"Leave me alone": anatomical structures and variations seen on computed tomography of the temporal bone.

The anatomical structure of the temporal bone is quite complex. There are a great number of anatomical variations that are often confused with temporal bone pathologies, especially fractures. It is important that radiologists and surgeons be able to recognize such variations.

O osso temporal é uma estrutura anatômica óssea bastante complexa. Apresenta grande número de variações anatômicas, que muitas vezes são confundidas com lesões ou doenças, principalmente fraturas. O reconhecimento dessas variações é importante para radiologistas e cirurgiões.

"Leave me alone": anatomical structures and variations seen on computed tomography of the temporal bone / "Deixe-me em paz": estruturas e variações anatômicas observadas em tomografia computadorizada do osso temporal

Abstract The anatomical structure of the temporal bone is quite complex. There are a great number of anatomical variations that are often confused with temporal bone pathologies, especially fractures. It is important that radiologists and surgeons be able to recognize such variations.

Resumo O osso temporal é uma estrutura anatômica óssea bastante complexa. Apresenta grande número de variações anatômicas, que muitas vezes são confundidas com lesões ou doenças, principalmente fraturas. O reconhecimento dessas variações é importante para radiologistas e cirurgiões.

Evaluation of the prevertebral soft tissue thickness by magnetic resonance imaging in patients with mild neck problem.

AIM: We encountered no study conducted on the evaluation of prevertebral soft tissue (PVST) thickness by magnetic resonance imaging (MRI) during our literature search. Measuring PVST thickness by MRI in the cervical region of adult cases was aimed in the present retrospective study. MATERIAL AND METHODS: For the intended purpose, a total of 136 patients, composed of both males and females, with ages ranging from 20 to 69 years, in whom no pathology in the cervical prevertebral region was revealed by MRI modality implemented for various reasons, were included in the study. RESULTS: The upper limit of normal for PVST thickness was measured in our study to be 10 mm, 7 mm and 20 mm at C1, C2-C3 and C6-C7 vertebral levels, respectively. The least variation in the measurements and standard deviations were obtained at C3-C4 vertebral levels. Upon making a comparison between the measured PVST thicknesses on the basis of gender, the measurements at C2,C4 and C7 were found to display significant difference, whereas that was not the case for the measurements obtained at the other levels. CONCLUSION: Progressively widespread use of MRI for the traumas inflicting the cervical region makes it obligatory to specify normal values for the thickness of PVST measured by MRI.

A huge duplication cyst of the ileum.

BACKGROUND: Massive unilocular intraabdominal cysts in children are rare. Alimentary tract duplications can present diagnostic and therapeutic difficulties. Although they can occur anywhere from the mouth to the anus, they are commonly seen in relation to the ileum. We herein present an unusual case of duplication cyst itself occupying virtually all of the available intraabdominal volume. It appeared to be an enteric duplication cyst of ileal origin. CASE REPORT: A 3-month-old girl was admitted to our hospital for investigation of progressive abdominal distension and biliary vomiting. Plain radiography of the abdomen showed normal air-fluid level in the stomach and paucity of gases in rest of the abdomen. Magnetic resonance imaging showed a huge, homogenous cyst extending from the xiphisternum down to the pelvis. The cyst was excised completely. Macroscopic examination and histologic findings confirmed the diagnosis of a huge enteric duplication cyst arising from the ileum. CONCLUSIONS: Enteric duplication cyst should be considered in a patient with an abdominal cystic mass. Radiologist must take into account patient age, clinical parameters, and imaging findings to identify the likely etiology of a cystic mass.

Multidetector CT findings of an extraordinary fenestration of the internal jugular vein.

Fenestration of the internal jugular vein is a rare malformation. Herein, the authors describe an extreme fenestration of the left internal jugular vein. This anomaly was found incidentally in a 47-year-old male patient undergoing multidetector computed tomography (MDCT) imaging and MDCT angiography evaluation for vertebral artery injury due to cervical trauma. MDCT angiography showed the presence of an extremely large fenestration in the left internal jugular vein.

Elongated styloid process associated with nevoid basal cell carcinoma syndrome.

This article presents a case with nevoid basal cell carcinoma syndrome (NBCCS) and an elongated styloid process. Basal cell carcinoma syndrome, also known as Gorlin-Goltz syndrome, is an autosomal dominant inherited syndrome manifested by multiple defects involving the skin, nervous system, eyes, endocrine system, and bones. Elongated styloid process or calcified stylohyoid ligament cause craniofacial or cervical pain. The actual cause of elongation of the styloid process or the calcification of the stylohyoid ligament is unclear. The cause of elongation of styloid process in this case may be the calcification induced by NBCCS. This report is the first case presentation of NBCCS with elongated styloid process. Elongated styloid process might be described as an anomaly of an NBCCS.

Diffusion-weighted Magnetic Resonance Imaging in the Early Diagnosis of Neonatal Adrenoleukodystrophy.

A newborn baby girl developed seizures right after birth. On the fourth day, the baby was examined using diffusion sequence magnetic resonance imaging (MRI) and diagnosed to have neonatal adrenoleukodystrophy. Laboratory findings confirmed the diagnosis. This is the first case of neonatal adrenoleukodystrophy (NALD) where diffusion MRI sequence helped in the diagnosis. We find association of NALD with seizures at birth is an extremely rare occurrence, and so far, only one case has been mentioned in the literature.

[An interesting journey of a grass inflorescence from broncho to dorsum: case report]. / Bir pisipisi otunun bronslardan sirta ilginç yolculugu: olgu sunumu.

A 15-years-old male was presented with hyperemic and painful right flank mass. His medical history was consisted of a treatment for pneumonia and hemoptysis in the other hospital five months ago. Diagnostic X-rays was showed consolidation in the posterobasal segment of right pulmonary lobe and abscess in the paravertebral muscle extending from L4-5 level. The patient was discharged after antibiotic treatment. At the second hospitalization, a grass inflorescence was discharged from the fistula. When the patient was reevaluated his history was consisted of the aspiration of a grass inflorescence eight months ago. To our knowledge, this patient represents the first case of penetration by a grass inflorescence migrated out of the lumbar region.

Amyand's hernia in the children: a single center experience.

BACKGROUND: The presence of a vermiform appendix in an inguinal hernial sac is termed Amyand's hernia. It may present as a tender inguinal or inguinoscrotal swelling, and it is often misdiagnosed as an incarcerated or strangulated hernia. METHODS: Between 1998 and 2006, we have managed 564 patients with acute appendicitis, 1,090 patients with inguinal hernia, 33 patients with incarcerated inguinal hernia, and 12 patients with Amyand's hernia on our pediatric surgery service. A retrospective analysis of clinical data of these patients with Amyand's hernia was performed. RESULTS: All patients with Amyand's hernia were boys with a median age of 40 days (range, 15 days-14 months). One patient's condition was diagnosed pre-operatively. All of them, therefore, underwent emergency operation with a presumptive diagnosis of either incarcerated or strangulated inguinal hernia. Operative findings included 2 normal appendices, 6 inflamed appendices, and 4 appendices with external signs of serosal inflamation of uncertain significaince in the inguinal hernial sac. Two patients with a normal appendix had hernia repair without an appendectomy. The other 10 patients with an abnormal appendix underwent an emergency open appendectomy with repair of the inguinal hernia. None of the patients developed recurrent hernia. The median postoperative follow-up period was 2.5 years. CONCLUSION: In pediatric patients with Amyand's hernia, the inflammatory status of the appendix can be used to determine the type of hernia repair and the operative approach. Incidental appendectomy in the case of a normal appendix is not favored by us. Treatment includes appendectomy (via the hernia sac) and hernia repair in children with an inflamed appendix.

Acute Necrotizing Encephalopathy in an Infant: Observations by CT, Contrast-Enhanced MRI and Diffusion MRI. A Case Report.

Acute necrotizing encephalopathy is characterized by bilateral necrotic, hemorrhagic lesions which occur symmetrically in the thalami, dorsal brainstem and dentate nuclei. Development of an extensive breakdown of the blood-brain barrier in the prominent lesions of acute necrotizing encephalopathy was demonstrated in a seven-month-old boy with the disorder, within 14 h after hospitalization by an initially negative post-contrast CT scan, and subsequently positive post-contrast T1-weighted MRI. Diffusion MRI demonstrated concomitant cytotoxic and vasogenic edema in the lesions. By the fortieth day, the lesions apparently regressed with remaining hemorrhagic material in the thalami.

[Diffuse cerebrovascular air embolism on CT secondary to cardiopulmonary resuscitation]. / Kardiyopulmoner resüsitasyon sonrasi BT'de saptanan difüz serebrovasküler hava embolizmi.

Air embolism is known to be a complicating factor in several clinical settings, including thoracic, cardiovascular and neurosurgical operations, central line placement, penetrating thoracic and cranial trauma and haemodialysis. Computed tomography (CT) is useful for showing cerebral air embolism. However, CT demonstration of massive air in all of the major cerebral arteries is extremely rare. In this report, we present a 45-year-old woman with cerebrovascular pneumoangiogram on postmortem CT examination after an unsuccessful posttraumatic cardiopulmonary resuscitation and discuss the possible mechanisms of pneumoangiogram.

Intermuscular hydatid cyst in a 4-year-old child: a case report.

Human Echinococcus infection still remains an important health problem in endemic regions. Primary musculoskeletal Echinococcus infection is very rare without involving the thoracic and abdominal organs. There has been no reported case of intermuscular hydatid cyst in the very early ages of childhood. Here we report a case of a 4-year-old girl with a primary intermuscular hydatid cyst in the left thigh. It was localized between the adductor muscles and iliopsoas muscle. It was removed without destroying the cyst wall and there were no complications. Hydatid cyst should be considered especially in the endemic areas when evaluating cystic masses. Hydatid cyst can be treated by operation.

Cerebral hemiatrophy (Dyke-Davidoff-Masson syndrome) in childhood: clinicoradiological analysis of 19 cases.

BACKGROUND: The purpose of this study was to emphasize the clinical and imaging findings of 19 child cases of cerebral hemiatrophy. METHODS: A total of 11 male and eight female patients underwent assessment with computed tomography and magnetic resonance imaging. The patients ranged from 1 to 17 years in age. The evaluated parameters were: location of the lesions, midline structural shift effect, ipsilateral calvarial and parenchymal changes. RESULTS: Left cerebral hemiatrophy was seen in 14 of the cases while right cerebral hemiatrophy was observed in five cases. Unilateral calvarial thickening was seen in 11 cases, hyperpneumatization of paranasal sinuses in five, and hypoplasia of the middle frontal cranial fossa in three patients. Cerebral peduncle atrophy was noted in seven cases. In total, 11 patients had thalamic atrophy and lentiform nucleus hypoplasia. In one case, cerebral hemiatrophy was associated with ipsilateral large schizencephalic cleft and absence of the septum pellucidum, whereas in another case, there was diffuse cerebellar atrophy associated with cerebral hemiatrophy. CONCLUSION: Computed tomography and, in particular, magnetic resonance imaging are the procedures of choice with respect to assessment of the etiology and extent of cerebral parenchymal involvement in cerebral hemiatrophy.

Acute disseminated encephalomyelitis in an adult patient. Magnetic resonance and diffusion-weighted imaging findings.

Acute disseminated encephalomyelitis ADEM is an uncommon inflammatory disease of the central nervous system and can be defined strictly as scattered focal or multifocal disseminated inflammation of brain or spinal cord, or both. An ADEM usually reveals patchy demyelinated lesions with a high signal on T2-weighted sequences. Here, we report a case of a 39-year-old man with ADEM. Echo-planar trace diffusion magnetic resonance imaging revealed high signal intensity changes at the lesion sites on b=1000 s/mm2 images, initially suggesting restricted diffusion. On corresponding apparent diffusion coefficient ADC maps, however, the lesions have a high signal intensity and high ADC values, compared with the normal white matter. This was consistent with the presence of elevated diffusion, and hence, vasogenic edema.

Magnetic resonance imaging of the brain in children with chronic kernicterus.

Advances in perinatal monitoring and early treatment for hyperbilirubinemia in high-risk patients have greatly reduced the incidence of kernicterus. Findings on MRI in patients with kernicterus are characteristic. The most characteristic pattern of neuropathological lesions in kernicterus is symmetric and highly selective involvement of the basal ganglia. In this study, we report the MRI findings in 2 infants with clinical and laboratory evidence of kernicterus.

The efficacy of ultrasonography in hemodynamically stable children with blunt abdominal trauma: a prospective comparison with computed tomography.

PURPOSE: In this prospective study we aimed to investigate the diagnostic value of ultrasonography (US) in hemodynamically stable children after blunt abdominal trauma (BAT) using computed tomography (CT) as the gold standard. MATERIALS AND METHODS: Between 1997 and 2001, 96 children with BAT were evaluated prospectively. CT was performed first, followed by US. US and CT examinations were independently evaluated by two radiologists for free fluid and organ injury. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US were assessed regarding CT as the gold standard. RESULTS: Overall 128 organ injuries were determined in 96 patients with CT; however, 20 (15.6%) of them could not be seen with US. Free intraabdominal fluid (FIF) was seen in 82 of 96 patients by CT (85.4%) and eight of them (9.7%) could not be seen by US. We found that sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of the US for free intra-abdominal fluid were 90.2, 100, 100, 63.6 and 91.7%, respectively. CONCLUSIONS: US for BAT in children is highly accurate and specific. It is highly sensitive in detecting liver, spleen and kidney injuries whereas its sensitivity is moderate for the detection of gastrointestinal tract (GIT) and pancreatic injuries.