Mehmet Emin Sakarya

Purpose Caudal epidural block (CEB), administered through the sacral hiatus, is a regional anesthetic technique commonly used in children. To facilitate and optimize pediatric CEB, morphometric data that may be important for the sacral hiatus have been obtained using multidetector computed tomography (MDCT). Methods This study is the first radio-anatomic study designed to address this topic in children. Images of 79 children (39 girls and 40 boys between 1 and 9 years old) were divided into three groups according to age [group I (ages 1–3), group II (ages 4–6), and group III (ages 7–9)] and were retrospectively examined. Data were gathered via 3D volume-rendered images. Measurements included the height and width of the sacral hiatus, S2–S4 (sacral vertebra) distance, the distances between the poles of the unfused spinous process of each sacral vertebra, and the dimensions of an imaginary triangle formed between the right and left posterior superior iliac spines (PSIS) and the apex of the sacral hiatus. Results The most frequently fused spinous process was at S2 level. The mean S2–S4 distance was 1.36 cm for group I, 1.78 cm for group II, and 2.17 cm for group III. There was not the imaginary equilateral triangle used in the method of finding the sacral hiatus for CEB, and the apex of this triangle did not occur at the standard level (S4) in most of the children. It was observed that the apex deriving from the most distal fused spinous process was at the level of S2 in one of two children. Conclusion Dural puncture is inevitable for CEB applied at the S2 level. Consequently, CEB should be applied below this level (range, 1.36–2.17 cm) from the midpoint of the interspinous distance between the PSIS (at the same level with S2) in children aged 1–9 years.

Aim: The aim of this study was to investigate the pulmonary magnetic resonance angiography (MRA) imaging findings in Swyer – James syndrome (SJS) as a alternative imaging modalities. Methods: Thirteen patients had posteroanterior inspiratory/expiratory chest X-ray films and pulmonary MRA with...

A ten-year-old girl arrived at the hospital with progressive loss of muscular strength on the right side of the body. The cranial MRI showed left fronto-parietal ischemia and atrophic changes in the left parietal lobe. Brain MRI initially disclosed a narrow left MCA. MRA and digital angiography confirmed the diagnosis of brain obstructive chronic vascular disease (Moyamoya). Angiography results demonstrated occlusion of the left MCA and right posterior cerebral artery, with Moyamoya vessels. It therefore appears that in some patients Moyamoya disease is accompanied by posterior circulation involvement.

The purpose of this study was to evaluate the feasibility of using an open-configuration magnetic resonance (MR) imaging system with MR fluoroscopic guidance to perform percutaneous transthoracic fine-needle aspiration biopsy in patients with lung masses. Percutaneous transthoracic aspiration biopsies were performed with MR fluoroscopic guidance in 14 patients. The masses were 2-7 cm in diameter (mean, 4.1 cm). The needle was positioned by using a free-hand technique with MR fluoroscopic guidance. The needle tip reached the target lesion, and biopsy was performed. Analysis of the biopsy specimens facilitated a specific diagnosis in all patients. Pneumothorax was noted in two patients (14%) with chronic obstructive pulmonary disease. Study results showed that the described MR fluoroscopy-guided transthoracic biopsy technique can be used safely and successfully for lung masses. MR fluoroscopy can be used to reach the target lesion easily and accurately.

Pericardial hydatid cyst is rare. We present a 32-year-old man with a pericardial hydatid cyst. Chest x-ray film showed a spherical mass located left mediastinum. A pericardial cyst with low signal intensity was noted on T1 weighted magnetic resonance (MR) images. The cyst had high signal intensity, but signal intensity of folded parasitic membranes in the cyst were seen lower intensity on T2 weighted MR images. Based on these MR findings, pericardial hydatid cyst was diagnosed. The patient underwent surgical removal of the cyst. Histologic study of the cyst confirmed hydatid cyst diagnosis.