Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI. METHODS: Thirty-nine women with SUI (SUI group; age: 38.87 ± 8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21 ± 11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated. RESULTS: No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p > 0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p < 0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p > 0.05). CONCLUSION: Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.

A Novel Deep Transfer Learning-Based Approach for Automated Pes Planus Diagnosis Using X-ray Image.

Pes planus, colloquially known as flatfoot, is a deformity defined as the collapse, flattening or loss of the medial longitudinal arch of the foot. The first standard radiographic examination for diagnosing pes planus involves lateral and dorsoplantar weight-bearing radiographs. Recently, many artificial intelligence-based computer-aided diagnosis (CAD) systems and models have been developed for the detection of various diseases from radiological images. However, to the best of our knowledge, no model and system has been proposed in the literature for automated pes planus diagnosis using X-ray images. This study presents a novel deep learning-based model for automated pes planus diagnosis using X-ray images, a first in the literature. To perform this study, a new pes planus dataset consisting of weight-bearing X-ray images was collected and labeled by specialist radiologists. In the preprocessing stage, the number of X-ray images was augmented and then divided into 4 and 16 patches, respectively in a pyramidal fashion. Thus, a total of 21 images are obtained for each image, including 20 patches and one original image. These 21 images were then fed to the pre-trained MobileNetV2 and 21,000 features were extracted from the Logits layer. Among the extracted deep features, the most important 1312 features were selected using the proposed iterative ReliefF algorithm, and then classified with support vector machine (SVM). The proposed deep learning-based framework achieved 95.14% accuracy using 10-fold cross validation. The results demonstrate that our transfer learning-based model can be used as an auxiliary tool for diagnosing pes planus in clinical practice.

Anatomical considerations and clinical implications of bicipital aponeurosis: A magnetic resonance imaging study.

The bicipital aponeurosis (BA) is the distal aponeurosis of the biceps brachii which usually covers the median nerve (MN), and the brachial artery (BrA) and sometimes causes compression of these structures. Since these situations are rarely reported in the literature, BA frequently does not come to mind as a cause of such compression. Therefore, the diagnosis may be delayed. In this study, we aimed to investigate the morphometry of BA and its relationship with the surrounding neurovascular structures and to draw attention to BA as a structure that can cause entrapment of the MN and rarely, the BrA. We examined the MRIs of the elbow of 279 patients (107 women, 172 men) aged between 18 and 72 years. We measured the thickness, length and width of BA, and investigated the anatomical relationship between BA, BrA, and MN. The respective median thickness, width, and length of BA were 0.7 (0.4-1.8 mm), 18.0 (6.0-34.0 mm), and 32.0 (18.0-50.0 mm), respectively. In all sections examined, the BA covered the BrA and MN, and was located immediately anterior to the BrA. In 225 (80.6%) of 279 MRIs, the BrA was located anterior to the MN and posterior to the BA. In the remaining 54 (19.4%) MRIs, the MN was located anterior to the BrA and posterior to the BA. The respective median thickness, width, and length of the BA were 0.7 mm, 18.0 mm, and 32.0 mm, respectively. It covered the BrA and MN and was located immediately anterior to the BrA. The BA sometimes causes compression syndromes of these structures, therefore, for physicians, it is important to understand the anatomy of the BA.

Reevaluation of the topographical anatomy of the mid-thigh: A magnetic resonance and ultrasound imaging study.

Adductor canal (AC) and sciatic nerve (SN) blockades are commonly used during total knee arthroplasties for postoperative pain control. Medical professionals have begun to utilize single injection combined regional anesthesia methods due to increased patient comfort. In this study, we examined the topographical anatomy of the mid-thigh, which is recommended as the appropriate intervention level for combined AC and SN blockades, in order to provide a safe approach for clinicians. We examined 184 thigh magnetic resonance images (MRI) from 98 patients. We measured the diameter of the mid-thigh, anterior thigh muscle thickness, subcutaneous adipose tissue thickness, and SN depth on the MRIs. We obtained ultrasound (US) images of the vastoadductor membranes (VAM) of 26 volunteers, and measured the vertical distances between the greater trochanter and the adductor tubercle (A) and the greater trochanter and the upper edge of the VAM (B). We then proportioned B to A in order to determine in which part of the thigh the AC was located. The AC was in the distal third of the thigh, and the SN's depth was located in the third quarter of the thigh's diameter. Only the adductor magnus, and no neurovascular structure, was at risk of injury between the AC and the SN. The upper edge of the VAM was 6.5 cm below the mid-thigh, therefore it is not appropriate to suggest performing an AC blockade at mid-thigh. We think that it is safe to perform a combined AC and SN blockade in a single injection in selected patients.

Is lumbosacral transitional vertebra associated with lumbar disc herniation in patients with low back pain?

PURPOSE: To evaluate lumbosacral transitional vertebrae (LSTV) frequency in patients with low back pain and lumbar disc herniation (LDH) and to analyze correlations between LSTV presence and intervertebral disc degeneration. METHODS: This retrospective study included patients with low back pain applying between January 2021 and August 2021. Inclusion criteria were age of 18-65, presence of a standing lumbosacral Xray and a lumbar MRI taken within 2 weeks of the indexed symptoms. Patients with a history of spondylolisthesis, spondylodiscitis, scoliosis and vertebral neoplasia were excluded. A total of 1821 patients met the inclusion criteria. Radiographs and MRIs were evaluated by 2 radiologists. RESULTS: Of all patients, 61.4% were female and the mean age was 43.2 ± 12.2. LDH was detected in 57.7% of patients while a LSTV was present in 43.3%. Sacralization and LSTV were significantly different between the patients with and without an LDH. Patients with LSTV had a higher incidence of a LDH affecting 3 or more intervertebral disc levels (p < 0.001). There was a significant difference in-between LSTV and non-LSTV groups regarding the M1 and M2 intervertebral disc degeneration levels. CONCLUSION: A LDH is more common in the presence of a LSTV. Female sex is highly correlated with herniation. Three or more intervertebral disc levels are affected in the presence of an LSTV. Significantly higher degeneration incurs at the M1 and M2 intervertebral levels. Sacralization is a risk factors for a lumbar disc herniation.

The ultrasonography, colour Doppler ultrasonography and sonoelastography findings of scar endometriosis in comparison with menstrual phases.

We aimed to evaluate ultrasonography (US), colour Doppler US (CDUS) and sonoelastography (SEL) findings of histopathologically proven abdominal wall scar endometriosis in comparison with menstrual phases. A total of 24 female patients with scar endometriosis were included. Lesion size, volume, echogenicity, solid/cystic or complex appearance, contour and location on US, vascularisation on CDUS, and elasticity on SEL were recorded in both menstrual and ovulatory phases. Hypoechoic heterogeneous lesions with increased peripheral echogenicity were observed in all lesions. The mean ± standard deviation (SD) volume of the lesions in the menstrual and ovulatory phases of the lesions was 4.36 ± 3.01 cm3 and 4.63 ± 7.61 cm3 (p = .316). The mean ± SD resistive index values on CDUS in the menstrual and ovulatory phases were 0.96 ± 0.09 and 0.97 ± 0.07, respectively (p = .667). The SEL examination demonstrated a hard coding pattern in all cases with no statistically significant difference between menstrual and ovulatory phases (p = .176). We found no significant difference in terms of US, CDUS and SEL findings of scar endometriosis in comparison with menstrual phases which suggests there is no need to evaluate the patient in a specific menstrual phase.Impact StatementWhat is already known on this subject? Scar endometriosis is the endometriosis located at the abdominal wall around the scar area with a very rare incidence. The typical sonographic findings of scar endometriosis are a hypoechoic solid mass with irregular contours. High resistive index on colour Doppler ultrasonography (CDUS) and hard coding pattern on sonoelastography (SEL) are seen in the lesion.What do the results of this study add? This is the first study that evaluates sonographic features of scar endometriosis lesions in the menstrual phase. We found that scar endometriosis lesions did not have a significant difference in terms of B-mode US, CDUS and SEL in menstrual and ovulatory phases.What are the implications of these findings for clinical practice and/or further research? Our findings suggest that there is no need to evaluate the patient in a specific menstrual phase.

Prevalence and clinical implications of the Gantzer's muscle.

PURPOSE: The Gantzer's muscle is considered to be the accessory head of the flexor pollicis longus. The prevalence of the Gantzer's muscle and its anatomical relations vary in the literature. So, we aimed to study its prevalence and anatomical relations on a broad population on magnetic resonance (MRI) and ultrasound (US) images. MATERIALS AND METHODS: We investigated a total of 473 upper extremities of 378 people (171 women, 207 men), aged between 18 and 73 years, by MRI and US. We investigated the prevalence and length of the Gantzer's muscle and its anatomical relationship with the median (MN) and anterior interosseous nerves (AIN). RESULTS: Of the 473 extremities, 96 had Gantzer's muscle (20.3%). Overall prevalence of the Gantzer's muscle was 21.9% (51 in 232) in women and 18.7% (45 in 241) in men. In the population we performed US, Gantzer's muscle was located 40.0% in only the right limb, 37.1% in only the left limb and 22.9% bilaterally. All the Gantzer's muscles originated from the coronoid process. Of the 43 Gantzer's muscles seen in US, thirty-four (79.1%) were attached to flexor pollicis longus and nine (20.9%) were attached to flexor digitorum superficialis. The mean length of the Gantzer's muscle was 29.7 (range 17.2-44.5) mm. MN was anterior to the Gantzer's muscle in all extremities except ten. In all extremities, AIN was located posterior to the Gantzer's muscle. CONCLUSION: Although it is seen at a rare rate of 20.3%, Gantzer's muscle should be considered in MN and AIN compressions due to its close proximity to these nerves.

The Relationship of Liver and Pancreas Density With Chest Computed Tomography Score Progression and Laboratory Findings in Patients With COVID-19.

OBJECTIVE: Abdominal involvement of COVID-19 is a current issue. We aimed to evaluate hepatic and pancreatic density alterations on computed tomography (CT) and to analyze whether these alterations had a relationship with chest CT score and laboratory findings. METHODS: Patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 from March 11, 2020, to February 6, 2021, were retrospectively analyzed. Patients were divided into nonprogressive and progressive groups according to their chest CT scores. Liver and pancreas density, and liver-to-spleen (L/S) ratio were calculated. Laboratory findings, medication, intensive care unit stay, and survival were noted. RESULTS: There were 51 patients in the nonprogressive group and 123 patients in the progressive group. The median (minimum to maximum) L/S value of the nonprogressive group was 1 (0.28-1.53) at admission and 1.06 (0.33-1.83) at follow-up ( P < 0.001). In the progressive group, the median L/S value was 1.08 (0.35-1.51) at admission and 0.92 (0.33-1.75) at follow-up ( P < 0.001). A significant difference was found between the 2 groups at admission and follow-up ( P = 0.010 and P < 0.001, respectively). Pancreatic density measured at follow-up was significantly lower in the progressive group ( P = 0.045). In the progressive group, aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values were higher; albumin and lymphocyte values were lower ( P < 0.05). CONCLUSIONS: Patients with COVID-19 with progressive CT scores may have a decrease in L/S values, and their pancreatic density is lower than nonprogressives. Aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values tend to be higher in patients with a high chest CT score.

Sarcopenia in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system. Sarcopenia, which is characterized by the loss of physical performance and poor outcomes, has recently become the focus of research. However, the relationship between sarcopenia and MS has not yet been investigated. This study aims to determine the prevalence of sarcopenia in MS patients and investigate the factors associated with sarcopenia. METHODS: One hundred and one MS patients who can walk without assistance and 55 healthy controls were included. Handgrip strength (HGS) and gait speed tests were applied to all participants. Additionally, anterior thigh muscle thickness (anterior TMT) and skeletal muscle mass index (SSMI) were estimated by ultrasound and bioelectrical impedance analysis (BIA), respectively. According to these tests, MS patients were grouped as either sarcopenic or non-sarcopenic. The groups were compared using clinical and laboratory data, handgrip strength and performance test, Modified Fatigue Impact Scale (MFIS), and the Godin leisure-time exercise questionnaire (GLTEQ). RESULTS: HGS, gait speed, fat free mass (FFM), SMMI, anterior TMT, and sonographic thigh adjustment ratio (STAR) values in patients with MS were significantly lower than healthy controls for both sexes (for female, p:0.001, p:0.001, p:0.010, p:0.049, p:0.001, and p:0.101, respectively; for male, all p:0.001). Compared with healthy controls, MS patients had a significantly lower GLTEQ score (p:0.001), while the MFIS score (p:0.001) was higher. According to STAR, HGS, and gait speed, sarcopenia was diagnosed in 12 (17.64%) female and 7 (21.21%) male patients with MS. Whole-body sarcopenia was diagnosed in only 11 (10.9%) of the patients by BIA. HGS, gait speed, FFM, anterior TMT, and STAR values in sarcopenic MS patients were significantly lower than in non-sarcopenic for females (p:0.001, p:0.001, p:0.004, p:0.001, and p:0.001, respectively) and males (p:0.001, p:0.001, p:0.011, p:0.003, and p:0.001, respectively). MFIS score was significantly higher in sarcopenic patients than non-sarcopenic for both females (p:0.001) and males (p:0.036), but only the physical fatigue subscale was significantly higher. While the physical fatigue score was negatively correlated with GLTEQ in MS patients (r:-0.276, p:0.005), it was positively correlated with the expanded disability status scale (r:0.409, p:0.001). CONCLUSION: We detected that approximately one-fifth of MS patients have sarcopenia. Regional sarcopenia was more prevalent than whole body sarcopenia. We found a high degree of fatigue and lack of exercise in sarcopenic MS patients.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study.

BACKGROUND: In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure. METHODS: Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m2) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m2) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively. FINDINGS: The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group. INTERPRETATION: Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

Evaluation of Tendon Disorders With Ultrasonography and Elastography.

The frequency of musculoskeletal system ultrasonography (US) has increased over time. The most common reason for musculoskeletal US is the evaluation of tendons. The superficial location of tendons makes US the most suitable diagnostic tool, and US is generally the initial imaging modality for tendon disorders. The primary advantages of US are its low cost, easy accessibility, rapidity, repeatability, freedom from x-rays, and enabling of a dynamic inspection. In addition, Doppler US and elastography can be performed simultaneously with US. We aimed to demonstrate the US and elastographic findings of tendon disorders that we frequently encounter in different regions.

Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players.

OBJECTIVES: Elastography is a new sonographic technique that evaluates the elasticity of different tissues such as the Achilles tendon. In this study, we aimed to investigate the elastographic findings of Achilles tendons in professional athletes in comparison with healthy volunteers. METHODS: Twenty-one professional male volleyball players with no history of Achilles trauma were included in this study. Twenty-one healthy male volunteers with similar ages and body mass indices were selected as control participants. All participants underwent sonographic and elastographic evaluations of the Achilles tendons to evaluate Achilles tendon thickness and stiffness. RESULTS: We observed thickening in many of the thirds of the Achilles tendons (right proximal, right middle, left middle, and left distal thirds) of athletes in comparison with healthy volunteers. We did not detect any abnormalities according to the sonographic evaluations in both athletes and healthy volunteers. In the elastographic evaluations, we observed softening in the middle thirds of the Achilles tendons of athletes according to the main types (P < .001) and subtypes (P < .001 for right; and P = .002 for left middle third). There was no difference observed in the elastographic evaluations of the proximal and distal thirds. CONCLUSIONS: On sonography and elastography, we observed thickening and softening in Achilles tendons of athletes in comparison with healthy volunteers who had similar ages and body mass indices. These changes could be associated with early tendon degeneration. Further longitudinal studies may support this consideration.

Fetal aorta larger than the main pulmonary artery on the three-vessel view: Correlation with postnatal echocardiographic findings.

PURPOSE: This study investigated postnatal cardiac anomalies determined by postnatal echocardiography in fetuses with the ascending aorta (AA) diameter larger than that of the main pulmonary artery (MPA) on the three-vessel view (3VV). METHODS: The study included 17 pregnancies. The diameters of the AA and MPA were assessed on the 3VV in second-trimester sonographic screening, and all the patients underwent postnatal echocardiography to assess the cardiac outcome. RESULTS: In the study population, the mean AA diameter was 3.7 mm (range, 2.2-5.6 mm), and the mean MPA diameter was 3.2 mm (range, 1.8-5.2 mm). The mean AA/MPA ratio was 1.2 (range, 1.1-1.9). According to the postnatal echocardiograms, one of the patients had tetralogy of Fallot. This patient had the highest prenatal AA/MPA ratio (1.9). Among the remaining 16 cases, five had secundum atrial septal defects, with two having concomitant dilatation of the AA. There was one case of isolated dilatation of the AA. CONCLUSIONS: Although an AA with a diameter larger than that of the MPA on the 3VV does not usually indicate severe congenital heart disease involving the ventricular outflow tract and/or great arteries, careful prenatal and postnatal echocardiographic examinations are mandatory to determine the presence of congenital heart disease. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:423-428, 2016.

Renal Cell Carcinoma Metastasis to Ipsilateral Parotid and Submandibular Glands: Report of a Case with Sonoelastographic Findings.

BACKGROUND: Renal cell carcinoma (RCC) - also known as hypernephroma or grawitz tumor - accounts for 3% of the adulthood malignancies. Approximately 30-40% of the patients have metastasis at the time of the diagnosis and most common sites for metastasis are lung, regional lymph nodes, bone and liver. A total of 8-14% of the patients with RCC has head and neck metastasis. However, metastasis to major salivary glands is rarely seen. In this paper, we aimed to report a RCC case with metastasis to parotid and submandibular glands that has the same sonographic and sonoelastographic findings with the primary tumor. CASE REPORT: 66-year old woman with RCC history was referred to our radiology department for neck ultrasound (US) with painful swelling in the right parotid gland region. A well-defined, 37×21 mm sized hypoechoic heterogeneous solid mass was detected in the superficial-deep lobe of the right parotid gland. The mass was prominently hypervascular in color Doppler ultrasonography scan. Coincidentally, a 13×13 mm hypoechoic lobulated solid mass was detected in the right submandibular gland with similar sonographic findings. Real-time sonoelastography (SEL) was performed to the masses and both of them were blue-green colored that indicates hard tissue. An US and SEL evaluation was also performed to the renal mass (RCC) of the patient. The primary mass was also similar in sonographic and SEL appearance as salivary gland masses. In the patient history, she revealed chemotherapy-radiotherapy treatment 1.5 years ago due to inoperable mass in the mid-lower pole of the left kidney diagnosed as clear cell RCC with vascular invasion, liver, lung and brain metastasis. Because of known primary tumor, the masses in the salivary glands were suspected to be metastatic and a tru-cut biopsy was performed. Pathological result was reported as clear cell RCC metastasis. CONCLUSIONS: The etiology of RCC is still unknown and metastatic involvement can be seen at unexpected tissue and organs. Metastatic disease should be considered when a salivary gland mass detected in patients with RCC history. SEL examination would be helpful in differentiation of the origin of the metastatic lesion with known SEL features.

Sonographic and sonoelastographic findings of a rarely seen soft tissue tumor: eccrine spiradenoma.

Eccrine spiradenoma is a rare benign tumor originating from sweat glands. Its sonographic characteristics have been described in only a few reports, and there is no such report available that describes sonoelastographic findings of this tumor. In this case report, we aimed to define the sonographic and sonoelastographic findings of a benign eccrine spiradenoma.

Transabdominal Sonographic Study of the Cavum Vergae Detection Rate in Healthy Third-Trimester Fetuses.

OBJECTIVES: We aimed to measure the thickness and volume of the cavum vergae by sonography in fetuses at gestational ages of 25 to 41 weeks to determine the relationship of cavum vergae thickness and volume with gestational age and biparietal diameter and to estimate the rate of cavum vergae closure in relation to gestational age. METHODS: A total of 336 patients in their third trimester of pregnancy had transabdominal sonography. The fetal cavum vergae was scanned in the coronal and axial planes. The thickness of the anteroposterior diameter of the cavum vergae and the largest inner surface were measured after marking the internal borders of the structure, and then longitudinal and vertical sizes were obtained. The values obtained were multiplied by each other and then by 0.52 to obtain the cavum vergae volume. RESULTS: In 55 of 322 cases, the cavum vergae volume and thickness could not be calculated because the cavum vergae was closed. In the remaining cases, the cavum vergae volume and thickness and biparietal diameter were measured. Although the degree of correlation between cavum vergae thickness and volume increased with increasing gestational age, there was no correlation between cavum vergae thickness and volume at 37 to 41 weeks. There was a positive but weak statistically significant correlation between biparietal diameter and cavum vergae volume (P= .05), but there was no statistically significant correlation between biparietal diameter and cavum vergae thickness. The cavum vergae closure rate increased significantly as gestational age increased (P < .001). CONCLUSIONS: Cavum vergae closure increases as gestational age increases. However, we did not find any relationships between cavum vergae thickness and volume, gestational age, and biparietal diameter.

The utility of diffusion-weighted magnetic resonance imaging in differentiation of endometriomas from hemorrhagic ovarian cysts.

The aim was to determine the utility of diffusion-weighted magnetic resonance imaging (DW MRI) and apparent diffusion coefficient (ADC) measurements in differentiation of endometrioma and hemorrhagic ovarian cyst. A total of 24 female patients who underwent pelvic MRI with an initial diagnosis of ovarian cyst were included in the study. The final diagnosis was endometrioma in 12 patients and hemorrhagic ovarian cyst in 12 patients. We observed significantly lower ADC values in endometriomas compared with hemorrhagic ovarian cysts in all b values. DW MRI with quantitative ADC measurements can be used for differentiation of endometrioma from hemorrhagic ovarian cysts.

Nontraumatic hepatic hematoma caused by Wegener's granulomatosis: an unusual cause of abdominal pain.

Wegener's granulomatosis (WG) is a vasculitis of unknown origin characterised by prominent involvement of upper and lower respiratory tract and kidney. There are only a handful of reported cases in the literature about hepatic involvement of WG. This report shows a patient with WG whose main complaint was severe abdominal pain due to nontraumatic subcapsular hepatic hematoma. To our knowledge, this is the first reported case of WG with hepatic hematoma depicted by US and CT in the English literature.

Idiopathic postpartum intussusception: a rare cause of acute abdominal pain.

OBJECTIVES: To present a case with acute abdominal pain due to idiopathic intestinal intussusception diagnosed by ultrasound and computed tomography (CT) during the early postpartum period. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old female patient was admitted to our hospital with abdominal pain, nausea and emesis after a normal vaginal delivery. Laboratory tests done at admission were within normal limits except for leukocytosis. Physical examination revealed abdominal distention, guarding and rebound tenderness. Abdominal ultrasound and oral contrast-enhanced CT showed a complex mass in the hypogastrium, with a typical configuration of intussusception. Emergent laparotomy revealed ileoileal invagination approximately 70 cm to the ileocecal valve but no lead point. A partial ileal resection was performed. CONCLUSION: This case shows that when intussusception is suspected, an abdominal ultrasound should be performed even in patients with atypical symptoms. CT may be used to confirm the diagnosis.