Comparison of kidney densities of cases with urinary dilatation in unenhanced CT scan

Purpose: The aim of this study was to investigate the diagnostic value of renal parenchymal density differences in distinguishing between acute and chronic urinary dilatations. Material and methods: Retrospectively, unenhanced CTs of 98 patients were evaluated. Thirty-three had acute urinary obstruction, and 33 had chronic urinary obstruction. Parenchymal density values (HU) and renal pelvic anterior-osterior (AP) diameters of all groups were evaluated by two different radiologists who were unaware of each other and the content of the study. The t-test was used to compare parenchymal densities and renal pelvic diameter differences with normal, acute urinary dilation and chronic urinary dilation groups. Results: Of the 98 cases who were included in the study, 33 people were in the acute obstruction group (7 females, 26 males), and 33 were in the chronic obstruction group. However, the second observer (observer 2) found a statistically significant difference (p < 0.01) during the measurements of density between the obstructed and normal sides. While for the first observer (observer 1), the correlation between right and left renal density measurements of the normal cases was moderate at 0.576; correlation of measurements done by the second observer was found to be high at 0.777. Conclusions: Pale kidney findings seems to be helpful in diagnosis of acute urinary occlusion, but different results are obtained with evaluations made by different observers. Moreover, it is not a specific finding because oedema can also be seen in some other conditions, such as acute pyelonephritis; for this reason, one must be careful during the evaluation of this finding

The accuracy of 3T magnetic resonance cholangiopancreatography in suspected choledocholithiasis

Purpose: The purpose of this study was to investigate interobserver agreement during magnetic resonance cholangiopancreatography (MRCP) evaluation and the sensitivity and specificity of MRCP obtained with 3T scanners in cases of bile duct obstruction. Material and methods: A total of 37 patients who had MRCP and endoscopic retrograde cholangiography (ERCP) were included. Choledochal pathology was divided into two groups regarding the presence of stones as "there is stone or not". MRCPs were performed with a 3-Tesla system using respiratory triggered HASTE technique in axial and coronal planes and with T2 SPACE sequence in the coronal plane. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated separately for each observer. The average of both observers was calculated for comparison with other studies. Results: Thirty-seven patients were in the study population. Agreement between the observers was analysed, and Cohen's κ value was evaluated as 0.84. For two observers, the sensitivity of MRCP was 93%, whereas the specificity was 75% for the first observer and 62% for the second. Conclusions: In this study we found a high level of interobserver agreement in evaluating MRCP. MRCP has a high sensitivity in detecting choledocholithiasis

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion

PURPOSE:We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS:This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS:According to Light’s criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4–33) was significantly higher than that of the transudates (median, 5; range, 2–15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION:CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation

Tümoral volume effect on survival in renal cell carcinoma patient

AMAÇ: Çalışmamızın amacı tümör hacminin BHK'li hastalarda sağkalıma olan etkisinin ve diğer prognostik belirteçlerle ilişkisinin araştırılmasıdır. GEREÇ VE YÖNTEM: Dokuz Eylül Üniversitesi Tıp Fakültesi (DEÜTF) Uygulama ve Araştırma Hastanesi'nde, Ocak 2002 - Ocak 2009 yılları arasında böbrek hücreli kanser (BHK) tanısı alan ve opere olan toplam 46 hasta retrospektif olarak değerlendirilmiştir. Bu incelemelerde hastaların demografik özellikleri (yaş, cinsiyet), klinik özellikleri (başvuru yakınması, tümörün bulunduğu yön, operasyon türü, metastaz, evre, ölüm), tümörün patolojik özellikleri (hücre tipi, Fuhrman derecesi, patoloji boyutu, perirenal yağ invazyonu, sinüs yağ invazyonu, adrenal invazyon, renal ven invazyonu, mikrovasküler invazyon) ve radyolojik özellikleri (tümör boyutu, tümör hacmi, perirenal heterojenite, perirenal vasküler heterojenite, tümör nekrozu ve tümör kontrastlanması) değerlendirildi.Hastaların yaşam süreleri belirlendi, kümülatif sağkalım oranları hesaplandı ve parametrelere göre yaşam eğrileri karşılaştırıldı. Yaşamı etkileyen birden fazla parametre arasından sağkalım üzerine etkisi olan bağımsız değişkenler araştırıldı. BULGULAR: Tümör hacminin 110 cm³'ün olması ile beraber perinefrik yağ, adrenal, renal ven ve mikrovasküler invazyon belirgin şekilde artmaktadır. Metastatik ve yüksek histolojik dereceli gruptaki hastalarda tümör hacmi anlamlı olarak 110 cm³'ün üzerindedir. Tümör hacmi, boyutu, klinik evre, metastaz, perinefrik yağ invazyonu, sinüs yağ invazyonu ve adrenal invazyon hastalığın prognozu ile ilgili anlamlı parametrelerdir ancak hiçbiri bağımsız prognostik faktör olarak bulunmamıştır. Bu seride genel sağkalımı belirleyen en önemli bağımsız prognostik faktörler Fuhrman derecesi ve T evresidir. SONUÇ: Tümör hacmi, BHK'li hastalarda sağkalımı üzerinde etkin bir faktördür ancak tek başına bağımsız bir etmen olarak bulunmamıştır. PURPOSE: The aim of the study is to evaluate the effect of tumor volume on the outcomes of patients with RCC and other prognostic factors. MATHERIALS AND METHODS: We evaluate 46 patients with renal cell carcinoma (RCC) who got surgery between January 2002 and January 2009 in University of 9 Eylul Medicine School. In this study, demographic characteristics of patients (age, gender), clinical features (symptoms at the beginning, the localization of tumor, surgery type, metastases, stage and death), the pathologic features of tumor (type of the cells, Furhman grade, pathologic size, perinephric fat involvement, sinus fat involvement, adrenal gland invasion, microvascular invasion), radiological features (size of tumor, tumor volume, perirenal heterogeneities, perirenal vascular heterogeneities, tumor necrosis, contrast accumulation in the tumor) are evaluated. We determined the survey for the patients. Cumulative survival ratios are calculated and survey graphics are compared according to the parameters. Independent variable factors which affect survey among the other parameters are searched. RESULTS: When the tumor volume is 110 cm³, we found that perinephric fat involvement, renal vein invasion, adrenal gland invasion, microvascular invasion increased clearly. Tumor volume of the patients who have metastasis and who have high histological grade, was over 110 cm³. Tumor volume, tumor size, clinical stage, metastasis, perinephric fat involvement, sinus fat involvement and adrenal gland invasion are related parameters with prognosis, however none of them are found as an independent prognostic factor. In these series, the most important independent factors which affect general survey are Furhman grade and T stage. CONCLUSIONS: The volume of tumor is an affective factor on the survey of the patient with RCC, but it was not found as an unique independent factor

Focal myositis: a rare case report

Focal myositis is an uncommon, self-limiting, benign skeletal muscle disease, which is generally determined as an inflammatory pseudotumor. The etiology is not fully known, although it has been suggested that subclinical damage may play a role. As it leads to a tumoral mass it may be confused with several diseases leading to incorrect evaluations. Definitive diagnosis is made by biopsy of the skeletal muscle. In radiologic diagnosis, magnetic resonance imaging is the most important modality. In this paper we presented the imaging findings of a 58-year-old female patient with focal myositis who was admitted with complaints of forearm swelling

Cutaneous Sinus Formation Is a Rare Complication of Thyroid Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy (FNAB) is essential in the diagnosis and management of thyroid nodules. In this paper, we report a rare complication, cutaneous sinus formation, after diagnostic FNAB guided by palpation. Sixty-three-year-old female patient was admitted with the complaints of hoarseness and discharge from the anterior neck wall which were present for the last 6 months. The patient underwent a near total thyroidectomy 17 years ago. Recurrent nodular goiter was detected six months before and a diagnostic FNAB guided by palpation was performed. Two weeks later the patient had wound discharge and hoarseness. Physical examination of the patient revealed a sinus, which was located superior to the thyroidectomy incision. A 1 cm nodule was palpated in the left side of her neck. A cervical ultrasonography (USG) showed a 9 × 7 mm nodule in the remnant thyroid and a 9.5 × 3.5 mm fistulized fluid collection. The patient underwent sinus tract and remnant thyroid removal. This case report presents a cutaneous sinus formation deriving from the granulation tissue, probably due to the silk suture reaction in the previous surgery, by the FNAB guided by palpation procedure. We suggest USG guided FNAB to achieve more accurate and safe diagnosis in evaluating the thyroid nodules