Discal Cyst Diagnosed by Radiologic Finding

Discal cyst is a very rare lesion that can result in refractory low back pain and leg radiating pain. Because they are so uncommon, their exact origin and pathophysiology are still unknown. A 31-year-old man visited our institute due to low back pain and severe left leg radiating pain. Magnetic resonance images (MRI) revealed spherically shaped extradural cystic lesion at L2-L3 level. Computed tomography (CT) discography demonstrated obvious communication between the intervertebral disc and the cyst. The patient underwent posterior decompression and excision of cyst. The symptoms were remarkably improved immediately after surgery.

Gossypiboma in the Abdomen: A Case Report

Gossypiboma is retained surgical sponge or swab. We experienced a case of gossypiboma resulting from a retained surgical sponge, which had been left in intraperitoneal cavity for 4 years after appendectomy. Abdominal CT scan revealed a non-calcified soft tissue mass with wall enhancement. We thought this lesion was an abscess or hematoma. So we tried to perform aspiration and drainage guided by ultrasonography. Ultrasonography showed illdefined hyperechoic stripe with strong posterior acoustic shadow within the mass, which has hypoechoic fibrous capsule. We could not puncture the lesion with aspiration needle due to its hardness, and the mass was removed by surgery. We report a case of gossypiboma confirmed by surgery, which was suspected by ultrasonographic feature and difficulty in puncture of mass.

Collecting Duct Carcinoma of the Kidney Mimicking Invasive Transitional Cell Carcinoma: A Case Report

Approximately 100 cases of collecting duct carcinoma have been reported in the medical literature. We herein report on a case of collecting duct carcinoma of the kidney in a 75-year-old patient. The abdominal sonography depicted a relatively poorly defined 7X6 cm sized, isoechoic mass lesion, as compared to the normal parenchyma, at the left kidney lower pole and the affected kidney showed preservation of the reniform shape. CT revealed a heterogeneous poorly defined low-attenuation mass that was mainly located in the medulla with involvement of the cortex and the lower half of the renal pelvis. Retrograde ureteropyelography showed a filling defect at the lower renal pelvis and severe narrowing of the left proximal ureter. We initially thought this lesion was invasive transitional cell carcinoma. Subsequent surgery confirmed a collecting duct carcinoma.

Ultrasound Guided Placement of Tunneled Hemodialysis Catheters

PURPOSE: To evaluate the usefulness of ultrasound guided confirm this change; the symbol has been corrupted in my version placement of tunneled hemodialysis catheters via internal jugular vein (IJV). METHOD: The outcomes of 52 hemodialysis catheters placed from January 2000 through December 2002 were retrospectively analyzed. Of 50 patients, 2 received two catheters. Initially, the patency of the IJV was evaluated with ultrasonography, after which the IJV puncturehe was performed under the guidance of ultrasonography. Under fluoroscopy, a 12.5 F double lumen hemodialysis catheter was placed at the caval atrial junction through a subcutaneous tunnel in the neck. To prevent initial failure we performed a flow test using a 50 cc syringe through the catheters in 47 patients. RESULT: Catheter placements were successful in all patients. Early complication was poorly functioning catheters immediately after placement (initial failure) in two cases (4%). However, no patients developed initial failure after we performed flow test using the 50 cc syringe through the catheters. There were no instances of pneumothorax or hemothorax. Nevertheless, late complications included injured catheters in two cases (4%), bacteremia in five (9.5%), and tunnel infection in 2 (4%). Mean duration of catheter use before removal was 86 days (3~55 days). The blood flow rate at first hemodialysis after catheter placement was 230+/-35.5 ml/min and after 1 month was 248+/-18.6 ml/min. Catheters were removed because of matured arteriovenous fistula in 36 cases (69%), bacteremia in five (9.5%), patient death in 7 (13.5%), injured catheters in two (4%) and tunnel infection in 2 (4%). Symptomatic central venous stenosis was not developed during the study period. CONCLUSION: Ultrasound guided placement of tunneled hemodialysis catheters via IJV is a safe method, and is useful for patients requiring long-term hemodialysis.

Placement of Tunneled Cuffed Hemodialysis Catheters Via Internal Jugular Vein by an Interventional Radiologist and a Vascular Surgeon Together / 대한신장학회잡지

BACKGROUND: The use of dacron-cuffed tunneled double-lumen catheters for hemodialysis has become more common as patients wait for creation and maturation of a permanent access. Placement of the catheters is done by interventional radiologists, vascular surgeons or nephrologists, and the differences in success rates, complications, blood flow rates and the durations of catheter uses are reported. This study evaluated the usefulness, complications, blood flow rates and duration of use of tunneled cuffed hemodialysis catheters implanted via the internal jugular veins by an interventional radiologist and a vascular surgeon together. METHODS: The outcomes were retrospectively analyzed of 31 hemodialysis catheters placed from December 1999 through January 2001. We investigated age, sex, indications and locations of insertion, catheter performance, complications and causes of catheter removal. All the catheters were placed via the internal jugular veins by an interventional radiologist and a vascular surgeon together. RESULTS: Catheter placements were successful in all patients. Procedural complication was limited to clinically unimportant minor local bleeding. No instances of pneumothorax, hemothorax, vessel injury, substantial bleeding, obstruction, malposition or stenosis occurred. The blood flow rate on the first hemodialysis after placement of the catheter was 230+/-35.5 mL/min and that after 1 month was 248+/-18.6 mL/min. Late complications included catheter breakage in two cases (6.5%) and bacteremia in four cases (12.9%). Catheters were removed because of catheter-related bacteremia in four cases (12.9%) and death of patients in three cases (9.7%). In 22 cases (71.0%) the catheters were removed because the A- V vascular accesses were available for hemodialysis. Mean duration of the catheter use before removal was 134+/-96 days. CONCLUSION: Tunneled cuffed catheters inserted via the internal jugular veins are safe and durable vascular accesses for hemodialysis with good blood flow rate and long duration of use, especially placed by the co-operation of an interventional radiologist and a vascular surgeon.

2 Cases of Lumbar Hernia

Lumbar hernia presents as a reducible protruding mass in the flank region between the 12th rib and the iliac crest. The superior lumbar hernia (Grynfeltt's) is covered by the thin latissimus dorsi muscle and bounded by the erector spinae and internal obliquus abdominis muscle. The lumbodorsal fascia forms the floor of the Grynfeltt's triangle. Spontaneous or acquired non-traumatic lumbar hernia occurs more frequently after middle age. The untreated lumbar hernia progresses in size gradually. As in most hernias, the larger the defect, the more complicated and difficult is the repair. Here we report 2 female patients with spontaneous lumbar hernia diagnosed at Presbyterian Medical Center with computerized tomogram. Their treatment consisted of tension-free surgical repair utilizing the overlap method for defect edge and the application of prolene mesh.

Accessory Left Gastric Artery: Angiographic Anatomy

PURPOSE: To evaluate the angiographic anatomy of the accessory left gastric artery (accLGA). MATERIALS AND METHODS: We evaluated the angiographic findings of the accLGA in 50 patients (Angiostar; Siemens, Erlangen, Germany). Performing celiac and selective angiography in 50 and 34 patients, respectively. By means of celiac angiography, 1) site of origin, 2) anatomical course, 3) diameter, 4) degree of tortuosity, and 5) distal tapering were evaluated, while selective angiography was used to determine 1) arterial branching, 2) area of blood supply, and 3) patterns of gastric wall stain. RESULTS: Celiac angiography showed that the accLGA arose from the left hepatic artery (LHA) in 45 cases(90%) and from the proper hepatic artery in five (10%). If the accLGA arose from the LHA, its origin entirely depended on the branching pattern of the latter. It always arose from the lateral branch of the LHA furthest to the left and uppermost, and proximal to its umbilical point. The most common anatomical course of the accLGA, seen in 27 cases (54%), was between the S2 and S3 segmental branch. The diameter and degree of tortuosity of the accLGA were similar to those of adjacent intrahepatic branches in 21 (42%) and 33 cases (66%), respectively. The degree of tapering was less than that of adjacent intrahepatic vessel in 28 (56%). Selective angiography demonstrated esophageal branching of the accLGA in 27 cases (79%), inferior phrenic arterial branching in three (9%), a mediastinal branch in one (3%), and hypervascularity of the lung in one (3%). In 15 cases (44%), bifurcation of the accLGA was recognized. The vascular territory of the accLGA was the gastric fundus together with the distal esophagus in 21 cases (62%), mainly the gastric fundus in six (18%), and mainly the distal esophagus in four (12%). The pattern of gastric mucosal stain was curvilinear wall in 31 cases (91%) and nodular in three (9%). CONCLUSION: A knowledge of the angiographic anatomy of the accLGA facilitates accurate recognition of this artery on routine celiac and hepatic arteriography, thus reducing gastric complications after transarterial management of hepatic tumors and improving the angiographic diagnosis and treatment of upper gastrointestinal bleeding.

A Chondromyxoid Fibroma of the Fibula: A Case Report

Chondromyxoid fibroma is the least common benign bone tumor, accounting for less than 1% of all bone tumors. Pathologically, it is composed of varying proportions of chondroid, myxoid and fibrous elements. The most common anatomical site is the metaphyseal region of the long bone, and the typical radiologic appear-ance is a cortical expansile osteolytic lesion with a lobulated sclerotic margin, and septa. We report the plain and MRI findings of a relatively typical chondromyxoid fibroma occuring in the proximal fibula.

MR Imaging of the Denvervated Skeletal Muscles in Rabbits

PURPOSE: To determine the time of magnetic resonance(MR) signal intensity changes in denervated skeletal muscle and to compare MR imaging with electromyography(EMG) in the evaluation of peripheral nerve injury. MATERIALS AND METHODS: We evaluated MR imagings of denervated muscles after experimental transection of the sciatic nerve in five rabbits using 1.0T MR unit. MR imaging and EMG were performed 3 days and 1, 2 and 3 weeks after denervation. T1-weighted images(T1-WI), T2-WI and Short Tau Inversion Recovery(STIR) images were obtained. The signal intensity (SI) of muscles in the denervated and normal sides were visually and quantitatively compared. After measuring the SI of the normal and abnormal areas, the time of SI change was determined when there was significant difference (P<0.05) of SI between the normal and denervated sides. RESULTS: On STIR images, two of the five rabbits showed significant SI changes at the third day(P<0.05) and all showed significant changes(P<0.05)at the first week. On T2-WI, one rabbit showed significant SI changes at the third day, and all showed significant SI changes at the first week. On T1-WI, significant SI changes were seen in one rabbit at the second week and in one at the third. One week after denervation, all showed denervation potential on EMG. CONCLUSION: This study suggests that MR imaging using STIR images is a useful method in the evaluation of denervated muscle, and that MR signal changes of denervated muscle may precede EMG changes after denervation. To localize and to determine the severity of the peripheral nerve injury, future analysis of the distribution of abnormal MR SI in denervated muscles would be helpful.

CT and US Findings of the Multilocular Cystic Renal Cell Carcinoma

PURPOSE: To find the CT and US findings of multilocular cystic renal cell carcinoma. MATERIAL AND METHODS: We retrospectively analysed CT and US findings of five cases of the pathologically proven multilocular cystic renal cell carcinoma. We analysed CT and US with view points of tumor margin, growth pattern, renal contour change, echogenicity, attenuation on pre- and postcontrast scan, thickness and number of septum, and perirenal change. RESULTS: The CT findings of the multilocular cystic renal cell carcinoma were large well defined round encapsulated multiple fluid filled cystic mass with exophytic growing pattern. The capsule and septum were relatively well enhanced with contrast medium. The cystic space and septurn were variable in size and shape. US revealed large multiple fluid filled cystic mass separated by echogenic septum. CONCLUSION: The above CT and US findings of multilocular cystic renal cell carcinoma may be helpful in the diagnosis.