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Summary Background Renal cell carcinoma is an interesting tumor due to its unpredictable behavior. Common metastatic sites of renal cell carcinoma are the lungs, lymph nodes, bones and liver. Concurrent thyroid metastasis of clear cell carcinoma is uncommon but it can appear as a rapidly growing cervical, painless nodular mass. Case Report We report a case of a 56-year-old male patient with clear cell renal carcinoma confirmed on a histopathological examination. The patient noticed a rapidly growing mass in the thyroid region when receiving medical anticancer therapy. Because of that, gray-scale thyroid ultrasonography and a fine-needle aspiration biopsy were performed. The histopathological examinationof the biopsy specimen revealed a lesion composed of malignant epithelial cells compatible with metastasis of renal carcinoma. Conclusions In patients with with a history of RCC, both past and present, a thyroid mass, especially co-existing with an adenomatous goiter, should prompt a work-up for thyroid metastasis.

Background: Idiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory breast disease, and erythema nodosum (EN) is an extremely rare systemic manifestation of IGM. Here, we report a rare case of IGM accompanied by EN. Case Report: A 32-year-old patient was admitted to our clinic with a history of a tender mass in the right breast. On physical examination, the right breast contained a hard, tender mass in the lower half with in-drawing of the nipple. She had florid EN affecting both legs. She was evaluated with mammography, ultrasound, power Doppler ultrasound, non-enhancing magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, fine needle aspiration biopsy (FNAB) and excisional biopsy. Time-intensity curves showed a type II pattern on dynamic contrast-enhanced MRI, which has an intermediate probability for malignancy. The FNAB reported a benign cytology suggestive of a granulomatous inflammation, which was also supported by the histopathological findings. A partial mastectomy was performed following medical treatment. There was no recurrence at 1-year follow-up. Conclusion: IGM should be considered in the differential diagnosis of EN. Although histopathological examination remains the only method for the definite diagnosis of IGM, MRI can be helpful in the diagnosis or differentiation of benign lesions from malignant ones.

Cavum vergae (CV) cysts are developmental cysts of the midline of the brain that is formed from the posterior extension of the cavum septum pellucidum. Several cases of enlarged CV have been reported previously, but prenatal diagnosis of this condition is very rare. We report a case of isolated dilated CV diagnosed prenatally. When midline intracranial cysts are determined prenatally, first physicians must pay attention to distinguish them from pathologic cyst and determine whether associated malformations are present or not. The sonography is a useful tool for both the differential diagnosis and identification of associated malformations. Although CV may be present as a normal variation without clinical findings, it has been also considered as a marker of impaired neurodevelopment. Although the relationship between the CV and the various clinical findings such as headache, papilla edema, cognitive and behavior disorders, and psychiatric problems has not been fully elucidated, an accurate evaluation will be helpful for estimation of prognosis, the assessment of the risk for the other related malformations, and for the follow-up of the patient. Also, it is important to identify these kinds of findings, to clarify their clinical importance and for genetic counseling.

Background/Aims: To investigate the anatomy and variations of right lobe accessory veins and segment 5-8 veins draining into middle hepatic vein with 64 slice multidetector computed tomography (CT). Materials and Methods: 100 consecutive living donor candidates underwent 64 slice CT angiography. Image interpretation was performed based on source axial images, multiplanar reformats, and three-dimensional postprocessing images by the same radiologist. Results: Segment 5 and 8 veins with larger diameters were frequently found to be the proximal ones. Accessory hepatic veins were present in the great majority of cases (83%). Most of them were the inferior right hepatic veins (55%). All cases were classified according to the number of segment 5-8 veins and the presence or absence of a right accessory hepatic vein. Most of the donors had more than one segment 5-8 vein and right lobe accessory veins (57%). Conclusion: Multidetector CT is a valuable technique for investigating the venous anatomy of the liver in living donor candidates. Anatomy and variations of the hepatic veins can easily be evaluated by using multiplanar images.

Cerebellar agenesis (CA) is an extremely rare entity. We present two adult patients with CA. The 61-year-old man had ataxia, dysarthria, abnormalities in cerebellar tests, severe cognitive impairment, and moderate mental retardation. The 26-year-old woman had dysmetria, dysdiadochokinesia, and dysarthria as well as mild cognitive impairment and mild mental retardation. Magnetic resonance imaging (MRI) showed complete absence of the cerebellum with small residual vermis. Brainstem was hypoplastic and structures above tentorium were normal. Supratentorial white matter bundles were unaffected in diffusion tensor tractography. Only few adult patients with CA have so far been published. These cases show that patients with CA present with a variety of developmental, clinical, and mental abnormalities; and emphasize the role of the cerebellum in normal motor, language, and mental development.

We report on the conventional and diffusion-weighted (DWI) magnetic resonance imaging (MRI) findings of a partially thrombosed torcular Herophili dural sinus malformation. DWI confirmed the intralesional partial thrombosis/blood clot characterized by restricted diffusion. In addition, focal or global intracerebral complications were excluded by fetal DWI. Our findings suggest that DWI is a valuable adjunct to the standard T1- and T2-weighted fetal MRI sequences.

CAKIR, Volkan/0000-0002-3039-8262 WOS: 000377453100014 PubMed: 26880174 The objective of our study was to prospectively evaluate the diagnostic performance of strain elastography for differentiation between renal cell carcinomas (RCCs) and transitional cell carcinomas (TCCs) of kidney. A total of 99 consecutive patients who were referred to our hospital because of a newly diagnosed solid renal mass suspicious for malignancy on radiological screenings were evaluated with sonography, including strain elastography. Strain elastography was used to compare the stiffness of the renal masses and renal cortex. The ratio of strain in a renal mass and nearby renal cortex was defined as the strain index value. Mean strain index values for RCCs and TCCs were compared, and mean strain index values between histological subtypes of RCC were also compared. Although TCCs were smaller than RCCs (p < 0.001), there were no significant differences in gender distribution and mean age of the patients, and mean probe-tumor distance between RCC and TCC. The mean strain index value +/- SD for TCC (5.18 +/- 1.12) was significantly higher than the value for RCC (4.04 +/- 0.72; p < 0.001). Mean strain index value for papillary cell carcinomas (4.09 +/- 0.45) was slightly higher than that for clear cell carcinomas (3.85 +/- 0.78): however, the difference was not statistically significant (p = 0.51). Strain elastography can be used as a valuable imaging technique for preoperative differentiation between RCC and TCC of kidney.

The aim of this study is to investigate the effectiveness of placental strain ratio (SR) values measured by real-time sonoelastography (SE) in the second trimester in the prediction of spontaneous preterm birth (sPTB).This study included 70 pregnant women who applied to our clinic for routine second-trimester screening. Placental SR measurements were performed with the SE method. Two different SR measurements were performed by taking two different tissues as references. The SR value measured when taking the rectus abdominis muscle as a reference was termed the muscle-to-placenta strain ratio (MPSR), while the SR value measured when taking subcutaneous tissue as a reference was termed the fat-to-placenta strain ratio (FPSR). Women whose gestational age at birth was less than 37 weeks 0 days were accepted as sPTB. The association between gestational age at birth and MPSR and FPSR was investigated. Receiver operating characteristics analysis was used to calculate the sensitivity and specificity of the elastographic outcomes.There was a low-level negative correlation between MPSR and gestational age at birth (r=-0.300, P=.012) and there was a moderate-level negative correlation between FPSR and gestational age at birth (r=-0.513, P.001). The multivariate linear regression analysis showed that the FPSR (β=0.609, P=.002) was the significant predictor for the sPTB.Our data indicate that the FPSR value measured with real-time SE in the second trimester of pregnancy may be effective in the prediction of sPTB.

WOS:000399047200001 PubMed: 26793586 Although torsion of epididymis is extremely rare, it should be kept in mind in the differential diagnosis of acute scrotal pain in adolescents. We report here a very rare cause of acute scrotum: torsion of the epididymis. (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

In this study, we aimed to investigate the arterial and venous flow volume rate (FV) in order to determine the tissue perfusion using duplex ultrasonography (DU). We hypothesized that FV provides reliable information regarding tissue perfusion in patients with peripheral arterial disease (PAD).The study comprised 38 patients (72 legs) with PAD. In all patients, common femoral, popliteal, anterior tibial, posterior tibial arteries and veins were examined with DU. Measurements were obtained in the supine position with 15 cm elevation of the foot to neutralise central venous pressure. The diameter, blood flow velocity, and FV of arteries and veins were measured for each patient.The FV of the common femoral artery and vein (p = 0.001), popliteal artery and vein (p=0.003), and posterior tibial artery and vein (p = 0.008) had statistically significant differences. However, there was no statistically significant difference between the FV of the anterior tibial vein and artery (p = 0.408). The mean FV values of all veins were significantly lower than those of homonymous arteries in patients with PAD.Our study showed that venous FV measured by DU can be used as an indicator of impaired tissue perfusion in patients with PAD.

Purpose: Diffusion weighted magnetic resonance imaging (DW-MRI) of the kidneys provides noninvasive information on renal function in healthy volunteers, and it is feasible in severely ill patients. It may provide information on the degree of kidney dysfunction. The purpose of this study is to evaluate apparent diffusion coefficient (ADC) values using DW-MRI in patients with obstructive uropathy and elevated serum creatinine levels. Methods: Fifty patients with high serum creatinine levels and diagnoses of chronic urinary obstruction detected by ultrasonography were included in this study. DW-MRIs were obtained from 50 patients with hydronephrotic kidneys and 26 healthy volunteers using a 1.5T whole-body MR scanner. Results: ADC measurements of renal parenchyma in hydronephrotic kidneys were significantly lower compared to normal kidneys (p < 001). Conclusion: The measurement of ADC values has potential value in the evaluation of the functional status of hydronephrotic kidneys.

We aimed to investigate the extent to which measurements of flow volume (FV) with colour flow duplex ultrasonography (CDU) could predict tissue perfusion. A 68 year-old male patient was admitted to our clinic complaining of intermittent claudication in the right leg. Digital subtraction angiography showed total occlusion of the right femoral artery. The right popliteal artery (PA) was filling by collaterals. CDU showed that the FV in the right PA was higher than in the left. Arterial-venous FV measurement with CDU should be performed rather than the detection of arterial stenosis to assess whether intervention is necessary.

Purpose. In this study, we aimed to evaluate the capability of diffusion-weighted magnetic resonance imaging (DWI) in differentiation between benign and malignant etiology of obstructive uropathy.Materials and Methods. DWI was performed in 41 patients with hydronephrotic kidneys and 26 healthy volunteers. MR imaging was performed using a 1.5 T whole-body superconducting MR scanner. The signal intensities of the renal parenchyma on DWI and apparent diffusion coefficient (ADC) maps were noted. DWI was performed with the following diffusion gradientbvalues: 100, 600, and 1000 s/mm2. A large circular region of interest was placed in the corticomedullary junction of the kidneys. For statistical analysis, the independent-samplesttest was used.Results. The mean renal ADC values forb100,b600, andb1000 in hydronephrosis patients with benign and malignant etiology and the healthy volunteers of the control group were analysed. ADC measurements of renal parenchyma in all hydronephrotic kidneys with benign and malignant etiology were found to be statistically low compared to those of normal kidneysP<0.05.Conclusions. There were significant differences in the ADC values of obstructed kidneys compared to those of normal kidneys. Obstructed kidneys with malignant etiology had lower ADC values forb1000 compared to obstructed kidneys with benign etiology, but these alterations were statistically insignificant.

A 46-year-old woman with Gaucher’s disease (GD) consulted our clinic for abdominopelvic magnetic resonance imaging (MRI), as physical examination had revealed hepatosplenomegaly. Upper abdominal MRI showed massive hepatosplenomegaly and innumerable hypointense splenic nodules on T1-weighted images. Diffusion-weighted MRI (DW-MRI) and magnetic resonance spectroscopy (MRS) were performed to liver parenchyma and splenic nodules. MRS revealed lactate, lipid, acetate, and alanine peaks in splenic nodules, and choline, creatine, lipid, myo-inositol-glycine, and lactate peaks in the liver parenchyma. The DW-MRI showed diffusion restriction in splenic nodules. It was concluded that MRI is a reliable method for the diagnosis and follow up of GD. Coupling DW-MRI and MRS allows quantitative evaluation, thereby increasing the efficacy of the method. This is the first report in the literature presenting advanced abdominal MRI findings in GD.