Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura.

Henoch-Schönlein purpura, although being a systemic vasculitis, mostly involves skin, gastrointestinal system, joints, and kidneys. Testicular involvement is a rare occurrence. A 7-year-old boy with Henoch-Schönlein purpura developed acute scrotum and was referred to rule out testicular torsion. On gray-scale ultrasonography, the testes and epididymis were slightly enlarged, and had heterogeneous and hypoechoic echotexture. The scrotal wall was thickened as well. Color and power Doppler ultrasonography revealed increased vascularity in scrotal contents. Testicular torsion was excluded and the diagnosis of testicular involvement of Henoch-Schönlein purpura was established. Color Doppler US, together with gray-scale findings, can be useful in the evaluation of Henoch-Schönlein purpura with acute scrotum, excluding testicular torsion and preventing unnecessary surgery.

Technology and archives in radiology research: a sampling analysis of articles published in the AJR and Radiology. American Journal of Roentgenology.

OBJECTIVE: Our aim was to determine the use of advanced technology and archiving and the contribution of countries other than United States in the articles published in the American Journal of Roentgenology (AJR) and Radiology. We analyzed the association of these features with the type of research, the main technical features of the modalities used, and the countries of origin. MATERIALS AND METHODS: We determined the proportion of articles published in 18 randomly selected issues of the AJR and Radiology that required advanced imaging techniques and relied on the analysis of archived data. "Advanced technology" was defined as imaging techniques that serve a purpose other than simple anatomic imaging or that are not widely available because of the high cost of the technology, such as functional imaging and computer programming designed for an individual study or simulation studies. We analyzed the association of these features with the country of origin, the topic, and the methodology used. RESULTS: Sixteen percent of the studies required advanced technology. MR imaging, CT, and sonography were the most frequently used modalities (31%, 27%, and 15% of studies, respectively). Archiving was used in 37% of the studies, and 67% of the original articles were prospective. The articles most commonly originated in North America (67%), Europe (20%), and Asia (12%). CONCLUSION: Only a small percentage of published research studies required advanced technology and approximately one third of the studies used archiving. These results may suggest that other criteria, such as the design of the study, its relevance for daily clinical use, and the originality of the paper, have a major impact on the acceptance of papers in clinically oriented radiology journals.

Power Doppler ultrasonography for the evaluation of skin tumors other than malignant melanoma.

The purpose of this prospective study was to evaluate the value of power Doppler ultrasonography (PDUS) in assessing the vascularity of skin tumors other than malignant melanoma, and to investigate possible diagnostic criteria to help to distinguish malignant from benign tumors preoperatively. Seventy-one patients with the clinical diagnosis of a skin tumor were initially evaluated by ultrasonography. Then PDUS was performed and the presence and type of vascularity (peripheral or mixed) were investigated. Of the 19 benign and 52 malignant lesions, 3 could not be visualized with US. Forty-nine lesions were found to have vascularity (21 peripheral, 28 mixed-type) on PDUS. Of the malignant lesions, 26 showed mixed and 17 showed peripheral-type vascularity; for benign lesions these numbers were 2 and 4 respectively. The presence of vascularity correlated well with pathological behavior (malignant versus benign) (P = 0.00002), width (P = 0.0001), thickness (P = 0.001), dermal disruption (P = 0.0018), and subdermal extension (P = 0.002) of the tumor; however, the type of vascularity correlated only with thickness (P = 0.014). In relation to malignancy, the sensitivity of the presence of vascularity on PDUS was 88% and the specificity was 63%. These values were 93% and 40% respectively, for the mixed type of vascularity when it was accepted as a feature of malignancy. PDUS may help to distinguish malignant from benign skin tumors during preoperative evaluation.

Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children.

The purpose of this study is to determine important variations and areas of risk for major complications in paranasal computed tomography (CT). We also made specific measurements for individual differences. This study consisted of 64 children (128 sides). Eleven participants had coronal and axial, and the remaining 53 only coronal CT. The distance of the anterior ethmoidal artery (AEA) and the lamina cribrosa to the inferior turbinate and the orbital roof, and the depth of the lamina cribrosa were measured. The percentages of some of the variations were as follows: upper attachment of uncinate process 25%, freely coursing AEA 43%, aerated anterior clinoids 8%, optic canal bulging 6% and extreme medially coursing carotid canal 3%. The frequencies of some of these variations and the existence of Onodi cells were significantly smaller than compared with adults. Specific measurements varied individually. In conclusion, children deserve more attention while evaluating CT, due to their tiny bony structures.

The diagnostic value of intrarenal colour duplex Doppler ultrasonography in children with lower urinary tract infection.

BACKGROUND: The diagnostic value of Doppler US in infectious disease of the kidney is well documented. Previous studies have demonstrated high resistive indices, especially in tubulo-interstitial diseases. OBJECTIVE: To evaluate the role of intrarenal colour duplex Doppler US in lower urinary tract infections (UTI). MATERIALS AND METHODS: This prospective study was carried out in 111 children (222 kidneys) (age range 1-180 months). Of the children, 78 were healthy while 33 presented with lower UTI. The resistive indices (RI) were measured from the spectral waveforms obtained from interlobar arteries. RESULTS: No statistically significant difference was found between RI of right and left kidneys in both groups. The mean RI was 0.75 +/- 0.07 in patients with lower UTI and 0.71 +/- 0.1 in the control group (P < 0.05). In the control group there was an inverse correlation between age and RI (P < 0.05). CONCLUSIONS: High RI may be found in lower UTI.

Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasal surgery.

The purpose of this study is to determine some important variations and dangerous areas carrying risks for major complications, in the routine CT examination. We also made specific measurements to evaluate the individual differences. This prospective study consisted of 111 patients (222 sides). Eighty patients underwent coronal, and the rest coronal and axial CT. The depth of lamina cribrosa, its distance to the inferior turbinate, and the distance of anterior ethmoidal artery (AEA) either to the orbital roof or inferior turbinate were measured. Variations of the upper attachment of uncinate process were encountered in 23%. AEA coursed freely within ethmoidal cells in 43%. Anterior clinoid aeration was seen in 14%, optic canal bulging into the sphenoid sinus in 13% and an extreme medial course of the carotid canal in 12% of the patients. The mean depth of lamina cribrosa was 5.9 mm, and its mean distance to the inferior turbinate was 25.7 mm. The mean distance of AEA to the orbital roof was 13.7 mm, and to the inferior turbinate 30.05 mm. Anterior clinoid aeration correlated well with the variations of carotid and optic canals, statistically (p < 0.01). A detailed CT study will provide important information on the areas carrying risks of complications and the size of the area to be worked on.

Surgical approaches to antrochoanal polyps in children.

Antrochoanal polyps (ACP) represent 4-6% of all nasal polyps in the general population, but this proportion increases to 33% in the pediatric group. The aim of this study is to discuss clinical and radiological findings, and some different surgical approaches with their results in the pediatric patients. This study consists of eight children with ACP diagnosed by means of clinical examination, nasal endoscopy and computed tomography. One patient was treated only with simple polypectomy. In five patients, transcanine sinuscopy (TS) was added to functional endoscopic sinus surgery. Four of the patients underwent anterior ethmoidectomy and uncinectomy. Middle meatal antrostomy was applied to two of them. No recurrence was encountered within 5-30 months. The decision for the appropriate type of surgery for ACP is influenced by factors such as patient's age, other accompanying sinus pathologies, recurrence after previous surgery, and the possibility of total excision. In patients carrying the risk of recurrence, it is especially important to remove the polyp completely and manage other sinus pathologies, as well as avoiding an unnecessarily expanded operation. In selected patients, we believe that TS may be adequate in totally removing ACP.