Prenatal diagnosis of abnormality of the umbilical portal DV complex: difficulty in universal classification due to various alternative routes in hepatic circulation for placental drainage.

OBJECTIVE: To review our experience with fetal abnormality of the umbilical-portal-DV complex and to discuss the new classification system for umbilical portal systemic venous shunts (UPSVS) according to our cases. METHODS: This study was a retrospective analysis of fetuses with a prenatal diagnosis of abnormality of the umbilical-portal-DV complex. The integrity of the fetal umbilical-portal ductus venosus complex and the hepatic venous system were evaluated using two-dimensional color Doppler sonography. The origin of the shunt, the location of the drainage, and the presence or absence of intrahepatic portal venous system and DV were noted. RESULTS: 35 cases of abnormality of the umbilical-portal-DV complex were identified. Agenesis of ductus venous was detected in 33 of them. Based on the abnormality of the umbilical-portal-DV complex, we divided the cases into five groups. Group 1, ductus venosus agenesis with normal hepatic venous anatomy (n = 11); Group 2 downward displacement of the umbilical-portal-DV complex (n = 13); Group 3, umbilical-systemic shunt (n = 5); Group 4, intrahepatic portosystemic shunt (n = 4), Group 5, hepatic arteriovenous malformation (n = 2). Three different intrahepatic portosystemic shunt and one different downward displacement of the umbilical-portal-DV complex cases were detected. CONCLUSIONS: Disruption of the normal anatomy of the umbilical-portal-DV complex causes various alternative pathway of the placental drainage. This illustrates highlights the challenge of creating a universal classification.

The frequency of intracranial arterial fenestrations: a study with 64-detector CT-angiography.

Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

Evaluation of interlobar and accessory pulmonary fissures on 64-row MDCT.

We aimed to describe the prevalence, morphology, and completeness of the oblique, horizontal, and accessory fissures on 64-row multidetector computed tomography (MDCT) scans. Three hundred and eighty-seven patients were included in this study. The lungs were scanned from apex to diaphragm using 1-mm collimation. Images were evaluated on a Philips workstation using the PACS system. Prevalence of the interlobar and accessory fissures and also incompleteness of the interlobar fissures was evaluated on axial, coronal, and sagittal planes. The frequencies of right oblique fissures, right horizontal fissures, and left oblique fissures were 99.7%, 94.8%, and 100%, and the percentage of incompleteness was 69.7%, 86.9%, and 48.3%, respectively. Accessory fissures were detected in 164 of the 387 patients (42.4%). Pulmonary fissures are well visualized on MDCT because of its capacity in evaluating the whole thorax with thin sections and at various planes. Fast-image acquisition in MDCT also accounts for less motion artifacts and high-image quality.

Effects of paramagnetic contrast agents on the gallbladder volume.

PURPOSE: Iodinated contrast agents lead to contraction of the gallbladder. The purpose of this prospective study was to investigate whether the paramagnetic contrast agents used for magnetic resonance imaging (MRI) cause volume changes in gallbladder or not. MATERIALS AND METHODS: The gallbladder volume changes were evaluated by ultrasound just before and 15 minutes after the imaging procedure in 10 patients without any paramagnetic contrast agent administration and 36 patients in whom paramagnetic contrast agents were administered during MRI. Gallbladder volume measurements before and 15 minutes after MRI were compared with each other. RESULTS: The mean pre- and post-procedural gallbladder volumes in patients on paramagnetic contrast agents were 30.2 +/- 19.3 cm(3) and 27.8 +/- 13.5 cm(3), respectively. They were 31.8 +/- 15.0 cm(3) and 29.5 +/- 9.3 cm(3), respectively, in patients who were not administered any paramagnetic contrast agent. There were no statistically significant difference between groups, regarding pre- and post-MRI gallbladder volumes. CONCLUSION: MRI, with or without paramagnetic contrast agents, does not lead to gallbladder volume contraction. In that regard, there appears to be no need to avoid ultrasound aimed to evaluate the gallbladder after MRI examinations.

Diameters of normal thoracic vascular structures in pediatric patients.

PURPOSE: To determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference. METHODS: Contrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated. RESULTS: There was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent. CONCLUSIONS: Diameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.

Migration of ventriculoperitoneal shunt into the lung by passing through the liver and the diaphragm.

Thoracic complications are rare after shunt placement for drainage of cerebrospinal fluid to treat hydrocephalus. We report a case of a ventriculoperitoneal shunt catheter that migrated into the lung by passing through the liver and the diaphragm. To our knowledge, there is no previously published report of a ventriculoperitoneal shunt that has migrated into the lung by a transdiaphragmatic and transhepatic route.

64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease.

OBJECTIVE: The purpose of our study was to investigate whether CT venography (CTV) performed after CT pulmonary angiography (CTPA) using 64-MDCT provides additional findings in the diagnosis of thromboembolic disease. MATERIALS AND METHODS: Three hundred six consecutive patients in whom pulmonary embolism (PE) was clinically suspected were included in the study. The study group was classified according to the diagnostic quality of the CTPA examinations, the presence or absence of PE and deep venous thrombosis (DVT), and the most proximal localization that the embolus could lodge in the pulmonary artery. RESULTS: The diagnostic quality of CTPA was insufficient in 5.9%, acceptable in 8.2%, and excellent in 85.9% of the patients. The diagnostic quality of CTV was insufficient in 11.4%, acceptable in 47.4%, and excellent in 41.2%. The percentages of nondiagnostic examinations for CTPA and CTV were 5.2% and 10.8%, respectively. Acute PE and acute DVT were observed in 25.2% and 18.0%, respectively. The percentage of subsegmental emboli among patients with acute PE was 15.6%. The percentage of patients with thromboembolic disease was 29.1%. Of patients who were diagnosed as having thromboembolic disease, 13.5% (12 of 89 patients) had DVT only. Of all patients, 3.9% (12 of 306) had only isolated DVT. The number of patients with subsegmental PE who had DVT was two (0.7% all patients). CONCLUSION: As in MDCT scanning with a smaller number of slices, the combination of CTV with CTPA in 64-MDCT results in a small but definitive increase in the percentage of patients with a diagnosis of thromboembolic disease.

Isolated traumatic gallbladder rupture: US findings and the role of repeat US in diagnosis.

We represent the US findings of isolated gallbladder rupture caused by blunt abdominal trauma in a 13-year-old boy. At the initial US examination, although a pericholecystic fluid collection was observed, the mildly collapsed gallbladder was regarded as a contracted gallbladder. Even though the patient was haemodynamically stable, repeat US examination after 24 h revealed gallbladder perforation. In haemodynamically stable trauma patients repeated US examinations can be useful and are strongly recommended.

Horseshoe lung associated with rare bilateral variant of scimitar syndrome: demonstration by 64-slice MDCT angiography.

Scimitar syndrome with bilateral abnormal venous drainage and horseshoe lung is extremely rare. These rare complex anomalies were diagnosed in a 5-year-old boy by 64-slice multidetector CT (MDCT). This technique provides high-quality visualization of vascular, bronchial and parenchymal structures in a single session, such that no further invasive techniques are required. One obvious disadvantage of MDCT is the radiation exposure, especially in paediatric patients. The use of a single phase of contrast material administration reduces radiation exposure. The workstation platforms of MDCT systems allow multiplanar 2-D and 3-D postprocessing. As a result, various complex pathologies, such as that discussed here, can be diagnosed following a single imaging session with a certain precision.

Clinical and cranial magnetic resonance imaging (MRI) findings of 21 patients with serious hyperbilirubinemia.

This study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 +/- 533 g. The mean age at admission was 4.47 +/- 2.22 days, and the mean bilirubin level was 35.0 +/- 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.