Osteosarcopenia in acromegaly: reduced muscle quality and increased vertebral fat deposition.

PURPOSE: Musculoskeletal disorders are among the most disabling comorbidities in patients with acromegaly. This study examined muscle and bone quality in patients with acromegaly. METHODS: Thirty-three patients with acromegaly and nineteen age- and body mass index-matched healthy controls were included in the study. Body composition was determined using dual-energy X-ray absorptiometry. The participants underwent abdominal magnetic resonance imaging (MRI) for cross-sectional evaluation of muscle area and vertebral MRI proton density fat fraction (MRI-PDFF). Muscular strength was measured using hand grip strength (HGS). Skeletal muscle quality (SMQ) was classified as weak, low, or normal, according to HGS/ASM (appendicular skeletal muscle mass) ratio. RESULTS: Groups had similar lean tissues, total body fat ratios, and total abdominal muscle areas. Acromegalic patients had lower pelvic BMD (p = 0.012) and higher vertebral MRI-PDFF (p = 0.014), while total and spine bone mineral densities (BMD) were similar between the groups. The SMQ score rate was normal only 57.5% in the acromegaly group, and 94.7% of the controls had a normal SMQ score (p = 0.01). Subgroup analysis showed that patients with active acromegaly (AA) had higher lean tissue and lower body fat ratios than controlled acromegaly (CA) and control groups. Vertebral MRI-PDFF was higher in the CA group than that in the AA and control groups (p = 0.022 and p = 0.001, respectively). The proportion of participants with normal SMQ was lower in the AA and CA groups than that in the control group (p = 0.012 and p = 0.013, respectively). CONCLUSION: Acromegalic patients had reduced SMQ and pelvic BMD, but greater vertebral MRI-PDFF. Although lean tissue increases in AA, this does not affect SMQ. Therefore, increased vertebral MRI-PDFF in controlled acromegalic patients may be due to ectopic adiposity.

Interobserver and intraobserver variations in sonographic measurement of thyroid volume in children.

OBJECTIVE: To determine the interobserver and intraobserver variations in sonographic measurement of thyroid volume in children. DESIGN: Thyroid volumes of 30 healthy children were measured by three separate observers. Additionally each observer measured thyroid volumes of ten separate children three times. METHODS: The data were used to assess intraobserver and interobserver variations in measurement of thyroid volume. Interobserver and intraobserver variations in measuring each diameter of the thyroid gland were also determined. The effect of thyroid size on interobserver and intraobserver variations was analyzed. RESULTS: Intraobserver variation in measurement of thyroid volume was 8.4+/-6.7% (mean+/-s. d.). Interobserver variation was 13.3+/-8.2%. The widest interobserver variation was encountered in determining the craniocaudal diameter of the thyroid gland. No correlation was found between thyroid volume and interobserver variation (r=-0.12, P=0.27), whereas a slight but statistically significant correlation was found between thyroid volume and intraobserver variation (r=-0.26, P=0.012). CONCLUSION: Significant interobserver and intraobserver variation occurs in sonographic measurement of thyroid volume in children.

Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach.

PURPOSE: To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery. METHODS: In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication. RESULTS: A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up. CONCLUSION: Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.

Intrahepatic portosystemic venous shunt: diagnosis by colour/power Doppler imaging and three-dimensional ultrasound.

Intrahepatic portosystemic venous shunt, considered to be a rare disease, can lead to hepatic encephalopathy. With recent advances in diagnostic imaging techniques, the number of reports of intrahepatic portosystemic venous shunts identified incidentally in patients without symptoms are increasing. We report an intrahepatic portosystemic venous shunt that was diagnosed incidentally by real-time ultrasound and colour Doppler imaging, including the use of three-dimensional ultrasound using minimum intensity projections and power Doppler.

A rare vascular malformation, Klippel-Trenaunay syndrome. Report of a case with deep vein agenesis and review of the literature.

The Klippel-Trenaunay syndrome (KTS) is a rare anomaly characterized by naevus, soft tissue hypertrophy and varicosities which is mainly unknown etiology. Associated deep venous system abnormalities have been reported with KTS. Here, a 4-year-old-boy with KTS was reported, because of the associated popliteal vein, common femoral vein with its deep and superficial branches, and external iliac vein agenesis. The originality of the presented case is that we have never observed such a case before.

Recurrent extraperitoneal low grade leiomyosarcoma with unusual localization.

Primary extragenital leiomyosarcoma is rarely found in pelvic localization. A 33-year-old multiparous woman who had recurrent low-grade leiomyosarcoma presented with the complaints of dyspareunia, pelvic pain and gait disturbance. Her past medical history revealed she had been subjected to maximal excision of a paravaginal mass by using vaginal and suprapubic transverse incision three years before. The pathology report showed that she had leiomyoma. Three years after the initial surgery, a paravaginal fixed mass was observed at the initial tumor bed and removed by the perineal approach. The histological examination of the specimen revealed a low grade leiomyosarcoma. She was discharged from hospital without any complications.

Dual energy virtual CT colonoscopy with dual source computed tomography: initial experience.

PURPOSE: To describe the technique of DE MDCT colonoscopy and to assess its feasibility. MATERIALS AND METHODS: 8 patients were scanned with DSCT with a DE scan protocol and dose modulation software. Analysis was performed using dedicated DE software. Prone non-contrast images and DE supine images after contrast injection were obtained. RESULTS: DE colonoscopic images were successfully obtained in 7 patients, but the FOV did not cover all colonic segments in 1 patient, thus resulting in a technical success rate was 87.5 %. Streak artifacts were present in the pelvic region in 2 patients. Virtual unenhanced images and iodine map images were obtained for all patients. In 1 patient a polypoid non-enhancing structure was noted on the iodine map, and conventional colonoscopy revealed impacted stool. Enhancing rectal cancer in 1 patient was correctly shown on the iodine map. Iodine maps helped to differentiate stool fragments/retained fluid by the absence of enhancement when compared to prone CT images. The major advantage of DE colonoscopy was the lack of misregistration. CONCLUSION: DE MDCT colonoscopy is technically feasible and may obviate the need for unenhanced prone images. It may be possible to perform noncathartic DECT colonoscopy. The major limitation is the limited FOV of tube B. The dose should be optimized to reduce streak artifacts in the pelvic region.

Duplicated right coronary artery: multidetector CT angiographic findings.

Multidetector CT is becoming an alternative method for the diagnosis of coronary artery anomalies. We present the multidetector coronary CT angiography findings from a patient with right coronary artery duplication. Two separate right coronary arteries originating from the right aortic sinus were observed. Their anatomical course was well depicted, and atherosclerosis was excluded based on the CT angiography findings.

MDCT of inferior mesenteric vein: normal anatomy and pathology.

Multidetector computed tomography (MDCT) is a useful technique for imaging the inferior mesenteric vein. The aim of the present review was to discuss the normal anatomy and the pathologies of the inferior mesenteric vein, including partial or total thrombosis secondary to inflammation (pyophlebitis) and malignancy, occlusion, dilatation and reversed flow, which are rarely encountered. Optimal reconstruction techniques are also discussed. The pathologies of the inferior mesenteric vein can be clearly demonstrated using MDCT using curved-planar reformatted multiplanar reconstruction (MPR) and minimum intensity projection (MIP) images.

Unusual presentation of prostate cancer with generalized lymphadenopathy and unilateral leg edema.

Prostate cancer most often metastases to bones and regional lymph nodes. Disseminated metastasis to distant lymph nodes is very rare. We report a case presenting with generalized lymphadenopathy and related left leg edema without any urinary symptoms and finally diagnosed as prostate cancer.

Bilateral hemorrhagic adrenal cysts in an incomplete form of Beckwith-Wiedemann syndrome: MRI and prenatal US findings.

Benign hemorrhagic adrenal cysts are a cause of subdiaphragmatic mass in the fetus and neonate with Beckwith-Wiedemann syndrome. Characteristic imaging features on ultrasonography, color Doppler, and magnetic resonance imaging help differentiate adrenal hemorrhage from neonatal neuroblastoma and help avoid unnecessary surgery in these patients. Bilateral adrenal hemorrhage is self-limiting, and spontaneous resolution is the usual outcome. This report presents this rare condition with prenatal ultrasonographic and magnetic resonance imaging findings and reviews the differential diagnosis of neonatal adrenal masses.

Bilateral cystic adrenal masses in the neonate associated with the incomplete form of Beckwith-Wiedemann syndrome.

We report a case of bilateral multilocular cystic adrenal masses in a neonate who demonstrated somatic hypertrophy and macroglossia, which are considered to constitute an incomplete form of Beckwith-Wiedemann syndrome (BWS). After surgical removal of the masses, histological study revealed benign hemorrhagic macrocysts with cortical cytomegaly. There was no evidence of tumor or adrenal apoplexia. Although very rare, association of unilateral hemorrhagic adrenal macrocysts with BWS has been reported before; this is the first case of bilateral benign adrenal macrocysts associated with BWS.

Radiological findings of intraparenchymal liver Ascaris (hepatobiliary ascariasis).

Ascariasis is a well-known cause of acute cholangitis and cholecystitis; however, very rarely do worms penetrate and colonize the liver parenchyma. Here we present the unique radiological demonstration (US, CT and ERCP) of hepatobiliary ascariasis in which worm was first alive in the parenchyma of the liver and subsequently died and formed liver abscess.

US and CT findings in the diagnosis of tuberculous peritonitis.

PURPOSE: To evaluate the ultrasonographic and CT findings of tuberculous peritonitis. MATERIAL AND METHODS: Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed. RESULTS: All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients. CONCLUSION: Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.

Giant benign cystic peritoneal mesothelioma: US, CT, and MRI findings.

Benign cystic peritoneal mesothelioma (BCPM) is a rare tumor, primarily affecting young women; approximately 130 cases have been described mainly in the pathological and surgical literature. We present imaging findings of a giant BCPM in a male patient and discuss the radiological differential diagnosis with a brief review of the literature.

US and CT findings of multicentric leiomyosarcomatosis.

This article presents a case of leiomyosarcomatosis with widespread lesions involving the soft tissues and the most unlikely organs such as thyroid and salivary glands, pancreas, ligamentum teres, bladder wall, and bones without lymph node or distant metastasis. The CT and US findings of this rare phenomenon are discussed with regard to the literature.

Neuroblastoma with spermatic cord metastasis in a child: sonographic findings.

We report a case of neuroblastoma in a patient who had no involvement of the spermatic cord at diagnosis but who developed spermatic cord metastasis 2 months later. The metastasis appeared on sonography as a hypoechoic, highly vascular, fusiform, hard, 14x10x7 mm mass located in the right inguinal canal and extending into the scrotum. The diagnosis of spermatic cord metastasis was confirmed by resection and histopathologic examination. We recommend that the scrotum and spermatic cord be evaluated by high-resolution sonography in children with neuroblastoma, both at the time of diagnosis and during follow-up.

Renal lymphangiomatosis during pregnancy: management with percutaneous drainage.

We report a unique case of exacerbation of renal lymphangiomatosis during pregnancy which was managed percutaneously until delivery. Renal lymphangiomatosis is a very rare benign disorder that might cause abdominal pain and rarely hypertension and hematuria. Surgical treatment options may result in nephrectomy. Percutaneous drainage of symptomatic renal lymphangiomas should be viewed as an efficient therapeutic option particularly when surgery is contraindicated.

Ultrasonographic diagnosis of intestinal ascariasis.

Ascaris lumbricoides is the most common roundworm in warm and temperate areas. Although radiological features of Ascaris lumbricoides are well defined, there are only a few reports on the ultrasonographic findings of intestinal ascariasis. In our two patients with no acute abdominal symptoms, intestinal ascariasis was initially diagnosed by abdominal ultrasonography. In both patients, tubular structures in the segments of the small intestine were demonstrated by ultrasonography.

Systemic oxalosis: pathognomonic renal and specific extrarenal findings on US and CT.

Hyperoxaluria is characterized by nephrocalcinosis and nephrolithiasis on radiological examination and may also result in diffuse deposition of calcium oxalate crystals in multiple extrarenal organs (oxalosis). In two cases, the renal findings of primary hyperoxaluria were diagnosed by ultrasound and computed tomography scans. In addition to renal involvement, both patients had liver involvement, and one patient had cardiac involvement.