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  • Küçük Resim
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    Anatomic variations of the colon detected on abdominal CT scans
    (2004) Ünal, Birsen; Kara, Simay; Aktaş, Aykut; Bilgili, Mirace Yasemin
    PURPOSE: The frequency of anatomic variations of the colon detected on abdominal CT scans was examined. MATERIALS AND METHODS: 296 consequtive abdominal tomography were evaluated prospectively for the presence of retrorenal colon, retrogastric (pancreaticogastric interposition or retrosplenic) colon, high positioned colon, interposition of the colon between the psoas muscle and the kidney and hepatodiaphragmatic interposition (anterior or posterior). RESULTS: We observed 2 retrogastric colon [1 pancreaticogastric (0.3%), 1 retrosplenic (0.3%)], 7 retrorenal colon (1.2%) being bilateral in two cases, 2 interposition of colon between the psoas muscle and the kidney (0.7%), 1 posterior (0.3%) and 6 anterolateral hepatodiaphragmatic interposition (2.1%) and 12 high positioned cecum (4.2%) (in 4 of them cecum was totally subhepatic in location). Terminal ileum was lying in Morrison's pouch and anterior to renal hilus in two of the cases with subhepatic cecum. CONCLUSION: Anatomic variations of the colon probably result due to mild embryologic abnormalities of bowel rotation and fixation, short transvers mesocolon, intraperitoneal ascending or descending colon, increased intraperitoneal pressure or decreased retroperitoneal fat. Pancreaticogastric interposition occurs in approximately 0.2%, partial retrorenal colon in 9-10%, complete retrorenal colon 1%, interposition between psoas muscle and kidney in 0.7-1.7%, anterolateral hepatodiaphragmatic interposition in 1.3-3% of individuals. When located in lesser sac it simulates several pathologies of this area. On intravenous urography images it may cause mass effect. In percutaneous interventions and surgical procedures colon may be perforated. For these reasons tomography images should be evaluated for the presence of these anatomic variations.
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    Column of bertin: Normal sonographic findings
    (2005) Ünal, Birsen; Aktaş, Aykut; Bilgili, Yasemin; Yilmaz, Erdal
    Introduction: We aimed to describe the normal and pathologic sonographic (US) findings of column of Bertin (CB). Materials and methods: The study was performed on sixty-six patients who had CB on CT. CB was found to be suspicious in 22 cases; with either hypoechoic, heterogeneous, bulging contour, increased vascularity or cystic areas on US. Patient underwent US and CT imaging following their initial CT and US examinations, respectively. On CT images, isodens and homogeneous texture, enhancement equal to renal cortex were accepted as normal findings. The thickness of CB on axial (AT) and longitudinal (LT) sonography images and the thickness of renal parenchyme (PT) on longitudinal images were measured. The ratio of AT to PT and LT to PT were calculated. Echogenity, vascularity, and contours of CB were evaluated on sonography. The data evaluated with Pearson and t tests. Results: CB was bilateral in 39, and double in 9 cases. Totally 136 CB were evaluated. In two sonographically suspicious CB, renal cell carcinoma (pathologically confirmed) and Bosniak type 2 cysts were detected. In LT, AT, LT/PT and AT/PT were 14.0+3.1 mm (maximum: 23.4mm), 13.2±2.9 mm (maximum: 21.8 mm), 1.1±0.19 (maximum: 1.56) and 1.0±0.17 (maximum: 1.67) in normal cases, 28 mm, 26 mm, 2.15 and 2 mm, in case with renal cell carcinoma. The correlation between thickness of CB and parenchyme was significant (AT-PT r=0.555, p<0.001, and LT-PT r=0.614, p<0.001). Peripheral vascularities were observed in all, central minute vascular focuses in 24 (18%), hypoechogenity in 12 (9.0%), bulging exterior contour in 9 (6%) CB. Conclusion: Increased vascularity, hypoechogenity, increased thickness of CB and thickness to parenchyme ratio are suspicious sonographic findings which may necessitate CT examination.
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    Giant arteriovenous malformation located on the chest wall - Diagnosis and endovascular treatment: Report of a case
    (Springer, 2010) Yılmaz, Sevda; Atinkaya, Cansel; Aktaş, Aykut; Peynircioğlu, Bora
    Congenital arteriovenous malformations are usually found in the lower extremities, but a chest wall location is extremely rare. Extensive vascular malformations present difficulties for patients because of severe unsightliness and life-threatening bleeding. Surgical planning and therapeutic indications in vascular malformations are still a difficult problem. This report describes the case of a 27-year-old woman with a congenital giant arteriovenous malformation of the left chest wall. Preoperative embolization was planned prior to surgical intervention because of the increased risk of massive bleeding, and the malformation was completely embolized with absolute alcohol.
  • Küçük Resim
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    Kolonun BT'de saptanan anatomik varyasyonları
    (2004) Ünal, Birsen; Kara, Simay; Aktaş, Aykut; Bilgili, Yasemin
    AMAÇ Abdomen BT incelemelerinde saptanan kolonun anatomik varyasyonlarının insidansını ve görünümlerini sunmak. GEREÇ VE YÖNTEM Bölümümüzde ardı ardına çekilen 296 abdomen BT incelemesinde retrorenal kolon, retrogastrik kolon (hepatopankreatik interpozisyon veya retrosplenik kolon), yüksek yerleşimli sağ kolon ve kolonun böbrek ile psoas kası arasına ve hepatodiyafragmatik (anterior veya posterior) interpozisyonu araştırıldı. BULGULAR Biri pankreatikogastrik (%0.3), diğeri retrosplenik (%0.3) 2 olguda retrogastrik kolon; 2 olguda (%0.7) böbrek ile psoas kası arasına interpozisyon; 2 olguda iki taraflı, 3 olguda tek taraflı retrorenal kolon (%1.2); 1 olguda posterior (%0.3), 6 olguda (%2.1) anterolateral hepatodiyafragmatik interposizyon; 4 olguda çekum tamamen subhepatik, 8 olguda sağ alt kadran ile karaciğer arasında ara bir bölgede olmak üzere 12 olguda (%4.2) yüksek yerleşimli sağ kolon saptandı. Subhepatik yerleşimli çekum olan olgulardan birinde terminal ileum Morrison boşluğunda, diğerinde renal hilus anteriorunda yerleşmekteydi. SONUÇ Kolonun yerleşim varyasyonlarının rotasyon ve fiksasyondaki hafif embriyolojik anormallikler, kısa transvers mezokolon, intraperitoneal asendan veya desendan kolon, abdomen içi basınç artışı ve retroperitoneal yağ dokusu miktarının azalması gibi nedenlere bağlı geliştiği düşünülmektedir. Kolonun pankreatikogastrik interpozisyonu %0.2, retrosplenik yerleşimi %0.03-0.3, kısmi retrorenal yerleşim %9-10, tam retrorenal yerleşim %1, böbrek ile psoas kası arasına interpozisyonu sağda %1.7 solda %0.7, anterolateral hepatodiyafragmatik interpozisyon %1.3-3 oranlarında gözlenebilmektedir. Atipik yerleşimli kolon, patolojik olduğunda tanı hatalarına yol açabilir. Küçük omentumda yerleştiğinde patolojik olmasa da, bu bölgenin birçok patolojisinin görünümünü taklit edebilir. İntravenöz ürografi tetkiklerinde kitle imajı yaratabilir. Karaciğer, böbrek, dalak veya safra kesesi perkütan girişimlerinde ve cerrahisinde kolon perforasyonu oluşabilir. Bu nedenlerle BT incelemelerinde kolonun atipik yerleşimleri araştırılmalıdır.