Pulmonary artery leiomyosarcoma: A clinical dilemma

Leiomyosarcomas are rare neoplasms of the smooth muscles. Primary pulmonary leiomyosarcomas, which constitute approximately 0.2%–0.5% of all primary lung malignancies, are extremely rare and highly lethal. They may originate from the smooth muscle cells of the bronchial wall, the blood vessels, or the pulmonary interstitium, and their rare occurrence, localization, and nonspecific clinical symptoms mean that correct diagnosis and proper management are often delayed. Here, we report a rapidly growing primary pulmonary leiomyosarcoma, which invaded the right atrium, vena cava superior, mediastinum, right hilar area, and left pulmonary artery within 4 months. On histopathology, a transthoracic needle biopsy of the mass confirmed leiomyosarcoma, and delayed presentation meant that there was a local spread to the neighboring structures at the time of diagnosis.

Nebivolol improves renal function in patients who underwent angioplasty due to renal artery stenosis: a pilot study

Renal artery stenosis (RAS) is a progressive disease and may lead to chronic kidney disease by deterioration of renal functions. Endothelial dysfunction is an important causative factor for kidney damage after RAS revascularization. Nebivolol, a new generation beta blocker induces endothelium-related arterial relaxation by nitric oxide (NO) and may improve endothelial dysfunction. This pilot study tested the effect of nebivolol on the glomerular filtration rate (GFR) in a series of 33 patients with severe RAS (>70%) who underwent revascularization. After revascularization, nebivolol was added to antihypertensive treatment in 17 randomly selected patients while 16 patients (control group) continued their standard treatment. Estimated glomerular filtration rate (eGFR), proteinuria as well as nitrite and nitrate levels were measured at baseline and 6 months after the revascularization procedure. Six months after revascularization, eGFR increased from 44.8 to 50.6 ml/min in the nebivolol group. In contrast, eGFR did not change in the control group. Nitrite/nitrate levels decreased to a significant extent both in the nebivolol and in the control group. Proteinuria decreased more in the nebivolol group compared to the control group. These pilot data support a full-fledged clinical trial, testing whether nebivolol may be beneficial in the post-revascularization phase in patients with RAS.

Extraperitoneal pelvic myolipoma

Myolipoma is a very rare adipocytic tumor occurring most frequently in adults, and usually is located in the retroperitoneum or abdomen. It has been described in the retroperitoneum, spinal cord, orbita, breast, round ligament, subcutaneous tissue, pericardium, rectus sheath of the abdominal wall, and abdominal cavity with attachment to the abdominal wall. Most of these tumors are discovered incidentally and are large when discovered. Radiological findings are nonspecific due to the nonlipomatous component of the tumor. We present radiological findings of a large extraperitoneal pelvic myolipoma adjacent to the anterior abdominal wall, detected incidentally in an elderly woman with a presenting complaint of intractable hiccups.

Complications of continuous ambulatory peritoneal dialysis: evaluation with CT

PURPOSE

To assess the frequency of abdominal computed tomography (CT) findings of continuous ambulatory peritoneal dialysis (CAPD)-related complications.

MATERIALS AND METHODS

CT examinations of 42 patients (23 females and 19 males; median age, 46.5 years; age range, 22-70 years) with end-stage renal disease receiving CAPD were investigated retrospectively. CT examinations were performed with a suspicion of CAPD-related complications who were admitted to dialysis unit with various complaints. Images were obtained from the level of the dome of the diaphragm to the pelvis with an 8-mm slice thickness before and after intravenous contrast injection. Oral contrast material was performed in 17 of these patients. CT peritoneography was performed in one patient.

RESULTS

Complications of CAPD detected on CT studies included peritoneal thickening (n = 19; 45.7%), peritoneal calcifications (n = 2; 4.7%), peritoneal enhancement (n = 2; 4.7%); intraperitoneal loculation of fluids (n = 16; 38.1%), dilatation of bowels secondary to adhesions (n = 3; 7.1%); leakage of dialysis fluid adjacent to the entry site of the CAPD catheter (n = 6; 14.3%)(leaked dialysis fluid was loculated near the catheter in 4 of these patients); abscesses (n = 3; 7.1%); hernias (n = 5; 11.9%); hematomas (n = 5; 11.9%); tuberculous lymphadenitis (n = 2; 4.7%); bowel perforation (n = 2; 4.7%); ischemic bowel disease (n = 1; 2.4%); acute pancreatitis (n = 2; 4.7%); and catheter malposition (n = 1; 2.4%).

CONCLUSION

CT of abdomen is useful in detection of CAPD-related complications. Peritoneal thickening and intraperitoneal loculation of fluids due to peritonitis were the most common complications of CAPD detected on abdominal CT.

Various origins of the duplicated middle cerebral artery

We describe the features of a duplicated middle cerebral artery identified by computed tomographic angiography that originates from a previously undefined origin, ie, from the petrous portion of the internal carotid artery. Recognition of this anomaly is important in patients with a possible aneurysm, which was not present in our patient.

Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis

PURPOSE

To determine the correlation between clinical and multislice computed tomography (MSCT) findings of early- and late-stage acute appendicitis.

MATERIALS AND METHODS

The study was conducted between June 2003 and February 2006 with 143 patients. Patients were divided into 3 groups according to Alvarado scores: group 1 (n = 18; 13%; score: 1-4), group 2 (n = 70; 49%; score: 5-7), and group 3 (n = 55; 38%; score: 8-10). Abdominal MSCT results were compared to histopathological diagnoses. Patients were then divided into 2 other groups according to pain onset (MSCT performed within the first 12 h of pain onset and MSCT performed thereafter).

RESULTS

Histopathological findings were normal in 13 of the 143 patients (9%). The positive predictive value of MSCT did not significantly differ between the 3 Alvarado groups (92.8% in group 1, 95.1% in group 2, and 98.0% in group 3). Additionally, the positive predictive value of MSCT did not differ whether the scans were performed within the first 12 h of pain onset or thereafter (88% and 89%, respectively; P = 0.89).

CONCLUSION

MSCT should be performed even in patients in whom the clinical suspicion of appendicitis is low. MSCT is effective in patients with early-stage appendicitis.

The effect of hypertension on the apparent diffusion coefficient values of kidneys

PURPOSE

The purpose of this study was to diagnose hypertension- induced renal microvascular dysfunction using renal diffusion magnetic resonance imaging (MRI) and to identify any correlation between blood pressure level and apparent diffusion coefficient (ADC) values.

MATERIALS AND METHODS

The study included 77 consecutive patients (41 women and 36 men). The patients were divided into 4 groups according to their blood pressure level. Group 1 consisted of normotensive control patients; group 2, pre-hypertensive patients; group 3, stage 1 hypertensive patients; and group 4, stage 2 hypertensive patients. All patients underwent transverse diffusion-weighted multi-section echo-planar MRI. In the transverse ADC maps, rectangular regions of interest were placed in the cortex at 3 sites (upper, middle, and lower pole) of each kidney. The ADCs of the kidneys were calculated separately for low, average, and high b values to enable the differentiation of the relative influence of the perfusion fraction and true diffusion. In addition, a multi-slab balanced turbo field-echo magnetic resonance angiographic technique (without the use of a contrast agent) was used to exclude renal artery stenosis.

RESULTS

There was no statistically significant difference between the groups in age, and no significant correlation between the ADC values of both kidneys and blood pressure level in each group (P > 0.05). In addition, the ADC values of patients with microalbuminuria did not differ from those of the other patients (P > 0.05). CONCLUSION Despite the end-organ damage caused by hypertension, renal microvascular functions were preserved and hypertension did not affect ADC values.

Perforated ileal diverticulitis: CT findings

Diverticulosis of the ileum is very uncommon. The differential diagnosis for any inflammatory process in the right lower quadrant of the abdomen includes appendicitis, Crohn's disease, and other infectious and inflammatory conditions of the terminal ileum and cecum. Diagnosis of small bowel diverticulitis is based on radiological findings, and computed tomography is the method of choice to demonstrate mural changes and the mesenteric extent of the inflammation. Preoperative knowledge of this condition may influence surgical and medical management.

Computed tomography volumetric follow-up of graft volume in living related liver recipients

AIM

Liver regeneration is a fascinating process that makes living related donor transplantation feasible for patients. In this study we evaluated the changes in graft volumes among living related liver transplantation (LRLT) patients using computerized tomography (CT)-assisted volumetry technique.

MATERIALS AND METHODS

Thirty three patients (17 adults, 16 children) who underwent liver transplantation were included in this study. Pediatric patients were referred to as group A, and adult patients were referred to as group B. The initial graft weight measured during operation was used as the initial graft volume. All patients' graft volumes were retrospectively calculated by CT volumetry technique. The data was compared with the initial graft volume in each patient. Paired samples Student t test was used for statistical analyses.

RESULTS

The graft volume increased from 2.7% to 285.6% with the mean increase 78% in group A, and 10.5% to 150.8% with a mean increase of 89% in group B. These changes were significant (P<.0001) in both groups.

DISCUSSION

The liver regeneration of recipient grafts is more complicated than that of the donors. There are a limited number of reports of complete volume recovery. We observed significant volume regeneration in liver grafts after transplantation, which was easily followed by CT-assisted volumetry.

Treatment of pelvic aneurysmal bone cysts in two children: selective arterial embolization as an adjunct to curettage and bone grafting

Treatment options of aneurysmal bone cysts include complete resection, curettage, curettage with bone grafting, selective arterial embolization (as a primary treatment or preoperative adjuvant therapy), and percutaneous injection of fibrosing agent. Treatment in pelvic locations is difficult because of the relative inaccessibility of the lesions, the proximity of the lesions to neurovascular structures, and the vulnerability of the acetabulum. Herein, we present 2 pediatric cases of pelvic aneurysmal bone cysts successfully treated with curettage with bone grafting following preoperative selective arterial embolization.

Six cases of Forestier syndrome, a rare cause of dysphagia

Dysphagia is a common presenting complaint in otolaryngology practice, and there are many causes. Forestier syndrome is a rare cause of dysphagia. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) syndrome or vertebral ankylosing hyperostosis. Forestier syndrome consists of anterolateral perivertebral ligament calcification. It was first described by Forestier and Rotes-Querol in 1950; diagnosis is primarily radiological and the etiology is unknown. In addition to dysphagia Forestier syndrome has been reported to cause laryngeal stridor, dyspnea, snoring and hoarseness. Other important symptoms associated with Forestier syndrome are stiffness and pain in the back, pain related to tendinitis, myelopathy related to core compression associated with the ossification of the posterior longitudinal ligament, and pain related to vertebral complications such as fracture or subluxation. We report six cases of Forestier syndrome as an etiologic factor in dysphagia and present clinical and radiological findings.

MR imaging and ultrasound of fetal cervical cystic lymphangioma: utility in antepartum treatment planning

We present a case of fetal cystic lymphangioma that was initially diagnosed by ultrasonography and further evaluated by prenatal MR imaging. MR imaging findings aided in improved delineation of the neck mass. T2-weighted MR images revealed partial compression of the airway by the neck mass. This information was useful in the decision to use ex utero intrapartum treatment (EXIT) and helped surgeons in planning their approach to establish airway control during delivery.

[Case report: Direct percutaneous placement of tunneled hemodialysis catheter into the inferior vena cava in a patient with dialysis access problem]

The paired hemodialysis catheters were inserted into the inferior vena cava (IVC) via translumbar approach in a 48-year-old man for lack of other suitable access. The catheter tip was thrombosed 2 months after the procedure. After local streptokinase infusion, control venogram showed resolution of the thrombus. Translumbar catheterization of the IVC is a safe and effective way in patients with thrombosed central venous access.