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Abstract Background Duchenne muscular dystrophy (DMD) is an X-linked muscular disease which is caused by the absence of dystrophin. Troponin elevation with acute chest pain may indicate acute myocardial injury in these patients. We report a case of DMD that presented with ACP and troponin elevation, who was diagnosed with acute myocardial injury, and successfully treated with corticosteroids. Case presentation A 9-year-old with DMD was admitted to the emergency department with the complaint of acute chest pain. His electrocardiogram (ECG) revealed inferior ST elevation and serum troponin T was elevated. The transthoracic echocardiography (TTE) demonstrated inferolateral and anterolateral hypokinesia with depressed left ventricular function. An ECG-gated coronary computed tomography angiography ruled out acute coronary syndrome. Cardiac magnetic resonance imaging revealed mid-wall to sub-epicardial late gadolinium enhancement at the basal to the mid inferior lateral wall of the left ventricle and corresponding hyperintensity on T2-weighted imaging, consistent with acute myocarditis. A diagnosis of acute myocardial injury associated with DMD was made. He was treated with anticongestive therapy and 2 mg/kg/day of oral methylprednisolone. Chest pain resolved the next day, and ST-segment elevation returned to normal on the third day. Troponin T decreased in the sixth hour of oral methylprednisolone treatment. TTE on the fifth day revealed improved left ventricular function. Conclusion Despite advances in contemporary cardiopulmonary therapies, cardiomyopathy remains the leading cause of death in patients with DMD. Acute chest pain attacks with elevated troponin in patients with DMD without coronary artery disease may indicate acute myocardial injury. Recognition and appropriate treatment of acute myocardial injury episodes in DMD patients may delay the development of cardiomyopathy.

Pulmonary adverse events and drug-induced lung disease (DILD) can occur when treating many conditions. The incidence of DILDs in clinical practice and the variety of radiological findings have increased, mainly due to the increased use of novel therapeutic agents. It is crucial to determine whether the newly emerging clinical and imaging findings in these patients are due to the progression of the underlying disease, infection, pulmonary edema, or drug use, as this will change the patient management. Although the diagnosis of DILD is usually obtained by excluding other possible causes, radiologists should be aware of the imaging findings of DILD. This article reviews the essential radiological results of DILD and summarizes the critical clinical and imaging findings with an emphasis on novel therapeutic agents.

A cardiac outpouching (CO) is a protrusion in a heart chamber’s internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance, requiring immediate surgery. Cross-sectional imaging findings of COs, such as location, morphology, size, and accompanying wall motion abnormalities, play an essential role in determining the correct diagnosis and appropriate clinical management. Therefore, radiologists should be familiar with them. This article reviews the key cross-sectional imaging findings and differential diagnoses of COs.

Zinner syndrome is a rare disorder, and it is associated with unilateral renal agenesis, ipsilateral ejaculatory duct atresia (obstruction), and cystic dilatation of the ipsilateral seminal vesicle. Here, we present an eighteen-year-old male with Zinner syndrome who presented to a urology clinic with perineal/pelvic pain and dysuria. We also emphasize the computed tomography and magnetic resonance imaging findings of Zinner syndrome.

Coronavirus disease 2019 (COVID-19) is a viral disease that causes life-threatening health problems during acute illness, causing a pandemic and millions of deaths. Although computed tomography (CT) was used as a diagnostic tool for COVID-19 in the early period of the pandemic due to the inaccessibility or long duration of the polymerase chain reaction tests, current studies have revealed that CT scan should not be used to diagnose COVID-19. However, radiologic findings are vital in assessing pneumonia severity and investigating complications in patients with COVID-19. Long-term symptoms, also known as long COVID, in people recovering from COVID-19 affect patients’ quality of life and cause global health problems. Herein, we aimed to summarize the lessons learned in COVID-19 pneumonia, the challenges in diagnosing the disease and complications, and the prospects for future studies.

A syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) is a rare autoimmune disease. It occurs in genetically predisposed individuals by immune activation triggered by possible infectious agents. A 60-year-old man was presented with musculoskeletal and cutaneous manifestations. After exclusion of differential diagnoses, he was diagnosed with SAPHO and successfully treated with adalimumab. He had a typical image defined as a bull’s head sign in bone scintigraphy with 99mTc- methylene diphosphonate. Positron emission tomography also revealed increased inflammatory activity in related anterior chest joints and soft tissue. We want to emphasize diagnostic radiological images in patients with SAPHO to increase the awareness of clinicians.

Abstract Background Although acute coronary syndrome is rare in children, it is the most important cause of mortality in children with end-stage renal disease. Case presentation Here, a 16-year-old pediatric patient, who has been on dialysis since the age of 3, and who was diagnosed with acute coronary syndrome and placed an emergency percutaneous transcatheter stent in the left anterior descending branch of the left coronary artery is presented. It is important that the present patient does not have any electrocardiography findings in favor of cardiovascular disease and that he cannot fully explain the complaint of chest pain due to his mental retardation. Conclusions Early detection of acute coronary syndrome is life-saving, especially in children with chronic kidney disease.

Pulmonary embolism is a common cardiovascular emergency. In case of delayed diagnosis and treatment morbidity and mortality is high. In this report, we presented a case of pulmonary embolism without apparent risk factors, which was initially misdiagnosed as peri/myocarditis.

PURPOSEWe aimed to assess the severity of coronavirus disease 2019 (COVID-19) pneumonia on computed tomography (CT) using quantitative (QCT) and semiquantitative (SCT) assessments and compare with the clinical findings.METHODSTwo observers independently examined the CT images of COVID-19 patients, and the SCT severity score was calculated. The SCT score was calculated as the sum of values ranging from 0 to 4, according to the volumetric rate of involvement for each lung lobe. In quantitative assessment, total lung volume (TLV) was automatically calculated from CT density values between -200 and -950 HU. Besides, healthy lung volume (HLV) was calculated from voxels between -800 and -950 HU. The QCT score was calculated with the following formula: (TLV – HLV / TLV) ×100. All patients were clinically divided into four groups: mild, common, severe, and critical. Interobserver agreement for SCT assessment was investigated using the Cohen's Kappa statistics (κ). Pearson's correlation coefficient was used for the relationship between continuous data. The diagnostic accuracy of SCT and QCT in the differentiation of clinically limited (mild, common) and extensive (severe, critical) disease was investigated using ROC analysis.RESULTSSeventy-six patients with a diagnosis of COVID-19 were included. There was good agreement between the two observers in the SCT evaluation of pulmonary disease severity (κ = 0.796; 95% CI, 0.751–0.841). A significant correlation was found between QCT and SCT scores (p < 0.001, r = 0.661). Both QCT and SCT scores showed a significant correlation with clinical severity score (p < 0.001, r = 0.620 and p = 0.004, r = 0.529, respectively). The ROC analysis revealed the AUC of QCT and SCT for differentiation of limited and extensive disease as 0.873 (95% CI, 0.774–0.972) and 0.816 (95% CI, 0.673–0.959), respectively.CONCLUSIONThe QCT assessment is an objective method in the evaluation of COVID-19 severity and is more successful than semiquantitative CT assessment to discriminate extensive from limited disease.

Myelolipoma is a rare benign neoplasm consisting of mature adipose and haematopoietic tissues and usually found in the adrenal gland. However, myelolipoma can be rarely detected in extra-adrenal regions but often detected incidentally in imaging studies performed for other reasons or at autopsy. While adrenal myelolipomas are easily recognised given its typical imaging features, the diagnosis of extra-adrenal myelolipomas may be challenging. Herein, we aimed to present computed tomography and magnetic resonance imaging findings of pelvic extra-adrenal myelolipoma in a 77-year-old woman with hepatocellular carcinoma and to describe the differential diagnoses.

Objectives Patients with head and neck cancer (HNC) have a high risk of sarcopenia, which is associated with poor prognosis. Skeletal-muscle area and index at the third lumbar (L3) vertebra level (L3MA and L3MI) are recommended for the detection of sarcopenia. However, L3 level is not included in many imaging protocols and there are no data for optimal levels and cutoffs for the diagnosis of sarcopenia in head and neck computed tomography (HNCT) scans. Our aim was to assess the relationship between cervical paravertebral muscle values and L3MI and to investigate optimal level to diagnose sarcopenia on HNCTs. Methods Patients with HNC (n=159) who underwent positron emission tomography-CT for tumor staging were retrospectively analyzed. On CT images, paravertebral and sternocleidomastoid muscle areas at second (C2), third (C3), and fourth (C4) cervical vertebrae levels (C2MA, C3MA, C4MA, SCMA) and L3MA were measured. Cross-sectional areas were normalized for stature (muscle area/height square) and muscle index (C2MI, C3MI, C4MI, SCMI, L3MI) values were obtained. Spearman correlation and linear regression analyses were used for assessing correlations. To calculate the diagnostic performance of SCMI, C2MI, C3MI, and C4MI for the diagnosis of sarcopenia with respect to the cutoffs of L3MI, receiver operating characteristic (ROC) analysis was used. Results Males had significantly higher muscle areas than females. Although C2MI, C3MI, C4MI, and SCMI values all showed very strong and significant correlation with L3MI (P

Introduction:The aim of this study was to investigate the prevalence and magnetic resonance imaging (MRI) findings of knee osteonecrosis (ON) in patients with arthralgia who received corticosteroid therapy. We also aimed to demonstrate the diagnostic performance of plain radiography in knee ON when MRI is accepted as the gold standard and to investigate the prevalence of accompanying femoral head ON in patients who underwent hip MRI.Methods:One hundred and sixty-two knee X-rays and MRI examinations of 136 patients with knee pain and a history of corticosteroid intake were retrospectively evaluated for the presence of ON. Localization, maximum size of dominant lesion, multiplicity of lesions, presence of bone edema, double-line sign and subchondral extension were evaluated in patients with ON. Accompanying femoral head ON was also investigated in patients who underwent hip MRI.Results:MRI revealed ON in 37 knees of 28 patients. The sensitivity and specificity of plain radiography in the diagnosis of knee joint ON was 29.73% and 98.40%, respectively. There were multiple lesions in 31 knees and subchondral space was affected in 24 knees. The double-line sign and bone marrow edema were present in most of the lesions. Of the 28 patients with knee ON, only 16 had hip joint MRI and five of these patients (31.3%) had femoral head ON.Conclusion:Plain radiography has low sensitivity but high specificity for the diagnosis of knee ON. Corticosteroid-induced ON tends to be multifocal, and a significant proportion of patients with knee ON during corticosteroid therapy have ON of the hip joint.

Objective:In systemic sclerosis (SS) patients who are receiving treatment, findings of extra-parenchymal chest involvement (such as thymic abnormality, mediastinal lymph node enlargement) have been previously examined. However, these findings may be affected by medical treatment. Our aim was to evaluate the extra-parenchymal chest high-resolution computed tomography (HRCT) findings of patients with SS at the time of initial diagnosis. Methods:We retrospectively analyzed medical database of patients with SS. Chest HRCT images within 1 month after initial diagnosis of these patients were re-evaluated for the presence of distal esophageal dilatation, thymic hyperplasia, mediastinal lymph node enlargement, pleural or pericardial abnormalities (effusion or thickening). Intergroup comparisons were performed using independent t-test or a Mann-Whitney U test. To detect the relationship between continuous variables, Spearman’s correlation coefficients and univariate correlations were used.Results:A total of 51 patients (45 women and 6 men, mean age + STD; 49.2 years+13.9) with SS were included in the study. Esophageal dilatation (88.2%) was the most common finding. Six patients (11.8%) had thymic enlargement. Mediastinal lymph node enlargement (11.8%) and pleural abnormalities (11.8%) were significantly more common in patients with SS diagnosed at late age (p

Introduction:Diaphragm thickness (DT) measurement in computed tomography (CT) has become popular in recent years. Our aim was to assess the intra- and inter-observer agreement of DT measurement and to investigate the best points for DT assessment in CT based on the most reliable measurement.Methods:Thoraco-abdominal CT angiography scans of 44 patients (23 males, mean age: 49.9±17.8 years) were retrospectively evaluated. All of the CT images were evaluated independently by four radiologists. Each observer evaluated images twice to assess intra-observer reproducibility. On both axial and coronal reconstructed CT images, the crura of 88 hemidiaphragms were measured at five different points. A p value less than 0.05 was considered to indicate statistical significance. Intra- and inter-observer agreement was evaluated by using intraclass correlation coefficient (ICC) scores with a 95% confidence interval.Results:In intra-observer analysis, ICC scores demonstrated substantial to almost perfect agreement for all measurements (ICC score range: 0.758-1). When we analyzed the inter-observer agreement, there was a moderate to almost perfect agreement for each measurement point (ICC score range: 0.523-0.895). All axial measurements showed the highest inter-observer agreement (ICC scores were 0.926 and 0.886 for first and second measurements, respectively). The maximum inter- and intra-observer agreement for single point DT measurements were found in maximum DT at the level of the origin of the celiac artery and in anterior DT at the level of the upper part of the L1 vertebral body.Conclusion:CT is a reliable tool DT measurement with excellent intra- and inter-observer agreement.

Objectives The purpose of this study is to investigate if any change exists in the values of tracheal bifurcation angles (subcarinal angle [SCA] and interbronchial angle [IBA]), right and left bronchial angles (RBA and LBA) in different pediatric age groups. Methods Chest computed tomography (CT) images of children aged 18 years and younger were reviewed retrospectively by two radiologists who were blinded to each other’s measurements. One hundred and eighteen children were involved. RBA, LBA, SCA, and IBA were measured on coronal reformatted images. Subjects were classified into three groups according to their age. Measurement of IBA was done by measuring the angle between the lines drawn along the central axis of right and left main bronchi over their length. RBA and LBA were measured at the intersection points of the lines drawn along the inferior borders of the right and left main bronchi and the line passing through the longitudinal axis of trachea. Sums of RBA and LBA gave SCA. Interobserver agreement was also analyzed. Results SCA, IBA, and RBA values were statistically significant between children of ages less than 10 years and over 10 years P

PURPOSEWe aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not.METHODSChest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system.RESULTSEpiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. CONCLUSIONCT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years.

İnternal herni, nadir görülen intestinal obstrüksiyon nedenidir. Hastalarda karın ağrısı, bulantı ve kusma gibi semptomlar bulunabilir. İnternal herni tanısı sıklıkla atlanmakta olup,yüksek mortalitesi nedeniyle intestinal obstrüksiyon bulgularıyla başvuran hastalarda internal herninin araştırılması, erken tanı ve tedavi büyük önem taşımaktadır. Biz buradaperiçekal internal hernisi bulunan bir olgu sunarak, bilgisayarlı tomografinin (BT) tanıdaki rolünü değerlendirdik.