Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed

Papillary Thyroid Carcinoma with Lung Metastasis Arising from Dyshormonogenetic Goiter: A Case Report

Prior radiation exposure is the best known risk factor for thyroid cancers, and papillary thyroid carcinoma (PTC) may arise from dyshormonogenetic goiter. A 17-year-old female patient was admitted to the department of chest diseases with respiratory symptoms. The patient had undergone a thyroid surgery for goiter at the age of 9. A bilateral nodular opacity was detected by radiological examination. The histopathologic examination of the specimen obtained from computed tomography guided trucut biopsy was diagnosed as PTC. We present a very rare case of PTC with lung metastasis that had undergone subtotal thyroidectomy due to dyshormonogenetic goiter eight years ago

İncisional endometrioma mimicking a malignant mass: report of two cases

Endometriozis dogurganlık çagındaki kadınlarda sık görülen klinik bir problemdir. Insizyon yerlesimli endometriomaya ise nadir rastlanır. Hastalarda genellikle sezaryen veya histerektomi gibi ameliyat öyküsü vardır. Endometriomayı olusturan dokudan malignite gelisebildigi bildirilmistir. Jinekolojik bir patoloji olmasına ragmen insizyonel herni ya da karın duvarı tümörleri gibi bulgu verebilmekte ve bu nedenle hastalar genellikle genel cerrahi polikliniklerine basvurmaktadırlar. Biz bu çalısmada dogurganlık çagında olan ve daha önce sezaryen ameliyatı öyküsü bulunan, klinik ve laboratuar olarak malignite süphesi tasıyan iki olguyu sunduk. Tedavide sezaryen skarındaki kitlelere genis eksizyon yapıldı ve olusan fasya defekti primer onarıldı. Patolojik inceleme sonucu kitlelerin endometrium dokusuna sahip endometrioma oldugu saptandı.Endometriosis is a common clinical problem of the child-bearing women. Incisional endometrioma is very rare. Patients frequently presented with a history of previous gynecological surgery such as cesarean section or hysterectomy. Although being a gynecological disorder, it may seem like an incisional hernia or abdominal wall tumor. Therefore, it is frequently referred to general surgery outpatient clinics. Here, we report two cases with previous histories of cesarean sections and questinable clinical and laboratory findings of malignancy. The masses located on the previous incision scars were excised widely, and pathological examination of surgical specimens revealed the diagnosis of endometrioma in both cases

Katatere bağlı inatçı sol ana koroner arter spazmı

Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2).Fifty one year old female patient was taken into the catheter laboratory for coronary angiography with the diagnosis of typical angina pectoris (CCS Class 2). A 6F JL4 Judkins catheter was placed into the left coronary artery.Immediately after sitting into the left main artery, damping in the pressure tracing was seen and catheter was removed from left main coronary artery (Figure 1). There was a 90% stenosis in the left coronary artery ostium which was seen in the non selectively taken image. LAD and Cx were seemed to be normal. 200 micrograms of nitroglycerin was non selectively administered for the possibility of left coronay artery spasm. 5F JL4 catheter was placed into the left coronary system very delicately. Because damping in the pressure recording recurred, catheter was removed. After administrating 200 micrograms of nitroglycerin a 5F JL4 catheter with two side holes was placed delicately. The procedure was terminated because of the pressure damping and chest pain. RCA was seen to be normal. After taken into the coronary unit, beta blocker therapy was switched to calcium channel blocker therapy and 24 hours of intravenous nitroglycerine infusion was administered. A multislice CT was planned to evaluate the suspected lesion in the left main coronary ostium. In the MSCT was reported that left main coronary ostium was normal and patient was treated medically (Figure 2). The patients with left main coronary lesions are the most risky patients in terms of complication. Therefore, pressure damping should be evaluated immediately after placing into the left coronary system. Damping is entity which is often seen in patients with severe left coronary lesions. Another finding suggestive of severe left main lesion is that no reflux of radiocontrast agent into the aorta is seen. In patients with no other obstructive lesions in the other coronary vessels before preceding to the diagnosis of "isolated coronary ostial lesion", the possibility of catheter induced coronary spasm should be evaluated.This spasm can persist, as occurred in our case, even after recurrent nitroglycerin administration and attempts for placing into the left system with delicate maneuvers and smaller catheters. Multislice CT should be kept in mind to evaluate the left coronary ostium in these group of patients.MSCT is an assisting imaging modality for diagnosis in these group of patients (1,2)

On yedi yaşındaki kız hastada sigmoid volvulus : Tanıyı düşünmek

Sigmoid volvulus genç erişkinlerde oldukça nadir görülen bir hastalıktır. Bu durum tanı ve tedavi girişimlerinde gecikmeye neden olarak kolonda hayatı tehdit eden iskemi ve nekroz gelişmesine yol açabilir. Bu yazıda giderek artan karın ağrısı, konstipasyon, obstipasyon ve distansiyon şikayetleriyle acil servise başvuran 17 yaşındaki genç kız hastada sigmoid volvulus tanısından şüphelenilerek yapılan tomografik incelemede tanısı doğrulanan olguyu sunduk. Tanıdaki en önemli adım karın ağrısı, konstipasyon, distansiyon gibi şikayetlerle başvuran hastalarda ayrıntılı bir öykü, fizik muayene ve uygun laboratuar testlerinin incelenmesi ile hekimin tanıdan şüphelenmesidir. Genç hastalarda erken tanıya götürecek en önemli yol öncelikle tanının akılda bulundurulmasıdır. Böylece tanıyı doğrulayacak ileri radyolojik ve endoskopik incelemelerin zaman kaybedilmeden planlanması mümkün olacaktır.Sigmoid volvulus is an extremely rare disease among young adults. This may cause delay in diagnosis and treatment and so it may cause life threatening ischemia and necrosis at the colon. In this article we present the case which was confirmed to be sigmoid volvulus with tomographic examinations which was carried upon suspicion of sigmoid volvulus in a 17 years old girl who attended with increasing abdominal pain, constipation, obstipation and distention complaints. Taking a detailed history, performing a physical examination and evaluation of laboratory tests of a patient presenting with complaints like abdominal pain, constipation and distention are the most essential steps to diagnose the sigmoid volvulus. The most important method for early diagnosis in young adults is to keep the diagnosis in mind. So it would be possible to plan advanced radiologic and endoscopic examinations which would confirm the diagnosis

Bruselloza bağlı gelişen epidural abse ile ilişkili spondilodiskit

Spondylodiskitis with epidural abscess due to brucellosis is very rare and serious complication, and it may result in neurological deficits. Here, we report a 29 year-old male patient with brucellosis causing spondylodiskitis and spinal epidural abscess resulting in neurological deficits such as paresis. Surgical therapy is the main approach in the treatment of the abscess. However, the patient did not accept the surgery. Therefore, initial drug combination therapy (doxycycline and rifampicin) was changed to another therapeutic protocol (streptomy- cin and doxycycline and rifampicin), and the treatment period was extended to three months. He was completely cured in aspect of the disorder and complications. In conclusion, brucellar spinal epidural abscesses are a rare complication of brucellosis. In contrast to the high morbidity and mortality rates reported in pyogenic or tuberculo- sis abscess, brucellosis with epidural abscess has a good prognosis with early diagnosis and appropriate treatment.Bruselloza bağlı spondilodiskitle birlikte görülen epidural abse nörolojik defisite de neden olabilen çok nadir bir komplikasyondur. Burada bruselloz nedeniyle spondilodiskitle birlikte epidural abse ve buna bağlı parezisi olan, 29 yaşında erkek hasta sunuldu. Cerrahi tedavi abselerde temel tedavi yaklaşımı olmasına rağmen hasta cerrahi tedaviyi kabul etmedi. Bu nedenle hastaya daha önce başlanan kombinasyon tedavisi (doksisiklin ve rifampisin) değiştirilerek diğer bir tedavi protokolüne (streptomisin + doksisiklin + rifampisin) geçildi ve tedavi süresi 3 aya uzatıldı. Hastanın bruselloz ve komplikasyonu tam olarak tedavi edildi. Sonuç olarak, pyojenik ve tuberküloz abselerinde yüksek morbidite ve mortalite bildirilmesine rağmen bruselloza bağlı epidural abselerde erken tanı ve uygun tedavi iyi prognoza sahiptir

Video mediastinoscopy : university first experience

Göğüs cerrahisi pratiğinde mediastinoskopi vazgeçilmezdir. Bu sebeple uzmanlık eğitiminde önemli bir yer tutar. Bizde kliniğimizde ilk kez videomedastinoskopiyi kullandık. Video- mediastinoskopi sırasında işlemin bütün cerrahi ekip tarafın- dan izlenmesinin yanı sıra arter ven yapılarının daha net ayırt edilmesi avantaj sağlamıştır. Bu açıdan özellikle asistan eği- timi veren hastaneler için videomediastinoskopi önerilebilir.Mediastinoscopy is indispensable in the practice of thoracic surgery and thus it plays an important role in training special- ists. We used videomediastinoscopy for the first time in our clinic. All surgical teams could watch the process; videomedias- tinoscopy provided an advantage in distinguishing the artery and vein structures. In this aspect, videomediastinoscopy is particularly recommended for assistant training hospitals

Primary pulmonary adenoid cystic carcinoma located at the end of the terminal bronchiolus : Case repo

Pulmonar adenoid kistik karsinoma genellikle trakea ve ana bronş gibi merkezi hava yollarında yerleşik, tükrük bezi tipinde, nadir bir malign solunum yolu tümörüdür. Periferal akciğerden kaynaklanan adenoid kistik karsinoma oldukça enderdir. Burada, 52 yaşında bir kadının sağ akciğer alt lobu terminal bronşiyol distalinde gelişmiş adenoid kistik karsinomayı rapor ettik.Pulmonary adenoid cystic carcinoma is a rare salivary gland-type malignant neoplasm of respiratory tract that is usually located in the central airways such as trachea and main bronchus. Adenoid cystic carcinoma arising from the peripheral lung is quite rare. Here, we report adenoid cystic carcinoma that developed at the end of the terminal bronchiol of the right lung lower lobe of a 52-year-old woman

Ectopic kidneys and congenital variations of their vasculatures

Amaç: Böbrek ektopilerinde damar anomalilerine sıklıkla rastlanılır. Multiple detector-row computerized tomography angiography (MDCTA), üriner sistem ve böbrek damarlarının değerlendirilmesinde günümüzde artan bir yere sahiptir. Bu çalışmamızda amacımız ektopik böbrekteki damar varyasyonlarını MDCTA kullanarak ortaya koymaktır. Gereç ve Yöntem: Hastanemize 2009 ila 2011 arasında altı ektopik böbrek hastası araştırıldı. MDCTA, dört erişkin hastaya hipertansiyon nedeniyle, bir böbrek taşı olan erişkin hastaya nefrektomi öncesi, bir çocuk hastaya ise diafram hernisi operasyon öncesi yapıldı. Bulgular: Altı hastanın 12 böbreğinin 20 renal arteri araştırıldı. İki vakanın birinin sol böbreğinde dört, diğerinde üç renal arter saptandı. Üçü ektopik biri normal olan dört böbrekte, bir ana bir de aksesuar arter saptandı. 17 ven inferior vena cava’ya, sol böbrekten çıkan bir ven sol common iliac vene, 2 sağ böbrek veni sol renal vene dökülüyorlardı. Sonuç: Günümüzde MDCTA ektopik böbreğin damarlarını değerlendirilmesinde önem kazanmıştır.Objectives: Renal vessel anomalies are more common in renal ectopia. Multiple detector- row computerized tomography angiography (MDCTA) has become increasingly important in the evaluation of the urinary system and the renal vasculature. The aim of this study is to demonstrate the variations of vascular supply of the ectopic kidneys by using MDCTA. Material and methods: Six renal ectopic kidney cases were identified among the patients admitted to our hospital between 2009 and 2011. MDCTA was planned for four adult patients due to hypertension, for one adult patient who would undergo nephrectomy due to nephrolithiasis, and for one neonatal patient who would be operated on due to diaphragmatic hernia. Results: 20 renal arteries were identified in 12 kidneys of six patients. There were four renal arteries in a left kidney and three renal arteries in another left kidneys of two cases. There were one main and one accessory arteries in four kidneys of which three were ectopic and one was normal. There were 17 veins connected to inferior vena cava, one vein of the left kidney was connected to left common iliac vein, and two veins of the right renal vein were connected to left renal vein

Our Incidence of Diaphragmatic Hernia Detected with MDCT in the Past Two Years

Aim: Diaphragmatic hernia develops as a result of extension of the intraabdominal organs to the thorax from a diaphragmatic defect which may be either a congenital fusion defect or subsequently formed defect(iatrojenic or traumatic). The diagnosis of symptomatic or asymptomatic diaphragmatic hernia can be easily done with the cross-sectional imaging, multidetector computed tomography (MDCT) devices our aim in this study is to investigate diaphragmatic hernia incidence diagnosed by MDCT retrospectively. Methods: An experienced radiologist retrospectively evaluated MDCT results of 1000 patients to whom thorax and abdominal computed tomography was done due to chest and abdominal discomfort or trauma during the last 2 years. Results: According to our results, out of 1000 patients, 77 (7.7%) patients had different types of diaphragmatic hernia the most common herniation was hiatal hernia which was seen in 54 patients. Congenital diaphragmatic hernia (n=21) and traumatic diaphragmatic hernia (n=2) were observed also. Conclusion: Diaphragmatic hernia diagnosis could be made easily with extensive use of MDCT in which multi-planar imaging can be taken