Evaluation of failing hemodialysis fistulas with multidetector CT angiography: comparison of different 3D planes.

PURPOSE: To evaluate failing hemodialysis fistula complications using 16-detector MDCTA, and to assess the accuracies of different 3D planes. MATERIALS AND METHODS: Thirty patients (16 men, 14 women, aged 27-79 years) were referred for hemodialysis access dysfunction. Thirty-one MDCTA exams were done prior to fistulography. For MDCTA, contrast was administered (2mL/kg at 5mL/s) via a peripheral vein in the contralateral arm. Axial MIP, coronal MIP, and VRT images were constructed. Venous complications were evaluated on axial source images, on each 3D plane, and on all-planes together. Results were analyzed using McNemar test. RESULTS: Axial MIP, VRT and all-planes evaluations were most sensitive for fistula site detection (93%). Coronal MIP had the highest sensitivity, specificity and accuracy (35%, 96%, and 85%, respectively) for detecting venous stenosis. VRT and all-planes had the highest sensitivity and accuracy for detecting aneurysms (100%). All-planes and axial MIP were most sensitive for detecting venous occlusion (61% and 54%). Comparisons of detection frequencies for each venous pathology between the five categories of MDCTA revealed no significant differences (P>0.05). MDCTA additionally showed 3 partially thrombosed aneurysms, 4 anastomosis site stenosis and 12 arterial complications. CONCLUSION: MDCTA overall gives low sensitivity for detection of central vein stenosis and moderate sensitivity for occlusion. For most pathology, all-planes evaluation of MDCTA gives highest sensitivity and accuracy rates when compared to other planes. For venous stenosis and occlusion, MDCTA should be considered when ultrasonography and fistulography are inconclusive. MDCTA is helpful in identifying aneurysms, collaterals, partial venous thromboses and additional arterial, anastomosis site pathologies.

Case report: Jejuno-jejunal invagination from metastatic renal cell carcinoma.

Jejuno-jejunal invagination caused by metastatic renal cell carcinoma is a rare entity in the literature. We report a case of metastatic renal cell carcinoma that led to jejuno-jejunal invagination, which was diagnosed by multidedector CT examination.

Hydatid cysts in breast: mammography and ultrasound findings.

A case of a 48-year-old woman with hydatid disease of the breast is presented. The ultrasound and mammogram findings are shown and an uncommon ultrasound appearance of hydatid cyst in the breast is discussed.

Case report: solid-pseudopapillary tumour of the pancreas associated with dorsal agenesis.

Solid-pseudopapillary tumour of the pancreas is a rare benign or low-grade malignant epithelial tumour; its association with pancreatic dorsal agenesis has been reported only once before. We present the radiological and histological findings of a case of pancreatic solid-pseudopapillary tumour associated with total pancreatic dorsal agenesis. A 49-year-old woman presented with abdominal pain radiating to the back for several months. Radiological findings showed absence of the dorsal pancreas and an 8 cm x 6 cm diameter tumour arising from the head of the pancreas. She underwent successful complete resection of the tumour. Histopathology revealed a diagnosis of solid-pseudopapillary tumour.

Osteoarthritis in hemodialysis patients: relationships with bone mineral density and other clinical and laboratory parameters.

OBJECTIVE: The aim of this study was to determine the role that hemodialysis (HD) plays in radiologically assessed osteoarthritis (OA) of the hand, knee, and hip. MATERIALS AND METHODS: Eighty patients who had been on regular HD for at least 2 years were included. Anterior-posterior radiographs of the pelvis, weight-bearing knees, and hands and wrists of each patient were examined. Bone mineral density (BMD) of spine, femur, and forearm was measured. RESULTS: Radiologic assessment of the 80 patients' hands showed that 41 individuals had osteopenia, 12 had midphalangeal subperiosteal resorption, 11 had cystic bone lesions, eight had bone erosion, four had osteophytic lesions, and three had subchondral sclerosis. Bone erosion in the hands was significantly associated with HD duration, forearm T score, and serum parathyroid hormone level. Radiologically, OA was demonstrated in eight knee and ten hip joints. Minimum joint space in the tibiofemoral compartment correlated with body mass index, and minimum joint space in the hip correlated with age. The mean BMD measurements at all three sites studied in the HD patients were low. Only the duration of HD significantly correlated with forearm BMD. CONCLUSION: Osteoarticular complications are common in HD patients.

Laryngeal atresia presenting as fetal ascites, olygohydramnios and lung appearance mimicking cystic adenomatoid malformation in a 25-week-old fetus with Fraser syndrome.

We describe a 25-week-old female fetus of consanguineous parents with ultrasonographic findings of increased echogenicity of lungs mimicking CAM (cystic adenomatoid malformation) type III, olygohydramnios and fetal ascites. A therapeutic abortion was performed and unilateral cryptophthalmos, laryngeal atresia and bilateral syndactyly of the hands and feet were observed at post-mortem. These findings confirmed the diagnosis of Fraser syndrome after abortion.

Thoracic CT findings in long-term hemodialysis patients.

PURPOSE: To evaluate thoracic CT findings of long-term hemodialysis patients. MATERIAL AND METHODS: Thoracic CT findings of 117 uremic patients (61 men, 56 women) with complaints of cough, dyspnea, low-grade pyrexia, malaise, weight loss, and profuse perspiration were retrospectively documented. RESULTS: Atelectasis (60%), cardiomegaly (60%), pleural effusion (51%), vascular congestion (44%), parenchymal consolidation (38%), parenchymal scarring-fibrosis (31%), and lymphadenopathy (29%) were the most common CT findings in the thoraces of the long-term hemodialysis patients. Staphylococcus aureus was detected in 13 patients (11%) who had parenchymal infiltration. Thoracic tuberculosis was identified in 15 patients (13%), 11 of these cases being confined to the lung parenchyma, 3 to the pleura, and 1 involving the pleura and pericardium. CONCLUSION: In patients under long-term hemodialysis treatment, parenchymal consolidation, secondary to infectious agents such as S. aureus and Mycobacterium tuberculosis, is the most important CT finding since these lesions can be detected and treated successfully if they are considered as etiologic factors early on.

Primary choriocarcinoma of the stomach and pancreas: CT findings.

In this report we present the CT findings of two non-gestational, extragonadal choriocarcinomas, one arising within the stomach and one in the pancreas. These are rare tumours and a pancreatic primary site has not been previously described.

Ultrasound appearances of liver hydatid disease.

They grey scale ultrasound features of liver hydatid disease have been evaluated on 65 surgically proven cysts in 38 patients. The majority of cysts showed the well-known ultrasound pattern of simple cysts. However, a minority of lesions were either multicystic or gave the appearance of a cyst within a cyst. Occasionally cysts showed a feature which we have called "the ultrasonographic water lily sign". Hydatid sand was also occasionally seen in the most dependent portion of hydatid cysts. We have noted that if a hydatid cyst becomes secondarily infected these typical ultrasound patterns are lost and the ultrasound diagnosis may then become more difficult.