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    CLINICAL UTILITY OF RADIOLOGICAL IMAGING IN THE EVALUATION OF GALLSTONE ILEUS
    (2019) Özdemir, Adnan; Yilmazsoy, Yunus; Arslan, Serdar; Pehlivanli, Faruk
    Objective: Gallstone ileus is a rare complication ofcholelithiasis. It occurs as a result of the passage of bile stonesinto intestinal system via bilioenteric fistulae, which are formedby recurrent attacks of cholecystitis, and obstruction of theintestinal lumen. The objective of our study was to discuss theimaging findings of gallstone ileus among patients diagnosed atour center.Material and Methods: Among patients that admitted to ourhospital’s radiology department between December 2016 andJanuary 2019, the medical records of those with a history of gallbladder stone detected on ultrasonography were retrospectivelyevaluated. Among those, cases of gallstone ileus were identified.Admission complaints, age, sex, comorbidities, radiologicalimaging findings, fistula localization, stone size, and obstructionlevel were recorded and analyzed.Results: Among 958 patients with bile stones, 342 (35.7%)were male and 616 (64.3%) were female. Gallstone ileus wasidentified in five patients. Three of them were female (mean age76.67± 13.05 years) and 2 were male (mean age 59±1.41 years).Ileus signs were detected on plain radiograms for all patients.The gallbladders were not clearly visualized by ultrasonographyin any of patients with gallstone ileus. A diameter increasesuggestive of ileus was detected in visualizable intestinalsegments. Computed tomography to identify the cause of ileusrevealed air in the bile ducts, cholecystoduodenal fistula, stonesin intestinal lumen, and an appearance consistent with ileusproximal to that segment. The mean size of the stones was26.20±16.3 mm (16-55 mm).Conclusion: Although gallstone ileus is a rare cause ofintestinal obstruction, it should be definitely remembered in thedifferential diagnosis in patients with advanced age and ahistory of cholelithiasis who present to the emergencydepartment.
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    DIAGNOSTIC ACCURACY AND COMPLICATIONS OF PERCUTANEOUS CT-GUIDED NEEDLE BIOPSY OF LUNG NODULES IN 161 PATIENTS
    (2022) Yilmazsoy, Yunus
    Objective: Transthoracic needle biopsy is a diagnostic method that has proven its reliability in lung nodules and is frequently applied in daily practice. The diagnostic accuracy of biopsies performed with computed tomography navigation is quite high, even if the lesion sizes are smaller than 1 cm. We aimed to evaluate the diagnostic accuracy and complications of the computed tomography-guided percutaneous transthoracic needle biopsy procedure performed in our center. Material and Methods: Patients who underwent computed tomography guided percutaneous transthoracic pulmonary nodule biopsy procedure between January 2017 and January 2020 were included in the study. The size and anatomic location of lesions, the distance between the pleura and the lesion, the angle of the needle with the pleura, the procedure time, the number of pathologic samples taken per patient, the total radiation dose, complications, and the pathological results of the lesions were analyzed from the patients’ computed tomography images and patients’ records. Results: Among the 161 patients admitted for the transthoracic percutaneous needle biopsy procedure, 135 were male (mean age 64.3±11.1 years) and 26 were females (mean age 61.3±15.4 years). The pathological evaluation of 32 patients were reported as non-diagnostic. The diagnostic accuracy of computed tomography guided transthoracic biopsy was calculated as 80.1%. Major complications occurred in 10 patients (6.2%), and minor complications occurred in 60 patients (37.2%). The rate of procedure requiring chest tube insertion was 4.9%. The mean effective radiation dose of the patients per procedure was calculated as 5.26±3.25 mSv. Conclusion: Computed tomography guided transthoracic biopsy procedure are a method with a high diagnostic accuracy rate, low rate of complications and can be preferred in all appropriate pulmonary nodules.
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    Retrieval of n-Butyl Cyanoacrylate Cast Migrated to the Dorsalis Pedis and Posterior Tibial Artery During Embolization of the Deep Circumflex Iliac Artery Using the Stent Retriever Device: A Case Report
    (Sage Publications Inc, 2024) Genez, Samet; Yilmazsoy, Yunus; Ozer, Hamza
    N-butyl cyanoacrylate (NBCA) is commonly used in interventional radiology procedures for its efficacy in vessel occlusion, yet it poses risks of embolic material migration. We present a unique case of NBCA cast migration during deep circumflex iliac artery (DCIA) embolization, leading to occlusion of the dorsalis pedis and posterior tibial arteries, subsequently retrieved using a stent retriever device. A 68-year-old woman with a history of heart valve replacement presented with a large intramuscular hematoma. N-butyl cyanoacrylate embolization of DCIA resulted in cast migration, occluding distal arteries. Retrieval was attempted using a stent retriever device, successfully restoring arterial flow. N-butyl cyanoacrylate use necessitates attention to vascular anatomy and test injections to mitigate complications. Stent retriever devices, originally designed for acute stroke thrombectomy, offer a viable solution for embolic material retrieval in vascular interventions. This case highlights successful NBCA cast retrieval in lower extremity arterial occlusion using a stent retriever device. Prompt recognition and intervention are crucial in mitigating complications associated with NBCA use. Stent retriever devices present a valuable tool for NBCA cast retrieval, preserving arterial perfusion in affected areas. Clinical Impact This case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians' ability to handle complex embolic events with greater confidence and efficacy.