The prevalence and clinical importance of incidental soft-tissue findings in cervical CT scans of trauma population.

OBJECTIVES: To define the age-related prevalence of incidental soft-tissue findings in cervical CT scans of a trauma population and to investigate their clinical importance. METHODS: The original diagnostic radiology reports and the CT images of the 357 patients with cervical trauma were retrospectively evaluated. Incidental soft-tissue findings were investigated. All findings were grouped according to age. The findings were classified based on their clinical importance into three categories: Category 1: no clinical importance, Category 2: possible clinical importance requiring further investigation and Category 3: obvious clinical importance. In addition, the medical records of the patients were investigated. The follow-up ratio of the pathologies mentioned in the original radiology report was recorded. RESULTS: The most frequently encountered findings in Categories 2 and 3 were carotid artery calcification (n = 89, 24.9%) and tonsillolith (n = 115, 32.2%), respectively. The reporting ratio in the original reports of Categories 1, 2 and 3 findings was 1.1% (n = 4), 9% (n = 27) and 34.5% (n = 64), respectively. No further investigations and follow-up was accomplished for Category 1 lesions, whereas 11.1% of Category 2 and 35.9% of Category 3 lesions were subjected to further investigations and follow-up. CONCLUSIONS: The cervical CT scans of trauma patients reveal many clinically important soft-tissue incidental findings. Cervical region incidental findings may be followed up on an outpatient basis, rarely being of life-threatening value. The ratio of reporting and follow-up of incidental findings increases parallel to the clinical importance of the lesions.

Stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage.

Xanthogranulomatous pyelonephritis (XPN) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma. Its standard therapy consists of total or partial nephrectomy. A case of stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage is presented in this paper.

Obstructive sleep apnoea and its association with left ventricular function and aortic root parameters in newly diagnosed, untreated patients: a prospective study.

This prospective study investigated whether untreated obstructive sleep apnoea-hypopnoea syndrome (OSAHS), which is strongly associated with cardiovascular disease, is a risk factor for left ventricular (LV) systolic and diastolic dysfunction and aortic root dilatation. Ninety consecutive patients with breathing and snoring problems, including 64 with newly diagnosed, untreated OSAHS, were classified into four groups based on their apnoea-hypopnoea index (AHI). All participants underwent overnight polysomnographic and complete echocardiographic examinations, and LV systolic, diastolic and aortic measurements were compared. Body mass index was the only demographic characteristic that significantly increased as the severity of OSAHS (AHI) increased and it significantly correlated with AHI. Patients with a higher AHI had a significantly higher aortic root diameter and aortic stiffness index, and significantly lower aortic strain. The LV diastolic parameters were least favourable in patients with more severe OSAHS. The LV ejection fraction did not differ significantly between groups. It was concluded that LV diastolic function and aortic elastic parameters deteriorate with OSAHS.

Two- and three-dimensional reformatted computed tomography imaging analysis of the lumbosacropelvic structure in degenerative anterolisthesis.

AIM: To evaluate the differences in the lumbosacropelvic structure between normal individuals and those with pseudospondylolisthesis. MATERIALS AND METHODS: The renal stone protocol abdominal CT images of 452 patients were retrospectively analysed. Twenty individuals who had degenerative anterolisthesis at the L5-S1 level were included in the study. Moreover, a control group of individuals was formed, similar in age and gender to the study group. A number of linear and angular lumbosacral morphological parameters were evaluated using two- and three-dimensionally reformatted CT images. The data of the two groups were compared using the t-test and Mann-Whitney U-test. RESULTS: There was an association between spondylolisthesis and decreased thickness of the transverse process (p=0.01), the height of the iliac crest (p=0.028), lumbar angle (p=0.041), sacral table angle (p=0.033), sacral table index (p=0.0001), sacral kyphosis (p=0.025), sacral slope (p=0.007), and width of the transverse process (p=0.038), and increased transverse articular dimension of the facet joint (p=0.003), axial angle of the facet joint (p=0.002), sagittal angle of the facet joint (p=0.012), S1 vertebra interfacet index (p=0.003), the distance between the L5 vertebral transverse process and the iliac crest (p=0.003), pelvic incidence (p=0.016), L5 vertebra posterior angle (p=0.001), and intersacroiliac joint angle (p=0.024). CONCLUSION: The lumbosacropelvic morphology in patients with degenerative spondylolisthesis is quite different from that of normal individuals. These abnormalities should be revealed using imaging methods as they can be defining for pseudospondylolisthesis development and have important effects on therapy planning.

CT and MRI in the evaluation of extraspinal sciatica.

Sciatica is the most frequently encountered symptom in neurosurgical practice and is observed in 40% of adults at some point in their lives. It is described as pain of the hip and the lower extremity secondary to pathologies affecting the sciatic nerve within its intraspinal or extraspinal course. The most frequent cause is a herniating lumbar disc pressing on the neural roots. Extraspinal causes of sciatic pain are usually overlooked because they are extremely rare and due to intraspinal causes (lumbar spinal stenosis, facet joint osteoarthritis, fracture, and tumors of the spinal cord and spinal column) being the main consideration. Early diagnosis of sciatica significantly improves the likelihood of relieving symptoms, as well as avoiding any additional neurologic injury and unnecessary surgery. We evaluate histolopathologically confirmed extraspinal causes of sciatica cases, accompanied by their presented computed tomography and/or magnetic resonance imaging findings.

A dermoid cyst of the round ligament clinically misdiagnosed as incarcerated inguinal hernia.

We present a case of a dermoid cyst located in the round ligament in a patient with a preliminary diagnosis of inguinal hernia. The dermoid cyst was diagnosed based on MRI findings and confirmed histopathologically. Dermoid cyst (mature teratoma) is a congenital cystic tumour formed by the well-developed (mature) tissues of at least two of the three germinal layers. It is mainly encountered in the gonads. Location within the round ligament is quite rare. Due to the anatomical localization of the round ligament, dermoid cysts within it or other inguinal canal masses are usually misdiagnosed as inguinal hernia. However, when an inguinal canal mass is encountered, despite the higher hernia frequency, a proper suspicion and investigation with regard to masses in this area could be extremely important in preventing intraoperative surprises.

Thorax CT findings in symptomatic hemodialysis patients.

The goal of the present study was to discuss thoracic problems in symptomatic hemodialysis patients based on the CT findings among 64 uremic patients including 34 females and 30 males of age range 14 to 83 years (mean = 61 years). We retrospectively documented complaints of cough, dyspnea, low-grade pyrexia, malaise, and weight loss. Atelectasis (79.7%), cardiomegaly (59.3%), parenchymal fibrosis-scar (50%), pleural effusion (45.3%), and ground-glass opacity (45.3%) were the most common findings. Pulmonary artery caliber was greater than 32 mm in 19 (29.7%) patients. Staphylococcus aureus (26.6%) and Mycobacterium tuberculosis (13.3%) were the most common infectious agents in patients who had parenchymal infiltrations, respectively. Chronic renal failure patients may display many thoracic and extrathoracic complications. The radiologic findings in these patients were multiple and complex, but, in most of cases, imaging techniques (predominantly CT) offered an accurate, noninvasive diagnostic approach.

Omental torsion without a whirl sign.

Omental torsion is a very rare cause of acute abdomen. Its primary diagnostic modality is CT. The whirl sign visible in CT images is pathognomonic. The whirl sign is not present in all cases. When no whirl sign is seen, omental torsion is rather difficult to be differantieted radiologically from omental infarct and epiploic appendicitis. The diagnosis of these three entites is clinically important due to their different treatments. We present in this paper an omental torsion case where whirl sign was not present and diagnosis was made by other suggestive CT image findings.