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    Association of pulmonary artery obstruction index with elevated heart-type fatty acid binding protein and short-term mortality in patients with pulmonary embolism at intermediate risk
    (Turkish Soc Radiology, 2012) Gul, Enes Elvin; Can, Ilknur; Guler, Ibrahim; Yesildag, Ahmet; Abdulhalikov, Turyan; Kayrak, Mehmet; Ozdemir, Kurtulus
    PURPOSE Heart-type fatty acid binding protein (H-FABP) is a sensitive marker of myocardial injury and predictor of worse prognosis in patients with pulmonary embolism (PE). Assessment of right ventricular dysfunction and pulmonary artery obstruction index (PAOI) with computed tomography (CT) has been reported as a predictor of mortality in PE. Therefore, we aimed to assess the correlation between H-FABP and CT angiographic PAOI in PE patients at intermediate risk. MATERIALS AND METHODS Sixty-one patients (28 males; mean age, 62 +/- 17 years) with diagnosis of PE were included in this study. CT was performed in all patients, and the following parameters were evaluated: right ventricle/left ventricle ratio (RV/LV), pulmonary artery axial diameter, superior vena cava axial diameter, and PAOI determined with Qanadli score. Blood samples were assessed for H-FABP and troponin levels. Patients were followed for 30 days after discharge. RESULTS Mean PAOI was 57 +/- 18%. Eleven patients died during the follow-up period due to PE (18% mortality rate). H-FABP was positive in 21 patients (35%). There was no difference in CT parameters between patients with positive H-FABP and negative H-FABP. In addition, CT parameters were similar between patients who survived and those who did not. RV/LV ratio correlated with PAOI score. Among the biomarkers, troponin levels correlated with both RV/LV ratio and PAOI. H-FABP was an independent predictor of mortality. PAOI and RV/LV ratio did not predict 30-day mortality. CONCLUSION Although H-FABP positivity confers a bad prognosis on PE patients at intermediate risk, PAOI did not predict mortality in this group.
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    Caroli disease with bilateral severe bullous emphysema An unknown component
    (Saudi Med J, 2012) Keskin, Zeynep; Keskin, Suat; Yesildag, Mihrican Y.; Yesildag, Ahmet
    We suspected that the multi-bullous parenchymal disease of our patient could be related to Caroli disease (CD) because he had no pulmonary pathology before the diagnosis of CD. The CD associated with bilateral multiple bullous emphysema may be an unknown component. Saudi Med J 2012; Vol. 33 (11): 1227-1228
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    Magnetic Resonance Imaging May Be a Valuable Radiation-Free Technique for Lung Pathologies in Patients with Primary Immunodeficiency
    (Springer/Plenum Publishers, 2016) Arslan, Sevket; Poyraz, Necdet; Ucar, Ramazan; Yesildag, Mihrican; Yesildag, Ahmet; Caliskaner, Ahmet Zafer
    Purpose In some primary immunodeficiency (PID) patients, especially in the subgroup with common variable immunodeficiency (CVID), radiosensitivity is a concern and avoidance of repeated radiation exposure has been recommended. To investigate the use of lung Magnetic resonance imaging (MRI) instead of Computed Tomography (CT) for the diagnosis and follow-up of various lesions in the lung parenchyma and airways, especially in PID patients in whom x-ray exposure should be limited. Methods The study enrolled 23 patients with PID who underwent thorax CT within the last 3 months and/or who will undergo initial radiological assessment. Lung MRI was performed in all patients to compare the pulmonary findings with CT images. Results MRI performance was weaker at detecting bronchiectasis extension, and a low concordance was found between MRI and CT in the assessment of the number of bronchial generations. CT better identified peripheral airway abnormalities, while CT and MRI gave similar results for detecting the presence and extension of consolidation, bullae, mucus plugging, bronchial wall thickening, bronchiectasis severity and nodules. Conclusions Despite the low spatial resolution, higher cost, and low availability, we suggest MRI as a possible radiation-free alternative to CT in selected patients with PID.
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    Photoclinic Diagnosis: Primary Lipoma of the Diaphragm and Enormous Pericardial Fat Pad Presenting with Long-term Dyspnea
    (Acad Medical Sciences I R Iran, 2013) Keskin, Zeynep; Keskin, Suat; Yesildag, Mihrican; Yesildag, Ahmet
    [Abstract Not Availabe]
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    Pott's Puffy tumor: The role of ultrasound, computed tomography and magnetic resonance imaging in diagnosis
    (Modestum Ltd, 2017) Kalkan, Havva; Eryilmaz, M. Akif; Kiresi, Demet; Arbag, Hamdi; Yesildag, Ahmet
    Pott's Puffy tumor is a rare disorder which is charactarized by frontal osteomyelitis and subperiosteal abscess as a complication of sinusitis. Nowadays we have forgotten this entity under the broad spectrum antibiotherapies for sinijsitis. We reported an adolescent with chronic sinusitis suffered from forehead swelling and headache. He was performed ultrasound, computed tomography, magnetic resonans imaging for accurate diagnosis. Early diagnosis with appropriate imaging is necessary in order to avoid more severe complications, such as subdural empyema, septic thrombosis of the dural sinuses. Emergency physicians should remember Pott's puffy tumor in differential diagnosis in patients presenting with forehead swelling and headache. Imaging modalities have an important role for the right diagnosis and guidance of the surgery. The thing that make this report special is the ultrasonographic images that are so rare reported in the literature. To our knowledge there are two reports which emphasized the sonographic findings of this entity.
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    Strain elastography in the characterization of renal cell carcinoma and angiomyolipoma
    (Canadian Urological Association, 2015) Keskin, Suat; Guven, Selcuk; Keskin, Zeynep; Ozbiner, Huseyin; Kerimoglu, Ulku; Yesildag, Ahmet
    Introduction: We evaluate the diagnostic performance of strain elastography to differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML). Methods: Strain elastography was performed in 65 patients (mean age 55.5 years; range: 32-81) who had renal lesions (24 AMLs and 41 RCCs) prospectively. Lesions were classified according to lesion size and histological subtypes. The strain ratios of the RCCs and AMLs were evaluated by a radiologist. The area under the curve and the cut-off point were used to assess diagnostic performance. Sensitivity, specificity, and positive and negative predictive values were obtained. Results: In assessing the mean strain ratio, we divided the groups in 3 according to size: (1) <20-mm lesions; (2) 20- to 40-mm lesions; and (3) >40-mm lesions; the respective mean strain ratios were: 1.5 +/- 0.5 (range: 0.06-5.92), 2.8 +/- 0.4 (range: 0.17-9.92), 2.7 +/- 0.3 (range: 0.08-6.15). When RCCs and AMLs were compared, there was a statistically significant difference in the strain ratio among the 3 groups divided per lesion size (p < 0.01). For the strain ratio, the mean +/- standard deviation was 1.1 +/- 0.1 for AMLs and 3.4 +/- 0.3 for RCCs (p < 0.01). When lesion subtypes were compared, there was a statistically significant difference in the strain ratio between the AML and clear cell RCC (p < 0.01). Conclusions: For assessing renal lesions, strain elastography and strain ratio values may be useful in differentiating RCCs from AMLs.