Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign-malignant nodules.

PURPOSE: The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). METHODS: This prospective study included 370 thyroid nodules in 308 patients aged 18-70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. RESULTS: One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). CONCLUSION: This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.

Can TERT rs2853669 polymorphysm indicate fibrosis in sarcoidosis?

BACKGROUND AND AIM: Sarcoidosis is a systemic inflammatory disease of unknown cause, characterized by the presence of non-caseating granulomas, which can affect all organs in the body, especially the lung. The fibrotic stage 4 of sarcoidosis usually does not respond adequately to treatment and may cause respiratory distress in the patient. Some telomerase gene polymorphisms have been significantly associated with lung cancer and idiopathic pulmonary fibrosis. In our study, we aimed to investigate the relationship between telomerase mutation and progression to fibrosis in patients with sarcoidosis. METHODS: A total of 93 patients, including 18 males and 73 females, who were clinically and histopathologically diagnosed with sarcoidosis were included in the study. The 78 patients included in the study were classified as non-fibrotic and 15 as fibrotic sarcoidosis. In telomerase rs2853669 single nucleotide polymorphism, three genotypes, homozygous TT, homozygous CC and heterozygous TC, were determined as the genotypes of the patients. RESULTS: When non-fibrotic and fibrotic sarcoidosis groups were compared, no significant difference was found in terms of genotypes (p=0.76).  The FEV1 (forced expiratory volume in the first second) % of the CC genotype was lower than that of the other genotypes (p=0.01). CONCLUSIONS: In sarcoidosis patients, telomerase rs2853669 polymorphism does not indicate progression to fibrosis, but since FEV1% was found to be lower in individuals with homozygous CC polymorphism, it is thought that it may predict loss of respiratory function. Further studies are needed to evaluate the association of telomerase polymorphisms with fibrosis in sarcoidosis.

A Rare Lesion of the Thoracic Wall: Giant Scapulothoracic Bursitis.

Scapulothoracic bursitis, a rare lesion of the thoracic wall, usually presents as a cystic mass growing at the scapulothoracic interface. Histopathologically, it is characterized by the presence of synovial cells lining the interior of the thickened fibrotic cystic wall and capillary proliferation. A 48-year-old male patient was admitted to our clinic with a complaint of swelling in the back. The magnetic resonance imaging of the lung and mediastinum showed a 43 mm × 130 mm axial lesion in the left infrascapular area between the external muscles and the serratus anterior muscle, hyperintense on T2 sequence, not suppressed on fat-suppressed sequences, with a peripheral minimally contrasted septated collection area. The patient underwent surgical total excision and was discharged on the second postoperative day with no morbidity. Histopathology of the tissue was reported as soft tissue compatible with an inflamed cyst wall with prominent fibroblastic proliferation. Scapulothoracic bursitis lesions can be treated with non-invasive or minimally invasive methods. However, when it becomes a giant lesion occupying space on the thoracic wall and has hemorrhagic content, surgical excision is the treatment of choice.

Rapidly Progressive Pulmonary Apical Fibrosis and Parenchymal Destruction in a Patient with Ankylosing Spondylitis.

Pulmonary apical fibrosis is a rare complication of ankylosing spondylitis (AS). The essential characteristics of this lesion are its very slow progression and frequently asymptomatic nature. Herein, we are presenting a patient with AS who rapidly developed pulmonary apical fibrosis in a 3-year period despite decreased musculoskeletal pains. The 60-year-old male applied with complaints of progressively increasing cough in the recent two years, dyspnea, and fatigue. He had no chronic disease except AS. He had no continuous medication except nonsteroid anti-inflammatory drugs for 2-3 days monthly since his musculoskeletal pains decreased in the recent years. His physical examination revealed reduced breath sounds in the upper zones of the right lung. Chest X-ray revealed increased diffuse opacity in the upper zones of the right lung. Thoracic high-resolution computed tomography showed a consolidation accompanied with traction bronchiectases compatible with chronic fibrosis in the upper lobe of the right lung. However, thoracic computed tomography of the patient performed 3 years ago did not reveal pulmonary apical fibrosis and parenchymal destruction. Biopsy revealed no finding of malignancy, granulomatous inflammation, or vasculitis. The results of cultures were negative. So, the patient was diagnosed as pulmonary involvement of AS, which developed in a 3-year period. This case has shown that extra-articular complications may continue to develop in patients with AS even if their musculoskeletal complaints have subsided. So, patients with AS should be followed up regularly with systemic examinations.

An adult patient presenting with right unilateral pulmonary agenesis: a case report and literature review.

Pulmonary agenesis is a rare developmental defect in which there is complete absence of one or both lungs. Although the diagnosis is often made during childhood, asymptomatic patients can be diagnosed later due to the absence of comorbid anomalies. Chest radiography with an elevation of the hemidiaphragm and heart shifted to the right should make physicians suspicious for right lung agenesis. Here, we present a case report of a 53-year-old male with unilateral pulmonary agenesis of right lung found incidentally. He had a complaint of dyspnea. The respiratory system examination revealed no breathing sounds on the right side with normal breathing sounds on the left side. A posterior anterior chest radiograph revealed homogenous opacity of the middle and lower radiological lung zone with elevation of the right hemidiaphragm. In addition, the trachea and heart were shifted to the right side. Contrast-enhanced multidetector computed tomography revealed the absence of the right lung parenchyma, right main bronchus, and right main pulmonary artery and vein. The left lung had normal pulmonary vasculature, was hyperinflated, and partially extended to the right hemithorax. A pulmonary conus was formed by only the left pulmonary artery. No congenital anomalies were detected.

Association between facial nerve second genu angle and facial canal dehiscence in patients with cholesteatoma: evaluation with temporal multidetector computed tomography and surgical findings.

INTRODUCTION: Otitis media, mastoiditis or the pressure effect of tumorous lesions such as cholesteatoma can be the cause of facial canal dehiscence and facial nerve paralysis. The most common segment involved in dehiscence is the tympanic segment and the second most common is the lateral aspect of the facial canal in the oval window area. OBJECTIVE: To determine the prevalence of the facial canal dehiscence and the relationship between the angle at the second genu of the facial nerve and facial canal dehiscence. METHODS: We evaluated the surgical findings in 113 patients who underwent surgery for cholesteatoma. Facial canal dehiscence was detected in 62 of the 113 patients. Patients were divided into two groups: Group 1, with dehiscence of the facial canal and Group 2, without dehiscence of the facial canal. RESULTS: The mean angles at the second genu of the facial nerve in Groups 1 and 2 were 117.8°±9.63° and 114°±9.9°, respectively. There was a statistically significant difference between the mean angles at the second genu for the two groups (p=0.04). CONCLUSION: In patients with dehiscence of the facial canal, the angle at the second genu was found to be wider than those without dehiscence.

The Role of Real-Time Sonoelastography in the Differentiation of Benign From Malignant Parotid Gland Tumors.

OBJECTIVE: The aims of this study are to evaluate the utility of sonoelastography for parotid gland masses and to determine which cutoff strain ratio (SR) would be best for the differentiation between benign and malignant lesions. METHODS: From August 2015 to December 2016, 39 parotid gland masses were examined prospectively by ultrasonography and strain sonoelastography. Elastographic scores were determined by a 4-point scoring method. Interventional procedures were performed on all patients after sonographic examinations. The lesions were divided into groups as benign or malignant according to histopathological findings. The difference in elastographic scores between benign and malignant masses was evaluated. RESULTS: Among the 39 parotid gland masses, 33 (84.6%) were benign and 6 (15.3%) were malignant tumors with 53.8% (n = 21) of the lesions being on the right side. Pleomorphic adenoma (41%) was the most common neoplasm followed by Warthin tumor (28.2%). The median elastographic score was 2 (range, 1-3) for benign tumors, and it was 3 (range, 2-4) (P = 0.003) for malignant tumors. Median SR was 1.11 (range, 0.26-2.15), and it was 2.75 (range, 1.03-3.54) (P = 0.01) for benign and malignant tumors. In the receiver operating characteristic analysis, the cutoff value of the SR was 2.1, sensitivity was 83.3%, specificity was 97%, positive predictive value was 83.3%, negative predictive value was 97%, and accuracy was 94%. CONCLUSIONS: There was a statistically significant difference between benign lesions and malignant lesions in both elastography score and SR. It is possible that elastography can improve the noninvasive diagnostic accuracy for certain pathological conditions.

MDCT of the temporal bone and audiological findings of pediatric acquired cholesteatoma.

Cholesteatoma is a benign epithelial lesion affecting the middle ear and/or mastoid process, causing otorrhea and hearing loss. Here, we retrospectively evaluated the temporal multidetector computed tomography and audiological findings of acquired cholesteatoma in children. Forty-three patients younger than 18 years old with middle ear acquired cholesteatoma were evaluated with regard to their clinical symptoms, temporal multidetector computed tomography findings, and audiometry results. The multidetector computed tomography findings were classified according to the site-ossicle-complication classification, and the relationships between the clinical, radiological, and audiological findings were evaluated. Only one patient had pars tensa cholesteatoma, and the remaining had attic cholesteatoma. The most common site-ossicles-complication classifications were S4 (acquired cholesteatoma involving four sites), O1 (involving one ossicle), and C0 (no complications), and the most common complaint was hearing loss, followed by otorrhea. There were no statistically significant relationships between the site of involvement and ossicle involvement. In addition, there were no statistically significant differences according to the S classification in either the air conduction or air-bone-gap levels; however, these levels differed statistically significantly with increasing ossicle involvement. Early diagnosis and treatment are essential to prevent hearing loss and serious complications in cases of acquired cholesteatoma. Therefore, it is important to evaluate the temporal multidetector computed tomography and audiological findings to accurately diagnose acquired cholesteatoma in children.

Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence.

OBJECTIVE: The aim of this study is to determine the prevalence of jugular bulb-vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry. METHODS: About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared. RESULTS: Jugular bulb-vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n = 38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n = 18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation. CONCLUSIONS: The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.

Does Type 1 Diabetes Mellitus Affect the Shear Wave Velocity of the Thyroid Gland of Children Without Autoimmune Thyroiditis?

OBJECTIVE: The aim of this study is to evaluate the shear wave velocity (SWV) of the thyroid gland with acoustic radiation force impulse elastography in children with type 1 diabetes mellitus (T1D). MATERIALS AND METHODS: Between November 2015 and April 2016, 35 T1D patients who were referred to our hospital's endocrinology outpatient clinic (mean age, 11.88 ± 4.1 years) and 30 children (mean age, 11.3 ± 3.08 years) in the control group were enrolled in the study. Five acoustic radiation force impulse elastography measurements from each lobe of the thyroid gland in m/s were recorded. Diabetes age, hemoglobin A1c, and C-peptide levels were recorded in T1D patients. Statistical analyses were performed using SPSS version 21 (IBM Corporation, Armonk, NY). RESULTS: The mean SWV of the thyroid gland in T1D patients and the control group was 1.11 ± 0.21 and 1.29 ± 0.23 m/s, respectively. The mean SWV of the thyroid gland in T1D patients was lower than that in the control group and this was significant (P = 0.002). The mean SWV of the thyroid gland was not correlated with hemoglobin A1c level, body mass index, or the insulin dose in T1D patients. CONCLUSIONS: The present study showed that T1D affects the thyroid gland stiffness even in patients without autoimmune thyroiditis. Acoustic radiation force impulse elastography may be a useful method in determining early changes in thyroid gland in T1D and may be used as a screening tool.

Efficiency of B-mode Ultrasound and Strain Elastography in Differentiating Between Benign and Malignant Cervical Lymph Nodes.

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy and efficiency of ultrasonography (US), especially when combined with strain elastography (SE), in differentiating between benign and malignant cervical lymph nodes (LNs). METHODS: Forty-one LNs were examined by B-mode US, power Doppler US, and SE. The following imaging features were analyzed: shape, echogenicity, echogenic hilum, calcification, intranodal vascular pattern, elasticity scores (5 categories), and strain ratio. The average strain ratio was calculated as the mean strain of the adjacent sternocleidomastoid muscle divided by the mean strain of the target LN. The results of the US and SE features were compared with the histopathologic findings. RESULTS: The imaging features that were significantly associated with malignant LNs were an increased short-to-long axis diameter ratio, abnormal or absence of hilum, microcalcification, type 2-3-4 vascularity, 3-4-5 elasticity scores, and a high level of strain ratio (P < 0.05). The cutoff value of the strain index was detected as 1.18. According to this, there was a significant difference (P = 0.004) in the strain index between benign and malignant LNs. CONCLUSIONS: Strain elastography is useful in differentiating between benign and malignant cervical LNs, thereby informing decisions to perform a biopsy and/or surgery, and facilitating follow-up.

Pseudoaneurysm of the Common Digital Artery with Magnetic Resonance Imaging and Surgical Findings.

Pseudoaneurysms are rare and are most commonly caused by blunt trauma. Taking a clinical history and doing an examination are very helpful to clinicians in making a diagnosis. In addition, imaging methods are very useful in distinguishing a pseudoaneurysm from soft-tissue tumors. Early diagnosis and treatment are crucial in preventing the development of possible complications. The treatment approach varies according to the localization and size of the lesion and presence of complications. We present a case-with imaging and surgical findings-of a pseudoaneurysm in a 27-year-old male in the second web interval after a penetrating trauma.

Pseudoaneurysm of the Radial Artery on the Hand Secondary to Stabbing.

Pseudoaneurysm of the radial artery is extremely rare. It usually occurs secondary to trauma, interventional procedures, and infections. Symptoms occur due to mass effect by the pseudoaneurysm, digital ischemia, or nerve suppression. B-mode and color Doppler ultrasonography are the first choice in diagnosis. The pathognomonic ultrasound sign of pseudoaneurysm is the turbulent flow, which is called the "ying-yang" sign. Bandages, ultrasound probe compression, ultrasound-guided thrombin injection, covered stents, and surgical ligation can be used in treatment. In here, we present the case of a 28-year-old woman who developed a radial artery pseudoaneurysm after a stabbing injury in her hand and discuss the radiological and treatment options.

The diseases of airway-tracheal diverticulum: a review of the literature.

Tracheal diverticulum (DV) is a type of paratracheal air cyst (PTAC) that is often asymptomatic and usually detected incidentally by imaging methods. Tracheal DV are divided into two subgroups: congenital and acquired. Dysphagia, odynophagia, neck pain, hoarseness, hemoptysis, choking, and recurrent episodes of hiccups and burping can also be seen in symptomatic patients. Thin-section multidetector computed tomography (MDCT) is useful for diagnosis of tracheal diverticulum. The relationship between DV and tracheal lumen can be demonstrated by axial, coronal, and sagittal reformat multiplanar images. Bronchoscopy can also be used in diagnosis for tracheal DV. However, the connection between DV and tracheal lumen can not be shown easily with bronchoscopy. Conservative treatment is the preferred treatment in asymptomatic patients. Surgical or conservative treatment can be performed for symptomatic patients, depending on patient age and physical condition.

Bilateral ectopic cervical thymus presenting as a neck mass: Ultrasound and magnetic resonance imaging.

Ectopic cervical thymus (ECT) is a rare cause of neck mass in the pediatric age group. It is extremely uncommon in infants. Overall more than 100 cases have been reported in the literature, though fewer than 10% involved infants. Furthermore, ECT is usually unilateral and more frequently seen in men than in women. Ultrasound (US) is the preferred initial imaging modality, especially in pediatric neck masses given its wide availability, low cost and lack of radiation exposure. US can show the location, extension, and echotexture of the ECT. Magnetic resonance imaging (MRI) can be performed to verify the diagnosis and confirm communication between the ECT and the mediastinal thymus. Diffusion restriction can aid diagnosis when seen in a neck mass similar to that in the mediastinal thymus. Herein is described a case of bilateral ECT in a 2-month-old boy with associated US and MRI findings.

Methanol-induced toxic optic neuropathy with diffusion weighted MRI findings.

We report a 52-year-old man with methanol intoxication who showed optic nerve damage as assessed by magnetic resonance imaging (MRI). He was admitted to the hospital with blurred vision after the consumption of alcohol (600-700 ml of cologne). He was treated with intravenous ethanol, NaHCO3 and hemodialysis. On admission, a brain and orbital MRI was performed. Bilateral mild contrast enhancement was detected on the contrast-enhanced images in the retrobulbar segment of the optic nerves (RBONs). Also, diffusion-weighted images showed restricted diffusion in the RBONs. Diagnosis was considered as methanol-induced optic neuropathy based on the MRI findings of the optic nerves.

Primary central nervous system histiocytic sarcoma presenting as a postradiation sarcoma: case report and literature review.

Histiocytic sarcoma (HS) is a rare neoplasm that occurs most commonly in the intestinal tract, skin, soft tissue, and lymph node. The incidence of primary central nervous system (CNS) HS is even rarer, with a total of 6 cases reported in the literature. An etiologic link has not been identified for CNS HS, and the current case of primary CNS HS is unique in that an etiologic link to prior radiation therapy is identified, associated with complex cytogenetic abnormalities in the tumor. Although radiation-associated sarcomas can present as any number of different pathologic entities, this is the first reported case of a radiation-associated CNS HS. The pathologic and immunophenotypic characteristics of this case, with a nearly obscuring heavy inflammatory infiltrate and expression of monocytic/histiocytic markers (CD163, CD68, CD4, fascin), are characteristic of CNS HS. A discussion of the differential diagnosis and review of relevant literature are presented.