The diagnostic performance and utility of chest XR in relation to chest CT in nontraumatic respiratory emergency patients.

Background and Aim: This study aimed to determine the diagnostic performance and utility of chest radiography in relation to chest computed tomography (CT) in nontraumatic respiratory emergency patients. Patients and Methods: Patients presenting to the emergency department with respiratory complaints due to nontraumatic pathologies and who had consecutive chest XR and chest CT assessments with an interval of fewer than 6 hours were enrolled in the study (n = 561). Results: The two methods were determined to be consistent with moderate agreement in detecting pleural effusion (κ = 0.576, P < 0.001), pneumothorax (κ = 0.567, P < 0.001), increased cardiothoracic ratio (κ =0.472, P < 0.001), and pneumonic consolidation (κ = 0.465, P < 0.001). The consistency rate was significantly higher in patients aged <40 years (95.5% in ≤30 years and 90.9% in 31-40 years) as compared to older patients (81.8%, 68.2%, and 72.7% in 41-60 years, 61-80 years, and >80 years, respectively; P < 0.001 for each). The consistency rate was also higher for posteroanterior (PA) chest XR views than for anteroposterior (AP) chest XR views (72.7% vs. 68.2%, P = 0.005) and for high- and moderate-quality chest XR views than for poor-quality views (72.7% and 77.3% vs. 70.5%, P = 0.001). Conclusion: The consistency between the chest XR and CT was more likely in patients aged <40 years and for PA and moderate-to-high quality chest XR views, as compared to older patients and AP and poor-quality views, respectively. We suggest that an upright position PA chest X-ray with high imaging quality may be the first choice, especially in patients aged <40 years admitted to the emergency department with respiratory symptoms.

Pancreas divisum: A risk factor for pancreaticobiliary tumors - an analysis of 1628 MR cholangiography examinations.

PURPOSE: This retrospective study was conducted to evaluate the relationships between pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors using magnetic resonance cholangiopancreatography (MRCP). MATERIALS AND METHOD: The MRCP examinations of 1628 patients were retrospectively reviewed for the presence of pancreas divisum, biliary duct anatomical variations and pancreaticobiliary tumors. Of these, 90 patients (31 men, 59 women) with a mean age of 62.6 years±15.8 (SD) (range: 22-101 years) had pancreas divisum. MRCP images were analyzed by two independent readers with discordances resolved by consensus opinion. RESULTS: A total of 1538/1628 patients (94.5%) had a dominant duct of Wirsung; of them 54/1538 patients (3.5%) had pancreaticobiliary tumors. A total of 90/1628 patients had pancreas divisum; of them, 7/90 patients (7.8%) had pancreaticobiliary tumors, including intrapancreatic mucinous neoplasm (n=3), ampullary carcinoma (n=2), pancreas carcinoma and gallbladder carcinoma (n=1 each). Pancreaticobiliary tumors were more frequent in patients with pancreas divisum than in those with a dominant duct of Wirsung (P=0.0383). CONCLUSIONS: The results of our study suggest that patients with pancreas divisum and biliary anatomical variations are more likely to develop pancreaticobiliary tumors and should be followed up closely using MRCP. However, our results should be confirmed by further prospective studies.

Bilateral deep neck space infection in the paediatric age group: a case report and review of the literature.

Deep neck space infections can occur at any age but require more intimate management in the paediatric age group because of their rapidly progressive nature. Concurrent abscess in distinct neck spaces has rarely been reported in healthy children. Herewith, a rare case of bilateral neck abscess is reported in a 16-month-old female and the clinical presentation and management are discussed with a review of the literature.

Fibroadenoma of the breast in a man associated with adenocarcinoma of the rectum and polyposis coli.

Fibroadenoma of the breast is an uncommon cause of breast lumps in men. Only a few cases have been reported in the literature, the majority of which were prescribed estrogen. We present herein the first case of a fibroadenoma of the breast in a 68-year-old man with adenocarcinoma of the rectum and polyposis coli. In this case, there was neither estrogen treatment nor any other medications which have been discussed in the literature as inducing fibroadenomas. Fibroadenomas in men without hormone treatment and with normal hormone levels are extremely rare and the developmental mechanism of the breast fibroadenoma in this man is under question.

Metastatic testicular germ cell tumor presenting with abdominal pain: CT and MRI findings.

Testicular tumors are the most common solid tumors in young adult males. Patients with testicular tumor often present with painless scrotal mass. Rarely, symptoms are related to metastases. We describe the case of a patient presenting with abdominal pain due to retroperitoneal lymphadenopathy. We describe the magnetic resonance imaging findings of lumbar spine osseous metastasis.

Differentiation of benign and malignant cervical lymph nodes: value of B-mode and color Doppler sonography.

OBJECTIVE: To evaluate the efficacy of color Doppler sonography in detecting possible differences in blood flow patterns and B-mode sonographic characteristics between malignant and benign cervical lymph nodes. PATIENTS AND METHODS: During a period of 10 months, the palpable cervical lymph nodes of 39 patients were prospectively evaluated with B-mode and color Doppler sonography. The echogenity, contour, ratio of longitudinal diameter to the transverse diameter and the presence of a hilus were evaluated by B-mode sonography. Capsullary and intranodal arterial flow rates were measured and maximal systolic, end-diastolic, mid-systolic flow velocities with pulsatility, resistivity and acceleration indices were obtained. Final diagnosis was established by excisional biopsy (n:34) and clinical follow-up (n:5). RESULTS: The lymph nodes in 20 cases were malignant and in 19 cases were benign. The B-mode contour characteristics and presence of a hilus in malignant and benign lymph nodes were statistically significant (P < 0.05), but there were no significant differences between the ratio of longitudinal diameter to the transverse diameter (P > 0.05), echogenity (P > 0.05) and the diameters of lymph nodes (P > 0.05). Flow patterns were obtained in 14 malignant (70%) and 10 benign (52.6%) cases. The maximal systolic, end diastolic, mid-systolic flow velocities and pulsatility, resistivity, acceleration indices did not differ statistically (P > 0.05). CONCLUSION: In the differentiations of benign and malignant cervical lymph nodes, the B-mode and color Doppler sonography are limited methods and can not replace biopsy.