Cardiac magnetic resonance imaging findings of isolated left ventricular apical hypoplasia.

Isolated left ventricular apical hypoplasia (ILVAH) is an uncommon and likely congenital cardiac abnormality that has been described as relatively new. ILVAH is characterized by a truncated, globular-shaped left ventricle (LV) with bulging of the interventricular septum toward the right ventricle (RV), wrapping of an elongated and lengthened RV around the absent LV apex, thinning and fat replacement of apical myocardium of the LV, and abnormalities in the papillary muscle arrangement of the LV. In this report, we present the cardiac magnetic resonance imaging findings of a 22-year-old female patient with non-specific cardiac complaints that were compatible with ILVAH. Recognition of this rare cardiomyopathy is important for clinicians and radiologists in order to follow up on patients with ILVAH, as it may lead to severe complications, and to distinguish it from other cardiomyopathies. Learning objective: Isolated left ventricular apical hypoplasia (ILVAH) is a rare congenital cardiomyopathy that has some serious complications, such as left-sided heart failure, severe pulmonary hypertension, and fatal arrhythmias. By recognizing and identifying the cardiac magnetic resonance imaging findings of ILVAH, clinicians and radiologists can take appropriate measures to manage and treat patients with this condition, potentially improving outcomes and reducing the risk of complications.

A Nine-year-old Boy with Renovascular Hypertension: Knowing Where to Look.

Renal artery entrapment (RAE) by hypertrophic diaphragmatic crura is an extremely rare cause of renovascular hypertension (RVH). Here, we report the case of a 9-year-old boy diagnosed with RVH caused by right RAE by a hypertrophic diaphragmatic crus and successfully managed with close medical monitoring. Diagnosis of this entity is easily overlooked if the optimal views are not obtained during imaging, which depends on a high index of suspicion. We would like to remind clinicians to keep this rare condition in mind when evaluating children with RVH.

A Doppler ghost in the pulmonary artery.

Long-standing left-to-right shunting across a patent ductus arteriosus (PDA) can result in Eisenmenger syndrome. In this report, we present echocardiographic findings of a 27-year-old female patient with pulmonary hypertension. In diagnostic work-up especially Doppler findings of the pulmonary artery suggested the presence of a reversed PDA as a cause of pulmonary hypertension. The diagnosis was confirmed by contrast study and computed tomography.

Do pulmonary findings of granulomatosis with polyangiitis respond to anti-tuberculosis treatment?

Granulomatosis with polyangiitis (GPA) involves upper and lower respiratory tracts and kidneys. Lung involvement is among the most important organ involvements in GPA. GPA's lung involvement might be confused with other granulomatous conditions with lung involvement. In this report, we presented clinical features of two cases with GPA who had been diagnosed as tuberculosis (TBC) and well treated with anti-tuberculosis (anti-TBC) drugs. However, one of two cases had ear-nose-throat (ENT) manifestations before the diagnosis of TBC and her extrapulmonary findings related with GPA have added to clinical features in the following years. In the second case, the manifestations of GPA appeared after 13 months of anti-TBC treatment. We speculated that lung involvement in these cases may be due to GPA rather than TBC. Our aim was to highlight difficulties in the differential diagnosis between GPA and TBC and suggest the possible beneficial effect of anti-TBC drugs on the lung involvement due to GPA in light of the literature data.

Bronchial Artery Embolization with Large Sized (700-900 µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research).

PURPOSE: To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis. METHODS: One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success. RESULTS: Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions. CONCLUSION: Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.

Atrium Advanta V12 Large Diameter Stent-Graft Applications for Infrarenal Abdominal Aortic Pseudoaneurysms (due to Behcet Disease): Safety and Efficacy.

BACKGROUND: The aim of the study was to determine the safety and effectiveness of Atrium Advanta V12 large diameter stent-graft applications for infrarenal abdominal aortic pseudoaneurysms (due to Behcet disease [BD]). METHODS: Data of Advanta V12™ (Atrium Europe B.V, Mijdrecht, the Netherlands) applied 12 female patients (mean age 30.5 ± 6.3, range 26-44) with infrarenal abdominal aortic pseudoaneurysms were analyzed retrospectively. All Advanta V12 large diameter stent grafts were implemented from right or left sided 12F femoral sheaths. Stent grafts with 12-16 mm in size and 29-61 mm in length were utilized. Technical success rate, procedure-related mortality and morbidity, and primary patency rate at 4 years were evaluated. RESULTS: Technical success rate was 100%. Neither procedure-related mortality nor morbidity was determined. The mean aortic diameter was 14.0 ± 0.8 mm for pseudoaneurysmatic abdominal aortas. The mean follow-up period was 46.5 ± 40.3 months (range 18-75). During follow-ups, only one recurrent aneurysm has evolved at the stenting site due to patients' withdrawal of immunosuppressive treatment. The advent of a new aneurysm proximal or distal to the stent-graft region or at the femoral access localization was not observed. There were no stent occlusions. Primary patency rate at 4 years was 100%. Complete aneurysm exclusion was achieved 100% at 48 months. CONCLUSIONS: The use of Advanta V12 large diameter stent grafts for infrarenal abdominal aortic pseudoaneurysms (due to BD), especially in female patients with small aortic diameter, is safe and efficient. Primary patency rate of the stent grafts at 4 years is excellent.

Impaired visibility of the hepatic veins on the multi-detector computed tomography in patients with cirrhosis.

OBJECTIVE: To determine the prevalence and associations of the impaired visibility of the hepatic veins (HV) on the multi-detector row computed tomography (MDCT) in cirrhotic patients. MATERIALS AND METHODS: Eighty-seven consecutive cirrhotic patients undergoing triphasic liver MDCT were enrolled. The patency of the HV and the direction of the blood flow in the main portal vein, inhomogeneity of the liver, portal vein thrombosis (PVT), a spontaneous splenorenal shunt, splenic indexes (cm(3)), contour abnormalities, and enlargement of the fissure were evaluated. RESULTS: The prevalence of the impaired visibility of the HV was 38% in the patients with cirrhosis. No significant associations exist between the impaired visibility of the HV and age (p=0.96), sex (p=0.14), portal vein thrombosis (p=0.29), or splenic indexes (p=0.32). Inhomogeneity of the liver (p=0.0001), marked contour abnormalities, (p=0.0001), splenorenal shunt (p=0.02), enlargement of fissure (p=0.0001), and hepatofugal flow (p=0.01) were significantly associated with the impaired visibility of the HV. CONCLUSION: Inhomogeneity of the liver, marked contour abnormalities, and hepatofugal flow are independently associated with the impaired visibility of the HV in cirrhotic patients on hepatic venous phase CT.

Extremely rare cardiac involvement: recurrent pericardial hydatid cyst.

Echinococcus granulosus is a common infestation in sheep and cattle raising countries. Although it is typically encountered in liver and lung, rare cardiac involvement of this infestation has very important clinical complications such as heart failure, valve regurgitation, pericardial effusion-tamponade and arrhythmia. In addition, pericardial infestation is an extremely rare condition of Echinococcus granulosus. Here, we report a case of recurrent pericardial hydatid cyst presenting exertional dyspnea, palpitation and presyncope attacks in a 72-year-old man. The diagnosis of recurrent pericardial hydatid cyst was made by transthoracic echocardiography, computed tomography and surgical history.

B-flow imaging for the measurement of residual lumen diameter of renal artery stenosis.

BACKGROUND: The aim of this study was to assess the accuracy and efficacy of B-flow imaging (BFI) in the diagnosis and measurement of renal artery stenosis (RAS) compared with color duplex ultrasonography (CDU) and digital subtraction angiography (DSA). METHODS: Fifty-one consecutive patients with RAS diagnosed and measured with DSA were subsequently and independently examined with BFI for the measurement of residual lumen diameter, and with CDU for the measurement of peak systolic velocity and renal-aortic velocity ratio. The diagnostic performances of BFI and CDU in determining 60-99% RAS were compared by receiver operating characteristic curve analysis. The agreement between DSA and BFI stenosis measurements was evaluated with Bland-Altman method. RESULTS: The area under curve was 0.983 for BFI and 0.959 for CDU, without a significant difference in diagnostic performances (p = 0.26). BFI yielded an 88% sensitivity and 94% specificity in the diagnosis of RAS with a 3% underestimation of RAS compared to DSA (95% confidence interval 1.4%, 4.6%). CONCLUSIONS: BFI is an accurate method that minimally underestimates RAS. It might provide an additional benefit to CDU in patients with RAS.

Bronchogenic cyst of interatrial septum.

Bronchogenic cyst, also known as inclusion cyst, is a type of congenital endodermal heterotropia derived from an abnormal development of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Its interatrial localization is extremely rare and making a final diagnosis without surgery challenges the clinician. Herein, we report a 58-year-old male patient who had an interatrial bronchogenic cyst related to transient ischemic attack.

Congenital and acquired abnormalities of the portal venous system: multidetector CT appearances.

A knowledge of normal anatomy as well as the most frequent variants and abnormalities of the portal venous system are of great importance for liver surgery and interventional procedures. An understanding of the varied MDCT appearances of these abnormalities will allow more definitive diagnoses and help avoid false diagnoses.

Does the right inferior phrenic artery have a supplying role in liver cirrhosis without hepatocellular carcinoma? A 64-slice CT study.

PURPOSE: To investigate whether the right inferior phrenic artery (RIPA) has a role in supplying the liver in cirrhotic patients without hepatocellular carcinoma (HCC) using 64-slice computed tomography (CT). MATERIALS AND METHODS: Fifty-eight consecutive cirrhotic patients were categorized into two groups in regard to the absence (group 1, n=33) or presence of portal vein thrombosis (group 2, n=25). In addition, 35 patients without liver disease were included as a control group (group 0). The diameters of the RIPA and left inferior phrenic artery (LIPA) were measured in the ascending portion of these vessels using arterial-phase CT images. The discrepancy between the diameters of the RIPA and LIPA were calculated. The diameters of the RIPA and LIPA and the discrepancy between the diameters of the RIPA and LIPA were then compared. RESULTS: The characteristics of all RIPA and LIPA were visualized. The diameter of the LIPA among the three groups was not significantly different (P = 0.363). The mean diameters of the LIPA were 1.8±0.19, 1.8±0.22, and 1.7±0.38 mm for groups 0, 1, and 2, respectively. The diameter of the RIPA was significantly greater (2.1±0.54 mm) in groups 1 and 2 (1.9±0.19 mm) than in group 0 (1.8±0.18 mm). There was significantly difference between groups 0 and 2 (P = 0.003), and groups 1 and 2 (P = 0.01) with regard to the discrepancy of the diameters of RIPA and LIPA. CONCLUSION: The RIPA may contribute to the blood supply of the liver in cirrhotic patients, especially those with portal venous thrombosis.

CT angiography of the celiac trunk: anatomy, variants and pathologic findings.

Celiac trunk variants and pathologies are relatively common occurrences. With the advent of computed tomography (CT) technology, these conditions are being diagnosed with an increased frequency even among asymptomatic patients. CT angiography is used noninvasively for preoperative staging and vascular mapping in patients with pancreatic and hepatobiliary neoplasm. Multidetector-row CT (MDCT) also allows the accurate depiction of the abdominal splanchnic vessels for stenosis, collateral vessels and atherosclerotic plaques. In this study, we describe the normal anatomy and variants of the celiac trunk as well as associated pathologic conditions, such as stenosis, occlusion, aneurysm and median arcuate ligament compression syndrome. The overall aim of this study was to emphasize the clinical importance of these abnormalities.

CT angiography of systemic to pulmonary venous shunt in superior vena cava obstruction.

Superior vena cava obstruction is associated with multiple venous collaterals. There is an unusual pathway involving pulmonary venous collaterals in which systemic veins drain directly into the left heart, resulting in a right-to-left shunt. We report here a rare case of systemic to pulmonary venous shunt on both hemithoraces in superior vena cava obstruction associated with Budd-Chiari syndrome due to coagulopathy which was diagnosed by multidetector computed tomography angiography.

Comparison of a low-osmolar contrast medium, iopamidol, and an iso-osmolar contrast medium, iodixanol, in MDCT coronary angiography.

OBJECTIVE: To prospectively compare iopamidol 370, which is a low-osmolar contrast medium and iodixanol 320, which is an iso-osmolar contrast medium, in terms of image quality and nonserious adverse effects that have the potential to influence the image quality in a 16-slice multi-detector row computed tomography coronary angiography. METHODS: Sixty patients were divided into two groups to receive iodixanol 320 or iopamidol 370. Image quality was assessed, using a five-point grading scale. Differences in the mean attenuation (Hounsfield units) at the origin of the coronary arteries and on the ascending aorta in both the groups were compared. The number and intensity of adverse effects were compared between the two groups. RESULTS: The mean attenuation values of the ascending aorta and the origins of the coronary arteries for the two groups showed no significant difference (P≥0.41). There was no significant difference in terms of image quality between the two groups on all evaluated segments. There was a statistically significant difference in the number of adverse effects (P=0.001) between the two groups. However, in both the iodixanol group and the iopamidol group, there was no significant difference in terms of image quality between the patients with and without adverse effects. CONCLUSION: The frequency of adverse effects is lower in the iodixanol group than the iopamidol group. Iodixanol 320 can provide both vascular enhancement and image quality, which is similar to iopamidol 370 in a 16-slice multi-detector row computed tomography coronary angiography. There was no significant difference in terms of overall image quality between the patients with and without adverse effects in either of the groups.

CT urography of a vesicourachal diverticulum containing calculi.

Urachal remnant disease is a relatively rare urological condition that presents a variety of clinical problems in adult patients. Contrast-enhanced multi-detector row computed tomography (MDCT) urography is a new diagnostic imaging technique providing comprehensive evaluation of the upper and lower urinary tract. MDCT urography performed with a combination of unenhanced, nephrographic phase, and excretory- phase imaging can demonstrate a wide spectrum of disease in these patients with a single study. We report a case of vesicourachal diverticulum containing calculus, which was diagnosed by MDCT urography.

Does the visceral fat tissue show better correlation with the fatty replacement of the pancreas than with BMI?

OBJECTIVE: Obesity is a risk factor of fatty replacement of the pancreas. We aimed to investigate whether there is a better correlation between the visceral fat tissue and the fatty infiltration of the pancreas than with the BMI. MATERIALS AND METHODS: One hundred-eighteen patients were visually divided into three groups according to the pattern of the fatty infiltration of the pancreas. Group 0 (n=70) has no fatty infiltration, Group 1 (n=23) has fatty infiltration on the head only, and Group 2 (n=25) has fatty infiltration on the entire pancreas. Additionally, the attenuation numbers (HU) were measured separately at the head, body and tail of the pancreas on contrast-enhanced Computed Tomography CT. The sum of the attenuation number of each part of the pancreas was calculated as the attenuation number of the pancreas. A CT-scan was used to calculate the visceral fat area (cm(2)). Correlation coefficients were determined between the visceral fat area and fatty infiltration of the pancreas and the BMI. RESULTS: The visceral fat area showed a stronger correlation with the attenuation number of the pancreas than the BMI (r=-0.552, r=-0.345 and p=0.0001, p=0.0001, respectively). The difference existed between the Groups 0 and 1 (p=0.0001) or Groups 0 and 2 (p=0.0001) in terms of visceral fat area. The difference existed only between Group 0 and Group 2 in terms of BMI (p=0.006). CONCLUSIONS: The visceral fat tissue area has a stronger correlation than the BMI in the fatty infiltration of the pancreas.