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OBJECTIVES: In this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies. MATERIALS AND METHODS: A total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated. RESULTS: Cartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17-19%, 100-100%, and 49-51%, respectively, while those values were 67-65%, 92-97%, and 84-77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively. CONCLUSION: T1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.
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Enfermedades de los Cartílagos , Articulación del Hombro , Humanos , Artrografía/métodos , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/patología , Enfermedades de los Cartílagos/diagnóstico por imagen , Enfermedades de los Cartílagos/patología , Imagen por Resonancia Magnética/métodos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography. MATERIALS AND METHODS: This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial. RESULTS: An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1-this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone-this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures. CONCLUSION: A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.
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Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Artrografía/métodos , Manguito de los Rotadores , Estudios Retrospectivos , Tendones/diagnóstico por imagen , Tendones/patología , Imagen por Resonancia Magnética/métodos , Articulación del Hombro/anatomía & histología , Espectroscopía de Resonancia Magnética , Lesiones del Manguito de los Rotadores/patologíaRESUMEN
BACKGROUND: The presence of degenerative changes in joint cartilage is one of the major features in osteoarthritis. PURPOSE: To investigate the contribution of shear wave elastography and T2* mapping to the early diagnosis of femoral trochlear cartilage damage. MATERIAL AND METHODS: A total of 30 individuals whose trochlear cartilage structure was evaluated as normal in conventional magnetic resonance imaging (MRI) sequences (control group) were prospectively compared with 30 patients who had early-stage cartilage damage findings on conventional MRI (study group), by performing B-mode ultrasonography, shear wave elastography, and T2* mapping. Cartilage thickness, shear wave, and T2* mapping measurements were recorded. RESULTS: After evaluating B-mode ultrasound and conventional MRI sequences, cartilage thickness was found to be significantly higher in the study group on both B-mode ultrasound and MRI. Shear wave velocity values of the study group (medial condyle [MC] 4.65 ± 1.11â m/sn, intercondylar [IC] 4.74 ± 1.20â m/sn, and lateral condyle [LC] 5.42 ± 1.48â m/sn) were observed to be significantly lower than the control group (MC 5.60 ± 0.77â m/sn, IC 5.85 ± 0.96â m/sn, and LC 5.63 ± 1.05â m/sn) (P < 0.05). T2* mapping values were significantly higher in the study group (MC 32.38 ± 4.04â ms, IC 35.78 ± 4.85â ms, and LC 34.04 ± 3.40â ms) than that of the control group (MC 28.07 ± 3.29â ms, IC 30.63 ± 3.45â ms, and LC 29.02 ± 3.24â ms). CONCLUSION: Shear wave elastography and T2* mapping are reliable methods for evaluating early-stage trochlear cartilage damage.
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Cartílago Articular , Diagnóstico por Imagen de Elasticidad , Humanos , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Fémur/diagnóstico por imagen , Ultrasonografía , Huesos , Imagen por Resonancia Magnética/métodosRESUMEN
Carotid body tumors (CBTs) originate from the paraganglionic tissue in the bifurcation of the common carotid artery. Magnetic resonance (MR) imaging is a commonly used diagnostic method in the preoperative diagnosis of these tumors. In this study, we demonstrated an isthmus between the right and left carotid body tumors in a patient with bilateral CBT. The left CBT also was associated with a saccular aneurysm of left external jugular vein.
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BACKGROUND: Arterial tortuosity is a widespread condition commonly occurring in cerebral arteries and often associated with the elderly. Moderate arterial tortuosity is often not symptomatic, but if there is severe tortuosity, various symptoms may occur, depending on the localization. In the literature, many factors have been reported as causing tortuosity in the vertebral arteries. In this case report, considering the age of our patient, we propose that, in addition to these previously reported reasons, congenital factors may also contribute to this situation. CASE PRESENTATION: We present a case of a 19-year-old Turkish patient with a tortuous vertebral artery causing pain and tingling in the right shoulder and neck. Magnetic resonance imaging revealed vertebral foramen enlargement thought to be secondary to a loop formation in the vertebral artery. The diagnosis was confirmed by magnetic resonance angiography. CONCLUSIONS: There are many causes of cervical radiculopathy. Arterial tortuosity, a rare cause of radiculopathy, should be considered as a differential diagnosis. Consideration of the existence of this variation is of great importance in preventing possible dangerous complications during surgery.
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Radiculopatía , Arteria Vertebral , Adulto , Anciano , Vértebras Cervicales , Humanos , Angiografía por Resonancia Magnética , Radiculopatía/diagnóstico por imagen , Radiculopatía/etiología , Canal Medular , Arteria Vertebral/diagnóstico por imagen , Adulto JovenAsunto(s)
Síndrome del Túnel Carpiano/diagnóstico , Antebrazo , Músculo Esquelético/anomalías , Adulto , Síndrome del Túnel Carpiano/complicaciones , Síndrome del Túnel Carpiano/fisiopatología , Síndrome del Túnel Carpiano/cirugía , Diagnóstico Diferencial , Edema/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Músculo Esquelético/diagnóstico por imagenRESUMEN
PURPOSE: Accessory cardiac bronchus (ACB) is a very rare congenital anomaly and may cause some clinical complications, such as recurrent episodes of both infection and hemoptysis. The purpose of this study was to assess the multidetector computed tomography (MDCT) characteristics of ACB and to classify this anomaly according to the MDCT aspects. MATERIALS AND METHODS: The routine thoracic CT scans from 5790 patients were evaluated retrospectively. The prevalence, location, length, diameter, division angle, distance from the carina, and the type of ACB were evaluated. RESULTS: A total of 12 ACBs were identified, with a prevalence of 0.2%. All ACBs originated from the intermediate bronchus. The median largest diameter of the ACBs was 7.75 mm (range: 5.8 to 10.30 mm), the median length was 12.1 mm (range: 8.6 to 35 mm), the median division angle was 61 degrees (range: 42 to 93 degrees), and the median distance from the carina was 16.95 mm (range: 5.7 to 22.20 mm). Six cases (50%) had a blind extremity (type 1: diverticulum or stump type), 3 cases (25%) had a mutiloculated cystic change at the end (type 2: cystic type), and 3 cases (25%) had a ventilated lobulus demarcated by an anomalous fissure (type 3: ventilated type). CONCLUSIONS: ACBs can be classified into 3 types according to their MDCT features. Recognition of ACB is important, as it is associated with clinical complications and is also salient in trauma cases.
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Bronquios/anomalías , Bronquios/diagnóstico por imagen , Enfermedades Bronquiales/diagnóstico por imagen , Enfermedades Bronquiales/epidemiología , Tomografía Computarizada Multidetector/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this study was to determine the characteristics of paratracheal air cysts (PACs) and their relationship with upper lobe pulmonary fibrosis. MATERIALS AND METHODS: The routine thoracic computed tomography scans of 3549 patients carried out between January 2014 and April 2015 were retrospectively evaluated. The presence, location, structural characteristics (uniloculated or multiloculated), number of cysts, and anterior-posterior and transverse dimensions of the PAC and its communication with the tracheal lumen were evaluated. The presence of upper lobe fibrosis, emphysema, and bronchiectasis was also evaluated. The relationship between upper lobe fibrosis, emphysema, bronchiectasis, and the presence of paratracheal cysts was evaluated in all patients. An equal number of randomized patients with no paratracheal cysts were selected as a control group. RESULTS: A total of 190 PAC cases were diagnosed, with a prevalence rate of 5.35%: 146 (76.8%) of the cases were men, 44 (23.2%) were female, and the mean (SD) age was 53.79 (16.64) years (range, 12-89 years). The control group included 105 men (57.4%) and 78 women (42.6%), and the mean (SD) age was 53.87 (16.65) years (range, 13-87 years). The groups were similar in terms of age (P = 0.876), whereas the proportion of men in the PAC group was significantly higher (P < 0.001). Most of the PACs were located on the right side (n = 188, 98.9%). The incidence of fibrosis in the paratracheal cyst group was 45.8% (n = 87) compared with 19.5% (n = 37) in the control group; this difference was statistically significant (P < 0.001). The prevalence rates of emphysema in the cyst group and the control group were 29.5% (n = 56) and 11.6% (n = 22), respectively, and the difference was statistically significant (P < 0.001). When the groups were compared regarding bronchiectasis (scar and non-scar related), the rate of bronchiectasis in the paratracheal cyst group was 17.9% (n = 34), compared with 3.7% (n = 7) in the control group; this difference was statistically significant (P < 0.001). CONCLUSIONS: Paratracheal air cysts are relatively common, but the etiology is still unclear. We detected increased rates of cyst formation that may result from the traction effect on the tracheal wall in the presence of upper lobe fibrosis.
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Quistes/complicaciones , Quistes/diagnóstico por imagen , Fibrosis Pulmonar/complicaciones , Fibrosis Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aire , Bronquiectasia/complicaciones , Bronquiectasia/diagnóstico por imagen , Niño , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Enfisema Pulmonar/complicaciones , Enfisema Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Tráquea/diagnóstico por imagen , Adulto JovenRESUMEN
Central venous catheters are a commonly used medical device which may sometimes cause complications. We present first case who had an asystolic cardiac arrest during insertion of a central venous catheter, needed cardiopulmonary resuscitation (CPR), and was resuscitated successfully. A46-year lady presented to the emergency department due to mushroom poisoning. Acentral venous catheter was inserted through the internal jugular vein. However, the patient suddenly lost consciousness and asystole was seen on the monitor immediately after the insertion of the catheter. Cardiopulmonary resuscitation was started, and the catheter was withdrawn nearly 5 cm. Spontaneous circulation returned 2 minutes later. The patient was hospitalised, hemodialysis was performed, and she was discharged the next day. Emergency physicians should be prepared for dysrhythmias and asystole during insertion of a central venous catheter. If cardiac arrest develops, the catheter should be withdrawn a few centimeters while CPR continues.
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Reanimación Cardiopulmonar , Catéteres Venosos Centrales/efectos adversos , Paro Cardíaco/etiología , Cateterismo Venoso Central , Servicio de Urgencia en Hospital , Femenino , Humanos , Persona de Mediana Edad , Intoxicación por Setas/terapiaRESUMEN
We present a case of 63-year-old man who was referred to the emergency department with a right-sided pneumothorax. He had a history of spontaneous pneumothorax for 2 times. The chest computed tomographic scan showed tracheobronchomegaly with an increase in the diameter of the trachea and right and left main bronchus. Fiberoptic bronchoscopy revealed enlarged trachea and both main bronchus with diverticulas. These findings are consistent with a diagnosis of Mounier-Kuhn syndrome. Mounier-Kuhn syndrome is a rare clinical and radiologic condition. It is characterized by a tracheal and bronchial dilation. Diagnosis is made by computed tomography and bronchoscopy. Mounier-Kuhn syndrome should be kept in mind in the differential diagnosis of recurrent spontaneous pneumothorax.
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Neumotórax/diagnóstico , Neumotórax/etiología , Traqueobroncomegalia/complicaciones , Traqueobroncomegalia/diagnóstico , Broncoscopía , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Tomografía Computarizada por Rayos XAsunto(s)
Conducto Auditivo Externo/patología , Linfoma de Células T Periférico/diagnóstico , Neoplasias de la Parótida/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Errores Diagnósticos , Humanos , Linfoma de Células T Periférico/tratamiento farmacológico , Linfoma de Células T Periférico/patología , Masculino , Persona de Mediana Edad , Otitis Externa/diagnóstico , Neoplasias de la Parótida/tratamiento farmacológico , Neoplasias de la Parótida/patología , Úlcera Cutánea/etiologíaRESUMEN
Osteitis fibrosa cystica is a skeletal disorder seen in advanced stages of persistent hyperparathyroidism. Although the measurement of serum Ca and intact-parathormone levels provides early diagnosis and decreases the incidence of radiographic bone involvement, progressive major bone lesions may still be seen in developing countries even in the modern era. We aimed to share, by writing up this report, our astonishment after observing how the skeletal system can be ruined by persistent hyperparathyroidism.
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Hiperparatiroidismo/complicaciones , Hiperparatiroidismo/diagnóstico , Osteítis Fibrosa Quística/diagnóstico , Osteítis Fibrosa Quística/etiología , Calcio/sangre , Errores Diagnósticos , Femenino , Fémur/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Pelvis/diagnóstico por imagen , RadiografíaRESUMEN
OBJECTIVE: Our aim was to analyze the changes in middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion. METHODS: This prospective, descriptive study was performed on 64 patients (with normal tympanic membranes and tympanograms) undergoing adenoidectomy or adenotonsillectomy. All patients were operated by single experienced team using curettage technique. First tympanometry was done on the day before surgery. Tympanometry was repeated on the first-, third-, and seventh-day after the operation. Patients are separated into two groups according to age as patients younger than 6 years (Group A) and patients older than 6 years (Group B). All data were separately evaluated for each ear using Jerger Classification. RESULTS: Of the 64 patients included in the study, 35 were male and 29 were female, and the average age was 91.01 ± 37.4 (35-178) months. Pathological decreases in the middle ear pressures of at least one ear were determined in 48 (75%) patients on the first postoperative day and in 10 (15.6%) patients on the third postoperative day. Middle ear pressures returned to preoperative values by the seventh postoperative day except in two patients. There were statistically significant differences (p<0.0001) among preoperative and first, third, and seventh postoperative day mean middle ear pressure. There were no statistically significant differences between Groups A and B in terms of tympanometry values of both ears obtained preoperatively and on the first, third, and seventh postoperative day. CONCLUSION: In our study, temporary eustachian dysfunction and aural fullness occur in the early period after adenoidectomy and/or adenotonsillectomy. This situation may be due to post-surgery clots and edema in nasopharynx. We consider that tubal orifice can be exposed to surgical trauma as adenoidectomy surgeries are done by curettage technique. There is a need for comparative studies using microdebrider or laser adenoidectomy accompanied by an endoscope.