Publications by authors named "Meltem Gülsün Akpınar"

15 Publications

  • Page 1 of 1

Magnetic resonance imaging findings of invasive breast cancer in different histological grades and different histopathological types.

Clin Imaging 2021 Feb 10;76:98-103. Epub 2021 Feb 10.

Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey.

Background: The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of invasive breast cancer in different histopathological types (invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and mixed ductal-lobular carcinoma (MDLC)) and different histological grades.

Methods: A retrospective review was made of 1256 patients who underwent breast MRI at our hospital between January 2015 and December 2018. A total of 152 lesions (27 ILC, 102 IDC, 23 MDLC and 20 grade 1, 83 grade 2 and 49 grade 3) were included in the study. All the lesions were evaluated according to size, shape, margin, dynamic curve, ADC value and T2 signal intensity ratio (SIR).

Results: Most of the lesions tended to show type 2 and type 3 dynamic curve, type 1 dynamic curve was more commonly seen in ILC and grade 1 groups. IDC showed higher T2 SIR than the other types and grade 3 showed higher T2 SIR than other grades (p< 0,05) There was no statistically significant difference between the groups according to morphological features and mean ADC values (p > 0,05).

Conclusion: T2 SIR and dynamic curve can help the radiologists predict histopathological findings while morphological features and ADC values were not helpful in distinguishing histological types and grades.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinimag.2021.01.039DOI Listing
February 2021

Does Internal Mammary Node Irradiation for Breast Cancer Make a Significant Difference to the Diameter of the Internal Mammary Artery? Correlation with Computed Tomography.

Breast Care (Basel) 2020 Dec 22;15(6):635-641. Epub 2020 Jun 22.

Department of Radiology, Hacettepe University Medical School, Ankara, Turkey.

Objective: Lymphatic irradiation in breast cancer improves locoregional control and has been shown to decrease distant metastasis. However, irradiation also accelerates the formation of atherosclerosis and can cause stenosis, not only in the coronary arteries but also in the internal mammary artery (IMA). The aim of this study was to investigate the effects of radiation on IMAs via computed tomography (CT).

Methods: We reviewed the data of 3,612 patients with breast cancer treated with radiotherapy (RT) between January 2010 and December 2016. We included 239 patients with appropriate imaging and nodal irradiation in the study. All patients were treated with lymphatic irradiation of 46-50 Gy, and a boost dose (6-10 Gy) to the involved internal mammary nodes (IMNs) when imaging studies demonstrated pathological enlargement. Bilateral IMA diameter and the presence of calcification were assessed via thin contrast-enhanced CT and those of ipsilateral irradiated IMAs were compared with those of contralateral nonirradiated IMAs.

Results: The mean diameter of irradiated IMAs was significantly shorter than that of nonirradiated IMAs, regardless of laterality. All vascular calcifications were determined on the irradiated side. A boost dose of radiation to the IMNs and radiation technique did not significantly affect the IMA diameter or the presence of calcification.

Conclusions: The diameter of the IMA is decreased due to RT regardless of laterality, radiation technique, and administration of a boost dose. Evaluation of vessels on CT before coronary artery bypass graft or flap reconstruction can help the surgeon select the most appropriate vessel.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000508244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768163PMC
December 2020

COVID-19 pneumonia: the great radiological mimicker.

Insights Imaging 2020 Nov 23;11(1):118. Epub 2020 Nov 23.

Department of Radiology, School of Medicine, Tıp Fakültesi Hastanesi, Hacettepe University, 06100, Sıhhiye, Ankara, Turkey.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since December 2019. Although the reference diagnostic test is a real-time reverse transcription-polymerase chain reaction (RT-PCR), chest-computed tomography (CT) has been frequently used in diagnosis because of the low sensitivity rates of RT-PCR. CT findings of COVID-19 are well described in the literature and include predominantly peripheral, bilateral ground-glass opacities (GGOs), combination of GGOs with consolidations, and/or septal thickening creating a "crazy-paving" pattern. Longitudinal changes of typical CT findings and less reported findings (air bronchograms, CT halo sign, and reverse halo sign) may mimic a wide range of lung pathologies radiologically. Moreover, accompanying and underlying lung abnormalities may interfere with the CT findings of COVID-19 pneumonia. The diseases that COVID-19 pneumonia may mimic can be broadly classified as infectious or non-infectious diseases (pulmonary edema, hemorrhage, neoplasms, organizing pneumonia, pulmonary alveolar proteinosis, sarcoidosis, pulmonary infarction, interstitial lung diseases, and aspiration pneumonia). We summarize the imaging findings of COVID-19 and the aforementioned lung pathologies that COVID-19 pneumonia may mimic. We also discuss the features that may aid in the differential diagnosis, as the disease continues to spread and will be one of our main differential diagnoses some time more.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13244-020-00933-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681181PMC
November 2020

Visual and software-based quantitative chest CT assessment of COVID-19: correlation with clinical findings.

Diagn Interv Radiol 2020 Nov;26(6):557-564

Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Purpose: The aim of this study was to evaluate visual and software-based quantitative assessment of parenchymal changes and normal lung parenchyma in patients with coronavirus disease 2019 (COVID-19) pneumonia. The secondary aim of the study was to compare the radiologic findings with clinical and laboratory data.

Methods: Patients with COVID-19 who underwent chest computed tomography (CT) between March 11, 2020 and April 15, 2020 were retrospectively evaluated. Clinical and laboratory findings of patients with abnormal findings on chest CT and PCR-evidence of COVID-19 infection were recorded. Visual quantitative assessment score (VQAS) was performed according to the extent of lung opacities. Software-based quantitative assessment of the normal lung parenchyma percentage (SQNLP) was automatically quantified by a deep learning software. The presence of consolidation and crazy paving pattern (CPP) was also recorded. Statistical analyses were performed to evaluate the correlation between quantitative radiologic assessments, and clinical and laboratory findings, as well as to determine the predictive utility of radiologic findings for estimating severe pneumonia and admission to intensive care unit (ICU).

Results: A total of 90 patients were enrolled. Both VQAS and SQNLP were significantly correlated with multiple clinical parameters. While VQAS >8.5 (sensitivity, 84.2%; specificity, 80.3%) and SQNLP <82.45% (sensitivity, 83.1%; specificity, 84.2%) were related to severe pneumonia, VQAS >9.5 (sensitivity, 93.3%; specificity, 86.5%) and SQNLP <81.1% (sensitivity, 86.5%; specificity, 86.7%) were predictive of ICU admission. Both consolidation and CPP were more commonly seen in patients with severe pneumonia than patients with nonsevere pneumonia (P = 0.197 for consolidation; P < 0.001 for CPP). Moreover, the presence of CPP showed high specificity (97.2%) for severe pneumonia.

Conclusion: Both SQNLP and VQAS were significantly related to the clinical findings, highlighting their clinical utility in predicting severe pneumonia, ICU admission, length of hospital stay, and management of the disease. On the other hand, presence of CPP has high specificity for severe COVID-19 pneumonia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/dir.2020.20407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664745PMC
November 2020

Lung and kidney perfusion deficits diagnosed by dual-energy computed tomography in patients with COVID-19-related systemic microangiopathy.

Eur Radiol 2021 Feb 29;31(2):1090-1099. Epub 2020 Aug 29.

Faculty of Medicine, Department of Radiology, Hacettepe University, Sihhiye, Ankara, Turkey.

Objectives: There is increasing evidence that thrombotic events occur in patients with coronavirus disease (COVID-19). We evaluated lung and kidney perfusion abnormalities in patients with COVID-19 by dual-energy computed tomography (DECT) and investigated the role of perfusion abnormalities on disease severity as a sign of microvascular obstruction.

Methods: Thirty-one patients with COVID-19 who underwent pulmonary DECT angiography and were suspected of having pulmonary thromboembolism were included. Pulmonary and kidney images were reviewed. Patient characteristics and laboratory findings were compared between those with and without lung perfusion deficits (PDs).

Results: DECT images showed PDs in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Among these patients, two had pulmonary thromboembolism confirmed by CT angiography. Patients with PDs had a longer hospital stay (p = 0.14), higher intensive care unit admission rates (p = 0.02), and more severe disease (p = 0.01). In the PD group, serum ferritin, aspartate aminotransferase, fibrinogen, D-dimer, C-reactive protein, and troponin levels were significantly higher, whereas albumin level was lower (p < 0.05). D-dimer levels ≥ 0.485 μg/L predicted PD with 100% specificity and 87% sensitivity. Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormalities in 13 patients (50%) with lower sodium levels (p = 0.03).

Conclusions: We found that a large proportion of patients with mild-to-moderate COVID-19 had PDs in their lungs and kidneys, which may be suggestive of the presence of systemic microangiopathy with micro-thrombosis. These findings help in understanding the physiology of hypoxemia and may have implications in the management of patients with COVID-19, such as early indications of thromboprophylaxis or anticoagulants and optimizing oxygenation strategies.

Key Points: • Pulmonary perfusion abnormalities in COVID-19 patients, associated with disease severity, can be detected by pulmonary DECT. • A cutoff value of 0.485 μg/L for D-dimer plasma levels predicted lung perfusion deficits with 100% specificity and 87% sensitivity (AUROC, 0.957). • Perfusion abnormalities in the kidney are suggestive of a subclinical systemic microvascular obstruction in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-020-07155-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455509PMC
February 2021

Imaging findings and classification of the common and uncommon male breast diseases.

Insights Imaging 2020 Feb 18;11(1):27. Epub 2020 Feb 18.

Department of Radiology, School of Medicine, Hacettepe University, 06100, Ankara, Turkey.

Male breast hosts various pathological conditions just like "female breast." However, histo-anatomical diversities with female breast lead to many differences regarding the frequency and presentation of diseases, the radiologic appearance of lesions, the diagnostic algorithm, and malignity features.Radiological modalities may play an important role in evaluating male breast lesions. Although some imaging findings are non-specific, having knowledge of certain imaging characteristics and radiologic patterns is the key to reduce the number of differential diagnoses or to reach an accurate diagnosis.Male breast imaging is mostly based on physical examination and is required for the complaints of palpable mass, breast enlargement, tenderness, nipple discharge, and nipple-skin changes. The majority of the male breast lumps are benign and the most common reason is gynecomastia. Although it is difficult to exclude malignancy in some cases, gynecomastia often has distinguishable imaging features. Pseudogynecomastia is another differential diagnosis that may be confused with gynecomastia. The distinction is important for the treatment plan.Apart from gynecomastia, other male breast lesions form a highly heterogeneous group and can be classified based on "Tissue origin," "Histopathological type and behavior," and "Radiologic features" for both simplification and comprehensive understanding.This article mainly focuses on emphasizing the results of basic histo-anatomical differences of male and female breasts, classifying male breast lesions, covering the spectrum of male breast diseases, and assisting radiologists in recognizing the imaging findings, in interpreting them through a holistic approach, in making a differential diagnosis, and in being a part of proper patient management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13244-019-0834-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028902PMC
February 2020

Can Radiologist and Pathologist Reach The Truth Together in The Diagnosis of Benign Fibroepithelial Lesions?

Eur J Breast Health 2019 Jul 1;15(3):176-182. Epub 2019 Jul 1.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: Benign fibroepithelial lesions (BFL) lesions of the breast are various and predominantly benign, although a few can be locally aggressive. Definitive diagnosis of some BFL can be challenging from core needle biopsy (CNB). Radiological findings can help guide the management of the lesions. The aim of this study was to investigate the accuracy rate of CNB results and evaluate the radiological findings of the most common BFL according to the final excision pathology results. The secondary aim was to assess the contribution of the imaging findings to CNB results.

Materials And Methods: A retrospective review was made of 266 patients diagnosed with suspicious BFL, conventional fibroadenoma, complex fibroadenoma, cellular fibroadenoma and benign phyllodes tumor (PT). The study included 132 patients who underwent surgical excision. The radiological and histopathological findings were evaluated.

Results: While 66 patients were diagnosed with more descriptive results on CNB, the other 66 patients were diagnosed with suspicious BFL. Agreement between CNB and excisional pathology was good, when CNB provided a definite diagnosis. While conventional and complex fibroadenoma were observed to have hypo or normal vascularity, cellular fibroadenoma and PT showed hypervascularity. Oval shaped and homogeneous internal echo pattern were significantly associated with conventional fibroadenoma. A heterogeneous internal echo pattern was seen in complex fibroadenomas and PT.

Conclusion: CNB often reaches the correct diagnosis alone when it gives a definite diagnosis. The radiological findings which help in the differentiation of BFL are hypervascularity, oval shape and internal heterogeneity. More accurate results can be obtained when histopathological and radiological findings are evaluated together.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/ejbh.2019.4656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619778PMC
July 2019

Imaging Findings and Clinicopathological Correlation of Breast Cancer in Women under 40 Years Old.

Eur J Breast Health 2019 Jul 1;15(3):147-152. Epub 2019 Jul 1.

Department of Pathology, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: The aim of this study was to evaluate the clinical, imaging and histopathological features of breast cancer in patients aged under 40 years of age. The relationship between radiological characteristics and histopathological features was also investigated.

Materials And Methods: The study included 131 patients aged under 40 years, diagnosed pathologically with breast cancer. A retrospective evaluation was made of the imaging and clinicopathological findings and the relationship between pathological and imaging findings was investigated.

Results: Most of the cancers were detected from clinical symptoms, especially a palpable mass (76.3%). The most common histological type of tumor was invasive ductal carcinoma and 64.8% of the tumors were high grade tumors. The predominant features were irregular borders (92.4%), microlobulated-angulated contours (43.5%), hypo-homogeneous internal echogenicity (80.9%) on ultrasonography, and the presence of a mass (41.2%) and suspicious microcalcifications (40.2%) on mammography. Magnetic resonance imaging commonly showed mass enhancement (66.7%) with type 2 or 3 dynamic curve (92.6%). High-grade tumors were associated with posterior acoustic enhancement (p: 0.03) while low-grade tumors presented with spiculated margins more than high grade tumors (p: 0.04).

Conclusion: Breast cancer in women aged under 40 years usually presents with a self-detected palpable mass and can show different imaging findings according to the histological grade. Ultrasonography is the main modality for the diagnosis of breast cancer in young women, but mammography and magnetic resonance imaging can help in both diagnosis and evaluation of the extent of disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/ejbh.2019.4606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619779PMC
July 2019

Comparison of MRI and US in Tumor Size Evaluation of Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

Eur J Breast Health 2019 Apr 1;15(2):119-124. Epub 2019 Apr 1.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: Magnetic resonance imaging (MRI) and ultrasonography (US) are commonly used in the pre-surgery determination of tumor size and the follow-up of breast cancer patients treated with neoadjuvant chemotherapy (NAC). The aim of this study was to compare the efficiency of preoperative MRI and US in tumor size evaluation of patients with breast cancer after NAC to guide clinicians on the appropriate treatment plan.

Materials And Methods: The study included a total of 75 patients who had undergone radiological follow-up, surgical treatment and pathological examination in our hospital between 2013 and 2016. Of these, 28 patients were followed-up with MRI and 47 with US. The dimension evaluations in pathology examination and on both MRI and US were based on the longest dimension of the tumor.

Results: There was no statistically significant difference between the tumor size measured pathologically and the size measured preoperatively on MRI (p=0.379). The tumor size measured on US before surgery was significantly smaller than the size measured in pathology (p=0.004). MRI did not overestimate by more than 10 mm in any patient, whereas US overestimated in 4 patients (8.6%). The correlation coefficient of MRI was higher than that of US (0.927 and 0.687, respectively).

Conclusion: MRI is superior to US in preoperative tumor size evaluation of patients receiving NAC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/ejbh.2019.4547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456278PMC
April 2019

Measurement of pulmonary artery to aorta ratio in computed tomography is correlated with pulmonary artery pressure in critically ill chronic obstructive pulmonary disease patients.

J Crit Care 2016 06 28;33:42-6. Epub 2016 Jan 28.

Hacettepe University Faculty of Medicine, Department of Internal Medicine, Medical Intensive Care Unit, Ankara, Turkey.

Aim: Chronic obstructive pulmonary disease (COPD) is one of the leading chronic diseases and a common cause of death. Identification of COPD patients at high risk for complications and mortality is of utmost importance. Computed tomography (CT) can be used to measure the ratio of the diameter of the pulmonary artery (PA) to the diameter of the aorta (A), and PA/A ratio was shown to be correlated with PA pressure (PAP). However, the prognostic value of PA size remains unclear in patients with COPD. We hypothesized that PA enlargement, as shown by a PA/A ratio greater than 1, could be associated with a higher risk of mortality in COPD patients admitted to the intensive care unit.

Methods: Data of patients admitted to a medical intensive care unit of a university hospital were retrospectively reviewed between January 2008 and December 2012. Patients who were identified to have a diagnosis of acute exacerbation of COPD and who had an echocardiogram and CT scan were included. Pulmonary artery to aorta ratio was calculated and patients were grouped as PA/A ≤1 and PA/A >1. Comparisons were made between the groups and between patients who died and survived. Correlation analysis, survival analysis, and logistic regression analysis were done, where appropriate.

Results: One hundred six COPD patients were enrolled. There were 40 (37.4%) patients who had a PA/A >1. Echocardiography measured PAP was higher in the group with PA/A >1 than in those with PA/A ≤1 (62.1 ± 23.2 mm Hg vs 45.3 ± 17.9 mm Hg, P = .002). Mortality rate of patients with PA/A >1 was higher (50%) than of those patients with PA/A ≤1 (36.4%), although the difference did not reach a statistical significance (P = .17). Correlation was found between vmeasured PA diameter and PAP (r = 0.51, P = .001) as well as between the Acute Physiology and Chronic Health Evaluation II values and PAP (r = 0.25, P = .025).

Conclusion: The PA/A ratio is an easily measured method that can be performed on thorax CT scans. Although, we failed to demonstrate a statistically significant association between higher PA/A and increased mortality, PA/A can be used as a surrogate marker to predict the pulmonary hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrc.2016.01.020DOI Listing
June 2016

Efficiency of ultrasound and ultrasound-guided fine needle aspiration cytology in preoperative assessment of axillary lymph node metastases in breast cancer.

J Breast Cancer 2012 Jun 28;15(2):211-7. Epub 2012 Jun 28.

Department of Radiology, Hacettepe University, Ankara, Turkey.

Purpose: We performed this study to detect preoperative axillary metastases with ultrasound (US)-guided fine needle aspiration biopsy (FNAB), to eliminate the need for time-consuming and costly sentinel lymph node (SLN) scintigraphy and biopsy steps in the treatment of breast cancer patients, and in that of with suspicious US findings, and to evaluate the accuracy of preoperative US-guided FNAB for patients with suspicious lymph node metastases on US.

Methods: Patients with a suspicious breast lump or histopathologically proven breast cancer underwent breast-axillary US. Increase in lymph node size, cortical thickening, non-hilar cortical flow, and hilar changes were evaluated with gray scale-color Doppler US. FNAB was performed if US results were suspicious for malignancy.

Results: Thirty-eight axillary lymph nodes (ALN) underwent FNAB. ALN dissection, SLN scintigraphy, and biopsy steps were bypassed in 23 axillas with positive ALN FNAB (60.5%). The sensitivity of ALN FNAB was 88.46%; specificity and positive predictive value were 100%; and negative predictive value was 66.6% (inadequate cytology included; 76.7%, 100%, 100%, 53.3%, respectively). Asymmetrical cortical thickening, non-hilar cortical flow, and increase in hypoechogenity were only detected in metastatic nodes. Cortical thickening, and lymph node and breast mass size was higher in the metastatic group.

Conclusion: By performing FNAB on suspicious lymph nodes, the routine, high-cost SLN scintigraphy and intraoperative gamma probe steps may be skipped, and axilla dissection can be performed directly. This leads to the elimination of the need for SLN investigation in more than half of the patients. The assessment of ALN metastases with preoperative US-guided FNAB is a cost-effective method with high specificity, that eliminates the need for costly and time-consuming SLN scintigraphy and biopsy steps, and helps in preoperative staging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4048/jbc.2012.15.2.211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395745PMC
June 2012

Pulmonary abnormalities on high-resolution computed tomography in ankylosing spondylitis: relationship to disease duration and pulmonary function testing.

Rheumatol Int 2012 Jul 9;32(7):2031-6. Epub 2011 Apr 9.

Department of Physical Medicine and Rehabilition, Hacettepe University Medical School, Ankara, Turkey.

The aim of this study was to identify the pulmonary abnormalities on high-resolution computed tomography (HRCT) in patients with ankylosing spondylitis (AS) and to examine the relationship with the duration of disease and pulmonary function test (PFT) results. Twenty male AS patients with a mean age of 37.1 ± 9.4 years were enrolled in this study. The patients were assigned into 2 groups according to disease duration: patients with disease duration <10 years (n = 10) and ≥ 10 years (n = 10). All patients underwent clinical examination, PFT and HRCT. HRCT revealed abnormalities in 14 patients (70%). The most common findings were apical fibrosis (45%) and emphysema (25%). HRCT findings were more prominent in late AS patients (disease duration ≥ 10 years) (P = 0.015). PFT were considered as abnormal in 4 patients (20%). While 3 patients had a restrictive type pulmonary deficiency, one patient had a mild obstructive pattern. Three of these patients had concomitant HRCT abnormalities. On the other hand, 10 patients with normal PFT had abnormalities on HRCT. These findings suggest that pulmonary involvement in AS patients without respiratory symptoms could be sensitively detected by HRCT. However, the clinical significance of these radiological abnormalities should be examined in further prospective studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-011-1923-xDOI Listing
July 2012

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases.

Braz J Infect Dis 2009 Oct;13(5):391-3

Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/S1413-86702009000500016DOI Listing
October 2009

CT findings in immunocompromised patients with pulmonary infections.

Diagn Interv Radiol 2008 Jun;14(2):75-82

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Purpose: To evaluate computed tomography (CT) findings of pulmonary infections in immunocompromised patients with hematologic malignancies, and to detect the accuracy of first-choice diagnoses.

Materials And Methods: CT chest scans of 57 immunocompromised patients who had pulmonary infections were evaluated retrospectively, and a first and second interpretation of etiology (first- and second-choice diagnosis) was proposed. The etiology of pulmonary infection was verified by microbiological tests such as blood, sputum, bronchoalveolar lavage (BAL) cultures, sputum, and BAL smears, or diagnosed on the basis of response to treatment and clinical follow-up.

Results: Nineteen patients had a bacterial infection, 20 patients had a fungal infection, 8 patients had a cytomegalovirus (CMV) infection, 8 patients had Pneumocystis jiroveci pneumonia (PCP) and 2 patients had a Mycobacterium tuberculosis infection. There were consolidations in 13 patients (68.4%) and areas of ground-glass attenuation and ground-glass nodules in 6 patients (31.6%) with bacterial infection. Six of 8 eight patients (75%) with CMV infection had centrilobular nodules associated with bronchial wall thickening and ground-glass areas and nodules. There were parenchymal nodules in 18 of 20 patients (90%) who had a fungal infection. All 8 patients who had PCP had bilateral areas of ground-glass densities on CT scans. The first-choice diagnosis was accurate in most of the fungal infections (95.0%) and PCP (87.5%), but was less accurate for bacterial and viral infections (73.7% and 75.0%, respectively). Neither of the 2 tuberculous infections was identified on the basis of CT findings.

Conclusion: In the evaluation of febrile immunocompromised patients, pulmonary fungal infection and PCP may be identified with high accuracy on the basis of CT findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2008

Imaging of pulmonary thromboembolism.

Clin Chest Med 2008 Mar;29(1):107-16, vi

Department of Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226-3596, USA.

Pulmonary thromboembolism usually results from deep venous thrombi originating in the lower extremities. Therefore, imaging of venous thromboembolism includes evaluation of the pulmonary arteries and the deep veins of the lower extremities. The introduction of helical CT and multidetector row CT into daily use has enabled direct visualization of pulmonary arteries. CT venography, performed 3 minutes after CT pulmonary angiography (without additional contrast administration), adds the ability to evaluate the veins of the lower extremities and pelvis. The modalities currently used in the diagnostic workup of venous thromboembolic disease and their advantages and disadvantages are discussed in this article.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ccm.2007.11.003DOI Listing
March 2008