Relationship between the Type of Laryngeal Penetration and Severity of Tracheal Aspiration in the Brain Injured

OBJECTIVE: To assess the incidence of tracheal aspiration in the brain injury patients with laryngeal penetration, and to investigate the relationship between the type of laryngeal penetration and the severity of tracheal aspiration. METHOD: One hundred videofluoroscopic swallowing tests in brain injury patients who showed laryngeal penetration were analyzed retrospectively. Laryngeal penetrations were classified into three groups: anterior, posterior and both. The incidence of the tracheal aspiration among the laryngeal penetration was evaluated. The severity of the tracheal aspiration was analyzed into the three groups: mild, moderate and severe. Each type of the laryngeal penetration were compared with the severity of the tracheal aspiration. RESULTS: Seventy-one patients showed the tracheal aspiration among the 100 patients with laryngeal penetration. The incidence of tracheal aspiration according to the type of the laryngeal penetration was 100% in both, 86.8% in posterior, and 50.9% in anterior type. The more severe tracheal aspiration was associated with the higher proportion of the posterior and both types. CONCLUSION: The incidence of tracheal aspiration in laryngeal penetration was 71%. More severe tracheal aspiration occurred with both & posterior laryngeal penetration than anterior type.

CT Findings of Inverted Papilloma and Aspergiollosis in Sinonasal Cavities: CT differentiation

PURPOSE: To describe the characteristic CT findings of inverted papilloma (IP) and aspergillosis involving sinonasal cavities and to differentiate between them on CT. MATERIALS AND METHODS: We retrospectively reviewed CT images in 22 cases of pathologically confirmed IP and 16 of aspergillosis; these were classified as one of four types, according to location. We also analyzed infundibular widening, displacement of the maxillary medial wall, the presence of air in the maxillary ostium, elevation of ethmoidom axillary plate (EMP), calcification within a lesion, reactive hyperostosis and CT density. RESULTS: Four cases were type I, which was seen only in aspergillosis (4/16, 25%); five were type IV, and all were IP (5/22, 22.7%), with a characteristic growing vector. Type II was seen in nine cases of IP and 11 of aspergillosis, and type III in eight cases of IP and one of aspergillosis. In types II and III (17 of 22 cases of IP; 12 of 16 of aspergillosis), five of 22 cases of IP (22.7%) and nine of 16 of aspergillosis (56.3%) showed infundibular widening, which was more severe in aspergillosis. Maxillary medial wall displacement was seen in five of 22 cases (22.7%) of IP, four of which showed lateral displacement and in five of 16 cases (31.3%) of aspergillosis, all of which showed medial displacement. Air in the maxillary ostium was seen in seven of 22 cases of IP (31.8%). Elevation of EMP was seen in two cases of IP (9.1%) and three of aspergillosis (18.8%), which showed oblique elevation. Calcification was detected in nine cases of aspergillosis (56.3%) but in only one of IP. Reactive hyperostosis was seen in 13 cases of aspergillosis (81.3%) and two of IP (9.1%). CONCLUSION: Although it is hard to differentiate between IP and aspergillosis involving sinonasal cavities, the findings of calcification, infundibular widening, air in the maxillary ostium,displacement of the maxillary medial wall, an elevated EMP pattern and reactive hyperostosis combined with duration of symptom may be helpful.

Fogging effect on MR in subacute cerebral infarct: Report of 2 cases

In acute phase, cerebral infartion is usually hypodense on CT and hyperintense on T2-weighted MR image. This hyperintensity on T2-weighted MR image gradually approaches an isointensity stage after 2 or 3 weeks of onset. In the later stage, cerebral infarction is observed hyperintense on T2-weighted MR image. This sequential phenomenon is so-called "fogging effect". We experienced two cases of "fogging effect". The first case did not show abnormal signal intensity on TI or T2 weighted MR images taken after 14 days of onset and the second case also did not show abnormal signal intensity after 17 days of onset. Each case revealed hyperintense in T2-weighted image with contrast enhancement taken after 20 weeks and 8 weeks of onset, respectively. We present two cases with MRI and brief review of literatures.