The utility of magnetic resonance angiography in children with nutcracker syndrome

Background/aim: The presented study aimed to evaluate the utility of magnetic resonance angiography (MRA) in the pediatric population with nutcracker syndrome. Materials and methods: Patients with suggestive clinical symptoms and laboratory findings and got the diagnosis of nutcracker syndrome with Doppler ultrasonography between January 2011­2019 were included in the study. In addition, children who had renal MRA due to hypertension were evaluated as the control group. MRA images of all patients were examined retrospectively by three radiologists at different levels of experience, and the superior mesenteric artery angle, aorta-mesenteric distance, left renal vein diameter both in the regions of aorta-mesenteric, and renal hilum were recorded. Results: Forty-five patients diagnosed with nutcracker syndrome were included in the study. The mean age of patients was 12 (4­16) and 30 (67%) were female. As the control group, 25 patients with hypertension who had MRA were included and they had a mean age of 12 (1­18) and 19 (76%) were male. The mean superior mesenteric artery angle was 26.5 ° (16­73 ± 12) in the patient group and 57.8 ° (25­139, ± 33) in the control group (p < 0.001); the mean aorta-mesenteric distance was 3.3 mm (1.7­6.5, ± 1.1) in the patient group and 8 mm (3.4­32, ± 5.9) in the control group (p < 0.001). MRA measurements of three radiologists were consistent with each other. Conclusion: MRA imaging can be applied as an alternative diagnostic method for Doppler ultrasonography and multidetector CT examinations by radiologists with different experience levels in pediatric patients with nutcracker syndrome.

Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts.

OBJECTIVE: This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts. METHODS: Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated. RESULTS: Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts. CONCLUSIONS: T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.

Gastrointestinal stromal tumor in a newborn diagnosed in prenatal period: a case report and review of literature.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Only 1.5% to 2% of all GISTs are observed in children and adolescents. Most of the pediatric cases are between 10 and 18 years of age, with a median age of 13 years. GIST is extremely rare in the newborn period. We could find only 5 reports on the neonatal cases. Herein, we have reported a case with abdominal tumor that was identified by prenatal ultrasonography and magnetic resonance imaging, and diagnosed as GIST on the seventh day of life. We have also reviewed the neonatal GIST cases reported in the English literature.

Contribution of MRI to ultrasound in the diagnosis of fetal anomalies.

PURPOSE: To evaluate the contribution of MRI to ultrasound (US) in the diagnosis of fetal anomalies. MATERIALS AND METHODS: After informed consent and institutional review board approval, concomitant US and MR imaging were performed for 184 fetuses with suspected anomalies in university hospital. Postnatal final diagnoses were obtained for 183 anomalies in 151 fetuses either by radiological examination, surgery, autopsy, or inspection. The prenatal US and MR diagnoses were compared with respect to postnatal diagnoses. Sign test was used to determine the statistical significance. RESULTS: Both ultrasound and MR imaging correctly diagnosed 93 (50%) cases and failed in 12 (7%) cases. Ultrasound was superior in 7 (4%) cases. MR imaging was superior in 71 (39%) cases (P < 0.001). MR contributed to the prenatal diagnosis by the confirmation of the suspected US diagnosis in 13%, by demonstration of additional findings in 31% and by changing the diagnosis in 56% of the cases. The contribution rates were 55% for the central nervous system (CNS) (P < 0.001), 44% for thorax (P = 0.016), 38% for gastrointestinal system (GIS) (P = 0.031) and 29% for genitourinary system (GUS) (P = 0.003) anomalies. In facial, cardiac and extremity-skeletal system anomalies, there was not a significant contribution of MR imaging over US. CONCLUSION: MR imaging can be used as an adjunct to US in the prenatal diagnosis of fetal anomalies of not only the CNS but also the non-CNS origin especially those involving the GIS, GUS and thorax.

MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor.

OBJECTIVE: To evaluate the accuracy of MDCT with multiplanar reconstruction in the preoperative local staging of rectal tumor. MATERIALS AND METHODS: Thirty-seven patients with rectal tumor underwent preoperative MDCT. Two radiologists evaluated the depth of tumor invasion (T staging), regional lymph node involvement (N staging) and mesorectal fascia involvement on axial, sagittal, and coronal multiplanar reconstruction images in consensus. MDCT findings were compared with pathologic results, which served as the reference standard. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed. RESULTS: Overall accuracy was 86% in T staging, 84% in N staging, 89% in International Union Against Cancer (UICC) Staging, and 94.5% in the prediction of mesorectal fascia involvement. CONCLUSION: MDCT with multiplanar reconstruction is an accurate technique in the preoperative local staging of rectal tumor.

Primary posterior mediastinal Burkitt lymphoma.

A 14-year-old boy admitted to our clinic with a 20-day history of fever, cough and respiratory distress. Mediastinal enlargement was observed on chest radiograph. Computed tomography of the chest demonstrated a large posterior mediastinal mass. The histopathological examination of the mass revealed Burkitt's lymphoma. We report this case because primary posterior mediastinal involvement in Burkitt lymphoma is extremely rare in childhood.

An unusual case of an aldosterone-producing adrenocortical adenoma presenting with rhabdomyolysis.

Rhabdomyolysis is a rare presentation of hypokalemia, although muscle weakness is a well known manifestation of marked hypokalemia. Here, we report a case of primary hyperaldosteronism due to unilateral aldosterone-producing adenoma in a 14 year-old girl who developed rhabdomyolysis following hypokalemia. To our knowledge, this is the first case of adrenocortical adenoma presenting with rhabdomyolysis in a child.

Evaluation of mesenteric panniculitis with computed tomography: benign condition or paraneoplastic syndrome?

Background/aim: This study aimed to investigate the prevalence and association of mesenteric panniculitis (MP) with other diseases and the clinicoradiological features of MP, and to examine computed tomography findings to estimate the presence of malignancy in patients with MP. Materials and methods: Between September 2012 and August 2016, we used a keyword search to identify patients diagnosed with MP. Associated diseases and malignancies of patients were recorded. Cut-off values and diagnostic efficiencies of total MP scores and short and long diameters of the greatest lymph nodes were determined. Results: Out of 22,033 patients, 309 were determined to have MP (prevalence 1.40%); 57.9% of these patients had a malignancy and 42.1% did not have a malignancy. The mean total MP scores and diameters of the greatest lymph nodes were significantly higher in the patients with a malignancy (P < 0.001). AUCs were 0.728, 0.879, and 0.767 for the short diameter, long diameter, and total score, respectively. The diagnostic efficiencies of the long diameter of the greatest lymph nodes were significantly higher than the total MP scores and the short diameter of the greatest nodes. Conclusion: MP is thought to be associated with abdominal and other system malignancies so MP may be a paraneoplastic syndrome in some patients.

Hepatic vein flow pattern in children: assesment with Doppler sonography.

BACKGROUND: Aim of this study is to establish normal hepatic vein flow pattern and effect of age, sex, activity and feeding status on the hepatic flow pattern in normal Turkish children less than 15 years of ages and also to compare our values with the previously reported studies. METHOD: Hepatic vein flow patterns were evaluated in 150 children (83 male, 67 female) without any cardiac, pulmonary and liver disease by using Doppler sonography. Blood flow patterns were compared with age, sex, activity, and feeding status of the children. RESULTS: Only 44% of the children had triphasic flow pattern in all hepatic veins. Monophasic flow pattern was the most common flow pattern in children less then 1 year of age. Triphasic flow pattern increase after 1 year of age. Although most of the children older than 1 year of age had triphasic flow pattern, there is some variation in the flow patterns of the hepatic veins in the same subject. Triphasic hepatic flow pattern is most commonly seen in the left hepatic vein and least commonly seen in the right hepatic vein. There was no significant difference between male and girl, children who were agitated or calm and fasting or not fasting in respect to triphasic flow pattern. CONCLUSION: Liver stiffening is not only the reason for abnormal hepatic flow pattern and some other physiologic factors may also lead to mono and/or diphasic flow pattern in the children. Absence of triphasic flow pattern must not be accepted as a liver pathology in children especially younger than 1 year of age.

Primary Burkitt's lymphoma only involving the chest wall at relapse in a child.

Burkitt's lymphoma primarily originating from the soft tissue is a very rare neoplasm. A five-year-old boy was admitted with a mass on the lateral side of the right breast. Radiological examination revealed a mass, which had originated from the soft tissue of the chest wall without any contiguous pleural and lung parenchyma disease. Histopathology showed this to be Burkitt's lymphoma. To our knowledge, this case is the first instance of Burkitt's lymphoma presenting as an isolated chest wall mass which originated from the soft tissue.

Agenesis of the internal carotid artery associated with aortic arch anomaly in a patient with congenital Horner's syndrome.

We report a rare case of agenesis of the left internal carotid artery (ICA) and an aortic arch anomaly that presented with ipsilateral congenital Horner's syndrome. Digital subtraction angiography revealed left ICA agenesis shortly after its origin and anastomosis between the left maxillary artery and the supraclinoid segment of the left ICA. Aortography of the aortic arch revealed the right subclavian artery arising as the first branch of a left aortic arch, followed by a bicarotid trunk and a left subclavian artery. High resolution CT of the skull base revealed the absence of the left carotid channel, consistent with congenital agenesis of the ICA.

Pontocerebellar hypoplasia in two siblings with dysmorphic features.

We present two siblings with pontocerebellar hypoplasia who have progressive microcephaly, mental and motor retardation, truncal ataxia, strabismus, and progressive spasticity and hyperreflexia of the lower limbs. Extrapyramidal dyskinesia and epilepsy, other main clinical features of pontocerebellar hypoplasia, are absent. The older sibling also has a high arched palate, triangular-shaped face, thoracolumbar scoliosis, pectus carinatum, kyphosis, cubitus valgus, arachnodactyly, long extremities, and a tall stature, which were not previously reported in association with pontocerebellar hypoplasia. The clinical phenotype should be expanded, especially within type II, with the reports of additional cases.

Brainstem encephalitis and acute disseminated encephalomyelitis following mumps.

A previously healthy female, aged 4 years 3 months, developed brainstem encephalitis with clinical manifestations of fever, decreased level of consciousness, and left facial and abducens paralysis 1 week after bilateral parotitis. Twenty days after remission of encephalitis, she manifested new symptoms of ataxia, dysarthria, and fever. Magnetic resonance imaging revealed multiple hyperintense lesions which were increased in size when compared with the first magnetic resonance imaging. She was treated with glucocorticoids and intravenous immunoglobulin. Forty-eight days after therapy, she was able to walk with support and recovered completely on follow-up. Brainstem encephalitis and acute disseminating encephalomyelitis are discussed as rare complications of mumps.

Spontaneous thrombosis of vein of Galen aneurysmal malformation after ventriculoperitoneal shunting.

Aneurysmal dilatation of the vein of Galen (AVG) is a common finding in vascular malformations that involve the Galenic system and spontaneous thrombosis is very rare. Although the presentation of the cases may differ with the age, the mortality and morbidity is high in all age groups. Here, we present a case of AVG in a six-month-old boy. The patient underwent insertion of a ventriculoperitoneal shunt. Surveillance of the lesion with subsequent MRI revealed spontaneous thrombosis of the AVG with excellent clinical outcome. Proposed mechanisms of spontaneous thrombosis include slow flow shunts, obstruction of the venous outflow or obstruction of the feeding artery. The case is discussed with the relevant literature.

Sphenoid sinus involvement in neuroblastoma: a case report and review of the literature.

Neuroblastoma is the most common extracranial solid tumors of childhood. The most frequent anatomic site of the primary tumor is abdomen. Metastatic spread of neuroblastoma to lymph node, bone, bone marrow and liver are common at presentation. However, primary or metastatic involvement of sphenoid sinus is extremely rare. Here, we report a case with stage IV neuroblastoma presents with the involvement of the sphenoid sinus. To our knowledge this is the fourth case of neuroblastoma involved sphenoid sinus in English literature.

Nonfunctional islet cell tumor of the pancreas in a patient with tuberous sclerosis: a case report with literature review.

Islet cell tumors (ICTs) are rare tumors of the pancreas. Association of this type of tumor with tuberous sclerosis is extremely rare. Only 13 cases of pancreatic ICT with tuberous sclerosis have so far been documented in the literature. However, awareness of the association of tuberous sclerosis and ICT is important for early diagnosis and appropriate treatment of this condition. This article presents the case of a 63-year-old female with angiomyolipoma (AML) of the kidney and liver, calcified subependymal nodules and a large mass in the pancreas, which was proven to be an ICT on histopathological examination.

Diagnostic performance of using effervescent powder for detection and grading of esophageal varices by multi-detector computed tomography.

PURPOSE: To investigate the effect of using effervescent powder (EP) on the efficacy of multi-detector computed tomography (MDCT) in detection and grading of esophageal varices in cirrhotic patients by considering endoscopy as the gold standard. MATERIALS AND METHODS: Ninety-two cirrhotic patients undergoing biphasic liver MDCT followed by upper gastrointestinal endoscopy within 4 weeks of MDCT were prospectively evaluated. The patients were divided into two groups before MDCT. The first group (n=50) received effervescent powder (EP) before and during MDCT procedure and the second group did not receive (n=42). The presence, size and grade of the esophageal varices were evaluated. MDCT findings were compared with endoscopic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of MDCT with EP and without EP were calculated and compared. Correlations between the grades of the varices for each group based on MDCT imaging and endoscopic grading were also evaluated. RESULTS: The sensitivity, specificity, accuracy, PPV, and NPV of MDCT were 100%, 88%, 96%, 94%, and 100%, respectively, in the EP group, whereas they were 76%, 67%, 74%, 89%, and 43%, respectively, in the non-EP group. Correlations between the grades of the esophageal varices on MDCT and endoscopy were significant in both groups (r=0.94, p<0.001 for EP group and r=0.70, p<0.001 for non-EP group). CONCLUSION: During periodic CT scanning of cirrhotic patients, use of EP increases the success rate of MDCT for detection and grading of esophageal varices.

The effects of bile duct obstruction on liver volume: an experimental study.

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group (n = 4) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (P = 0.01). It was increased up to 60% of baseline values 25 days after BDL (P = 0.002). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (P = 0.002). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.

Metastatic adenocarcinoma in the right atrium and secondary Budd-Chiari syndrome (a case report).

Budd-Chiari syndrome is a rare clinical syndrome which is characterized by the occlusion of the major hepatic veins or the inferior vena cava at the suprahepatic level. Metastatic cardiac tumors (MCT) are much more common than the primary cardiac tumors. Although MCT are frequently clinically silent, rarely pericardial tamponade or effusion may be the first clinical sign of MCT. Budd-Chiari syndrome rarely developed secondary to MCT. We report an unusual case of Budd-Chiari syndrome which was associated with metastatic right atrial adenocarcinoma with unknown origin in a 60-year-old woman. This combination in Budd-Chiari syndrome has been never published before.

Effect of subclinical Helicobacter pylori infection on gastric wall thickness: multislice CT evaluation.

PURPOSE: To evaluate the effect of subclinical Helicobacter pylori infection on the gastric wall thickness with multislice computed tomography (MSCT). MATERIALS AND METHODS: In 99 subjects without gastric disease, CT scans of the abdomen were obtained after water ingestion and intravenous contrast administration. CT images were evaluated for degree of luminal distention and the thickness of the walls of the gastric antrum and body. We also looked for other radiological signs of gastritis such as the presence of fold thickening, mucosal enhancement, submucosal hypodensity, focal gastric mass-like lesion, and focal wall thickening. All subjects were tested with rapid urease test or stool antigen test and grouped as H. pylori positive or negative according to the results. RESULTS: The average gastric body and antrum wall thicknesses did not show statistically significant difference between H. pylori positive and negative groups. The average antral wall thickness was greater than the gastric body wall thickness in 68.5% of cases, independent of H. pylori positivity; and antral wall thickness was more than 5 mm in more than 50% of cases. There were no significant differences between the groups in terms of other signs of gastritis. CONCLUSION: Wall thickening of gastric antrum relative to gastric body is a common finding even in the use of MSCT, and antral thickness commonly exceeds 5 mm. Subclinical H. pylori infection has no effect on gastric wall thickness.