Duplication of the inferior vena cava with azygos continuation, retroaortic left renal vein and iliac vein variations.

UNLABELLED: We present a rare complex variation of the inferior vena cava and internal iliac veins demonstrated by a multidetector computed tomography. It was shown that patient had double inferior vena cava with azygos continuation of the right inferior vena cava, retroaortic left renal vein and the left and right internal iliac veins converged and drained to the right external iliac vein through a common trunk. These variations of the inferior vena cava and iliac veins are important in the retroperitoneal surgery. We present multidetector computed tomography findings of this complex variation (Fig. 3, Ref. 12). KEYWORDS: double inferior vena cava, azygos continuation, retroaortic left renal vein, iliac vein variation, multidetector computed tomography.

Idiopathic infantile arterial calcification: prenatal diagnosis and postnatal presentation.

Idiopathic infantile arterial calcification (IIAC) is a rare disease of unknown etiology, which is characterized by arterial calcification. A 29-year-old primigravida at 33 weeks' gestation was referred for further evaluation for polyhydramniosis. An ultrasonographic examination revealed an intrauterine growth restricted fetus, pericardial effusion, increased renal cortical echogenicity with sparing of corticomedullary differentiation, and diffuse arterial calcifications involving the aorta, pulmonary artery, common iliac arteries, renal arteries, and common carotid arteries. At 35 weeks of gestation a cesarean section was performed because of fetal distress. A 1900 g male infant was delivered. Postnatal examination confirmed the diagnosis of IIAC with dysmorphic features (clinodactily and low-set ears) and normal constitutional karyotype. The baby died when he was four months old in the newborn care unit. During routine obstetric ultrasonography, the combination of polyhydramniosis and intrauterine growth restriction may necessitate examination of the major vessels for presumptive a diagnosis of IIAC.

Intracranial and subcutaneous lipoma associated with sagittal sinus fenestration and falcine sinus.

Intracranial lipomas are rare lesions. Intracranial lipoma associated with a subcutaneous lipoma is extremely rare. Various vascular abnormalities have been described in association with intracranial lipoma, including distension, kinking, or narrowing of arteries and veins; arteriovenous malformation; and aneurysm. To our knowledge, association of sagittal sinus fenestration, falcine sinus, and absent straight sinus with intraextracranial lipoma has not been reported before. We report the imaging findings of an infant with interhemispheric and subcutaneous lipoma associated with falcine sinus and sagittal sinus fenestration.

Bile duct injury complicated by bilioma after blunt liver trauma in a child.

Nonoperative management with close observation represents the standard of care for blunt liver injury, unless vital signs deteriorate or an associated injury requires emergency operation. Injuries of the biliary tract remain important concomitant lesions following liver trauma. Posttraumatic extraductal biliary collections or biliomas are rare complications of blunt abdominal traumas and only a few cases have been reported in the pediatric age group. We report a 5-year-old boy who suffered from blunt abdominal trauma that resulted in liver laceration and, eventually, bilioma formation. The patient was managed nonoperatively for liver injury. The diagnosis was confirmed by computed tomography (CT)-guided needle aspiration and percutaneous catheter drainage, which also allowed nonoperative management. The patient was symptom-free with normal liver function tests and a normal liver appearance on ultrasound examination six months after the accident. The possibility of missed bile duct injury should be considered when nonoperative management is used and close observation of the patient is necessary over a prolonged period.

Cranial Doppler ultrasonography as a predictor of neurologic sequelae in infants with bacterial meningitis.

OBJECTIVE: To perform transcranial Doppler sonography in newborns and infants with bacterial meningitis to evaluate predictive value of neurologic sequelae. MATERIALS AND METHODS: Thirty-three patients (15 newborn, 18 infant patients) with bacterial meningitis underwent cranial Doppler ultrasonography during acute phase and 3rd and 6th months after disease. Patients were examined regularly for neurologic outcome with electroencephalography and magnetic resonance imaging. The age-matched control group consisted of 20 healthy children underwent cranial Doppler sonography only. RESULTS: To compare with the healthy controls, the mean blood flow velocity was significantly increased (P < 0.001), and pulsatility index was higher than those control group (P < 0.05) during acute bacterial meningitis. None of the patients were diagnosed with stenosis of cerebral artery. According to neurologic outcome, 14 of 33 patients had neurologic sequelae. The mean cerebral blood flow was significantly higher (P < 0.01) in patients without neurologic sequelae; pulsatility index was significantly higher (P < 0.05) in patients with neurologic sequelae when compared with the healthy controls. There was no significant difference between mean cerebral blood flow velocities and mean pulsatility index values of newborn and infant patients, regarding to neurologic outcome (P < 0.05). CONCLUSION: Cranial Doppler ultrasonography is useful for prediction of neurologic sequelae in infants with bacterial meningitis.

Marfan's syndrome, dextrocardia and situs inversus associated with discrete subaortic stenosis and aortic insufficiency in an adult female: case report.

Marfan's syndrome is an inherited connective tissue defect that affects many organs, especially of the musculoskeletal, ophthalmic and cardiovascular systems, and may be associated with some rare conditions. Here, we report the first known case of Marfan's syndrome, combined with situs inversus totalis with dextrocardia and discrete subaortic stenosis and aortic insufficiency in a 22-year-old woman.

Parry-Romberg syndrome associated with Adie's pupil and radiologic findings.

We describe Adie's pupil and radiologic changes related to Parry-Romberg syndrome in a child who presented with facial hemiatrophy with no neurologic deficit. We suggest that cerebral lesions in Parry-Romberg syndrome without neurologic symptoms must be carefully investigated.

Obliteration of maxillary and sphenoid sinuses in Gaucher's disease.

Paranasal sinus obliteration is described in a patient with adult type Gaucher's disease. Plain radiographs and computed tomography showed obliteration of paranasal sinuses due to medullary expansion of surrounding bone. The mandible and maxilla are rarely affected in Gaucher's disease and obliteration of paranasal sinuses due to bony expansion has not previously been reported.

Proteus syndrome associated with liver involvement: case report.

We report a patient with proteus syndrome who has epidermal nevus, right-sided asymmetric growth of extremities, pelvis, vertebrae and hemimegalencephaly. This patient also had enlargement of the liver which is not reported before in the proteus syndrome.

Fuhrmann syndrome associated with cortical dysplasia.

We describe a male newborn with bilateral angle bowing of femora, absent fibulae, aplasia of the fingernails, hypoplastic toenails, malformed thumbs, hypospadias, inguinal hernia and cortical dysplasia in a consanguineous Turkish Family. The MCA syndrome in the present patient is similar to these reported in 3 affected sibling by Fuhrmann et al.

Fetal biometry: size and configuration of the third ventricle.

PURPOSE: To evaluate the normal configuration and size of the third ventricle in second and third trimester fetuses in a normal population, and to compare our values with those of previously published studies. MATERIAL AND METHODS: Evaluation of fetal third ventricular width and configuration was obtained by antenatal ultrasonography in 474 fetuses with gestational age between 12 weeks and term (mean 28 weeks). Percentiles for third ventricle width were estimated by combining separate fractional polynominal regression models fitted to the mean and standard deviation, assuming that the measurements had a normal distribution at each gestational age. Appearance of the third ventricle was correlated with each gestational age. RESULTS: The third ventricle could be visualized in 471 (99%) of 474 fetuses. The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. The third ventricle was seen as a single echogenic line in 153 (32.4%) of 474 fetuses. Two-hundred-and-ninety-nine (61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen. V-shaped third ventricular configuration was seen in only 28 (5.9%) of the fetuses. From 24 weeks to term, parallel echogenic lines were the most commonly (83.7% to 79.6%) encountered configuration for the third ventricle. CONCLUSION: The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. In the early second trimester, 77% of the fetuses had a single echogenic line appearance on ultrasonography. As the brain and ventricular structures mature, a parallel echogenic line becomes the prominent ultrasonography appearance (>80% of fetuses) in third trimester healthy fetuses.

Synovial hemangioma in Hoffa's fat pad (case report).

A 15-year-old girl presented with anterolateral knee pain for 6 months. There were tenderness and pain at the anterolateral triangulation of the knee joint. Magnetic resonance imaging revealed a tumor in the anterolateral corner of the knee joint. Arthroscopy did not show the tumor because it was located in fat pad. The tumor was found during fat pad shaving and was resected arthroscopically. Synovial hemangioma was demonstrated histologically. The patient is asymptomatic postoperatively.

Mesenteric involvement in neurofibromatosis type 1: CT and MRI findings in two cases.

We report computerized tomographic and magnetic resonance imaging findings of neurofibromatosis type 1 with mesenteric involvement in two patients. The first patient was a 13-year-old female with a panmesenteric plexiform neurofibroma with segmental involvement of the bowel wall; she had a 3-year history of abdominal pain. The second patient was a 60-year-old female who presented with malignant transformation of multiple mesenteric neurofibromas 4 months after primary operation.

Computed tomography evaluation of cavitary necrosis in complicated childhood pneumonia.

The purpose of the present study was to retrospectively investigate the chest radiograph (CR) and CT findings of childhood pneumonia complicated by cavitary necrosis, and to evaluate the role of CT in decision-making for surgical intervention. Chest CT was performed in 51 patients presenting with persistent or progressive pneumonia, respiratory distress and sepsis despite 7-10 days of appropriate antibiotic treatment and closed tube drainage. Chest radiograph and CT findings were retrospectively evaluated in 23 patients (45%) with cavitary necrosis. Chest radiographs showed consolidation in 19 of 23 patients, cavitation in five patients, parapneumonic effusions in 17 patients and air-fluid levels in the pleural space in one patient. The CT scans demonstrated consolidation and cavitary necrosis in all patients. There were parapneumonic effusions in all patients with concomitant loculated collections in six patients. Twenty-two of 23 patients had pleural thickening. In seven patients there were air-fluid levels in the pleural space. In five of these patients, CT scans demonstrated bronchopleural fistulae. On the basis of the CT and clinical findings, 11 patients underwent surgical intervention. Computed tomography is superior to CR for demonstrating cavitary necrosis complicating pneumonia, and other parenchymal and pleural complications. It also has a crucial decision-making role for surgery.

Multi-slice computed tomography urography after diuretic injection in children with urinary tract dilatation.

PURPOSE: To evaluate the potential use of multi-slice computed tomography urography (MSCTU) after diuretic injection in children with urinary tract dilatation. MATERIAL AND METHODS: MSCTU was performed in 19 patients (11 boys, 8 girls, mean age 5.4 years) with suspicion of urinary tract obstruction and dilatation. Furosemide, 1 mg/kg, was injected 3 min before contrast material administration and followed by a bolus of 30 ml of physiologic saline solution immediately after application of contrast material. Excretory-phase images were obtained through the abdomen and pelvis beginning 10 min after initiation of the injection of contrast material. Maximum intensity projection (MIP) and volume rendering (VR) images were post-processed to obtain urographic views. RESULTS: MSCTU revealed pathology in 16 of 19 patients, while 3 patients had normal findings. Ureteropelvic obstruction was found in 4 patients, obstructive megaureter in 8. Both ureteropelvic obstruction and obstructive megaureter were disclosed in 1 patient, partial ureteral duplication in 1 patient, and both complete ureteral duplication and ureterocele in 2 patients. In all patients, MIP and VR images could satisfactorily show the pathologies of the urinary tract. The estimated effective average doses of MSCTU were higher than IVU. CONCLUSION: Preliminary results of furosemide-enhanced MSCTU demonstrated consistently dilated urinary tracts, obstruction levels, and underlying pathologies better than US and IVU.