Background: Umbilical vein catheterization (UVC) is an early venous access route in newborns and is frequently used for delivering total parenteral nutrition (TPN) and medications. Vascular, hepatic parenchymal, and infectious complications of UVC can be seen rarely. Objective: We present preterm neonates' X-ray, US, and MRI findings with parenchymal TPN extravasation and portal vein thrombosis. Our case was the first case about MRI findings of TPNoma Case Presentation: A 30 week female with a birth weight of 1340 g was born via Cesarean section. Because of the diagnosis of transient tachypnea of the newborn and prematurity, the infant was hospitalized in the neonatal intensive care unit. On the first day of hospitalization, UVC was inserted and TPN with 20% lipid content was started. After 10 days, UVC was removed and TPN treatment was continued with a piccline catheter. Abdominal US and portal venous Doppler examination was applied to the patient whose general condition deteriorated on the 12th day. US and Doppler revealed a lesion of 17x17x18mm in size with lobulated contour, hyperechoic heterogeneous internal structure, and no central or peripheral blood supply was observed in the left lobe of the liver. Moreover, a filling defect compatible with a thrombus was observed in the proximal part of the left portal vein. An abdominal MRI was performed to characterize this liver lesion. Axial T1 weighted and T2- weighted images showed a heterogeneous hyperintense lesion without contrast enhancement. Axial fat saturation T1-weighted and out of phase T1-weighted images showed a reduction in signal intensity. US and MRI examinations showed that the thrombosed umbilical vein ended superior to the lesion. In the differential diagnoses, fat-containing lesions such as lipoma-teratoma and fat-containing collection secondary to extravasation of TPN treatment via UVC were thought. Conclusion: In the differential diagnosis of liver localized lesions in newborns, UVC-related liver injury should be considered and the localization of the catheter tip should be checked. In case of the doubt based on US and X-ray findings, presence of fat on MRI could be diagnostic. Serious complications should be avoided with catheter revision or removal.
Aim: We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical or malignant papillary breast lesions and to assess additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI. Background: Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma. Methods: Seventy two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups as benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups. Results: Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologist 1 and 2 respectively), closer to areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively) and had higher ADC values (p=0.001 for two radiologists) than atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p<0.0001 for two radiologists) and showed a cut-off value of ≤957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2). Conclusion: MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size and higher ADC values should be considered benign, whereas peripherally located, larger in size and lower ADC values should be considered malignant
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