Radiological management and challenges of the twin earthquakes of February 6th.

Two major earthquakes measuring 7.8 and 7.7 on the Richter scale struck Turkey and Northern Syria on February 6, claiming more than 50,000 lives. In such an unprecedented disaster, radiologists were confronted with very critical tasks of stepping out of the routine reporting process, performing radiological triage, managing acute adverse events, and optimizing imaging protocols. In our experience, radiologists can take three different positions in such disasters: (1) in the scene of the disaster, (2) serving in teleradiology, and (3) working in tertiary hospital for transported patients. With this article, we aimed to describe the challenges radiologists face on the three main fronts and how we manage these challenges.

Could computed tomography histogram analysis add value to the diagnosis of cholesteatoma?

BACKGROUND: To investigate the potential role of computed tomography (CT) histogram analysis in differentiating cholesteatoma (CHS) and non-cholesteatoma (NCHS). METHODS: We evaluated 77 temporal bone CT images (from November 2016 to February 2020) that were obtained preoperatively (mean age, 37.10±17.27 years in CHS; 36.72±16.08 years in NCHS group). Histogram analyses of the resulting XML files were conducted using the R Project 3.3.2 program. ROC analysis was used to find threshold values, and the diagnostic efficiency of these values in differentiating CHS-NCHS was determined. RESULTS: The CT images of 41 CHS (53.25%) and 36 NHCS cases (46.75%) were evaluated. There was a statistically significant difference between the CHS and NCHS group in terms of the mean, maximum, and median values (p = 0.036, p = 0.006, p = 0.043). When examining the ROC curve obtained from the mean of these parameters, area under the curve (AUC) is determined as 0.638, and when the threshold value is selected as 42.55, the mean value was determined to have a sensitivity of 86.50% and specificity of 56.10% in differentiating CHS-NCHS.

MIS-C with diarrhea complaint and acute kidney injury: A pediatric COVID-19 patient.

We present the case of a 3-month-old male infant patient who initially presented with severe dehydration with acute kidney injury secondary to COVID-19. Regarding the individual's previous history, the patient had congenital heart disease and was taking furosemide and captopril. The patient improved after initial hydration therapy. However, on the fourth day of hospitalization, the patient suddenly deteriorated and was found to have MIS-C. The patient's clinical course progressively worsened despite maximum support, and he died from severe MIS-C. We conclude that during the COVID-19 period, MIS-C is a serious health problem that should be considered in the differential diagnosis of patients with acute kidney injury.

Investigation of the radiotherapy-related changes in the eye lens using computed tomography entropy analysis.

OBJECTIVE: The aim of this study was to apply texture analysis to investigate whether there was a change in the lens following radiotherapy. PATIENTS AND METHOD: Patients who received radiotherapy (RT) for head and neck cancer or brain tumor were enrolled. Computed tomography (CT) images taken in the last month before RT and the most recent images after RT were compared. Entropy values were calculated using lens attenuation values. The lens doses were obtained from the dose-volume histogram data. RESULTS: A total of 55 lenses were evaluated. The mean Hounsfield Unit value of the lenses was 66.14±12.16 before RT and 72.02±9.12 after RT (p = 0.007). The mean entropy value was 1.87±0.31 before RT and this reduced to 1.31±0.34 after RT (p < 0.001), respectively. As time increased, the difference in entropy also increased (p = 0.007). A correlation close to statistical significance was determined between the entropy difference and minimum, maximum and mean lens radiation dose (p = 0.052, p = 0.052, p = 0.063, respectively). The entropy difference was significantly reduced in the >4 Gy group (p = 0.046). CONCLUSION: Study results indicated that the entropy values in the lens were signifcantly changed after radiotherapy and the degree of the change associated with dose and time.

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.

Evaluation of Parotid Glands With Real-time Ultrasound Elastography in Children.

OBJECTIVES: The aim of this study was to determine the strain index for parotid glands in children by using ultrasound elastography. METHODS: In this prospective study, apparently healthy children were referred from the ear-nose-throat clinic to the radiology clinic for elastographic examinations. Conventional sonographic and elastographic examinations of the parotid glands were performed. A linear 5-12-MHz transducer was used to obtain the images. RESULTS: A total of 54 children were enrolled in this prospective study. The normal mean strain index value ± SD for the parotid glands was 1.24 ± 0.67 (range, 0.29-1.39) regardless of sex. The mean age of girls was 7.42 ± 2.94 years (range, 3-14 years), and the age of boys was 8.50 ± 3.46 years (range, 4-16 years). The strain index values for the parotid glands in boys was 1.25 ± 0.76, and in girls it was 1.22 ± 0.55. There was no statistically significant difference in the strain index values between girls and boys (P= .986). There was no correlation between the strain index and age (r = 0.026) or body mass index (r = 0.066). CONCLUSIONS: This study determined the mean strain index values for apparently healthy children. Such information can serve as a baseline from which pathologic parotid diseases can be diagnosed with ultrasound elastography in combination with other sonographic criteria.

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.

Correlation between ultrasonography and MR proton density fat fraction techniques in evaluating the severity of liver steatosis.

Background and Aim: To investigate the relationship between ultrasonography (US) and magnetic resonance (MR) proton density fat fraction (PDFF) techniques, using the modified DIXON method, in determining the severity of liver steatosis. Materials and Methods: This study included seventy consecutive patients who underwent upper abdominal MRI for various reasons between June 2016 and January 2017. Fatty liver staging was performed using US as indicated.The liver fat percentage was measured and staged according to PDFF values. Results: In the study, of the 70 cases, 36 were male and 34 were female. On US, 18.5% of the cases had stage 0, 32.8% had stage 1, 42.8% had stage 2, and 5.7% had stage 3 liver steatosis. A significant correlation was found between ultrasonographic evaluation and PDFF in determining the percentage of liver fat (r=0.775, p<0.001). When comparing the percentages, MR-evaluated PDFF and ultrasonographic staging were most compatible at grade 3 and least compatible at grade 2. When the PDFF threshold value was set at 8.1%, the sensitivity of US in distinguishing between obvious and indistinct steatosis was 97.1%, and the specificity was 88.9%. Conclusion: Ultrasound continues to be a useful tool for detecting fatty liver disease. However, magnetic resonance (MR) proton density fat fraction (PDFF) imaging is essential for accurately determining the severity and prevalence of steatosis. Our study revealed inconsistencies between US and MR PDFF in grading liver steatosis, showing higher agreement in severe cases and lower agreement in moderate cases. Therefore, we recommend classifying steatosis as either uncertain or apparent rather than using a grading system in US.

Voxel level dense prediction of acute stroke territory in DWI using deep learning segmentation models and image enhancement strategies.

PURPOSE: To build a stroke territory classifier model in DWI by designing the problem as a multiclass segmentation task by defining each stroke territory as distinct segmentation targets and leveraging the guidance of voxel wise dense predictions. MATERIALS AND METHODS: Retrospective analysis of DWI images of 218 consecutive acute anterior or posterior ischemic stroke patients examined between January 2017 to April 2020 in a single center was carried out. Each stroke area was defined as distinct segmentation target with different class labels. U-Net based network was trained followed by majority voting of the voxel wise predictions of the model to transform them into patient level stroke territory classes. Effects of bias field correction and registration to a common space were explored. RESULTS: Of the 218 patients included in this study, 141 (65%) were anterior stroke, and 77 were posterior stroke (35%) whereas 117 (53%) were male and 101 (47%) were female. The model built with original images reached 0.77 accuracy, while the model built with N4 bias corrected images reached 0.80 and the model built with images which were N4 bias corrected and then registered into a common space reached 0.83 accuracy values. CONCLUSION: Voxel wise dense prediction coupled with bias field correction to eliminate artificial signal increase and registration to a common space help models for better performance than using original images. Knowing the properties of target domain while designing deep learning models is important for the overall success of these models.

Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis.

PURPOSE: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. METHODS: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. RESULTS: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. CONCLUSION: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

Evaluation of thymic dimensions in patients with multisystem inflammatory syndrome.

BACKGROUND: Multisystem inflammatory syndrome (MIS-C) is the most important complication of COVID-19 in the pediatric population. Unfortunately, this problem is an unpredictable situation in patients with COVID-19. We aimed to evaluate the effects of MIS-C on thymus dimensions in pediatric patients. METHODS: We retrospectively analyzed the files of 368 pediatric patients aged 2-18 years, who were diagnosed with COVID-19. Computer Tomography (CT) images of 22 patients diagnosed with COVID-19 and 10 patients diagnosed with MIS-C were evaluated in detail by two board-certified radiologists. Eighteen age and sexmatched patients who applied to the emergency department of our hospital for any reason and had a CT scan for any reason were selected as the control group. The data of both groups were statistically compared. RESULTS: Considering the differences between the groups in terms of laboratory data, monocytes, hemoglobin, and platelet were significantly lower in the MIS-C group than the other groups. Procalcitonin, C- reactive protein, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proBNP levels were statistically significantly higher in the MIS-C group compared to the other groups Regarding the differences in thymus dimensions, thymus AP diameter, transverse diameter, length, thickness, and volume were significantly higher in the MIS-C group than in the other groups There was a significant positive correlation between the transverse diameter of the thymus and CRP, procalcitonin, pro-brain natriuretic peptide (proBNP), and NLR levels. CONCLUSIONS: Our study shows that thymus dimensions and acute phase reactants are higher in pediatric patients in the MIS-C group. Also, thymus transverse diameter, thymus thickness, and PLR values pose a risk for the development of MIS-C. More research is needed on the role of the thymus gland in the pathogenesis and diagnosis of MIS-C.

Vertebral artery occlusion with Amplatzer vascular plug 4 to prevent subsequent endoleak in stent-graft treatment of subclavian artery gunshot injury.

Endovascular treatment options have evolved in many ways and become an important alternative for open surgical repairs in various vascular territories. Herein, we present a case of an 18-year-old man with complex injury to the left subclavian artery and vein caused by a gunshot 4 months ago. After the gunshot, a high-flow fistula between the left subclavian artery and the vein occurred with pseudoaneurysm formation. This fistula led to a significant left subclavian steal phenomenon. A stent-graft was deployed along the injured left subclavian artery after embolization of the left vertebral artery by Amplatzer vascular plug 4 (AVP-4) in order to prevent subsequent endoleak due to the subclavian steal syndrome.

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.

Self-expandable metallic stent application for the management of upper gastrointestinal tract disease.

OBJECTIVE: The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure. RESULTS: Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage. CONCLUSION: Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.

Comparison of the T2-star Values of Placentas Obtained from Pre-eclamptic Patients with Those of a Control Group: an Ex-vivo Magnetic Resonance Imaging Study.

BACKGROUND: Endotel dysfunction, vasoconstriction, and oxidative stress are described in the pathophysiology of pre-eclampsia, but its aetiology has not been revealed clearly. AIMS: To examine whether there is a difference between the placentas of pre-eclamptic pregnant women and those of a control group in terms of their T2 star values. STUDY DESIGN: Case-control study. METHODS: Twenty patients diagnosed with pre-eclampsia and 22 healthy controls were included in this study. The placentas obtained after births performed via Caesarean section were taken into the magnetic resonance imaging area in plastic bags within the first postnatal hour, and imaging was performed via modified DIXON-Quant sequence. Average values were obtained by performing T2 star measurements from four localisations on the placentas. RESULTS: T2 star values measured in the placentas of the control group were found to be significantly lower than those in the pre-eclampsia group (p<0.01). While the mean T2 star value in the pre-eclamptic group was found to be 37.48 ms (standard deviation ± 11.3), this value was 28.74 (standard deviation ± 8.08) in the control group. The cut-off value for the T2 star value, maximising the accuracy of diagnosis, was 28.59 ms (area under curve: 0.741; 95% confidence interval: 0.592-0.890); sensitivity and specificity were 70% and 63.6%, respectively. CONCLUSION: This study, the T2 star value, which is an indicator of iron amount, was found to be significantly lower in the control group than in the pre-eclampsia group. This may be related to the reduction in blood flow to the placenta due to endothelial dysfunction and vasoconstriction, which are important in pre-eclampsia pathophysiology.

Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis / Avaliação de pacientes pediátricos apresentando blefaroptose transitória unilateral de início agudo

ABSTRACT Purpose: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

RESUMO Objetivo: Avaliar as características clínicas de pacientes pediátricos com blefaroptose adquirida unilateral, transitória e de início agudo. Métodos: Neste estudo retrospectivo, foram revisados prontuários clínicos entre abril de 2015 e junho de 2020. Os pacientes foram avaliados em termos de características demográficas, manifestações neurológicas e oftalmológicas associadas, duração dos sintomas, etiologia e achados de imagem. Foram excluídos pacientes com blefaroptose congênita e com blefaroptose adquirida de etiologia crônica. Resultados: Foram incluídos neste estudo 16 pacientes pediátricos (10 masculinos e 6 femininos) com blefaroptose adquirida transitória unilateral de início agudo. A média de idade dos pacientes foi de 6,93 ± 3,16 anos. As causas etiológicas mais comumente identificadas foram trauma em 7 pacientes (43,75%) e infecção (casos parainfecciosos) em 5 pacientes (31,25%). Além disso, a síndrome de Miller-Fisher, a síndrome de Horner secundária a neuroblastoma, a síndrome de Brown adquirida e pseudotumor cerebral foram determinados como causas etiológicas em um paciente cada uma. Achados oculares adicionais estavam associados à blefaroptose em 7 pacientes (58,33%). Foi observada a resolução espontânea da blefaroptose, sem tratamento, em todos os pacientes, exceto nos pacientes com síndrome de Miller-Fisher, neuroblastoma e pseudotumor cerebral. Nenhum paciente precisou de tratamento cirúrgico. Morbidades oculares, como ambliopia, não foram encontradas em nenhum paciente. Conclusão: Este estudo demonstrou que a blefaroptose transitória unilateral de início agudo, rara na infância, pode regredir sem a necessidade de tratamento cirúrgico na população pediátrica. No entanto, também não deve ser esquecido que patologias graves que requerem tratamento podem se apresentar com blefaroptose.

A giant choledochal cyst in infancy: a case report.

Choledochal cyst is a dilation that encloses the intrahepatic or both extra- and intrahepatic portions of the biliary ducts. Postnatally, ultrasonography is the initial diagnostic modality of choice, allowing for precise measurements of intra- or extrahepatic duct dilatation and identification of stones and sludge. Symptoms depend on the age at presentation. Common bile duct malformations should be considered as a differential diagnosis of a cystic mass regardless of the cyst's size or patient's age, especially in children presenting with abdominal pain, jaundice, and palpable mass. To the best of our knowledge, we report the largest choledochal cyst in infancy.