Shear-wave Elastography of Palatine Tonsils: A Normative Study in Children.

Background: Shear-wave elastography (SWE) was used to determine normal elasticity values of palatine tonsils (PTs) in children and adolescents who did not have any health problem, and the relationship between these values and various parameters influencing this result was examined. Methods: The current prospective study has been approved by the local Institutional Review Board. Our study included 122 people aged 2-18 years. SWE values for both PTs, as well as gender, age, and body mass index (BMI), were recorded. The Kolmogorov-Smirnov test was used to determine whether the data had a normal distribution. Numerical variables with a normal distribution are reported as mean ± standard deviation, while variables with a nonnormal distribution are reported as medians with minimum and maximum values. Numbers and percentages are used to report categorical variables. Results: The study group's average age was 10.77 ± 4.35 years. The mean SWE values were 9.89 ± 2.494 kPa for the right PT and 9.57 ± 2.631 kPa for the left PT. Both PT volumes were found to be 1.6 ± 0.9 mm3. There was no significant correlation between the SWE values obtained and age, height, weight, and BMI. Tonsil dimensions show a positive correlation with age, height, weight, and BMI. Conclusion: PT dimensions have a positive correlation with age, height, weight, and BMI, but not with SWE values. SWE may be a reliable diagnostic criterion independent of anthropometric values.

Paediatric liver biopsies: A single-centre experience in Erzincan Binali Yildirim University.

Introduction: Liver biopsies are the main method in the diagnosis and treatment of paediatric liver pathologies. Major complication rates of paediatric liver biopsies range from 0% to 6.6% in the literature and minor complication rates range from 0% to 25%. In this study, we aimed to review the complications, indications and results of percutaneous core liver biopsies with paediatric sonography in a tertiary care centre by an interventional radiologist. Methods: We retrospectively evaluated the results, indications and complications of paediatric liver biopsies performed in our tertiary health centre between January 2017 and December 2020. Biopsies were performed with a 16G semi-automatic needle in 17 patients (29.8%) and with an 18G semi-automatic needle in 40 patients (70.2%). Biopsies were performed only with local anaesthesia in patients older than 12 years; in younger patients, it was performed under general anaesthesia. Results: Fifty-eight liver biopsies were obtained from 57 children (34 males, 23 females). The most common indications were elevated liver enzymes (33 patients), cholestasis (14 patients), and adiposity and metabolic problems (6 patents). The most common pathological diagnoses were chronic hepatitis (33 patients) and steatosis (10 patients). Major complication in the form of symptomatic subcapsular haematoma developed after liver biopsy performed with 18G needle in only one patient (1.8%). Conclusions: As previously stated in the literature, percutaneous biopsies performed by interventional radiologists in paediatric patients under the guidance of sonography can be used in diagnosis and treatment; the complication rate is low and it is a safe method.

Thyroid malignancy in children: where does it locate?

Objective: As far as we know, in English literature, a limited number of studies has examined the relationship between the location of the nodule and malignancy risk. The studies were performed with adults and their results were mainly inconsistent. We aim to evaluate the potential association between the location of the thyroid nodules and risk for malignancy in the pediatric population. Materials and methods: Patients younger than 18 years old with a pathological diagnosis were included. Nodules were divided into 5 categories according to the Thyroid Imaging Reporting and Data System (TI-RADS) algorithm. The location of the nodules was recorded: Right lobe, left lobe, isthmus, upper pole, lower pole, and middle. Thyroid glands were divided into 3 equal longitudinal areas to define upper, lower, and middle portions. Results: Ninety-seven nodules of 103 children were included. The mean age of the population was 14.9 ± 2.51 years (7-18 years). Eighty-one participants were female (83.5%) and 16 male (16.5%). Fifty nodules were benign (51.5%) and 47 nodules were malignant (48.5%). We did not detect a significant correlation between the risk of malignancy and location of the nodule as right or left lobes or isthmus (P = 0.38). Rate of malignant nodules were significantly higher in middle lobe (23%, P = 0.002). Being located at middle part of thyroid gland increases the possibility of malignancy 11.3 times (OR = 11.3, P = 0.006). Conclusion: Nodule location can be used as a predictor for thyroid malignancy in pediatric patients, similar to adults. Middle lobe location increases the risk of malignancy. Using nodule location along with TI-RADS categorization can increase the efficacy of malignancy prediction.

Does the use of computed tomography scenogram alone enable diagnosis in cases of bowel obstruction?

BACKGROUND: Ileus is a pathological condition of the abdomen that presents as a medical emergency. It is characterized by potential complications such as perforation and ischemia, which can lead to significant morbidity and mortality if not promptly addressed. The successful management of ileus relies heavily on the timely and precise identification of the condition. While conventional radiography (CR) is commonly used as the primary diagnostic tool, its accuracy in identifying obstructions ranges from 46% to 80%. Furthermore, the diagnostic accuracy of identifying the location and etiology of intestinal obstruction by CR is limited, therefore making computed tomography (CT) the ideal imaging modality in this regard. AIM: To determine the presence of acute bowel obstruction (BO) on abdominal CT scenogram images and the accuracy of determining its possible location, taking into account the experience of the observers. METHODS: A retrospective screening was conducted on an ensemble of 46 individuals who presented to the emergency department between January 2021 and January 2022 with severe abdominal pain and were subsequently monitored for suspected ileus. The abdominal CT scans of these patients were assessed by three radiologists with varying levels of experience (1, 3, and 10 years) at different intervals (1 mo apart). The evaluation focused on determining the presence or absence of BO, as well as identifying the potential location of the obstruction (small bowel or large bowel). The study employed Kappa statistics to assess inter-observer variances, while the McNamer test was used to evaluate obstruction and segmentation discrepancies between observations. A significance level of P < 0.05 was determined to indicate statistical significance. RESULTS: Out of the total sample size of 46 patients, 15 individuals (32.6%) were identified as female, while the remaining 31 individuals (67.4%) were identified as male. The ultimate diagnosis of 42 instances (91.3%) indicated ileus resulting from mechanical obstruction (MO). Among these patients, 14 (33%) experienced obstruction in the large bowel (LB), while 28 (66%) experienced obstruction in the small bowel (SB). The initial evaluation yielded sensitivity rates of 76.19%, 83.31%, and 83.33%, and diagnostic accuracy rates of 69.56%, 76.08%, and 80.43% for the detection of BO among the three observers. The initial study revealed that the average sensitivity of three observers in detecting the presence of ileus caused by MO was 80.94%, while the diagnostic accuracy was 75.35%. Based on the first evaluation, the senior observer demonstrated the highest sensitivity (85.71%), negative predictive value (92.60%), and diagnostic accuracy (80.43%) when accurately estimating the thick and thin segmentation, as per the final diagnosis. There was no statistically significant disparity observed in the sensitivities pertaining to the identification of ileus during the second assessment, as well as the precise determination of the segment level inside the LB or SB, when comparing the second and third observers. Nevertheless, although there was no statistically significant alteration in the detection rate of ileus by the first observer, there was a notable rise in the accuracy rate of segment estimating (73.91%). The senior assessor had a higher level of accuracy in assessing the existence of ileus and segmentation compared to the other evaluators in both evaluations. CONCLUSION: The findings of our study indicate that the sensitivity and accuracy rates of abdominal CT scenogram scans in diagnosing acute MOs are similar to or greater than those of CR. Additionally, the study revealed that radiologists with more experience demonstrated a higher likelihood of accurately predicting the existence and potential localization of MO compared to their less experienced counterparts.

A Comprehensive Look at Maxillofacial Traumas: On the Basis of Orbital Involvement.

INTRODUCTION: Orbital wall fractures that may develop in maxillofacial traumas (MFTs) may cause ophthalmic complications (OCs). The aim of this study is to determine the frequency of orbital fractures (OFs) accompanying MFTs and findings suspicious for orbital traumatic involvement. MATERIALS AND METHODS: Computed tomography (CT) images of 887 patients who presented to the emergency department within a 1-year period with a history of MFT were retrospectively scanned. During the examination, patients with orbital wall fractures, craniofacial bone fractures, and posttraumatic soft tissue changes were recorded. RESULTS: OF was observed in 47 (5.3%) of the patients admitted for MFT. In cases with OFs, accompanying nasal (25.5%), ethmoid (2.1%), frontal (19.1%), maxillary (38%), and zygomatic bone fracture (10.6%), sphenoid (4.3%), and soft tissue damage (55.3%) were observed. It was observed that the pathologies mentioned at these levels were significantly higher than in patients without orbital involvement (p < 0.05). In our study, mild (48.9%) and moderate-severe (2.12-4.25%) OCs accompanying OFs were observed after MFT. CONCLUSIONS: The frequency of MFT varies depending on various factors, and such studies are needed to take preventive measures. Knowing the risk and frequency of orbital damage accompanying MFTs may help reduce complications by allowing rapid and accurate diagnosis.

Thyroid malignancy in children: where does it locate?

ABSTRACT Objective: As far as we know, in English literature, a limited number of studies has examined the relationship between the location of the nodule and malignancy risk. The studies were performed with adults and their results were mainly inconsistent. We aim to evaluate the potential association between the location of the thyroid nodules and risk for malignancy in the pediatric population. Materials and methods: Patients younger than 18 years old with a pathological diagnosis were included. Nodules were divided into 5 categories according to the Thyroid Imaging Reporting and Data System (TI-RADS) algorithm. The location of the nodules was recorded: Right lobe, left lobe, isthmus, upper pole, lower pole, and middle. Thyroid glands were divided into 3 equal longitudinal areas to define upper, lower, and middle portions. Results: Ninety-seven nodules of 103 children were included. The mean age of the population was 14.9 ± 2.51 years (7-18 years). Eighty-one participants were female (83.5%) and 16 male (16.5%). Fifty nodules were benign (51.5%) and 47 nodules were malignant (48.5%). We did not detect a significant correlation between the risk of malignancy and location of the nodule as right or left lobes or isthmus (P = 0.38). Rate of malignant nodules were significantly higher in middle lobe (23%, P = 0.002). Being located at middle part of thyroid gland increases the possibility of malignancy 11.3 times (OR = 11.3, P = 0.006). Conclusion: Nodule location can be used as a predictor for thyroid malignancy in pediatric patients, similar to adults. Middle lobe location increases the risk of malignancy. Using nodule location along with TI-RADS categorization can increase the efficacy of malignancy prediction.