A rare cause of hydronephrosis: Left retrocaval ureter without situs inversus or inferior vena cava duplication with CT and US imaging findings.

Retrocaval ureter is a rare congenital anomaly. It usually occurs on the right side and cases on the left side without accompanying conditions such as situs inversus or double inferior vena cava (IVC) are uncommon. Instances of left retrocaval ureter without situs inversus or double IVC are rarely reported in the literature, and there are no cases presented sonographically. In this case, we present a demonstrative sonographic and tomographic images of a left-sided Type 1 retrocaval ureter case where situs inversus and double IVC were not present. In cases where hydronephrosis is detected on ultrasound, a medially displaced ureter should raise suspicion for retrocaval ureter.

Association between left-sided varicocele and epididymo-orchitis with sonographic findings.

OBJECTIVE: The aim of this study was to investigate the relationship between left-sided varicocele and epididymitis or epididymo-orchitis. MATERIALS AND METHODS: The study included 72 patients with left side epididymitis (EP) or epididymo-orchitis (EPO) (Group 1) and a control group of 72 patients without EP or EPO (Group 2). Those with right EP-EPO were excluded due to possible other underlying retroperitoneal pathologies causing varicocele. Groups were evaluated for presence of left side varicocele, varicocele grade and pampiniform plexus vein diameter. RESULTS: The average age was 38 ± 8.4 years (range, 18-50 years) in Group 1, and 36 ± 9.1 years (range, 16-47 years) in Group 2. Varicocele was significantly more common in patients with EP or EPO (p < 0.001). The rate of varicocele was 66.7% (48/72) in Group 1, and 22.3% (16/72) in Group 2. The median grade of varicocele was 2 in Group 1, and 0 in Group 2. Pampiniform plexus vein diameters were found to be significantly larger in patients with EP or EPO compare to patients without EP and EPO. The median vein diameter was 3.3 mm with the 25th and 75th percentiles at 2.7 and 3.8 mm, and was 1.9 mm with the 25th and 75th percentiles at 1.7 and 2.3 mm, respectively (p < 0.001). CONCLUSIONS: Left-sided varicocele was significantly more common in patients with EP or EPO and it is an important cause for the development of EP/EPO because of chronic venous stasis.

Patellar height: an important parameter in knee MRI associated with tendinopathy, quadriceps fat pad edema (QFPE), anterior cruciate ligament mucoid degeneration (ACL-MD), and lateral cartilage damage.

BACKGROUND: Some pathologies associated with abnormal patellar height have been reported in the literature. However, its relationship with some pathologies, such as anterior cruciate ligament mucoid degeneration (ACL-MD) and focal cartilage defect, has not been investigated. PURPOSE: To investigate the relationship between patellar height with patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. MATERIAL AND METHODS: Magnetic resonance imaging of the knees of 261 patients were classified into three groups as normal, patella alta, and patella baja, and evaluated in terms of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and focal cartilage defect. RESULTS: There were 261 patients (140 men, 121 women; age range = 18-60 years; mean age = 30 ± 4.7 years). Of the 261 patients, 181 (69.3%) were normal, 56 (21.4%) were patella alta, and 24 were patella baja (9.1%). Patellar-quadriceps tendinopathy, quadriceps fat pad edema, and ACL-MD rates were significantly higher compared to the normal group (P <0.05). While a moderate positive correlation was found between patellar height shift and patellar-quadriceps tendinopathy and ACL-MD, there was a small correlation between patellar height shift and quadriceps fat pad edema. The rate of focal cartilage defect was significantly higher in the middle part of the lateral femoral condyle and lateral knee joint only in patella alta. CONCLUSION: The risk of patellar-quadriceps tendinopathy, quadriceps fat pad edema, ACL-MD, and lateral focal cartilage defect is higher in patients with alta-baja. The radiologist should evaluate these pathologies more carefully, especially subtle ones, in patients with abnormal patellar height.

The Effect of Patellofemoral Maltracking and Patella Type on Symptomatic Bipartite Patella.

Purpose The aim of this study is to investigate the relationship of trochlear dysplasia (TD) and patella type with bipartite patella (BP). Materials and methods A total of 5,081 knee MRIs taken in our institution were reviewed retrospectively. Patients with a history of knee surgery, previous or recent trauma, and rheumatologic involvement were excluded from the study. The MRIs of 49 patients with bipartite/multipartite patella were detected. Three patients were excluded: two patients had a tripartite variant, and one had multiple osseous dysplastic findings. Overall, 46 patients with BP were included in the study. BPs were classified as type I, II, and III. Patients were divided into symptomatic and asymptomatic groups according to the presence of edema within the bipartite fragment and adjacent patella. Patients were examined in terms of patella type, trochlear dysplasia, tuberosity-trochlear groove (TT-TG) difference, sulcus angle, and sulcus depth. Results There were 46 patients with BP (28 males and 18 females) (mean age: 33±9.5 years, range: 18-54). Thirty-eight bipartite fragments (82.6%) were type III and eight (17.4%) were type II. There was no type I BP. Seventeen (36.9%) were symptomatic, and 29 (63.1%) were asymptomatic. Seven of the type II (87.5%) and 10 of the type III (26.3%) bipartite fragments were symptomatic. The frequency and degree of trochlear dysplasia (p=0.007 and p=0.041, respectively) were found to be higher in symptomatic patients. The trochlear sulcus angle was higher (p=0.007) and the trochlear depth was lower (p=0.006) in the symptomatic group. No statistically significant difference was found (p=0.247) in terms of TT-TG difference. Type III and type IV patella were more common in the symptomatic group. Conclusion The current study shows that patellofemoral instability and patella type are associated with symptomatic BP. Patients with trochlear dysplasia, type II BP, and disproportionate patellar facet may have a significantly increased risk of symptomatic BP.

Inferior Vena Cava Agenesis Associated with Urogenital Anomalies: A Case Report.

BACKGROUND: Inferior Vena Cava (IVC) agenesis, ectopic ureterocele, and ureteral duplication are very rare congenital anomalies. CASE PRESENTATION: A-25-year-old female patient was referred with right flank pain, chills and dysuria. Laboratory tests and CT showed findings consistent with acute pyelonephritis. The medical history revealed only frequent urinary tract infections and Factor V Leiden mutation. The patient was treated with antibiotherapy. CT examination demonstrated IVC Agenesis (IVCA). Urogenital anomalies such as vaginal ectopic ureterocele, ureteral duplication and septate uterine anomaly were also present. CONCLUSION: We report the first occurrence of IVC agenesis associated with multiple urogenital anomalies in the literature.

An Unusual Complication of Transarterial Chemoembolization of Hepatocellular Carcinoma; Pseudoaneurysm: A Case Report.

BACKGROUND: Transarterial chemoembolization (TACE) is a globally recognised treatment method for hepatic tumors, especially unresectable hepatocellular carcinoma (HCC). Although the technique is relatively safe, it may cause serious complications, such as liver abscess, liver failure, and non-target embolization. Here, the case of a rare complication of TACE is presented. CASE PRESENTATION: A-55-year-old male patient was referred to the interventional radiology department for surgically unresectable HCC. CT scan showed a heterogeneously enhancing lesion with capsular enhancement consistent with HCC. On MRI examination, a central necrotic part was seen within the lesion, and TACE was performed. At the end of the TACE, a pseudoaneurysm of the hepatic artery was detected, which was successfully embolized with pushable micro-coils. CONCLUSION: To the best of our knowledge, very few cases of pseudoaneurysm of the hepatic artery have been described in the literature, and in those cases, the cause has been thought to be guidewire manipulation. In contrast, in the current case, it was thought that it might occur due to central necrosis and central perfusion insufficiency of the lesion. Pseudoaneurysm is a treatable condition with coil embolization.

Effect of cerebral microhemorrhages on neurocognitive functions in patients with end-stage renal disease.

BACKGROUND: Death is the most serious complication of intracerebral hemorrhage. Microbleeding can be a precursor of intracerebral hemorrhage. Susceptibility weighted imaging (SWI) should be included in imaging protocols for some specific groups such diabetic hemodialysis patients in terms of prediction of macrohemorrhages. PURPOSE: To investigate intracerebral microbleeding in hemodialysis patients and the correlation between microbleeding and neurocognitive impairment. MATERIAL AND METHODS: Forty-nine hemodialysis cases were involved in the study. Locations of microbleeding, correlation between microbleeding and hypertension, diabetes mellitus (DM), age, and duration of dialysis were analyzed. Standardized mini-mental test was performed. The tested cases were divided into two groups: intracerebral microbleeding (group 1, n = 26) and without intracerebral microbleeding (group 2, n = 17). RESULTS: Incidence of microbleeding and macrohemorrhage was noted as 59% and 14%, respectively, in all cases. All macrohemorrhagic cases also have microbleeding. In group 1, neurocognitive impairment was detected in 10 (38.4%) cases: six and four cases with moderate and mild impairment, respectively. In group 2, neurocognitive impairment was detected in 2 (11.7%) cases, both with mild impairment. A significant positive correlation was detected between microbleeding and neurocognitive impairment (P = 0.031). Although there was no correlation between attention disorder and microbleeding, a positive correlation was detected between close memory impairment and microbleeding (P = 0.027). A positive correlation was detected between DM and microbleeding (P = 0.027). CONCLUSION: In hemodialysis patients, microbleeding can be a cause of neurocognitive impairment which will be important for guide to treatment protocols. SWI should be included in the imaging protocol of diabetic hemodialysis patients with neurocognitive deterioration.

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit.

BACKGROUND: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. MATERIALS AND METHODS: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. RESULTS: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17-92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. CONCLUSION: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.

INTRODUÇÃO: Apesar da pancreatite aguda resolver espontaneamente com medidas de suporte na maioria dos doentes, esta também pode ser grave e fatal. A prediçãoinicial da gravidade da doença orienta a estratégia terapêutica.O nosso objetivo foi definir os doentes com pancreatite ligeira que podem ser considerados para terapêutica em ambulatório com redução dos custos. MATERIAL E MÉTODOS: Estudo prospetivo observacional com 180 doentes com pancreatite aguda ligeira segundo os scores de HAPS e Imrie. As relações entre os parâmetros bioquímicos, as alterações no score de Balthazar e o curso clinico foram examinadas. RESULTADOS: Este estudo incluiu 180 doentes (111 mulheres, 69 homens; idade média 53.9±17.2 anos). A etiologia foi biliar em 118 (65%) e permaneceu indeterminada em 38 (21.1%) doentes, respetivamente. A tomografia computorizada (TC) realizada nas primeiras 12 h revelou pancreatite ligeira e moderada em 159 (88.3%) e 21 (11.7%) doentes, respetivamente. A TC repetida às 72h revelou pancreatite aguda, moderada e grave em 155 (86.1%), 24 (13.3%), e 1 (0.6%) dos doentes, respetivamente. As comparações entre os estadios A+B+C e D+E mostraram diferenças significativas nos níveis de amílase nos dias 1 e 3, e na PCR no dia 3. Também nos estadios D e E, a toma de narcóticos, tempo de inicio da dieta oral e a dor foram significativamente superiores. CONCLUSÃO: Não se verificaram alterações significativas na TC dos doentes com pancreatite ligeira nem às 12 nem às 72h. A maioria dos doentes (99.4%) recuperou sem complicações.Doentes com pancreatite ligeira segundos os scores de HAPS e Imrie podem ser considerados para orientação em ambulatório. A recuperação é mais longa nos estadios D e E da doença.

Is surgery necessary to confirm diagnosis of right-sided diverticulitis in spite of relevant clinical and radiological findings?

BACKGROUND: Diverticulosis of the right colon is an uncommon entity. Aim of the present study was to report outcome in patients with right-sided diverticulitis diagnosed using computed tomography (CT) and treated conservatively. METHODS: Twelve patients with clinical and radiological diagnosis of cecal or right-sided diverticulitis who were treated conservatively between February 2013 and December 2014 were included. Demographic and clinical data were retrospectively analyzed. RESULTS: Female to male ratio was 1:1 with mean age of 45.08±14.4 years. Mean length of symptom history before admission was 2.08±1.3 days. Most common presenting symptom was right lower abdominal pain, seen in 72.7% of the patients. Abdominal ultrasound alone was performed for 10 patients, and 2 also had abdominal CT. Mean duration of hospitalization was 2.8±1.5 days. All patients were successfully treated with medical therapy. There was no recurrence during mean follow-up period of 8.2±5.6 months. CONCLUSION: If uncomplicated diverticulitis of the right colon is correctly diagnosed with radiological evaluation, antibiotic therapy and bowel rest should be considered as treatment modality, as there was no recurrence observed in short-term follow-up period and this option presents advantage of avoiding surgical intervention.

Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions.

PURPOSE: The physical examination of the shoulder is usually not reliable for the true diagnosis of superior glenoid labrum anterior to posterior (SLAP) lesions. Magnetic resonance imaging (MRI) has been routinely used for the diagnosis. This prospective study investigates the radiological diagnosis of the SLAP lesions and compares accuracy of arthroscopic and MRI classifications. METHODS: One hundred thirty-two patients with positive physical examination signs using O'Brien, Yergason, resistance supination external rotation and Krank tests and MRI findings are included in the study. Shoulder MRIs were obtained for all patients within three months prior to the surgeries. SLAP lesion is detected in 90 and 102 patients according to MRI and arthroscopy, respectively. Arthroscopic and MRI classifications of the patients were performed according to modified Snyder classification. RESULTS: Sensitivity and specificity of the MRI were found as 70.59 and 40%, respectively. No difference was detected between MRI and arthroscopy classifications in 52 (39%) patients. Although the diagnosis was compatible with arthroscopy in 34 (25%) patients, the classification was incompatible. In 46 (34%) of patients the diagnosis was incompatible with the MRI. CONCLUSION: Although MRI is a good diagnostic tool for SLAP lesions, its use for the classification is limited. Level of evidence Level III, Diagnostic study.

A rare case of isolated macronodular hepatic tuberculosis (Tuberculous) in an immunocompetent patient.

Tuberculosis is one of the most common and well described infectious diseases, with a world wide distribution and a vast spectrum of clinical manifestations. There are three forms of hepatic tuberculosis. Diffuse hepatic involvement with pulmonary or miliary tuberculosis, diffuse hepatic infiltration without recognizable pulmonary involvement is the second form and the third very rare form presents as a focal/local tuberculoma or abscess. In this case report we describe an unusual appearance of macronodular tuberculomas of the liver.

Hyperperfusion in carotid stenting patients.

PURPOSE: This study aimed to define hyperperfusion in carotid stenting patients without excluding patients with stenosis on the contralateral side. MATERIALS AND METHODS: A total of 32 patients were enrolled. Prestent computed tomography perfusions were performed within 1 week before stenting, poststent perfusions 3 days after stenting. Prestent relative cerebral blood volume, relative cerebral blood flow, and relative mean transient time (rMTT) were calculated by dividing measurements from ipsilateral stent sides to contralateral sides and prestent difference mean transit time (dMTT) by subtracting contralateral mean transient time (MTT) from ipsilateral MTT. Poststent values were calculated similarly. For differences between prestent and poststent values, independent t test was used between groups and paired sample t test within the groups. RESULTS: Of the 31 patients, 4 showed poststent clinical hyperperfusion syndrome. Six showed poststent radiologic hyperperfusion with increased cerebral blood flow, increased or spared cerebral blood volume, and shortened MTT values, but only 1 demonstrated clinical hyperperfusion. Between normal and hyperperfused groups, only appreciable difference was noted in prestent and poststent dMTT without statistical significance. Within the groups, only statistical difference (P < 0.001) was noted in rMTT and dMTT in normal groups and no significant difference in the hyperperfused group. CONCLUSIONS: Radiologic hyperperfusion does not match clinical hyperperfusion. Normal group responded to stenting with statistically significant changes of rMTT and dMTT. Hyperperfusion mostly occurred in the contralateral critically stenosed patients. The hyperperfused group, due to similar MTT of both hemispheres and ipsilateral internal carotid artery being the main feeder of both hemispheres, did not show significant changes in their rMTT and dMTT values after stenting. This shows that reduced hemodynamic reserve is the main reason behind the hyperperfusion after carotid stenting.

Susceptibility weighted imaging features of nonketotic hyperglycemia: unusual cause of hemichorea-hemiballismus.

Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. MRI features tend to be hyperintense in the putamen on T1-weighted images. We present conventional MRI with diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) features of two cases with nonketotic hyperglycemia. T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.

MRI findings in encephalopathy with primary carnitine deficiency: a case report.

BACKGROUND AND PURPOSE: We presented MRI and DWI findings of a 12-year-old boy with primary carnitine deficiency, manifested with hypoglycemic hypoketotic encephalopathy. METHODS: Magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) were performed to the patient. RESULTS: In our case, T2 hyperintensity and diffusion restriction were noted bilaterally in the corona radiate, cerebral white matter, deep white matter of cerebellum, ascending (inferior cerebellar peduncle) and descending tracts (corticospinal and corticobulbar tracts) of brainstem. CONCLUSIONS: MRI and DWI are helpful in the diagnosis, therapy planning and follow up of encephalopathic cases with carnitine deficiency.

Gossypiboma/textiloma mimicking as tumour recurrence.

A surgical sponge accidentally left in a surgical wound, called a textiloma or gossypiboma, is underreported in literature due to medicolegal consequences. Abdominal textiloma may be asymptomatic or present serious gastrointestinal complications such as bowel obstruction, perforation or fistula formation because of misdiagnosis. It may mimic abscess formation in early stage or soft-tissue masses in chronic stage. If there is an intraabdominal abscess resistant to catheter drainage in the postoperative period or an intraabdominal soft tissue mass with a history of previous surgery, textiloma should be included in the differential diagnosis. Whirl-like spongiform pattern especially on CT, well-defined border and fibrous capsule especially on MRI can help in the diagnosis of textiloma. We describe a case of intraabdominal textiloma mimicking abscess and soft tissue tumour on CT and MRI examination.

Primary pancreatic leiomyosarcoma.

Primary pancreatic leiomyosarcomas are rare malignant neoplasms with an aggressive course and a large size. A 56-year-old woman presented with an 8-year history of abdominal pain. Multislice computed tomography revealed a large heterogeneous mass with necrotic, calcified and macroscopic fatty areas. The tumor was excised. Histopathological evaluation revealed leiomyosarcoma of the pancreas. If a patient has a large size mass with a cystic-necrotic component, pancreatic leiomyosarcoma should be considered in the differential diagnosis list after excluding other common differential diagnoses.

Retroperitoneal mature cystic teratoma arising from intra-abdominal undescended testis in an adult.

Teratomas are a type of germ-cell tumour which may contain embryological tissues from more than one germ-cell layer, usually occurring in the gonads. Primary retroperitoneal teratomas account for 1-11% of retroperitoneal neoplasms and are most commonly found in neonates and young adults. In the clinical literature, retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in adult males has been very rarely reported. We report a case of surgically proven retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in an adult male by multislice helical computed tomography and magnetic resonance imaging.

CT angiography evaluation of unusual transorbital penetrating injury: a toothbrush.

Orbital penetrating injuries may cause significant harm to optic nerves and eyeball as well as to the brain and cerebral vasculature. Defining surrounding neurovascular structures by CT angiography (CTA) is important for surgical removal. We present an uncommon case of a 3-year-old child with a penetrating orbital injury caused by a toothbrush. To the best of our knowledge, there is no report orbital injury with a toothbrush so far.

Diagnosis of Appendicitis in Patients with Abnormal Position of the Appendix due to Mobile Caecum.

Acute appendicitis is usually diagnosed on the basis of signs, symptoms, clinical history, physical examination, and results of laboratory tests.The position of the appendix can vary considerably, both in relation to the caecum and because of the inconsistent position of the caecum itself, and may cause variable clinical symptoms. We present the CT findings of surgically proven acute appendicitis associated with atypically located caecum in two patients.