with no anomalies detected via US on the gray scale, in comparison with a pediatric group with normal levels. METHODS: A total of 42 apparently healthy children with no thyroid disorder (Group 1) and 54 euthyroid CH (Group 2) using thyroid hormone were included in this study. Both B-mode gray scale ultrasound (US) and elastography examinations were made using Toshiba Aplio 400 device (Toshiba Medical Systems Corporation, Otawara, Japan), with a 12 MHz linear probe. All the radiological examinations were made by a single radiologic physician with at least 5 years of experience in elastography. RESULTS: In total, 96 occurrences in the right and left lobes of 192 thyroid gland measurements were included in the research. There were 20 males and 22 females in the healthy group (n=42), and 28 males and 26 females in the CH group (n=54). Although, there were no significant differences in the average age or gender (p=0.563), there were significant differences in the strain index (SI) values in the CH group.The receiver operating characteristics (ROC) curve was done to calculate the cut-off value for diagnosing CH with strain index ratio (SIR); the value of the cut-off was 0.695, with 63.1% sensitivity and 50.9% specificity. CONCLUSIONS: This was the first study about CH in children. Our study found the SIR of CH to be higher than the normal thyroid parenchyma. It showed that in parenchymal related CH, SE should be used. This study should be a guide for new studies that should be done about the different etiological factors of CH.

The relationship between tinnitus and vascular anomalies on temporal bone CT scan: a retrospective case control study.

INTRODUCTION: Tinnitus is a common symptom in which etiology is unclear in a group of patients. Some of anatomic or vascular variations diagnosed on temporal bone computed tomography (CT) has been known to cause tinnitus particulary pulsatile form. Therefore significance of these anatomic variations has not been validated in patients with nonpulsatile tinnitus. The aim of this study is to ascertain several anatomic variations previously attributed to pulsatile tinnitus in nonpulsatile tinnitus patients. And secondly to assess the relationship between the amount of sigmoid sinus bulging and mastoid emissary vein (MEV), enlargement of those was not evaluated before in tinnitus patients. METHODS: Retrospectively, temporal bone CT scans of 70 patients with an existing complaint of tinnitus with unexplained etiology were enrolled. As a control group, 70 patients were selected from paranasal sinus CT scans without any otological or clinical findings. RESULTS: The type of tinnitus was subjective and nonpulsatile in the overall group. The diameters of enlarged MEV on the left side were significantly higher in the tinnitus group. Carotid canal dehiscence and high riding jugular bulb were significantly higher in the tinnitus patients. Petrous bone pneumatization was significantly lower in the tinnitus patients than in the control group. CONCLUSIONS: In patients who complained of subjective nonpulsatile tinnitus with unknown etiology, some temporal bone vascular variations, including high riding jugular bulb, dehiscent carotid canal, left-sided MEV enlargement, and petrous bone pneumatization, seemed to have an association with tinnitus. Further studies comparing all these entities between pulsatile and nonpulsatile groups and healthy controls should be undertaken.

Ultrasound Elastography Evaluations in Patient Populations With Various Kidney Diseases.

Renal elastography is an ultrasonographic method that has been recently found to provide information on renal functions and fibrosis. In this study, we aimed to investigate the relationship between elastography scores and renal functions and proteinuria levels in patient populations with various kidney diseases. Seventy-five diabetic nephropathy patients, 66 kidney transplant patients, and 45 glomerulonephritis patients were included in the study. The amount of proteinuria was measured according to the protein-to-creatinine ratio in spot urine samples. The estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease formula. Ultrasound elastography scores were measured in each patient group by a radiologist. The mean age of diabetic nephropathy patients was 61 ± 10 years. The mean elastography score was 0.96 ± 0.30. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels and was negatively correlated with eGFR value. The mean age of kidney transplant patients was 42 ± 12 years. The mean elastography score was 1.10 ± 0.38. There was a significant relationship between elastography score and proteinuria level. The mean age of glomerulonephritis patients was 37 ± 13 years. The mean elastography score was 0.91 ± 0.41. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels. However, there was no relationship between elastography score and eGFR value and proteinuria level. Although renal elastography provides information on renal functions and proteinuria in patients with diabetic nephropathy, renal transplant, and glomerulonephritis, there is a need for studies with a larger number of patients on this subject.

Evaluation of the diagnostic efficacy of strain elastography in infertile population with normal and abnormal semen parameters.

OBJECTIVE: The aim of the present study was to investigate the diagnostic value of strain elastography (SE) of testicular tissues in infertile population. We also evaluated the correlation between SE results with semen parameters and hormone profiles of the patients. MATERIAL AND METHODS: A total of 61 patients and 122 testes were evaluated. Patients who were evaluated in an andrology outpatient clinic with the diagnosis of infertility and referred to radiology department for investigation of reproductive organs between June 2015 and January 2016 were included. Patients were divided into two groups according to semen analyses results as normal (Group 1) and abnormal (Group 2). Hormone profiles, semen analyses, B-mode, coloured Doppler ultrasonography and sonoelastography examinations were performed for each patient. Measurements of testicular volumes, resistive indices (RI) in intraparenchymal arteries, strain, strain ratio (SR) and presence of varicocele were recorded. RESULTS: Mean age of participants was 33.7±6.3 years. Mean testicular volumes (Group 1, 19.41±4.8 mL, and Group 2, 17.64±3.62 mL) were significantly different between groups (p=0.023). Mean SRs were also different between Groups 1 and 2 (0.12±0.08 vs. 0.22±0.18, p<0.001). Testicular volumes were directly proportional with SRs in Group 1. Strain values had inverse relationship with sperm concentration and total motile sperm counts in Group 2 (p=0.01). SRs were found to be positively correlated with RI and sperm morphology in Group 2 (p<0.05). Although FSH values showed significant difference among groups, any correlation between FSH and elastographic parameters could not be displayed. CONCLUSION: Strain elastography results were found to be significantly different in patients with abnormal sperm counts. This technique may provide promising results, however, further large scale studies may help to clarify the value of this imaging modality in the assessment of male infertility.

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

OBJECTIVE: To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS: 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. RESULTS: Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). CONCLUSION: This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study.

BACKGROUND: This study aimed to determine the strain index (SI) of normal thyroid parenchyma in a group of healthy children, using ultrasound elastography (USE). METHODS: The participants consisted of 54 healthy children. The USE of the normal thyroid parenchyma was performed by using the Hitachi Hi VisionPreirus model ultrasonography (US) device. By following sinusoidal waves at the base of the screen, regular and slight compressions and decompressions were made by the transducer. After the regular sinusoidal waves were acquired, standard region of interest (ROI) circles were used to measure the SI values of the thyroid glands by placing one ROI on a superficial part of the normal thyroid gland parenchyma and the other on the adjacent soft tissue at the same depth (within 10-mm proximity). Three measurements were obtained for each (right and left) thyroid gland, and the mean value was used for statistics. RESULTS: The mean SI value of normal thyroid glands was 0.54±0.38 for the whole group. There was no statistically significant difference between girls and boys on the basis of age, weight, height, BMI (body mass index), and thyroid SI values (p=0.15, p=0.18, p=0.12, p=0.31, and p=0.96, respectively). No correlation was found between thyroid gland SI values and each of the following variables: age (r=0.22, p=0.15), gender (r=0.007, p=0.96), and BMI (r=0.26, p=0.09). CONCLUSIONS: The study determined the normal elasticity values of thyroid glands in healthy children. Such information can serve as a baseline from which thyroid diseases can be examined.

Penile Mondor's Disease: Primum Non Nocere!

PURPOSE: Penile Mondor's disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical diagnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultrasonography for diagnosis of penile Mondor's disease. MATERIALS AND METHODS: Seven patients with the clinical presentation of penile Mondor's disease were included in the study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients. RESULTS: Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic purposes, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according to us. CONCLUSION: Recovery from penile Mondor's disease is usually spontaneous and smooth. A simple physical examination is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests should be avoided so that patients are not harmed.

The relationship between mean platelet volume and other platelet indices with testicular artery blood flow and fertility: a preliminary study.

OBJECTIVES: To examine the relationship between platelets (PLT) and platelets indices such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) as noninvasive biomarkers with testicular artery blood flow and fertility. METHODS: Fifty-seven healthy and fertile men with normal semen values and 52 patients with abnormal semen values were included in the study. The participants' PLT, MPV, PDW and PCT values were analyzed. Four different levels of the testicular artery, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured using color Doppler ultrasound. RESULTS: There was no significant difference in terms of platelet and platelet indices (MPV, PDW and PCT) between the fertile and infertile group. There were no between group differences in the RI values of the testicular- and intra-testicular artery. When all fertile and infertile participants were considered together, there was no statistically significant correlation between the parameters of the testicular artery blood flow (PSV, EDV and RI) and platelet and platelet indices (MPV, PDW and PCT) (P > 0.05). CONCLUSIONS: There is not statistically significant correlation between any of the following parameters: platelets and platelet indices such as MPV, PDW and PCT, RI of the testicular artery, and fertility.

The value of susceptibility weighted magnetic resonance imaging in evaluation of patients with familial cerebral cavernous angioma.

OBJECTIVES: We investigated the imaging features of Cavernous angioma (CA) lesions and the value of Susceptibility-weighted imaging (SWI) by comparing with T2*-weighted gradient echo (GRE) sequences in patients with familial CA disease. MATERIAL AND METHODS: We retrospectively evaluated 19 familial CA patients (8 men, 11 women; mean age, 36 years). T1-weighted, T2-weighted, T2*-weighted GRE, and SWI sequences were performed to all patients. The numbers of CA lesions seen on T2*-weighted GRE and SWI sequences were analyzed. The correlations between the numbers of lesions on both sequences with age were evaluated. CA lesions were classified according to the classification of Zabramski et al. RESULTS: The number of CA lesions was higher on SWI than T2*-weighted GRE significantly (P<.001). There was a significant strong correlation between the age of the patients and number of lesions in the cohort on T2*-weighted GRE (r = 0.81, P<0.001) and SWI (r = 0.85, P<0.001) sequences. Approximately 44% of the CA lesions which were detected only by SWI could not be categorized according to the classification of Zabramski et al. CONCLUSION: SWI can provide helpful additional information by determining the CA lesions more accurately than T2*-weighted GRE. Thus, routine clinical neuroimaging protocols should contain SWI to assess the true prevalence of lesions for optimal diagnosis and treatment. Moreover, this study show that the Zabramski classification is insufficient to identify all CA lesions, and a new type (type V) should be added to represent lesions that are seen on SWI but not on T2*-weighted GRE.

A patient with pneumopericardium secondary to extranodal T-cell lymphoma.

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoma derived from either activated NK cells or cytotoxic T cells. Most cases with T/NK cell lymphoma present with extranodal manifestations. Primary nodal disease is very rare. The upper respiratory tract is the most common site involved in extranodal disease. Symptoms include epistaxis and nasal obstruction. T/NK cell lymphomas show aggressive and invasive clinical progression, with a poor prognosis. Without treatment, survival is measured in months. We report a case of a 51-year-old male patient with pneumopericardium as a complication of intestinal T/NK cell lymphoma. To the best of our knowledge, this is the first report showing pneumopericardium as a fatal complication of T/NK cell lymphoma. Pneumopericardium should be considered in patients diagnosed with T/NK cell lymphoma presenting with chest pain.

Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

ABSTRACT Objective To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS). Subjects and methods 69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants. Results Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05). Conclusion This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.