A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagn... more A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.
Herein we present a 63-year-old male patient with a solid hepatic alveolar echinococcosis diagnos... more Herein we present a 63-year-old male patient with a solid hepatic alveolar echinococcosis diagnosed by surgical biopsy. His liver lesion, which was infected, was drained by percutaneous catheterization. The lesion surprisingly disappeared completely after the treatment. The patient was followed-up without any symptoms for 20 months after the drainage. As alveolar echinococcosis of the liver behaves like a slow-growing liver cancer, the disappearance of our patient's lesion was a very unusual and rare outcome, which, to the best of our knowledge, has never been published in the literature.
Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to eithe... more Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to either benign or malignant causes. In this study the clinical importance of raised serum levels of tumor markers have been evaluated, with particular reference to obstructive jaundice and percutaneous biliary drainage. We conducted a prospective longitudinal before-after trial. Twenty-one patients with obstructive jaundice were investigated, 5 with benign obstruction and 16 with malignant disease. All patients were examined with abdominal CT prior to biliary drainage. All patients underwent percutaneous transhepatic cholangiography, and 20 of 21 patients underwent percutaneous biliary drainage within 3 days after the CT examination. The mean CA 19-9 at presentation was lower in the group with benign disease (95 +/- 60.9 IU/mL) than those with malignancy (461.9 +/- 331.4 IU/mL). The mean CA 19-9 level in the benign group 1 week after drainage was 12 +/- 11.8 IU/mL. The mean CA 19-9 level in th...
We report our experience with a radiologically placed peritoneal port-catheter in palliation of m... more We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for rep...
PURPOSE/AIM 1-To learn the technique of unenhanced MDCT, secondary signs of urinary tract obstruc... more PURPOSE/AIM 1-To learn the technique of unenhanced MDCT, secondary signs of urinary tract obstruction and strategies that minimize the radiation dose 2-To discuss the treatment strategies for urinary tract stones 3-To which findings alter the treatment 4-To discuss when we need contrast enhanced MDCT with illustrative cases CONTENT ORGANIZATION Unenhanced CT has proved to be an accurate, safe, and a rapid examination used to diagnose patients presenting with acute flank pain. Treatment options include: observation, extracorporeal shockwave lithotripsy (ESWL), endoscopic procedures, percutaneous nephrolithotomy and open surgery. In this exhibit we discuss the MDCT findings of the urinary tract stones and indications and patient selection based on current literature for each type of treatment. SUMMARY 1-This exhibit will discuss the imaging findings of urinary tract stones, complications secondary to stone disease and associated pathologies that alters the management.
LEARNING OBJECTIVES To learn the new standardised WHO classification of cystic echinococcosis(CE)... more LEARNING OBJECTIVES To learn the new standardised WHO classification of cystic echinococcosis(CE). To discuss and illustrate the US findings of liver CE with CT correlation. ABSTRACT WHO developed a new standardised classification of US images of cystic echinococcosis(CE). Use of such a classification will enable clinicans to recommend clinical procedures for different cyst types. The WHO classification have the following characteristics: is easy to use, reflect the natural history of the cyst cycle. And the classification is intended to follow the natural history of CE and starts with undifferentiated simple cyst and they recorded as cystic lesions (CL). Type CE 1 and 2 cysts are active usually fertile cysts containing viable protoscoleces. Type CE 3 are cysts entering a transitional stage where integrity of the cyst has been comprimised. Type CE 4 and 5 are inactive cysts which have normally lost their fertility. In this educational exhibit we discuss the WHO classification and il...
The major purpose of this paper is to outline and correlate US, CT and MR imaging findings of liv... more The major purpose of this paper is to outline and correlate US, CT and MR imaging findings of liver in patients with Wilson's disease. Twenty-eight patients (10 male, 18 female, median age 16) with Wilson's disease were examined with US, CT and MRI. Liver echogenicity, echo pattern, contour irregularity, periportal thickness, perihepatic fat layer thickness, the presence of focal parenchymal lesion, and other associated findings were recorded by US in every patient. CT and MRI were done in 20 and 12 patients, respectively. Contour irregularity was observed in 24 patients and heterogeneous parenchymal echo pattern was seen in 26 patients with US. The presence of increased perihepatic fat layer was observed in eight patients. Severe parenchymal atrophy was seen in all lobes of the liver including caudate in contrast to post-viral chronic liver disease. Nineteen patients had periportal thickening. US showed multiple hyper and/or hypoechoic nodules smaller than 1cm in 13 patient...
The aim of this study is to investigate the efficacy and long-term results of percutaneous transc... more The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was ...
Determination of renal neoplasms, hematoma, infarct, urinoma, cysts, and pyelonephritis may requi... more Determination of renal neoplasms, hematoma, infarct, urinoma, cysts, and pyelonephritis may require contrast material administration following unenhanced CT in patients with flank pain. In this pictorial review, we aimed to clarify when contrast material administration is needed following vague urinary system findings on unenhanced CT.
Diagnostic and interventional radiology (Ankara, Turkey), 2006
Chronic pancreatitis is one of the indications for pancreatic duct stenting. The success rate of ... more Chronic pancreatitis is one of the indications for pancreatic duct stenting. The success rate of endoscopic stenting of the pancreatic duct is very high (98%). Reports of percutaneous stenting of the Wirsung's duct are very sparse. We present a case with Wirsung's duct stenosis secondary to chronic pancreatitis, which was treated by percutaneous antegrade balloon dilatation and insertion of a plastic stent. We also report on the long-term follow-up of this patient.
To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) te... more To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) technique for outpatients. Percutaneous treatment with US guidance was applied to 33 patients for 44 cysts. Patients treated with the PAIR technique, were outpatients. PAIR and catheterization technique were evaluated for efficacy and safety of procedure and complication rates. Thirty-five of 44 cysts were treated with the PAIR and 9 of 44 were treated with the catheterization technique. The success rate of the cysts Gharbi type 1 (CE1) and type 2 (CE3a) treated with the PAIR technique was 100%. In the follow up of 9 cysts treated with the catheterization technique, 2 of them (22%) developed cyst infection and 1 (11%) developed a biliary fistula. The PAIR technique was found to be an effective and safe approach in order to treat Gharbi type 1 and type 2 cysts percutaneously for outpatients. It has a very low complication rate in comparison with the catheterization technique. So every effort should be made to finish the treatment with PAIR technique.
... radyofrekans ablasyonu Serdar Geyik, Okan Akhan, Osman Abbasoğlu, Devrim Akıncı, Orhan Şeref ... more ... radyofrekans ablasyonu Serdar Geyik, Okan Akhan, Osman Abbasoğlu, Devrim Akıncı, Orhan Şeref Özkan, Erhan Hamaloğlu, Mustafa Özmen ... Takip işlemden sonraki birinci ayda aynı protokol kullanılarak BT ile yapıldı ve sonraki her üç ayda bir tekrarlandı. ...
Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement i... more Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions
We aimed to describe radiological findings of patients with incidentally diagnosed segmental dist... more We aimed to describe radiological findings of patients with incidentally diagnosed segmental distal hepatic vein occlusion on computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). We retrospectively reviewed CT (n = 8), color Doppler US (n = 6), and MRI (n = 3) findings of 9 patients with incidentally diagnosed segmental occlusion of the hepatic veins from our archive. Computed tomography and US examinations were performed in 4 patients; only CT in 2; US, CT, and MRI in 1; US and MRI in 1; and CT and MRI in 1 patient. Liver contour, presence, and location of hepatico-hepatic shunts were evaluated. Middle hepatic vein (n = 6) was the most commonly segmentally occluded vein, followed by left hepatic vein (n = 3). Mean length of segmental occlusion was 1.9 cm (range, 1.2-4.2 cm). Hepatico-hepatic shunts were found close to hepatic vein confluence in all but 1 patient. Segmental distal hepatic vein occlusion can cause antegrade (n = 5) or retrograde (n = 1) flow in the affected vein on color Doppler examination, depending on presence of intraparenchymal hepatico-hepatic shunt. In the patient with retrograde flow, occluded segment was very short, and no intraparenchymal shunt was visible. Patients were asymptomatic, and no change in liver morphology (including caudate lobe hypertrophy) was noted. We propose that segmental Budd-Chiari syndrome can be a valid terminology for asymptomatic patients with segmental hepatic vein occlusion most likely developing as a sequela of subclinical Budd-Chiari syndrome. Acquaintance of practicing radiologists to this phenomenon may be highly useful in the prevention of the diagnostic confusion and potentially unnecessary interventions.
A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagn... more A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.
Herein we present a 63-year-old male patient with a solid hepatic alveolar echinococcosis diagnos... more Herein we present a 63-year-old male patient with a solid hepatic alveolar echinococcosis diagnosed by surgical biopsy. His liver lesion, which was infected, was drained by percutaneous catheterization. The lesion surprisingly disappeared completely after the treatment. The patient was followed-up without any symptoms for 20 months after the drainage. As alveolar echinococcosis of the liver behaves like a slow-growing liver cancer, the disappearance of our patient's lesion was a very unusual and rare outcome, which, to the best of our knowledge, has never been published in the literature.
Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to eithe... more Some tumor markers such as CA 19-9 are shown to be increased in obstructive jaundice due to either benign or malignant causes. In this study the clinical importance of raised serum levels of tumor markers have been evaluated, with particular reference to obstructive jaundice and percutaneous biliary drainage. We conducted a prospective longitudinal before-after trial. Twenty-one patients with obstructive jaundice were investigated, 5 with benign obstruction and 16 with malignant disease. All patients were examined with abdominal CT prior to biliary drainage. All patients underwent percutaneous transhepatic cholangiography, and 20 of 21 patients underwent percutaneous biliary drainage within 3 days after the CT examination. The mean CA 19-9 at presentation was lower in the group with benign disease (95 +/- 60.9 IU/mL) than those with malignancy (461.9 +/- 331.4 IU/mL). The mean CA 19-9 level in the benign group 1 week after drainage was 12 +/- 11.8 IU/mL. The mean CA 19-9 level in th...
We report our experience with a radiologically placed peritoneal port-catheter in palliation of m... more We report our experience with a radiologically placed peritoneal port-catheter in palliation of malignant ascites. Port-catheters were successfully placed under ultrasonographic and fluoroscopic guidance in seven patients (five women, two men) who had symptomatic malignant ascites. The long-term primary patency rate was 100%. The mean duration of catheter function was 148 days. Seven patients had a total of 1040 port-days. Two patients received intraperitoneal chemotherapy via the port-catheter. There were no procedure-related mortality and major complications. Minor complications such as ascitic fluid leakage from the peritoneal entry site, migration of the catheter tip to the right upper quadrant, and reversal of the port reservoir occurred in four patients. None of these complications affected the drainage and required port explantation. In patients with symptomatic malignant ascites, a peritoneal port-catheter can provide palliation and eliminate multiple hospital visits for rep...
PURPOSE/AIM 1-To learn the technique of unenhanced MDCT, secondary signs of urinary tract obstruc... more PURPOSE/AIM 1-To learn the technique of unenhanced MDCT, secondary signs of urinary tract obstruction and strategies that minimize the radiation dose 2-To discuss the treatment strategies for urinary tract stones 3-To which findings alter the treatment 4-To discuss when we need contrast enhanced MDCT with illustrative cases CONTENT ORGANIZATION Unenhanced CT has proved to be an accurate, safe, and a rapid examination used to diagnose patients presenting with acute flank pain. Treatment options include: observation, extracorporeal shockwave lithotripsy (ESWL), endoscopic procedures, percutaneous nephrolithotomy and open surgery. In this exhibit we discuss the MDCT findings of the urinary tract stones and indications and patient selection based on current literature for each type of treatment. SUMMARY 1-This exhibit will discuss the imaging findings of urinary tract stones, complications secondary to stone disease and associated pathologies that alters the management.
LEARNING OBJECTIVES To learn the new standardised WHO classification of cystic echinococcosis(CE)... more LEARNING OBJECTIVES To learn the new standardised WHO classification of cystic echinococcosis(CE). To discuss and illustrate the US findings of liver CE with CT correlation. ABSTRACT WHO developed a new standardised classification of US images of cystic echinococcosis(CE). Use of such a classification will enable clinicans to recommend clinical procedures for different cyst types. The WHO classification have the following characteristics: is easy to use, reflect the natural history of the cyst cycle. And the classification is intended to follow the natural history of CE and starts with undifferentiated simple cyst and they recorded as cystic lesions (CL). Type CE 1 and 2 cysts are active usually fertile cysts containing viable protoscoleces. Type CE 3 are cysts entering a transitional stage where integrity of the cyst has been comprimised. Type CE 4 and 5 are inactive cysts which have normally lost their fertility. In this educational exhibit we discuss the WHO classification and il...
The major purpose of this paper is to outline and correlate US, CT and MR imaging findings of liv... more The major purpose of this paper is to outline and correlate US, CT and MR imaging findings of liver in patients with Wilson's disease. Twenty-eight patients (10 male, 18 female, median age 16) with Wilson's disease were examined with US, CT and MRI. Liver echogenicity, echo pattern, contour irregularity, periportal thickness, perihepatic fat layer thickness, the presence of focal parenchymal lesion, and other associated findings were recorded by US in every patient. CT and MRI were done in 20 and 12 patients, respectively. Contour irregularity was observed in 24 patients and heterogeneous parenchymal echo pattern was seen in 26 patients with US. The presence of increased perihepatic fat layer was observed in eight patients. Severe parenchymal atrophy was seen in all lobes of the liver including caudate in contrast to post-viral chronic liver disease. Nineteen patients had periportal thickening. US showed multiple hyper and/or hypoechoic nodules smaller than 1cm in 13 patient...
The aim of this study is to investigate the efficacy and long-term results of percutaneous transc... more The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was ...
Determination of renal neoplasms, hematoma, infarct, urinoma, cysts, and pyelonephritis may requi... more Determination of renal neoplasms, hematoma, infarct, urinoma, cysts, and pyelonephritis may require contrast material administration following unenhanced CT in patients with flank pain. In this pictorial review, we aimed to clarify when contrast material administration is needed following vague urinary system findings on unenhanced CT.
Diagnostic and interventional radiology (Ankara, Turkey), 2006
Chronic pancreatitis is one of the indications for pancreatic duct stenting. The success rate of ... more Chronic pancreatitis is one of the indications for pancreatic duct stenting. The success rate of endoscopic stenting of the pancreatic duct is very high (98%). Reports of percutaneous stenting of the Wirsung's duct are very sparse. We present a case with Wirsung's duct stenosis secondary to chronic pancreatitis, which was treated by percutaneous antegrade balloon dilatation and insertion of a plastic stent. We also report on the long-term follow-up of this patient.
To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) te... more To demonstrate utility and safety of the puncture aspiration injection and reaspiration (PAIR) technique for outpatients. Percutaneous treatment with US guidance was applied to 33 patients for 44 cysts. Patients treated with the PAIR technique, were outpatients. PAIR and catheterization technique were evaluated for efficacy and safety of procedure and complication rates. Thirty-five of 44 cysts were treated with the PAIR and 9 of 44 were treated with the catheterization technique. The success rate of the cysts Gharbi type 1 (CE1) and type 2 (CE3a) treated with the PAIR technique was 100%. In the follow up of 9 cysts treated with the catheterization technique, 2 of them (22%) developed cyst infection and 1 (11%) developed a biliary fistula. The PAIR technique was found to be an effective and safe approach in order to treat Gharbi type 1 and type 2 cysts percutaneously for outpatients. It has a very low complication rate in comparison with the catheterization technique. So every effort should be made to finish the treatment with PAIR technique.
... radyofrekans ablasyonu Serdar Geyik, Okan Akhan, Osman Abbasoğlu, Devrim Akıncı, Orhan Şeref ... more ... radyofrekans ablasyonu Serdar Geyik, Okan Akhan, Osman Abbasoğlu, Devrim Akıncı, Orhan Şeref Özkan, Erhan Hamaloğlu, Mustafa Özmen ... Takip işlemden sonraki birinci ayda aynı protokol kullanılarak BT ile yapıldı ve sonraki her üç ayda bir tekrarlandı. ...
Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement i... more Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions
We aimed to describe radiological findings of patients with incidentally diagnosed segmental dist... more We aimed to describe radiological findings of patients with incidentally diagnosed segmental distal hepatic vein occlusion on computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI). We retrospectively reviewed CT (n = 8), color Doppler US (n = 6), and MRI (n = 3) findings of 9 patients with incidentally diagnosed segmental occlusion of the hepatic veins from our archive. Computed tomography and US examinations were performed in 4 patients; only CT in 2; US, CT, and MRI in 1; US and MRI in 1; and CT and MRI in 1 patient. Liver contour, presence, and location of hepatico-hepatic shunts were evaluated. Middle hepatic vein (n = 6) was the most commonly segmentally occluded vein, followed by left hepatic vein (n = 3). Mean length of segmental occlusion was 1.9 cm (range, 1.2-4.2 cm). Hepatico-hepatic shunts were found close to hepatic vein confluence in all but 1 patient. Segmental distal hepatic vein occlusion can cause antegrade (n = 5) or retrograde (n = 1) flow in the affected vein on color Doppler examination, depending on presence of intraparenchymal hepatico-hepatic shunt. In the patient with retrograde flow, occluded segment was very short, and no intraparenchymal shunt was visible. Patients were asymptomatic, and no change in liver morphology (including caudate lobe hypertrophy) was noted. We propose that segmental Budd-Chiari syndrome can be a valid terminology for asymptomatic patients with segmental hepatic vein occlusion most likely developing as a sequela of subclinical Budd-Chiari syndrome. Acquaintance of practicing radiologists to this phenomenon may be highly useful in the prevention of the diagnostic confusion and potentially unnecessary interventions.
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