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Thyroid gland infection, although rare, may be a life threatening disease. Thyroid abscess, arising from acute suppurative thyroiditis (AST), is a rare clinic condition depending on widespread use of antibiotics. Infection may involve one or both lobes and abscess formation may not be apparent until late stage of the progress of illness. Thyroid left lobe is more often affected than the right one. Brucellosis, especially obvious in endemic areas, is a widely seen zoonosis around the world. Although brucella infection can affect many organs through various complications, thyroid gland infection is rare. We aimed to present ultrasonography (USG) and magnetic resonance images (MRI) of a case with an acute thyroiditis which rapidly developed and grew fast on the left half of the neck during the first postpartum month. As far as we know from literature reviewing, our case is the first case report of a thyroid abscess arising from brucella infection which is developed in first postpartum period with images of ultrasonography and MRI.

Introduction. Vulvar cyst in adolescent girls is very uncommon. Epidermoid cyst can be seen in many sites including face, trunk, and extremities but its occurrence in vulva is uncommon. This is the first case of epidermoid cyst of vulva reported in an adolescent girl. Case. A 17-year-old, adolescent girl admitted to our gynecology outpatient clinic with a complaint of painful and palpable mass in her vulva. On examination, a giant mass located in left vulva and labia majora with 11 cm in diameter was seen. The magnetic resonance imaging (MRI) showed a well-defined cystic mass without contrast enhancement. The surgery was advised to the patient and the pathologic examination of mass revealed vulvar epidermoid cyst. Discussion. Vulvar cysts generally grow slowly and the main etiologies are vulvar trauma and surgical interventions including episiotomy and female circumcision in some culture. The exact treatment is total surgical excision and pathologic examination. MRI is an important imaging modality for detection of extension to deep perineal tissue and localization of mass in vulva especially in giant ones. Conclusion. Although vulvar mass in adolescents is rare, the epidermoid cyst with benign origin should be kept in mind.

BackgroundIn the present study, the role and efficiency of strain elastography (SE) were evaluated in diagnosis and staging of acute appendicitis in pediatric patients.Material/MethodsWe enrolled 225 pediatric patients with suspected clinical and laboratory findings of acute appendicitis. Gray-scale sonographic findings were recorded and staging was made by the colorization method of SE imaging. Appendectomy was performed in all patients and the results of the surgical pathology were compared with the imaging findings. The sensitivity, specificity, and accuracy of SE imaging were determined in terms of evaluating the “acute appendicitis”.ResultsSonographic evaluation revealed acute appendicitis in 100 patients. Regarding the SE analysis, cases with appendicitis were classified into 3 groups as: mild (n=17), moderate (n=39), and severe (n=44). The pathological evaluation revealed 95 different stages of appendicitis and normal appendix in 5 cases: acute focal (n=10), acute suppurative (n=46), phlegmonous (n=27), and perforated (n=12), regarding the results of surgical pathology. Five patients with pathologically proven “normal” appendix were noted as “mild stage appendicitis” based on gray scale and SE analysis. In total, when gray-scale and SE results were compared with pathology results regardless of the stage of appendicitis, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96%, 96%, 95%, 96.8%, and 96%, respectively. No statistically significant difference was detected between other groups (P<0.05).ConclusionsIn acute appendicitis, the use of SE imaging as a supportive method for the clinical approach can be useful in diagnosis, and its results are closely correlated with the histopathologic stage of appendix inflammation.

Paraduodenal hernia is a rare congenital anomaly; however, it is the most common cause of internal herniation. Clinical findings are often indeterminate. Computerized tomography is usually diagnostic; however, the diagnosis is often made intra-operatively. Paraduodenal hernia carries a risk of incarceration leading to bowel obstruction and strangulation; therefore, it should be repaired surgically when diagnosed. Here we present a case of left PDH that was diagnosed preoperatively and repaired laparoscopically.Keywords: Laparoscopy, paraduodenal, hernia INTRODUCTIONInternal hernias result from the extension of the intestine through a defect within the peritoneum or mesentery (1). They may be either congenital or acquired. Paraduodenal hernia (PDH) is a rare congenital anomaly that results from an error of rotation of the midgut (2). PDHs are the most common form of internal hernias, accounting for 53% of all internal hernias (1, 3). PDHs are difficult to diagnose because the clinical symptoms are variable (4). PDH can begin with symptoms of acute obstruction or recurring abdominal pain (43%) or can be asymptomatic throughout the patient's life. Between 10% and 50% of internal hernias are discovered during unrelated abdominal surgeries or imaging exams and autopsy (5). Preoperative computerized tomography scan of the abdomen is usually diagnostic; however, the diagnosis is often made intra-operatively. Surgical treatment can be performed with traditional open methods or minimally invasive laparoscopic techniques. We describe herein the preoperative radiological diagnosis and successful laparoscopic repair of a left PDH in an adult man. CASE PRESENTATIONA 39-year-old man was admitted to the emergency department with complaints of epigastric cramps and nausea and vomiting that persisted for almost one day. It was known that he had been suffering from similar problems for a long time, and he had applied to 3 different hospitals in the last 10 days. There was no specific finding except for upper left quadrant tenderness. He had no history of abdominal surgery. His vital signs were normal. On his plain abdominal film, vague and limited air-fluid levels and a mass-like lesion were found in the left quadrants. Laboratory results were normal, except his leukocyte count was 11600. He was hospitalized for follow-up. It was noticed that he was comfortable while resting on his left side; however, his pain worsened in the supine position. Encapsulated and moderately dilated small bowel loops were detected in the upper left quadrant between the stomach and pancreas by CT (Figure 1). He was preoperatively diagnosed with left PDH. Four ports were inserted; one 10 mm supraumblical port for the camera, another port 10 mm from the upper left quadrant, and two 5 mm ports in the upper right quadrant. During exploration, left PDH was observed on the left side of Treitz's ligament behind the inferior mesenteric vein. An entrapped jejunum loop of approximately 80 cm was then reduced from the hernia sac into the abdominal cavity with an ...