Relationship between internal carotid artery stenosis grade and optic nerve sheath diameter measured by transorbital ultrasonography.

PURPOSE: To assess the consequence of the presence, grade, and asymmetry of carotid artery stenoses on the optic nerve sheath diameter (ONSD) measured by ultrasonography. METHODS: ONSD was measured with B-mode ultrasonography in 129 patients referred for duplex and color Doppler imaging of the carotid arteries. Internal carotid artery stenosis was graded on the basis of peak systolic flow velocity. RESULTS: The mean ONSD was 3.04 ± 0.38 mm in the patients without or with <50% internal carotid artery stenosis and 2.46 ± 0.35 mm in those with >70% stenosis. There was an average difference of 0.58 mm between the ONSD of the patients with <50% and the patients with >70% stenosis. CONCLUSION: ONSD is lower in patients with carotid artery stenosis. Carotid arteries should be investigated, especially in patients with cardiovascular risk factors or diseases, before interpreting ONSD values.

Is the presence of echo-rich periportal cuffing in the liver indicator for abdominal inflammation in pediatric patients?

AIMS: Hyperechoic/echo-rich periportal cuffing (ErPC) is defined as an increase in echogenicity relative to the adjacentliver parenchyma. Thickening in the periportal area may occur with proliferation of bile ducts, hemorrhage, oedema, fibrosis,inflammatory changes or a combination of these. The aim of this study is to determine which intraabdominal inflammatory diseases are associated with the presence of ErPC in the pediatric population and to calculate the sensitivity and specificity of this finding. MATERIAL AND METHODS: In this prospective study 200 consecutive children who underwent abdominal ultrasonography (US) were included: group 1, the patient group (100 children with appendicitis, gastroenteritis, mesenteric lymphadenitis, intestinal infection, terminal ileitis and invagination as cause of intra-abdominal inflammation) and group 2, the control group (100 children). RESULTS: The ErPC was positive in 74 (74%) cases in the patient group and in 3 (3%) in the control group. According to final diagnoses, we found ErPC in most of patients with gastroenteritis (16/17), perforated appendicitis (10/11), mesenteric lymphadenitis (5/6) and acute appendicitis (27/37). The sensitivity of ErPC in indicating intra-abdominal inflammation was 0.80 and its specificity was 0.87. No significant correlation between ErPC and age, gender and CRP was found but a moderate and significant positive correlation between ErPC and WBC (p=0,010; r=0.255) was detected. Very good concordance between observers in terms of the presence of ErPC on abdominal US was found (concordance 97% and kappa 0.93). CONCLUSIONS: We consider that the presence of ErPC in pediatric patients, when evaluated alongside clinical and laboratory findings, has a high sensitivity and specificity for inflammatory intra-abdominal pathology.

Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report.

BACKGROUND: Hydatid disease can involve any part of the body, but the liver is the most frequently affected organ. Intrabiliary rupture is one of the most serious complications of a hepatic hydatid cyst. Radiological findings, especially magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP), are helpful in the diagnosis of hydatid disease. CASE REPORT: We present a 48-year-old female patient with complaints of abdominal pain and jaundice. Radiological examination showed a heterogeneous lesion that contained cystic-solid components and millimetric calcifications in the liver. Adjacent intrahepatic bile ducts were dilated. CONCLUSIONS: In geographical areas endemic for hydatid disease, cyst rapture into the bile ducts should be included in the differential diagnosis even in seronegative cases, although it is not typical for hydatid cyst to be found as a mass lesion in the liver on US in patients with right upper quadrant pain and jaundice.Detailed imaging by MRI/MRCP should be done.

Jejunal Diverticulosis Presented with Acute Abdomen and Diverticulitis Complication: A Case Report.

BACKGROUND: Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting. CASE REPORT: A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks. CONCLUSIONS: In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum.