Rejection evaluation after renal transplantation using MR diffusion tensor imaging.

Background Renal allograft dysfunction monitoring is mainly performed using the serum creatinine (SC) level, Doppler ultrasound (US), or renal biopsy. Recently proposed diffusion-based magnetic resonance imaging (MRI) methods have been explored as new, non-invasive tools for assessing renal function after transplantation. Purpose To investigate the value of fractional anisotropy (FA) measurements in the evaluation of acute rejection cases after renal transplant. Material and Methods Doppler US and MRI diffusion tensor imaging (DTI) were performed in 21 patients with graft dysfunction requiring graft biopsy after renal transplantation and in 21 patients with normal graft function. The MR examinations were performed on a 1.5-T MRI using two b-values (0 and 800 s/mm2). FA values were measured from the cortex and medulla of the transplanted kidney at the upper, middle, and lower poles. Results Twenty-one transplant patients diagnosed with acute rejection (Group 1) were compared to the control group of 21 transplant patients with normal graft function (Group 2). The measured FA values of the medulla were 0.19 ± 0.02 and 0.22 ± 0.05 ( P = 0.017) for Groups 1 and 2, respectively. On the other hand, the measured FA values of the renal cortex were 0.18 ± 0.04 and 0.18 ± 0.04 ( P = 0.97) for Groups 1 and 2, respectively. Conclusion The good correlation between the renal medulla FA values and allograft function shows that MR DTI has potential for non-invasive functional assessment of transplanted kidneys. On the other hand, the renal cortex FA values had no correlation with the allograft function.

Ossifying fibroma of the inferior turbinate.

Hypertrophy of inferior turbinate is a common condition, especially with nasal septum deviation. Sometimes, the cause of hypertrophy of inferior turbinate can be fibro-osseous lesions. Benign, rare, and non-aggressive fibro-osseous neoplasms such as ossifying fibroma can affect paranasal sinuses. Isolated inferior turbinate involvement is extremely rare in ossifying fibroma. In this article, we present a 28-year-old female suffering from nasal obstruction due to septal deviation and hypertrophy of inferior turbinate. Preoperative and postoperative investigation show that cause of hypertrophy of inferior turbinate is ossifying fibroma. To our knowledge, that this is the second case of ossifying fibroma reported in the English-language literature due to its isolated localization. However, if the patients with inferior turbinate hypertrophy are examined carefully, we can prevent unnecessary medical treatment and surgery for inferior turbinate hypertrophy.

Diffusion-weighted imaging of adnexal torsion.

We report the diffusion-weighted imaging findings (DWI) of a case with ovarian torsion. Magnetic resonance imaging revealed a large cyst within a non-enhancing ovary. DWI depicted restricted diffusion which in turn was found to be related with the infarction of the ovary in the laparoscopic salpingo-oophorectomy performed.

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization.

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.

Isolated giant intrathoracic meningocele associated with vertebral corpus deformity.

Published reports of intrathoracic meningocele with vertebral corpus defects in the absence of neurofibromatosis are very rare. We report a 9-year-old male with intrathoracic meningocele. We believe that vertebral corpus defects may play a certain role in the etiology of intrathoracic meningocele.

Giant aneurysm of the azygos pericallosal artery: case report and review of the literature.

BACKGROUND: Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. METHODS: A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left M1. RESULTS: After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. CONCLUSIONS: The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.

[Pictorial essay: Pneumocephalus]. / Pnömosefali.

Imaging in pneumocephalus aids in the diagnosis and management of this condition, which usually results from trauma, iatrogenic causes, infections, tumors, and cranium abnormalities. The role of computed tomography and magnetic resonance imaging is especially addressed in this article.

Short term effects of valsartan on portal blood flow in cirrhotic patients.

BACKGROUND/AIMS: Portal hypertension is a common syndrome characterized by a chronic increase of the portal pressure and is the most frequent clinical manifestation of cirrhosis. In this study short term effects of Valsartan, an angiotensin II receptor antagonist, upon portal blood flow in 36 cirrhotic patients was determined by Doppler ultrasonography. METHODS: Patients were divided into three groups of 12 according to Child-Pugh classification. They (18 women and 18 men with a mean age of 50+/-14 years) received a daily dose of 80 mg valsartan for one week after which the effects upon hemodynamic changes were evaluated by colored Doppler ultrasonography. Hemodynamic measurements were performed 24 hours prior to valsartan administration and then four and eight days after adiministration. The following parameters were evaluated: for hemodynamic changes: peak systolic flow velocity, diastolic flow velocity, peak systolic flow velocity/diastolic flow velocity ratio, resistive index and pulsatility index were evaluated in hepatic, superior mesenteric and right and left renal arteries. In the portal vein, diameter, mean flow velocity and flow volume were evaluated. Results are expressed as means+/-SD. RESULTS: Hemodynamic parameters showed no significant change during the measurement in hepatic, superior and right and left renal arteries. Valsartan induced a significant decrease (p<0.05) in portal vein diameter, in portal vein maximal flow velocity and in portal vein flow volume. The decrease in portal vein flow volume was 11.7% on day four and 24.4% on day eight. In two patients, a symptomatic hypotensive attack occurred. Serum potassium levels were increased significantly (p<0.05). CONCLUSIONS: These results indicate that valsartan can be used in portal hypertension safely.

Laryngeal neurofibroma associated with neurofibromatosis type 2.

We present a case of laryngeal neurofibroma associated with neurofibromatosis type 2. Although laryngeal neurofibromas have previously been reported in cases of neurofibromatosis type 1, their presence has never been described in a patient with neurofibromatosis type 2.

Fat containing unusual tumor of the pancreas.

Fat-containing pancreatic tumors are very rare. In the literature, less than ten cases of lipoma originating from the pancreas have been reported. We present a case of pancreatic lipoma in a 65-year-old woman with findings of ultrasonography, computed tomography, and magnetic resonance imaging in addition to a brief review of the literature.