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Introduction Thoracic giant masses do not have a clear definition. In some publications, giant thoracic mass definition is used in tumors whose long axis is> 10 cm and in other publications covering more than 50% of the hemithorax. In this study, demographic data of patients with a massive resectable giant thoracic mass and the difficulties and experiences experienced in the peroperative process were reviewed with a general perspective. Materials and Methods 14 giant intrathoracic masses operated at the department of Thoracic Surgery, School of Medicine, Ankara University were included in the study. The masses occupying more than half of the hemithorax and mediastinal lesions with a long axis of 15 cm or larger radiologically were included and evaluated. Result 9 (64.3%) of our patients were male and 9 (35.7%) were female. The average age was 49.2 ± 17.1(between18-68). The tumor localizations of our patients were determined as 9 (64.2%) hemithorax and 5 (35.8%) mediastinal. When the radiological and intraoperative dimensions were examined separately, it was observed that the mean of long axis of CT image is average 18 ± 3.8 cm (between 12 cm and 26 cm), and the mean of long axis of specimen is average 18.14 ± 3.6 cm (between 15 cm and 23 cm). The heaviest mass was average 844 ± 473 g (350 g-2204 g). Conclusions The surgical maneuvers and hence the excision of giant masses become difficult to operate due to the narrow localization of the masses and the frequent invasions of adjacent vascular structures and nerve tissues. However, complete resection of these slowly growing and generally encapsulated masses can provide the cure.

PURPOSE: We aimed to assess the diagnostic performance of transluminal attenuation difference (TAD) in predicting the severity of internal carotid artery (ICA) stenosis. METHODS: The study cohort consisted of 48 patients with 70%) stenosis compared with control arteries and low-moderate stenosis. A TAD ratio cutoff of 4.5 predicted 70%–99% stenosis with a sensitivity of 100% and specificity of 93%. The inter- and intraobserver agreements in TAD measurements were almost perfect (ICC, 0.89–0.86). CONCLUSION: Assessment of TAD ratio predicts the degree of stenosis in concordance with NASCET system.

The aim of this study is to determine the correlation between the predonation computed tomography (CT)-based calculated kidney volume and post-transplant renal function in recipients of renal transplants and to compare two different CT techniques.The study group is comprised of 55 paired living kidney donor-recipients transplants. The total parenchymal renal volumes were calculated by using two CT-based techniques (3-dimensional renal volume [3DRV] and voxel-based volume calculation). Post-transplant creatinine and estimated glomerular filtration rate (eGFR) levels for the recipients at hospital discharge and sixth month were obtained. We tested the association with eGFR and creatinine by adjusting the renal volume to body weight and body mass index. For the creatinine levels above 1.5 mg/dL at discharge, a threshold value for renal volume-to-weight ratio on receiver operating characteristic curve (ROC) analysis and odds ratio (OR) were calculated.The renal volumes adjusted to weight were found to be moderately correlated with eGFR and creatinine levels at discharge (r = 0.51 and r = -0.54 for voxel-based calculation; r = 0.52 and r = -0.52 for 3DRV calculation, P .001, respectively) and at sixth month (r = 0.55 and r = -0.58 for voxel-based calculation; r = 0.51 and r = -0.54 for 3DRV calculation, P .001 respectively). A threshold value of 1.84 mL/kg was calculated for parenchymal volume-to-recipient weight ratio on ROC analysis (AUC±SE, 0.760 ± 0.078, P = .008). The likelihood of creatinine elevation above 1.5 mg/dL was found to be nine times greater for smaller renal volume-to-recipient weight ratios (OR = 9.6; 95% CI, 1.8-50.6) CONCLUSIONS: Predonation renal volume adjusted to recipient weight may estimate the renal function at discharge and 6 months after transplantation.

Objectives:Evaluation of kidney size and volume is very important in the diagnosis, treatment and follow-up of kidney diseases. Ultrasonography is the preferred imaging modality which provides a safe, reliable and affordable way of imaging the kidneys in the follow up of kidney diseases..In this study, we aimed to determine the kidney volume in normal adults and try to find out which of the physical features are more related with kidney volume.Materials and Methods:Between June 2005 and December 2008 177 patients referred for routine abdominopelvic ultrasonography (US) were included in the study. 16 patients who had renal masses, hydronephrosis and nephrolithiasis were excluded. Height, weight, body surface area (BSA) and body mass index (BMI) of the patients were recorded. Renal ultrasonography was performed and kidney sizes were evaluated in lateral decubitis position. Kidney sizes were measured on longitudinal and transverse scan. Ellipsoid formula was used to determine the kidney volume.Results:A total of 161 patients 69 (42,8%) male, 92 (57,5%) female were enrolled in the study. Mean kidney volume for right kidney was 125 mL and 134 mL for left kidney in women whereas it was 149 mL for right kidney and 155 mL for left kidney in men. There was a significant difference between right and left kidney volumes (p

To reveal the MR enterography (MRE) findings that distinguish backwash ileitis (BWI) from terminal ileitis due to Crohn's disease (CD) and to determine the usability of barium studies manifestations (ileocecal valve (ICV) gaping, terminal ileum dilatation) in MRE for the diagnosis of BWI in ulcerative colitis (UC) patients by pointing at the diagnostic performance of these imaging findings.The study population consisted of patients who were diagnosed as ulcerative colitis (UC), and underwent 1.5 T MRI between August 2011 and November 2017 to rule out small bowel involvement. The matched controls were comprised of Crohn's patients examined at the same period. Ileocolonoscopic/ histopathologic findings were accepted as reference standard. Mural/extramural changes in bowel segments, ileocecal valve (ICV) gaping, terminal ileum dilatation, restricted diffusion and anatomical extent of involvement were evaluated. In UC patients, the association between ICV gaping and terminal ileum dilatation and BWI was assessed by χ2 test. The diagnostic accuracy of these two findings in BWI was determined.Sixty patients were included in the study (30 UC; 30 CD; mean age, 43 years in both groups). Ileocecal valve gaping and terminal ileum dilatation were significantly more frequent among BWI patients (p 0.001) in UC. Patients with BWI showed a higher rate of pancolitis (88.9%). Median terminal ileum wall thickness was found to be significantly greater in patients with CD (p 0.001).In patients with definite diagnosis of UC, ileocecal valve gaping and terminal ileum dilatation suggest the development of BWI. However, these findings cannot be use to differentiate cause of terminal ileitis in patients with unconfirmed diagnosis and do not give reliable information about the causative factor of ileitis.

Purpose To evaluate the association of visceral adiposity measured on computed tomography (CT) in preoperative period with lymph node (LN) metastasis and overall survival in gastric adenocarcinoma patients. Methods Preoperative CT scans of 246 gastric adenocarcinoma patients who did not receive neoadjuvant chemoradiotherapy were evaluated. Visceral fat area (VFA), subcutaneous fat area (SFA) and Total fat area (TFA), VFA/TFA ratio were quantified by CT. VFA/TFA > 29% was defined as visceral obesity. The differentiation, t-stage, n-stage and the number of harvested-metastatic LNs were noted. The maximum thickness of tumor and localization were recorded from CT. Chi-square, Student's t-test, multiple Cox regression, Spearman's correlation coefficient, and Kaplan-Meier algorithm were performed. Results The overall survival (OS) rates and N-stage were not different significantly between viscerally obese and non-obese group (p = 0.994, p = 0.325). The number of metastatic LNs were weakly inversely correlated with VFA (r = −0.144, p = 0.024). Univariate analysis revealed no significant association between visceral obesity and OS or LN metastasis (p = 0.377, p = 0.736). In multivariate analyses, OS was significantly associated with poorly differentiation (HR = 1.72, 95% CI =1.04–2.84, p = 0.035), higher pathologic T and N stage (T4 vs T1 + T2 HR = 2.67, 95% CI =1.18–6.04, p = 0.019; T3 vs T1 + T2 HR = 1.98, 95% CI = 0.90–4.33, p = 0.089; N3b vs N0 HR = 2.97, 95% CI1.45–6.0, p = 0.003; N3 (3a+ 3b) vs N0 HR = 2.24 95% CI =1.15–4.36, p = 0.018). Conclusion Visceral obesity may not be a prognostic factor in resectable gastric adenocarcinoma patients.

OBJECTIVES: The purpose of this study was to investigate the relation between pancreatic steatosis and visceral adiposity. Furthermore, the study sought to explore the association between pancreatic steatosis, pancreas volume, hepatic steatosis, age, and sex in adults without prior history of pancreatic disease. The research also served to define a cut-off value of visceral fat tissue area (VFA) predicting fatty pancreas. MATERIAL AND METHODS: CT scans of 98 living-liver donor transplant patients without prior history of pancreatic disease were evaluated for the presence of fatty pancreas. Pancreas volume, VFA, subcutaneous-total FA, VFA/TFA ratios of the patients with and without fatty pancreas were quantified with a semi-automated model on CT. Coexistence of hepatic steatosis was also recorded. RESULTS: VFA, TFA and VFA/TFA were significantly greater in the fatty group (p

Purpose The aim of this study was to investigate the impact of the primary location of colorectal adenocarcinoma on the lobar distribution of its hepatic metastases based on the streamline hypothesis. Material and methods The hospital database was utilised to identify the colorectal cancer patients. Eighty-six patients diagnosed with colorectal adenocarcinoma, who had hepatic metastases on the initial diagnostic stage or on the follow-up investigations, were enrolled the study. Computed tomography (CT) images of the study population were reviewed for the primary location of the colorectal tumour, and the side and number of hepatic metastases. Results A total of 481 metastases were counted on CT from 22 right-sided and 64 left-sided colon tumours. The ratio of right-to-left hemiliver involvement was 1.97 : 1 for whole study population. The right-to-left ratio was calculated as 1.55 : 1 for right colon tumours and 2.17 : 1 for left colon tumours (p = 0.106). In the subgroup analysis with unilobar metastatic patients, again there was no significant difference in terms of the colorectal tumours' primary location (p = 0.325). Conclusions The lobar distribution of hepatic metastases from colorectal adenocarcinoma may not be associated with the primary tumour localisation.

Objectives:The aim of this study is to evaluate the diagnostic value of mean and net enhancement attenuation values, net enhancement percentage in discrimination of Bosniak category 3 and 4 lesions on multiphasic computed tomography (CT).Materials and Methods:A search was performed through the PACS system using the key word “Bosniak cyst” to identify candidates for the study population. Twenty nine patients with Bosniak category 3 and 4 were enrolled in the study. Enhancement values were measured on precontrast, corticomedullary and nephrogram phases. Net enhancement attenuation value and net enhancement percentage were calculated. The presence of calcification on cyst wall/septa, renal vein thrombosis or lymphadenopathy and mean diameter of these complex cystic lesions were utilized.Results:Bosniak category 4 cysts had a significantly higher mean attenuation value compared with that of Bosniak category 3 cysts on corticomedullary and nephrogram phases (167.2±53.6 HU, 99.8±43 HU; p=0.001, p=0.023; respectively). Significant differences were observed between two pathologies with regard to net enhancement value and net enhancement percentage (p=0.003, p=0.015; respectively). By the use of ROC curve analysis, the cut off value of 131 HU for the mean attenuation value of Bosniak category 4 cyst on corticomedullary phase had the appropriate combination of sensitivity of 82% and specificity of 83% with the area under the cure being 0.848±0.081 (95% CI: 0.68-1).Conclusion:Bosniak category 4 cysts had larger net enhancement value and enhancement percentage. A value of >131 HU on corticomedullary phase can be a predictor value for Bosniak category 4 cysts.

The purpose of this study was to determine whether the computed tomography (CT) features might be used in distinguishing pulmonary carcinoids from hamartomas.Ninety solid pulmonary nodules (43 carcinoids and 47 hamartomas) in 90 patients were evaluated. The following CT scan features were evaluated: size, location (peripheral/central), contour (lobulated/nodular), number of lobulation, attenuation, calcification, endobronchial status, bronchial extension and involvement, parenchymal abnormalities distal to the lesion e.g. hyperlucency, atelectasis, and nodularity. The final pathologic diagnosis of the lesions and bronchial extension were confirmed by review of histopathological specimens.Out of 43 carcinoids, 37 (86%) were typical. Twenty-three carcinoids and four hamartomas were central (p 0.001). Ten carcinoids and one hamartoma were endobronchial. The majority of tumors had lobulated contours (65% of carcinoids, 44% of hamartomas) and carcinoids tended to have more lobulations (p = 0.052). Distal nodularity (p = 0.001), distal hyperlucency (p 0.001), and atelectasis (p = 0.005) were significantly more common in carcinoids. Carcinoids had significantly more bronchial extension and involvement (p 0.001; respectively). In addition, a new sign that we call "bronchial triangle sign" differentiated carcinoids with a sensitivity and specificity of 84.9% (95% CI: 69,1%-93.4%) and 91% (95% CI: 79.7%-96.6%).To the best of our knowledge this is the first study on discrimination of carcinoids and hamartomas. A new CT sign called "bronchial triangle sign" might be used to differentiate carcinoids from hamartomas. Distal parenchymal abnormalities are more common in carcinoids than in hamartomas.

Background Cavitary lung disease (CLD) in renal transplant recipients is an infrequent complication causing high morbidity and mortality. We aimed to examine incidence, demographics and treatment properties of cavitary lung lesions in our renal transplant patient population. Methods We retrospectively examined renal transplant recipients, who were operated between January 2002-October 2013 and observed at Renal Transplantation Unit of Ankara University Faculty of Medicine. Demographic features, treatment and outcome of cavitary CLD were investigated. Results A total of 343 kidney recipients were studied, 7 (2.0%) of whom developed CLD. Median time to develop CLD was 15 months (min:1, max:115) after transplantation. 3 (42.8%) patients had experienced acute rejection and treated with anti-thymocyte globulin within 6 months prior to disease development date. No graft lost, but 2 (28.5%) patient lost was seen because of CLD. Conclusions Although developments in immunsuppression and antibiotic treatment in recent decades, cavitary lung disease is an important morbidity and mortality reason in renal transplant recipients.

Purpose We aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). Methods A search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. Results Biliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). Conclusion MRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant difference.

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly. Generally, it is seen on the right side and is associated with an atrial septal defect. Herein, we present a case of a 50-year-old male patient with a supracardiac type PAPVC detected during pneumonectomy for a right hilar mass. This is the second case report in the literature presenting surgical treatment of both lung cancer and PAPVC using pneumonectomy. Thoracic surgeons should be aware of this anomaly when they are planning to perform a major lung resection. If PAPVC and lung cancer are in the same lobe, anatomical lung resections including pneumonectomy can be safely performed.

Introduction: subcapsular renal hematoma is a very rare complication of double-J stenting in urology practice. Infection, malposition and migration are well known stent complications, which may be monitored by blood and urine analyses and kidney ureter bladder radiographs. However, follow-up of patients with regular ultrasound examinations is crucial as unexpected and potentially fatal complications may take place at any time during or after stent insertion. case report: We present a rare case with chronic subcapsular renal hematoma diagnosed by ultrasonography, two weeks after the removal of double-J stent. conclusion: Ultrasonography is important to rule out stent malposition or other serious stent complications.