Ceyda Civan Kuş

To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.

Purpose The aim of the study is to compare prone with supine breast magnetic resonance imaging (MRI) in terms of breast tumor location, size, shape, and tumor-to-tumor distances in multifocal lesions to improve image-based guidance for surgical planning. Methods A retrospective analysis was conducted on 75 lesions in 50 patients with pathologically proven breast cancer who underwent MRI in prone and supine positions between December 2019 and December 2020. The transverse, anteroposterior, and craniocaudal dimensions (in millimeters) of the tumor in the x-, y-, and z-axes were measured. Distances from the center of the tumor to the chest wall and the adjacent skin were measured on transverse and reformatted sagittal images. In cases where multifocal lesions were present, the transverse, anteroposterior, and craniocaudal distances between the tumor centers in the x-, y-, and z-axes were measured. Differences between measurements in supine and prone MRI were evaluated with the Mann-Whitney U and the Wilcoxon tests. P values of less than 0.05 were considered to indicate a statistically significant difference. Results The analysis revealed 31 MRIs with 1 and 20 with multifocal lesions. The x-axis dimension of the lesions in prone and supine positions did not significantly differ (P = 0.198) between the 2 positions. A significant difference in the y- and z-axes dimensions was observed between the prone and supine position (P = 0.00 for both). The distance from the tumor to the chest wall and the adjacent skin showed significant difference (P = 0.00 for both). For multifocal lesions, the distance between the lesions showed a significant difference on the y-axis (P = 0.00). Conclusions This study showed a significant difference in the tumor size, location, and tumor-to-tumor distances due to change of patient position, from the standard prone MRI to the supine position in the operating room, resulting in distortion, spatial repositioning, and convergence of the lesions. Supine MRI may be considered in providing a less extensive surgery.

Acute appendicitis is the most common cause of acute abdomen requiring surgery. Although the standard treatment has been surgery, it has been seen in recent years that treatment is possible with antibiotics and non-operative observation. In this study, our aim is to determine whether the computed tomography (CT) findings in patients diagnosed with acute appendicitis can be used for directing treatment. A retrospective analysis was conducted on 138 patients with acute appendicitis who underwent CT between 2015 and 2019. In this study, medical treatment group (n = 60) versus surgical treatment group (n = 78) and successful antibiotic treatment group (n = 23) versus unsuccessful antibiotic treatment group (n = 14) were compared. Appendiceal wall thickness, appendiceal diameter, the severity of mural enhancement, intra-abdominal free fluid, the severity of periappendiceal fat stranding, size of pericecal lymph node, appendicolith, adjacent organ findings, and the CT appendicitis score of groups were compared with Pearson Chi-square and Mann–Whitney U tests. Multivariable logistic regression was used to identify predictors of surgical treatment, expressed as odds ratios (ORs) with 95% CIs. Diagnostic efficacies of appendiceal diameter, the CT appendicitis score, and the developed model were quantified by receiver operating characteristic curves. Appendiceal diameter (P < .001), adjacent organ findings (P = 0.041), the CT appendicitis score (P < .001), the severity of periappendiceal fat stranding (P = .002), appendicolith (P = .001), and intra-abdominal free fluid (P < .001) showed statistically significant differences between the medical and surgical treatment groups. According to the logistic regression test, if the patients are with appendiceal diameter ≥13 mm (OR = 5.1, 95% CI: 1.58-16.50), appendicolith (OR = 4, 95% CI: 1.17-13.63), and intra-abdominal free fluid (OR = 3.04, 95% CI: 1.28-7.20), surgeons should prefer surgical treatment. The area under the curves for the CT appendicitis score, the appendiceal diameter, and the model were 0.742 (95% CI: 0659-0824), 0.699 (95% CI: 0.613-0.786), and 0.745 (95% CI: 0.671-0.819), respectively. As the successful and unsuccessful medical treatment groups were compared, the only significant parameter was the severity of mural enhancement (P = .005). CT findings may be helpful in patients with uncomplicated acute appendicitis whose treatment surgeons are indecisive about. We can recommend surgical treatment in cases with appendix diameter ≥13 mm, intra-abdominal free fluid, appendicolith, high CT appendicitis score, and severe mural enhancement.

Background: Orbital metastasis of breast cancer is an unusual condition, especially in the absence of a previous diagnosis of primary breast cancer. The main MRI findings in patients with orbital metastasis are retroorbital soft tissue with thickening of extraocular muscles. Paradoxical enophthalmos secondary to fibrosis can be seen. Case Report: In this case report, we present a 75-year-old female patient with left eye pain and blurred vision and retraction. Although there was no evidence of malignancy in the biopsy of the orbita; since the patient's complaints continued despite idiopathic pseudotumor treatment, mammography was recommended to rule out the possibility of breast cancer metastasis. Her mammography revealed a suspicious lesion in the left breast and proved to be pleomorphic invasive lobular cancer. Conclusion: Breast cancer metastasis should be kept in mind in women with pseudotumor -like the involvement of the orbita.