Axillary lipogranuloma mimicking carcinoma metastasis after silicone breast implant rupture: a case report.

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. However, silicone implants have some well-known complications, such as implant rupture, which requires surgical intervention. Dissemination of silicone particles out of the implant causes a granulomatous reaction, a phenomenon known as silicone granuloma, in breast parenchyma as well as axillary, breast and chest wall lymph nodes, which mimics breast cancer metastasis. However, lipogranuloma after silicone breast implant rupture has not been reported in the literature, although it is a common complication after mineral oil or liquid silicone injection. We present a case report of an axillary lymphadenopathy resulting from lipogranuloma after silicone-gel-filled implant rupture. Review of the literature suggests that this is the first report of a lipogranuloma resulting from implant rupture.

Morphometric analyses of the development of nasal cavity in human fetuses: an anatomical and radiological study.

OBJECTIVE: It was aimed to research the morphometric development of the nasal cavity with dissection and radiological scanning methods and to detect anatomical variations. DESIGN: Retrospective study. SETTING: Departments of Anatomy and Radiology, Meram Medical Faculty, Selcuk University. PATIENTS: Dissection stage was performed on 80 spontaneously aborted fetuses (40 males and 40 females) (63 second trimesters and 17 third trimesters) between 13 and 40 weeks of gestation. Radiological scanning stage was carried out on 40 spontaneously aborted fetuses (19 males and 21 females) (12 second trimesters and 28 third trimesters) with multi-detector computed tomography. METHODOLOGY: One hundred and sixty nasal cavities and related structures were examined by means of bilateral dissection. Reference images were obtained in the axial plane with 3-mm collimation using multi-detector computed tomography (MDCT; Sensation 64, Siemens, Erlangen, Germany). These reference images were sent to the workstation (Leonardo, Siemens, Germany) and three-dimensional (axial, sagittal, and coronal) reformatted images with 1mm thickness were obtained via multiplanar imaging method. RESULTS: In the dissected fetuses 16 suprema nasal conchae were determined. Six (15%) NSDs (four towards the left and two towards the right) were detected on radiological sections. The angle between the virtual line from sphenoidal sinus ostium through limen nasi and the horizontal plane was 32.72+/-3.3 degrees on average. CONCLUSION: It was thought that some anatomic variations (e.g. suprema nasal concha, nasal septum deviation) occur in the fetal period; however, other certain differences (e.g. Onodi, Haller, and Agger nasi cells, concha bullosa) might be with effects of environmental factors (trauma and chronic infections) in postnatal period.

Assessment of myometrial invasion in endometrial cancer by transvaginal sonography, Doppler ultrasonography, magnetic resonance imaging and frozen section.

OBJECTIVE: We aimed to compare the diagnostic performance of transvaginal sonography (TVS), magnetic resonance imaging (MRI), and intraoperative frozen section in the assessment of myometrial invasion and to evaluate intratumoral blood flow in any myometrial invasion with transvaginal Color Doppler ultrasonography (TV-CDU). METHODS: This prospective study included 64 women consecutively diagnosed with endometrial carcinoma. The subjects were evaluated by TVS, MRI, and TV-CDU by 2 radiologists with a special training in gynecology. Intraoperatively, a frozen section was obtained and processed for interpretation by a blinded pathologist. Sensitivity, specificity, negative, and positive predictive values were calculated for each imaging modality and frozen section with regard to assessment of myometrial invasion. The intratumoral blood flow was evaluated by TV-CDU. RESULTS: Transvaginal sonography, MRI, and frozen section showed no statistical significant differences in overall diagnostic performance for the preoperative and intraoperative assessment of any myometrial invasion, although frozen section seemed to be slightly superior to the imaging techniques. The positive rate of intratumoral blood flow was higher in deep myometrial invasion, but statistical significance was not obtained. The mean value of resistance index was significantly lower in the cases with deep myometrial invasion. CONCLUSIONS: Transvaginal sonography with concomitant TV-UCD is low-cost, easily performed, and repeated technique for particularly deep myometrial invasion. Because of its high costs and time-consuming, MRI may be recommended in the cases with poor quality of TVS. Because depending solely on imaging methods could lead to insufficient treatment schedules, intraoperative frozen section should also be performed for myometrial assessment.

Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: imaging features.

Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

Pyosalpinx caused by the tubal migration of an intrauterine device--a case report.

Migration of an intrauterine device (IUD) is a complication occurring at or following insertion. After having perforated the uterine wall, the IUD usually will settle into the peritoneal cavity. Tubal migration of an IUD is extremely rare and little is known about its mechanism. We describe a case of pyosalpinx caused by the tubal migration of a copper IUD. The tail of the device was embedded in the mesocolon.

Comparison of two different approaches to the pterygomaxillary junction in Le Fort I osteotomy.

OBJECTIVE: The purpose of this study was to compare the damage before and after down fracture in Le Fort I osteotomies performed with and without the separation of pterygomaxillary junction using curved osteotomes in a cadaver model. STUDY DESIGN: The study sample comprised 6 cadavers aged between 55 and 70 years (mean age: 63.8 years). Three cadavers were partially edentulous, 2 cadavers still maintained a full complement of teeth and 1 cadaver was edentulous. Le Fort I osteotomy was performed on all cadavers. Pterygomaxillary osteotomies were only performed on the right sides whereas the left sides were left intact. Subsequently, the maxilla was mobilized by applying digital pressure on the anterior maxillary segment. Computed tomography scans of each specimen were obtained before surgery, after surgery-before down fracture and after down fracture to document secondary fractures. RESULTS: Before the down fracture, secondary fractures were found in only 1 specimen (right side), whereas after the down fracture, secondary fractures were found in 5 specimens by CT. After the down fracture, the rate of occurrence of secondary fractures was 62% in the right side and 38% in the left side. CONCLUSION: With respect to the results of the present study, the use of osteotomes for pterygomaxillary dysjunction increases the incidence of fractures in maxillary osteotomy. However, the occurrence of almost all fractures subsequent to down fracture suggests the presence of possible bony splits that could not be diagnosed by radiographic examination immediately after maxillary osteotomy may have become apparent or transformed into fractures following down fracture.

A case with prepontine (clival) arachnoid cyst manifested as trigeminal neuralgia.

Most cases of "idiopathic" trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.

First case report of neurobrucellosis associated with hydrocephalus.

Brucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs.

A case of Burkitt lymphoma re-presenting as periportal hepatic and multiple organ infiltration.

Burkitt lymphoma (BL) is a high-grade, B-cell-originated pediatric malignancy that is a type of non-Hodgkin lymphoma involving different organs. Mediastinal mass, ascites, peritoneal thickening, and infiltration of the small intestine, kidney, and liver were found in our patient. In this case, we describe the radiologic appearances and possible infiltration patterns of multi-organ BL. Also, we discuss infiltration of the periportal area, such as hypodense lesions in the liver, which is rarely seen in BL.

CT measurement of trunk muscle areas in patients with chronic low back pain.

PURPOSE: The objective of this study was to determine the cross-sectional area changes of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles with CT in patients with chronic low back pain. MATERIALS AND METHODS: In this study, we evaluated 36 patients with chronic low back pain and 34 healthy volunteers. The mean age of the patients was 43.2 +/- 6.9 years (range, 30- 58 years) and the mean age of control group was 44.4 +/- 6.9 years (range, 31-61 years). We defined pain that lasts more then one year as chronic pain. Female patients were selected for standardization. All patients were housewives. None of the patients or controls engaged in physical activity other than routine housework. We used a visual analog scale and the Oswestry Pain Questionnaire for clinical evaluation. We made CT cross-sections of the paraspinal muscles at the upper and lower endplates of L4, and of the gluteus maximus at the head of the interfoveal level. RESULTS: In the patient group the multifidus, psoas, and quadratus lumborum cross-sectional areas were smaller than in the control group, and the P values were P = 0.002, P = 0.042, and P = 0.047, respectively, at the L4 endplate. At the L4 endplate level, cross-sectional areas of the multifidus and paravertebral muscles in the patient group were smaller than in the control group, and the difference was statistically significant (P = 0.001, P = 0.010, respectively). We did not find any significant difference between the patient and the control groups in gluteus maximus cross-sectional area. CONCLUSION: Chronic low back pain caused atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles to varying degrees, which was most prominent in the multifidus. Atrophy was noted in all of the studied muscles, except the gluteus maximus. The reliability of CT in measuring the cross-sectional areas of the back muscles was acceptable.

Be aware of bone marrow edema syndrome in ankle arthroscopy: a case successfully treated with iloprost.

Bone marrow edema syndrome (BMES) is a nontraumatic syndrome characterized by disabling joint pain. The disease occurs especially in the hip joint, and the ankle joint has been reported in the English-language literature to be affected only rarely. We describe here the case of an adult with BMES in both ankle joints. She has been treated with nonsteroidal anti-inflammatory drugs and physical therapy, as well as ankle arthroscopy, all of which have been unsuccessful. BMES was diagnosed on the basis of clinical and magnetic resonance imaging (MRI) findings. The patient was treated with iloprost (Ilomedin; Schering AG, Berlin, Germany); the course of therapy consisted of 5 infusions of 40 microg of iloprost in 500 mL of sodium chloride solution, given over 6 hours on 5 consecutive days. MRI at the third monthly visit showed nearly complete resolution of bone marrow edema. The patient was followed for 2 years and 6 months and was completely asymptomatic. This case report suggests the need for orthopaedic surgeons to know about BMES. Before all-arthroscopic interventions are performed, MRI views should be evaluated carefully. Iloprost infusion therapy seems to be effective and safe in the management of BMES.

Arterial spasm following perimesencephalic nonaneurysmal subarachnoid hemorrhage in a pediatric patient.

Perimesencephalic nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhages. This entity is well recognized as a distinct type of subarachnoid hemorrhage in adults. However, perimesencephalic nonaneurysmal subarachnoid hemorrhage in pediatric patients is not well recognized. Angiographic changes such as vasospasm are uncommon in patients, especially in pediatric patients suffering from this type of hemorrhage. This case study reports a 12-year-old male who suffered from perimesencephalic nonaneurysmal subarachnoid hemorrhage. Cerebral carotid angiography performed on the tenth day of the posthemorrhagic period revealed severe vasospasm affecting the basilar artery. The patient, treated symptomatically, was discharged after improvement. One year later, magnetic resonance angiography revealed completely normal features.

Mesenteric ischemia: an unusual presentation of fistula between superior mesenteric artery and common hepatic artery.

Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.

Pneumomediastinum and pneumopericardium due to intracavitary aspergilloma: an unusual complication of fungal pneumonia.

We describe a 14-year-old boy with acute lymphatic leukaemia who developed pneumomediastinum and pneumopericardium as a complication of invasive pulmonary aspergillosis.