The Radiologic Evaluation of Pediatric Acute Abdomen; Results of Tertiary Referral Center

Purpose: In this study we aimed to evaluate the radiological examinations of the pediatric patients who were operated with initial diagnosis of acute abdomen. Methods: We retrospectively reviewed the clinical records and imaging findings of 252 children. All patients were evaluated by plain abdominal radiographs (PAX) and ultrasonography (US). Only 10 patients were examined using computed tomography (CT). The findings of the PAX, US and CT of each patient were determined from their detailed archive records according to their clinical diagnosis. Results: The most frequent pathology was appendicitis in our study whereas the other pathologies were invagination, ovarian torsion, the complications of Meckel’s diverticulum, gastrointestinal obstruction and tuboovarian abscess in decreasing frequency. PAXs were valuable in diagnosis of the patients with ileus. It has been showed that US was the most useful for patients with appendicitis and invagination. CT was performed only in 4% of our cases as an advanced diagnostic method. Conclusion: The pediatric patients with acute abdomen have been evaluated radiologically by PAX and US routinely and frequently. CT was performed as an advanced diagnostic method very rarely. CT would be utilized to a lower extent as a more advanced method of imaging in unsolved patient group, as US and PAX solve the pediatric acute abdominal pathologies in high percentages

Yüksek pozitif ekspiryum sonu basıncı nedeniyle oluşan pnömomediyastinum olgusu

A 26-year-old female patient, who presented to the emergency department with chronic renal failure, general condition disturbance and dyspnea, was intubated due to low oxygen saturation. The results of the blood biochemical test were normal except for low saturation. Our case did not have any coronary artery disease or obstructive pulmonary disease. While she was undergoing the positive end-expiratory pressure (PEEP) treatment in the intensive care unit, the patient was detected to have right heart failure on her echocardiogram examination and pneumomediastinum was found on her direct radiography examination and on chest x-ray and computed tomography (CT) on the 2nd day of her hospitalization. The development of pneumomediastinum associated with PEEP for low saturation appears to be a rare phenomenon. In accompany with the findings of the case, the examination data and the literature information were prepared as a case report.Kronik böbrek yetmezliği, genel durum bozukluğu ve solunum sıkıntısı ile acil servise başvuran 26 yaşındaki kadın hasta satürasyon problemi nedeniyle entübe edildi. Satürasyon düşüklüğü dışında genel kan biyokimyasında belirgin patoloji ayırt edilmedi. Olguda koroner arter hastalığı ya da kronik obstruktif akciğer hastalığı yoktu. Yoğun bakımda, pozitif ekspiryum sonu basınç (PEEP) tedavisi altındayken, ekokardiyografi (EKO) tetkikinde olgunun sağ kalp yetmezliği olduğu ve direkt grafi tetkikinde, yatışının 2. gününde akciğer grafisinde ve bilgisayarlı tomografi (BT) tetkikinde pnömomediyastinum tespit edildi. Düşük saturasyon için yapılan pozitif expirium sonu basınç (PEEP) tedavisi altında iken pnömomediastinum gelişmesi nadir bir durumdur. Olgunun bulguları eşliğinde tetkik verileri ve literatür bilgisi olgu sunumu olarak hazırlandı

Osteopetrosis: A Case Report

Osteopetrozis literatürde "taş kemik" veya "mermer kemik" veya "Albers Schonberg hastalığı" olarak geçmektedir. Çok nadir ve kalıtsal bir hastalıktır. Osteopetrozisde kemik formasyonunu sağlayan osteoblastlar ile kemik rezorbsiyonundan sorumlu osteoklastlar arasındaki dengenin bozulması söz konusudur. Osteopetrozis tanısı ile izlenen 8 yaşındaki kız hasta sol bacak ağrısı nedeniyle hastanemize başvurmuştur. Hastanemizde çocuk hematoloji polikliniğinde anemi nedeniyle takip edilen hasta öksürük, kalçada ve bacakta ağrı, halsizlik gibi şikayetlerle bir çok kez yatışı yapılmış ve bu esnada elde olunan direk grafileri osteopetrozis tanılı olgunun kemik tutulum radyolojik bulguları sunulmuştur. Ayrıca anemi, trombositopeni ve hepatosplenomegalisi bulunan olgumuz çocuk hematoloji polikliniğinde takipli olup zaman zaman kan transfüzyonu yapılmaktadır. Çoğu zaman başka nedenlerle çekilen direkt grafilerde sklerotik kemik değişikliklerinin fark edilmesi osteopetrozisi düşündürür. Radyolojik görünümlere ek olarak anemi, hepatosplenomegali ve/veya görme kaybı varlığında tanı yüksek olasılıkla konabilir. Yenidoğanlarda osteoskleroz yanında kemik uçlarında genişleme de meydana gelir. Bulguların yenidoğan döneminden itibaren ortaya çıkması nedeniyle osteopetrozisin otozomal resesif (OR) olarak kalıtılan ağır şekli olabileceği düşünüldü. Sonuç olarak, yenidoğan döneminde anemi, trombositopeni, hepatosplenomegali gibi sık rastlanan ve özgün olmayan bulgular saptanan bebeklerde ayırıcı tanıda osteopetrozisin de düşünülmesi gerektiği akılda tutulmalı ve bu bebeklere erken dönemde kemik iliği transplantasyonu şansı verilmelidirOsteopetrosis, also called as "marble bone", "stone bone" or "Albers-Schönberg disease" is a very rare hereditary entity. In this disease, the balance between boneforming osteoblasts and bone resorbing osteoclasts is altered. Our patient was an 8-year-old girl who was diagnosed with osteopetrosis and followed by the pediatric hematology department. She has been referred to our hospital several times with the complaints of cough, fatigue and hip and leg pain. X-ray examinations showed typical signs of osteopetrosis. The patient also had anemia, thrombocytopenia and hepatosplenomegaly and received blood transfusions several times. In these patients, usually the sign of sclerotic bone detected by x-ray establishes the diagnosis. Our patient had anemia, hepatosplenomegaly and loss of vision in addition to the typical radiologic signs. In newborns, the diagnosis of osteopetrosis can be established if osteosclerosis is associated with widening of the long bones. Since the signs were prominent in the newborn period, our patient was assumed to have autosomal recessive (OR) form of the disease which has a poorer prognosis. In conclusion, anemia, thrombocytopenia, and hepatosplenomegaly, which are common, but are not specific signs, must suggest osteopetrosis when sclerosis of bone accompanies and, the child must be given a chance for bone marrow transplantatio

Radiologic Approach in the Rotation Problems of Lower Extremity

Alt ekstremitenin rotasyonu, morfolojik değişikliklerden deformiteye kadar uzanan geniş bir spektrumdur. Çocukluk çağındaki alt ekstremite hastalıkları arasında, pes planustan sonra ikinci sıklıkta görülen antite multifaktoryel özellikteki rotasyonel sorunlardır. Bu derlemede, bu sorunlarda kullanılan radyolojik yöntemleri, örnek olgular ve tıbbi literatürle tartıştık. Farklı görüntüleme yöntemleri ve olguların klinik yönetimindeki farklılıklar nedeni ile radyolojik standardizasyon güçtür. Bu derlemede amacımız, kendi deneyimlerimizle birlikte en sık kullanılan yaklaşımları, astebular anteversiyonu, femoral ve tibial torsiyonu, patellofemoral uyumu anlatmaktır.The rotation of the lower extremities involves a broad spectrum of varieties from deformities to morphological differentiations. The rotational problems are the second most common entity after pes planus among the lower extremity diseases of childhood. Lower extremity problems are multifactorial. In this review the radiological methods used for imaging of common causes are discussed through representative case, considering the literature. Because of the varying clinical manangements and several different imaging methods, radiological standardization is very difficult. In this review, we aimed to provide contribution to this challenging issue by adressing the most common approaches and our experiences. Regarding the terminology and evaluation of acetabular anteversion, femoral torsion, patello-femoral adjustment and tibial torsion

Ewing's sarcoma metastasis into the breast

The metastasis of extramammary malignancies into the breast is very unusual. Lymphoma, malignant melanoma, and rhabdomyosarcoma are the most common tumors that metastasize into breast tissue. The histological spectrum of breast masses in children and adolescents is different from that of adults. Imaging findings are useful for performing a diagnosis, but in a patient with a known malignancy, any enlarging breast mass, even one with a benign radiological appearance, should be investigated with a biopsy. In this article, we present the imaging findings of a 12-year-old female patient with breast metastasis of Ewing's sarcoma