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Objective The purpose of this study was to assess the diagnostic performance of multiphasic computed tomography (CT) in the discrimination of metastatic lymph nodes (LNs) of papillary thyroid cancer by using quantitative parameters. Methods This study enrolled 272 pathologically proven metastatic and benign LNs. Multiphasic CT was utilized by using nonenhanced, arterial (25-second delay), and venous (80-second delay) phases. Mean tissue attenuation values (MAVs) of metastatic and benign LNs were measured, and normalized MAV (common carotid artery and paraspinal muscle) and wash-in and wash-out percentages were also calculated. Results The arterial phase showed the highest diagnostic performance in differentiation (area under the curve ± standard error, 0.97 ± 0.02; 95% confidence interval, 0.94–1.0; P < 0.001). Cutoff values for MAVs, normalized MAVs, and wash-in and wash-out percentages to predict metastatic LNs were calculated as 109 HU, 0.33, 1.93, 122.5, and −5.6 (sensitivity: 93.4%, 93.3%, 90.4%, 94.1%, and 97.8%, and specificity: 99.3%, 90.4%, 98.5%, 92.6%, and 99.3%, respectively). Conclusions Early-phase enhanced CT and the use of quantitative parameters derived from multiphasic CT improve the detection of cervical lymph node metastasis from papillary thyroid cancer.

ongenital anomalies of the pancreatic duct may remain undiagnosed until adulthood and they are often diagnosed incidentally. Pancreas divisum (PD) is the most common congenital anomaly of the pancreas which occurs from a failure of ventral and dorsal bud fusion (1, 2). It accounts for about 4%-14% of the population at autopsy series, and approximately 9% are detected using magnetic resonance cholangiopancreatography (MRCP) (3). In PD, the ventral (Wirsung) duct opens into the major papilla without merging with the dorsal (Santorini) duct. The dorsal duct, which opens into the minor papilla, is responsible for the majority of the drainage from the pancreas. The clinical importance of PD is not clear. Most patients are asymptomatic, whereas in some patients, PD may cause recurrent pancreatitis due to lack of adequate drainage into duodenum via minor papilla (3, 4). Of patients with idiopathic recurrent pancreatitis, 12%-26% have PD (5). There are various type of examinations to evaluate the pancreaticobiliary system; however, MRCP has been shown to be an effective noninvasive imaging modality for the visualization of the biliary tree and pancreatic duct. Bret et al. (6) reported an accuracy rate of 100% in the diagnosis of PD using MRCP (6).Laparoscopic cholecystectomy, transplantation surgery, hepatic resection, and tumor surgery are the most common hepatobiliary surgeries in which complications related to the bile duct variations comprise one of the most common reasons for morbidity and mortality. PURPOSEWe aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). METHODSA search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. RESULTSBiliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). CONCLUSIONMRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant differ...

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly. Generally, it is seen on the right side and is associated with an atrial septal defect. Herein, we present a case of a 50-year-old male patient with a supracardiac type PAPVC detected during pneumonectomy for a right hilar mass. This is the second case report in the literature presenting surgical treatment of both lung cancer and PAPVC using pneumonectomy. Thoracic surgeons should be aware of this anomaly when they are planning to perform a major lung resection. If PAPVC and lung cancer are in the same lobe, anatomical lung resections including pneumonectomy can be safely performed.