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Akhan O, Yildiz O, Unal E, Yildiz AE, Ciftci TT, Akinci D. Case Report: Imaging-Guided Percutaneous Catheterization and Microwave Ablation of a Bone Hydatid Cyst with Soft-Tissue Component. Am J Trop Med Hyg 2022; 107:tpmd220066. [PMID: 35895346 PMCID: PMC9490662 DOI: 10.4269/ajtmh.22-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022] Open
Abstract
Cystic echinococcosis (CE) of the bone is a rare disease compared with CE of the viscera, and the most involved bony structures are the spine and the pelvis. Both the diagnosis and the treatment of bone CE are challenging for several reasons. The combination of surgery and antimicrobial therapy is the most common approach, the results are far from adequate. Luckily, percutaneous treatment has appeared on the horizon for bone lesions as a more practical option with fewer drawbacks in light of current reports. This article deals with the successful result of ablation-assisted percutaneous treatment of a bone CE lesion and a soft tissue CE lesion treated by modified catheterization technique in a male patient with left hip pain that was unresponsive to previous surgery for CE.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oguzhan Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Adalet Elcin Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Parlak E, Simsek C, Koksal AS, Eminler AT, Unal E, Ciftci TT, Akinci D, Yilmaz S. The Classification of Biliary Strictures in Patients With Right-Lobe Liver Transplant Recipients and Its Relation to Traversing the Stricture With a Guidewire. Transplantation 2022; 106:328-336. [PMID: 33724243 DOI: 10.1097/tp.0000000000003738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traversing the stricture with a guidewire is a prerequisite for the endoscopic treatment of biliary strictures after living donor liver transplantation. We aimed to evaluate the effect of variations in the biliary anastomosis and strictures on the success of endoscopic treatment and suggest a cholangiographic classification. METHODS The 125 strictures among the 104 patients with right-lobe living donor liver transplantation were reviewed. The strictures were classified by the anastomosis pattern according to the number (1, 2, or >2), location (common bile, hepatic, or cystic duct), the angle between the proximal and distal sites of the anastomosis, and the contrast enhancement pattern. The relationship between the success rate of traversing the anastomosis and the classification was evaluated. RESULTS Of the 125 biliary strictures, 86 (68.8%) could be passed via endoscopically. Thirty-three strictures were managed either percutaneously (n = 13) or by magnetic compression anastomosis (n = 20). Compared with the round, the triangular (odds ratio [OR], 6.5), the intermediate form (OR, 17.7), and the end-to-side anastomosis (OR, 5.1) were associated with an increased chance of traversing. The contrast enhancement pattern of the strictures and the bile ducts was also related to the successful rate of the endoscopic treatment (P < 0.001). The success rate was higher in the patients with the angle between the proximal and distal sites of the anastomosis approximated was small (0°-30° = 74%, 30°-60° = 69%, 60°-90° = 63%, >90° = 41%). CONCLUSIONS The type of biliary anastomoses and stricture affect the success rate of endoscopic treatment. These data may play role in making decision about the type of anastomosis during the surgery.
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Affiliation(s)
- Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cem Simsek
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aydin Seref Koksal
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmet Tarik Eminler
- Department of Gastroenterology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Emre Unal
- Department of Radyology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radyology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Devrim Akinci
- Department of Radyology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezai Yilmaz
- Department of Surgery, Faculty of Medicine, Liver Transplant Institute, Inonu University, Malatya, Turkey
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Ozkale Yavuz O, Ozcan HN, Oguz B, Ayaz E, Ekinci S, Ciftci TT, Haliloglu M. Imaging findings of benign and malignant pediatric splenic lesions. Abdom Radiol (NY) 2021; 46:3245-3252. [PMID: 33661318 DOI: 10.1007/s00261-021-03004-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/06/2023]
Abstract
Splenic lesions in children have a wide histological spectrum. The majority of pediatric splenic lesions are benign and detected incidentally, and the most common benign lesions are cysts, followed by hemangiomas and lymphatic malformations. Most of the splenic malignancies in children are secondary to leukemia or lymphoma. The purpose of this article is to describe the ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) features of benign and malignant splenic lesions in the pediatric age group.
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Affiliation(s)
- Ozlem Ozkale Yavuz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey.
- Division of Pediatric Radiology, Department of Radiology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Hatice Nursun Ozcan
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
| | - Ercan Ayaz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
- Department of Radiology, Diyarbakır Children Hospital, Diyarbakır, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Sıhhiye, 06230, Ankara, Turkey
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Turan Ciftci T, Akinci D, Unal E, Tanır G, Artas H, Akhan O. Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study. ACTA ACUST UNITED AC 2021; 27:401-407. [PMID: 34003128 DOI: 10.5152/dir.2021.20331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children. METHODS A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months. RESULTS Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001). CONCLUSION Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options.
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Affiliation(s)
- Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine. Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine. Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine. Ankara, Turkey
| | - Gonul Tanır
- Department of Pediatric Infectious Disease, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Hakan Artas
- Department of Radiology, Firat University School of Medicine, Elazig, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine. Ankara, Turkey
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Abstract
Cystic echinococcosis (CE) may be encountered in almost every site of the body, but bone involvement is relatively rare. The vertebral column and pelvis are the most affected areas. The combined medical and surgical approach is the main treatment option in current literature. Although percutaneous treatment of CE cysts located in the liver, spleen, kidney, and soft tissues has become a serious alternative to surgery, there is no bone CE cyst treated percutaneously in the literature. This case report aims to point out that percutaneous treatment can be an effective treatment choice and alternative to surgery.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
| | - Oguzhan Yildiz
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Ciftci TT, Unal E, Azizova A, Ayyildiz VA, Akinci D, Akhan O. Renal Cystic Echinococcosis: Long-Term Outcomes of Percutaneous Treatment. J Vasc Interv Radiol 2021; 32:890-895.e2. [PMID: 33727151 DOI: 10.1016/j.jvir.2021.03.519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To evaluate the long-term outcomes of percutaneous treatment of renal cystic echinococcosis (CE) stratified by cyst stages according to the World Health Organization (WHO) classification. MATERIALS AND METHODS Between January 1997 and February 2019, 34 patients with renal CE (18 women; mean age, 38 years) were treated with 3 different percutaneous techniques. According to the World Health Organization classification, the cysts were classified as CE1, CE2, CE3a, and CE3b. Puncture, aspiration, injection, reaspiration (PAIR) or standard catheterization was used for the dimension-based treatment of CE1 and CE3a cysts. Modified catheterization (MoCaT) was used to treat all CE2 and CE3b cysts. Technical and clinical success, complications, and reduction in cyst cavities were evaluated. RESULTS The technical success rate was 100%. PAIR, standard catheterization, and MoCaT were used to treat 12, 9, and 13 cysts, respectively. The only severe adverse event was a bacterial superinfection that occured in the cyst cavity of a patient (3%) treated with MoCaT. Four patients (12%) experienced mild/moderate periprocedural allergic adverse events and were managed conservatively. The mean length of hospital stay was 1, 5, and 7 days for patients treated with PAIR, standard catheterization, and MoCaT, respectively. The clinical success rate was 97%. In 1 of 34 cysts (3%), recurrence was detected and the cyst was successfully re-treated. During the 10.5-year follow-up period, 95% volume reduction was achieved. The median final cyst volume was 10 mL. CONCLUSIONS Renal CE can be successfully treated with minimum adverse events and recurrence rates using appropriate percutaneous techniques selected according to their stages as classified according to WHO.
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Affiliation(s)
- Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aynur Azizova
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Veysel Atilla Ayyildiz
- Department of Radiology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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Uysal A, Unal E, Karaosmanoglu AD, Arellano R, Ciftci TT, Akinci D, Akhan O. The role of interventional radiology in the treatment of patients with pancreatic cancer. Br J Radiol 2020; 94:20200702. [PMID: 33156695 DOI: 10.1259/bjr.20200702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Interventional radiology (IR) provides minimally invasive therapeutic and palliative options for the treatment of pancreatic cancer depending on the stage of the disease. IR plays a critical, and also a very effective role, in both pre- and post-operative care of the patients with early stage resectable disease and also in palliative treatment of the patients with locally advanced or metastatic disease. In this article, we aimed to present the capability and the limitations of IR procedures including: local treatment options of primary and metastatic pancreatic cancer, palliation of biliary and intestinal obstructions, minimally invasive treatment of post-operative complications, and pain management.
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Affiliation(s)
- Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Ronald Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Akhan O, Erdoğan E, Ciftci TT, Unal E, Karaağaoğlu E, Akinci D. Cystobiliary Fistula of Liver CE Treatment as a Major Problem. Cardiovasc Intervent Radiol 2020; 43:1718-1719. [PMID: 32914369 DOI: 10.1007/s00270-020-02631-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
| | - Erhan Erdoğan
- Department of Radiology, Eskisehir Yunus Emre State Hospital, 26190, Eskişehir, Turkey
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Ergun Karaağaoğlu
- Department of Biostatistics, Hacettepe University, 06100, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Yildiz O, Unal E, Ciftci TT, Akinci D, Ariyurek OM. An unusual presentation of pulmonary artery sarcoma: Several pseudoaneurysms with massive hemoptysis. Am J Emerg Med 2020; 38:1966.e1-1966.e3. [PMID: 32444291 DOI: 10.1016/j.ajem.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
A 53-year-old woman was admitted to the emergency department with sudden onset of massive hemoptysis. She had previous history of dyspnea and cough for two months. She had no history of chronic disease, smoking, or use of anticoagulant and antiplatelet drugs. On arrival, she was tachycardic and tachypneic, but her body temperature was normal. Chest X-ray showed enlarged right hilus and multiple nodular opacities predominantly in the left lung basis. Computed tomography (CT) scan of the chest demonstrated massive intraluminal filling defect extending from the right pulmonary artery through the main and left pulmonary arteries. Pulmonary artery sarcoma (PAS) was the preliminary imaging-based diagnosis. However, CT also revealed presence of several pseudoaneurysms arising from the distal branches of the left pulmonary artery encased by metastatic nodules. Although hemoptysis is an uncommon presentation for patients with PAS, accompanied pseudoaneurysms were the main reason for massive hemoptysis. Differentiation of PAS from bland thromboembolism could be challenging on CT. Herein reported case provides an additional imaging feature that may utilize differentiating pulmonary artery sarcoma from bland thrombus.
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Affiliation(s)
- Oguzhan Yildiz
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Emre Unal
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey.
| | - Turkmen Turan Ciftci
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Orhan Macit Ariyurek
- Department of Radiology, Hacettepe University School of Medicine, Ankara 06100, Turkey
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