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Öğe Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: Clefts, aneurysms, diverticula and terminology problems(ELSEVIER IRELAND LTD, 2012) Erol, Cengiz; Koplay, Mustafa; Olcay, Ayhan; Kivrak, Ali Sami; Ozbek, Seda; Seker, Mehmet; Paksoy, YahyaObjectives: Our aim was to evaluate congenital left ventricular wall abnormalities (clefts, aneurysms and diverticula), describe and illustrate imaging features, discuss terminology problems and determine their prevalence detected by cardiac CT in a single center. Materials and methods: Coronary CT angiography images of 2093 adult patients were evaluated retrospectively in order to determine congenital left ventricular wall abnormalities. Results: The incidence of left ventricular clefts (LVC) was 6.7% (141 patients) and statistically significant difference was not detected between the sexes regarding LVC (P = 0.5). LVCs were single in 65.2% and multiple in 34.8% of patients. They were located at the basal to mid inferoseptal segment of the left ventricle in 55.4%, the basal to mid anteroseptal segment in 24.1%, basal to mid inferior segment in 17% and septal-apical septal segment in 3.5% of cases. The cleft length ranged from 5 to 22 mm (mean 10.5 mm) and they had a narrow connection with the left ventricle (mean 2.5 mm). They were contractile with the left ventricle and obliterated during systole. Congenital left ventricular septal aneurysm that was located just under the aortic valve was detected in two patients (0.1%). No case of congenital left ventricular diverticulum was detected. Conclusion: Cardiac CT allows us to recognize congenital left ventricular wall abnormalities which have been previously overlooked in adults. LVC is a congenital structural variant of the myocardium, is seen more frequently than previously reported and should be differentiated from aneurysm and diverticulum for possible catastrophic complications of the latter two. (C) 2012 Elsevier Ireland Ltd. All rights reserved.Öğe Coronary Artery Anomalies: The Prevalence of Origination, Course, and Termination Anomalies of Coronary Arteries Detected by 64-Detector Computed Tomography Coronary Angiography(LIPPINCOTT WILLIAMS & WILKINS, 2011) Erol, Cengiz; Seker, MehmetObjective: The purpose of this study was to determine the prevalence of origination, course, and termination anomalies of coronary arteries, all of which were detected by 64-detector coronary computed tomography angiography (CTA). Methods: Images of 2096 patients who underwent CTA were evaluated retrospectively to determine coronary artery anomalies (CAAs). Results: Anomalies in origin and course were detected in 1.96% of the cases. The prevalence rates of the right coronary artery (RCA) branching from the left coronary sinus, the circumflex artery from the right coronary sinus (RCS) or from the RCA, absence of the left main coronary artery, and high takeoff coronary arteries were similar and seen in 0.43% of the cases. The left main coronary artery originating from the RCS, a single coronary ostium from the RCS, the circumflex artery from the distal RCA, and the RCA from the pulmonary artery were observed in 0.1%, 0.05%, 0.05%, and 0.05% of the cases, respectively. A coronary artery fistula, which is a termination anomaly, was detected in 0.33% of the patients. The presence of coronary atherosclerosis with CAAs was less than the study group that was statistically not significant (64.6% vs 72.5%, P = 0.213). Conclusions: Computed tomography angiography provides essential information about CAAs to interventional cardiologists and surgeons that helps to prevent incorrect procedures by showing the exact origin, complex anatomy, course, and termination of the coronary arteries.Öğe Epiploic Appendagitis: Is There Need for Surgery to Confirm Diagnosis in Spite of Clinical and Radiological Findings?(SPRINGER, 2012) Hasbahceci, Mustafa; Erol, Cengiz; Seker, MehmetThe present retrospective study was conducted to review the authors' experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions. Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances. Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients. In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.Öğe The prevalence and clinical importance of incidentally detected noncoronary cardiovascular findings with coronary multidetector CT angiography(SPRINGER WIEN, 2014) Erol, Cengiz; Koplay, Mustafa; Seker, Mehmet; Paksoy, YahyaThe purpose of this study was to determine the prevalence and clinical importance of incidental findings of noncoronary cardiac structures and mediastinal great vessels in patients who underwent coronary computed tomography angiography (CCTA). The study included 2,096 consecutive patients (1,472 men and 624 women, with a mean age of 55 years). Cardiovascular findings were categorized into three groups according to the clinical importance: group 1 included findings necessitating immediate treatment or intervention; group 2 included findings requiring clinical awareness, follow-up, or further clinical and/or radiological investigations; and group 3 included findings not requiring any follow-up or further tests. We also evaluated whether there was any previous diagnosis of cardiovascular findings. A total of 174 abnormalities (8.3 %) were detected in 170 patients. Of these abnormalities, 21 findings (12 %) were considered as group 1, 121 (69.5 %) as group 2, and 32 (18.5 %) as group 3. The majority of cardiovascular findings (140 of 174, 80.5 %) were unknown by the reporter during the interpretation of CCTA examinations and regarded as incidental findings. Noncoronary incidental cardiovascular findings in patients who underwent CCTA are common. It is important to be aware of these findings necessitating immediate treatment or intervention, and follow-up or further investigations, and careful attention must be paid to all the structures included in the images.Öğe The prevalence of coronary artery variations on coronary computed tomography angiography(SAGE PUBLICATIONS LTD, 2012) Erol, Cengiz; Seker, MehmetBackground: Coronary computed tomography angiography (CCTA) can delineate the coronary artery anatomy precisely. Basic knowledge of the normal coronary artery anatomy and familiarity with its common variations are essential in order to assess CCTA accurately. Purpose: To determine the prevalence of coronary artery variations detected by 64-slice mutidetector CT. Material and Methods: CCTA images of 2096 patients were evaluated retrospectively. Relatively unusual coronary artery morphological features that were seen in greater than 1% of the study population were classified as variations. Results: Coronary artery circulation was right dominant in 86.6%, left dominant in 9.6%, and balanced in 3.8% of patients. The conus artery arose from the right coronary artery in 83%, or directly from the aorta with a separate ostium in 17% of cases which was much more common in men than women. The sinoatrial node artery originated from the right coronary artery (65.6%) or the circumflex artery (33.7%). The atrioventricular node artery originated from the right coronary artery in 86.4% or the circumflex artery in 13.6% of cases. The left main coronary artery was shorter than 0.5 cm in 4.7% of cases and trifurcated into the intermediate artery in 31.3% of cases. A myocardial bridge was observed in 21.6%, coronary ectasia-aneurysm in 2%, dual left anterior descending artery (LAD) type 1 in 1.38%, and a variant of type 1 in 0.1% of cases. The presence of coronary atherosclerosis was higher in patients with coronary ectasia-aneurysm than the patients who did not have coronary ectasia-aneurysm (90.5% vs. 72.2%, P = 0.000). Conclusion: CCTA is a non-invasive imaging modality for the depiction of variations of the coronary arteries. The incidence of coronary artery variations is high and various, and readers should be familiar and looking for these conditions during interpretation of CCTA examinations.
