PURPOSE. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. MATERIALS AND METHODS. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. RESULTS. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. CONCLUSIONS. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis.
Retrosternal guatr veya intratorasik guatr, tiroid bezinin torasik kavite icerisine uzanimini ifade eden bir tanimlamadir. Lokalizasyonu itibariyle onemli kardiopulmoner semptomlara yol acabilmektedir. Bu yazida uc yil boyunca kronik obstruktif akciger hastaligi ve astim ontanilariyla medikal tedavi uygulanmis olan retrosternal guatrli bir hasta sunulmaktadir. Bu hastanin sikayetleri kismi sternotomi ilave edilerek yapilan total tiroidektomi ameliyati ile duzelmistir. Anahtar Kelimeler: Retrosternal guatr, kardiopulmoner semptomlar, Sternotomi
Background: Axial spondyloarthritis has characteristic clinical features such as enthesitis, sacroiliitis and spondylitis, and extra-articular manifestations(1). Magnetic resonance imaging (MRI) of sacroiliac (SI) joints is used to detect early sacroiliitis(2). Health institutions in our country carry out some of the radiology reporting services by outsourcing for reasons such as high cost and insufficient number of radiologists(3). Objectives: We decided to evaluate the interobserver agreement in active MRI findings of SI between radiologist of outsourcing radiology services and local/expert radiologist in musculoskeletal diseases. Methods: Between the years of 2015 and 2019, 8100 sacroiliac MRIs were taken at our center. The MRI of 1150 patients who were reported as active or chronic sacroiliitis from these sacroiliac MRIs or whose MRI was considered by the primary physician in favor of sacroiliitis was included in the study. Concordance between Evaluation and Service Procurement was examined using Kappa (k) coefficients. Mc Nemar test was used to compare the evaluation result between two observers. A p-value <0.05 was considered significant. Analyses were performed using commercial software (IBM SPSS Statistics, Version 23.0. Armonk, NY: IBM Corp.) Results: Of the 1150 patients examined in the study, 526 (45.7%) were male and 624 (54.3%) were female. The general average age is 37.20 ± 11.65 and the average age of men and women is 34.98 ± 11.19 and 39.07 ± 11.71 respectively. A statistically significant difference was found between the expert radiologists and outsourcing radiologist reports. In other words, a high level of compatibility was not found among the evaluators (p <0.001). When the consistency between expert radiologist and outsourced radiologist reports was examined, it was observed that there was a medium level of concordance (k = 0.589). Conclusion: The diagnosis of a spondyloarthropathy may be delayed for some reasons. In addition to the insidious course of the disease, being contented with an outsourced radiologist report may delay diagnosis. If the patient’s clinic and MRI report are not consistent, the patient should not be removed from follow-up. References: [1]Braun J. ‘Axial spondyloarthritis including ankylosing spondylitis’ Rheumatology (Oxford). 2018 1;57(suppl_6):vi1-vi3 [2]Jans L, Egund N, Eshed I, Sudoł-Szopińska I, Jurik AG. Sacroiliitis in Axial Spondyloarthritis: Assessing Morphology and Activity. Semin Musculoskelet Radiol. 2018;22: 180–188. [3]Quélin B, Duhamel F. Bringing Together Strategic Outsourcing and Corporate Strategy: European Management Journal. 2003. pp. 647–661. doi:10.1016/s0263-2373(03)00113-0 OUTSOURCING RADIOLOGIST REPORTS TOTAL p NOT ACTIVE SACROILIITIS ACTIVE SACROILIITIS EXPERT RADIOLOGIST REPORTS NOT ACTIVE SACROILIITIS 508 178 686 <0.001 0.589 ACTIVE SACROILIITIS 59 405 464 TOTAL 567 583 1150 Disclosure of Interests: None declared
Liver disease may lead to both reduced and increased risk of venous thromboembolism (VTE) caused by the changes in the coagulation cascade. We present a case of pulmonary embolism after the use of pegylated interferon (peg-IFN) plus ribavirin for treatment of chronic hepatitis C (CHC). Echocardiography revealed thrombus imaging in the pulmonary bifurcation zone and the patient treated successfully with thrombolytic therapy. Hemostatic work up showed no significant abnormalities. In the absence of underlying diseases and predisposing factors, drug interactions and incidental co-existence of pulmonary embolism should be kept in mind.
Placental percreta is a complication involving an abnormally deep placental attachment to the myometrium, resulting in obstetric hemorrhage and peripartum hysterectomy A 38-year-old pregnant woman, with a history of 2 Cesarean births, myomectomy 9 pregnancies, and 6 spontaneous abortions, was admitted after experiencing intrauterine fetal death, which occurred at 19 weeks gestation. The patient was referred to our institution after 8 days of unsuccessful medical treatment. Doppler ultrasonography and vacuum curettage revealed possible signs of abnormal placentation. Because of the unsuccessful separation of the placenta and massive bleeding, we used a Bakri Balloon to treat excessive bleeding during the acute phase, followed by the conservative administration of parenteral methotrexate to treat the spontaneous involution of the placenta at 7 weeks of conservative therapy Bakri Balloon and methotrexate application to treat bleeding after curettage is a useful choice in placenta percreta and hemorrhage after abortion.
Median arcuate ligament syndrome is an anatomic and clinical entity characterized by dynamic compression of the proximal celiac artery by the median arcuate ligament, which leads to postprandial epigastric pain, vomiting, and weight loss. These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. In this report, we presented a 72-year-old male patient with celiac artery compression syndrome causing recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia. This association is relatively uncommon and therefore not well determined. In addition, we reported the CT angiography findings and three-dimensional reconstructions of this rare case.
COVID-19 shows characteristic computed tomography (CT) features during its course, so CT examinations can help monitoring the course of the disease and provide timely treatment.The hallmark of COVID-19 is the bilateral presence of patchy ground glass opacities (GGO), consolidating lesions in the subpleural spaces and bronchovascular bundles with a predominantly peripheral distribution.As the disease progresses, lesions may increase rapidly and extend into central areas.During recovery from the illness, the lesions gradually regress over two weeks, causing fibrotic changes.In addition to GGOs and consolidations, many other CT findings can be seen in COVID-19 pneumonia, such as interstitial thickening, cobblestone appearance, halo sign, reverse halo sign, and airway and vascular changes.These findings and distribution patterns may help differentiate COVID-19 pneumonia from other types of pneumonia.The predominant CT pattern in COVID-19 is bilateral
Tanısal ve terapötik girişimsel işlemlerinin gerekliliğinin belirlenmesiMastitlerin en sık komplikasyonunun meme apsesi olduğunun bilinmesi Tüm meme apselerinin apse drenajı ve eş zamanlı olarak antibiyoterapi ile tedavi
Small bowel obstruction is a commonly encountered clinical condition in emergency departments. Small bowel feces sign (SBFS) is a CT finding that can be detected in small bowel obstruction. SBFs was identified in the abdominal CT examinations of four patients admitted to the emergency department with complaints of abdominal pain and vomiting. Two patients were treated by surgery and two with medication. In these cases were presented to highlight the importance of the SBFs in the treatment algorithm. doi: http://dx.doi.org/10.4021/jmc1429e
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