Behçet’s disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.

British Journal of Hospital MedicineVol. 80, No. 4 Images in MedicineA giant renal artery aneurysm presenting as a calcified hydatid cystMustafa Koplay, Emine Uysal, Kazim S Kelesoglu, Kemal ÖdevMustafa KoplayCorrespondence to: Dr M Koplay (E-mail Address: [email protected])Professor, Department of Radiology, Medical Faculty, Selcuk University, 42075, Konya, TurkeySearch for more papers by this author, Emine UysalAssistant Professor, Department of Radiology, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this author, Kazim S KelesogluSpecialist, Department of Radiology, Medical Faculty, Selcuk University, Konya, TurkeySearch for more papers by this author, Kemal ÖdevProfessor, Department of Radiology, Medical Faculty, NEU University, Konya, TurkeySearch for more papers by this authorMustafa Koplay; Emine Uysal; Kazim S Kelesoglu; Kemal ÖdevPublished Online:5 Apr 2019https://doi.org/10.12968/hmed.2019.80.4.iiiAboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 April 2019Volume 80Issue 4ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 5 April 2019 Published in print 2 April 2019 Information© MA Healthcare LimitedPDF download

The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest-X- Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

Multi-detector CT (MDCT) has considerable advantage over single-detector helical CT in the form of the shorter acquisition time, greater coverage and superior image resolution. It can be used to systematically evaluate the cardiovascular anatomy, morphologic features of thoracic vessels such as aorta, systemic veins and pulmonary vessels and relationship between the upper lobe bronchi and pulmonary arteries, coronary artery, valves, systemic veins. In diffuse lung diseases, this technique can increase nodule detection and help differentiate between small nodules and vessels. MDCT with three-dimensional (3D) volume rendering provides a unique perspective on thoracic anatomy and disease. MDCT allows shorter acquisition times, greater coverage and superior image resolution. In vascular imaging, this technique provides image quality that equals or surpasses that of conventional angiography. Its use has expanded to aid in diagnosis and surgical planning. In this article we present a pictorial review of the current applications of MDCT in diseases of the thorax.

A 50-year-old woman with paralysis was admitted to our hospital. She was known to have lung neuroendocrine tumor. She had chemoradiotherapy for neuroendocrine tumor. A magnetic resonance imaging of the whole spine was performed to further evaluate her condition. Magnetic resonance imaging showed multiple hyperintense lesions on T2-weighted sequences at different levels of cervical and thoracic spinal cord (Fig. 1, Fig. 2). There was also avid enhancement of lesions on postcontrast T1-weighted images (Fig. 1, Fig. 2). Fig. 2T2-weighted (Left) and postcontrast T1-weighted (Right) ,magnetic resonance images showed the multiple thoracic intramedullary spinal cord metastasis (arrows). View Large Image Figure Viewer Download Hi-res image

Introduction The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate diagnosis and treatment of the huge mediastinal masses extending into the pleural cavity. Methods Records were reviewed for eight patients who had the diagnosis of huge benign mediastinal masses and who underwent operation; details of the patients and operations were recorded. Results Mean age was 34.5 (range 22 to 44) years, and male-to-female ratio was 2:6. Computed tomography and magnetic resonance imaging (MRI) were used to evaluate the location and extent of the abnormality and to characterize the tissue components of the mass. Most of the tumors were located in the posterior mediastinum. The most frequent presenting symptom was exertional dyspnea. The majority of cases underwent posterolateral thoracotomy, and complete resection was possible in seven patients. Partial resection could only be performed in one. The mean diameter of the resected masses was 15 × 10 cm. Histopathologic examination revealed 3 neurogenic tumors, 2 teratomas, 1 thymolipoma, and 1 ectopic thyroid, and 1 hemangioma. Minor complication was seen in two cases. Conclusion The presurgical thoracic MRI provided correct diagnosis along with radiologic characterization and topography. Surgery must be the preferred treatment in huge benign mediastinal masses.

Objective: The aim was to review the radiological findings and to find new prognostic factors that determine the need for pediatric intensive care unit (PICU) in children with swine-origin influenza (H1N1) virus infection.Methods: Chest X-ray (CXR) and computed tomography (CT) findings of 18 children with laboratory-confirmed H1N1 infection (9 boys, 9 girls) with a median age of 34 (1-216) months were retrospectively evaluated.Results: CXRs were performed in 15 (83.3%) and thorax CT in 7 (38.8%) children. Abnormal findings were detected in 60% of the patients who underwent CXR and 85.7% of the patients who underwent thorax CT. Radiological findings were mostly diffuse, bilateral, and asymmetric. Ground-glass opacity (GGO) (66.6%) was the leading abnormality and was followed by reticulation (38.8%), nodules (27.7%), consolidation only (16.6%), tree-in-bud pattern (11.1%), consolidation with GGO (5.5%), and septal lines (5.5%). Lymphadenopathy (22.2%), air trapping (5.5%), and parenchymal band (5.5%) were other recorded findings. CXR was found to be insufficient to detect subpleural nodules, lymphadenopathies, and sometimes GGO. Only existence of nodules (p=0.04) affected the need for PICU admission.Conclusion: The most common radiological findings in children with H1N1 infection were bilateral, asymmetric GGO with or without associated multifocal areas of consolidation. CXR was insufficient to detect subpleural nodules, lymphadenopathies, and sometimes GGO. The existence of nodules is a bad prognostic factor in determining the need for PICU admission.

FIG. 1. a-c.Contrast-enhanced computerized tomography showing a lesion of fat density within the superior vena cava (arrow) (a), intraluminal mass (in circle), which markedly enlarged the lumen of the superior vena cava, in contrast-enhanced magnetic resonance venography (b), perioperative view of the excised tumoral mass (c) a b c

Wegener's granulomatosis is a necrotising granulomatous vasculitis which has a variable manifestations in the chest that are best described on computed tomography. Imaging findings may include masses or nodules, which may cavitate; consolidations and ground-glass opacities. Wegener's granulomatosis can mimic pneumonia, malignancy, and noninfectious inflammatory diseases. The purpose of this pictorial essay is to demonstrate the characteristic computed tomography findings of pulmonary Wegener's granulomatosis.

Purpose We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. Materials and Methods Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectil disfunction. Results In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. Conclusions Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process

75 A 23-year-old man with an established diagnosis of Behcet disease (BD) for five years presented with cough and hemoptysis. The laboratory findings were normal with the exception of mild leukocytosis. An anteroposterior radiograph revealed multiple round lesions (Figure 1). He underwent multidetector computed tomography (MDCT) to determine the cause of hemoptysis. MDCT demonstrated multiple pulmonary artery aneurysms (PAAs) bilaterally (Figures 2A and 2B). Alveolar hemorrhage (Figure 3A) and subpleural fibroticatelectatic changes (Figure 3B) were also detected within the pulmonary parenchyma on images reconstructed using a lung algorithm. BD is a multisystem disorder first described by Hulusi Behcet in 1937. It is a vasculitis that presents with a triad of findings including recurrent ulcers of the oral and genital mucosa with relapsing uveitis. Additional clinical manifestations were later described and include involvement of the skin, joints, large vessels, lung, brain, and gastrointestinal and genitourinary tracts (1). The underlying pathological process in BD is perivascular inflammation affecting vessels of different sizes in various organs. The inflammatory process is acute and results in destruction of the walls of the affected vessels. BD can cause aneurysms that can rupture (1). The most commonly affected arteries are the aorta, the pulmonary arteries and the femoral artery. Vascular manifestations of BD in the thorax are observed in both the arterial and venous system. Venous involvement is, in fact, observed more frequently than arterial involvement. Occlusion with or without evidence of thrombosis of the superior vena cava or brachiocephalic vein are quite common and, less frequently, occlusion and/or stenosis and aneurysms of the pulmonary arteries can occur. PAA is the most common lung manifestation of BD, which is the most common cause of PAAs. Additional parencymal findings, including atelectasis, hemorrhage and infarction (focal or subpleural consolidation), have also been reported. These are commonly encountered secondary to thrombosis of the pulmonary vessels. Pneumonia, bronchitis, fibrosis, subpleural infiltrates, subpleural nodules, pleural effusion and emphysema have been described (2,3). Clinically, patients most frequently present with hemoptysis secondary to PAA. This is more commonly observed in male patients with BD.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus (EG), characterized by cystic lesions in the liver, lungs, and rarely in other parts of the body. Lungs and liver are the most frequent sites involved. Simultaneous lung and liver cysts are observed in less than 10% of the cases. Hydatid cysts are found more frequently in the lungs of children and adolescents than in their liver, while most cysts in adults are hepatic and relatively few are in the lungs. The hydatid serology results are often negative in patients with isolated pulmonary hydatidosis, and hence may not be helpful in problematic cases. Radiologic approach to the intact, complicated, or ruptured pulmonary hydatid cysts includes a CT scan following the chest radiograph. Thoracic CT may be supplemented with magnetic resonance (MR) imaging and occasionally with ultrasound (US) in clarifying a pleural-based hydatid cyst as extrapleural, pleural, or parenchymal.

Purpose: The aim of this study was to determine the relationship between chemotherapy use and the frequency of pulmonary embolism (PE) and associated mortality, clinical, and biochemical parameters. An additional aim was to analyze computed tomography pulmonary angiography findings. Materials and Methods: The study population comprised 65 of 368 consecutive patients diagnosed with PE who underwent chemotherapy in the Medical Oncology Department. The study population had cancer of various origins, including breast, colorectal, lung, gynecological, gastric and pancreatic, lymphatic, and other sites. The patients' clinical records were reviewed for leukocyte and platelet count, mean platelet volume (MPV), neutrophil to lymphocyte ratio, and level of mortality. As the parameters were normally distributed, the correlation coefficients and their significance were calculated using Pearson's test. One-way analysis of variance was used to compare the leukocyte counts among the cancer groups. A t-test was used to compare the means of the platelet and leukocyte counts between the patients. A Chi-square test was used to compare binary outcomes for categorical variables. Patients who died in the 1 st year and others (survivors and patients who died after the 1 st year) were compared using multinomial logistic regression analysis. Results: When the patients who died in the 1 st year and the survivors were compared, there was a statistically significant difference in the platelet count between the two groups. The platelet count, MPV, and leukocyte count of the patients with PE were significantly high. The leukocyte count was also significantly high in patients with breast, colorectal, lung, and gynecological cancers. Conclusion: Our results indicate that in cancer patients with PE who undergo chemotherapy, the platelet count, MPV, and leukocyte count are significantly high.

A 60-year-old patient with cirrhosis due to chronic hepatitis B was admitted to the hospital for routine controls. An ultrasonographic examination demonstrated a soft tissue mass originating from the gallbladder. A CT scan and after 3 months a dynamic liver MRI were performed for the possible diagnosis. Based on these imaging studies, laparoscopic cholecystectomy was performed. The histopathological examination diagnosed non-Hodgkin's lymphoma.

The aim of our study was to investigate the contribution of CT angiography in cases with a presumptive PTE diagnosis, evaluating lower extremity veins with CT venography and color Doppler ultrasonography (CDU) and the role of these methods at diagnosis of DVT. 46 patients with presumptive diagnosis of PTE which was confirmed with a positive CT angiography (CTA) were included in the study. Lower extremities between the iliac crest and head of femur and the popliteal region were scanned having 17-18 slices from each area, without administring extra contrast medium with a 0.8 mm slice gap. The patients underwent lower extremity CDU on the same day. Four out of 46 patients were shown to have thrombus by CDU while their CTV were normal. Two of them had an appearance of thrombus on CTV while their CDU were normal. When we consider CDU as the gold standard method, the sensitivity of CTV is calculated as 81.8% and the specificity as 91.6%. Kappa value between two modalities was calculated as 0.738 and a consistency of 87% is found. Mean radiation dose was calculated as 2.43 mSv for CTA and 0.457 mSv for CTV. With the imaging technique so-called combined CTA-indirect CTV method, DVT can be determined with moderate sensitivity and high specificity with application of low dose extra radiation.