Endovascular Treatment with a Stent-Graft for Internal Carotid Artery Laceration during Trans Sphenoidal Surgery: A Case Report

An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft.

Self-Expandable Polytetrafluoroethylene (PTFE)-covered Nitinol Stent for the Palliative Treatment of Malignant Biliary Obstruction

PURPOSE: We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. MATERIALS AND METHODS: Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S & G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. RESULTS: Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice occurred in six cases; stent migration occurred in four cases and tumor overgrowth occurred in two cases. The survival rates were 97%, 80%, 67% and 59% at 1, 3, 6 and 9 months, respectively. The stent patency rates were 96%, 92%, 86% and 86% at 1, 3, 6 and 9 months, respectively. CONCLUSION: Self-expandable PTFE-covered nitinol stent placement seems to be technically feasible and effective for the palliative treatment of malignant biliary obstruction.

Cystic Change in a Primary Retroperitoneal Angiosarcoma: A Case Report

A retroperitoneal angiosarcoma is rare. Especially, a cystic change in retroperitoneal angiosarcoma is extremely rare and it is difficult to distinguish an angisarcoma with a cystic change in the differential diagnosis with other retroperitoneal cystic masses. We report here a case of a cystic change in a retroperitoneal angiosarcoma of a 61-year-old woman who complained of abdominal pain. Imaging studies, including ultrasonography and computed tomography, detected a lobulating cystic mass with inner enhancing irregular septations and walls in the retroperitoneum. The tumor was surgically resected and was histopathologically diagnosed as an angiosarcoma.

A Comparative Study of Stenting versus Surgical Bypass in Gastric Outlet Obstruction Caused by Gastric Cancer

PURPOSE: In gastric cancer patients with gastric outlet obstruction, there are several complications such as malnutrition and vomiting. Palliative enteral stenting is a less invasive procedure as compared with a gastrojejunostomy. The aim of this study was to determine whether there was a significant difference between patients that undergone palliative enteral stenting and patients that had received a bypass gastrojejunostomy. MATERIALS AND METHODS: One hundred patients underwent palliative entering stenting and 31 patients were subjected to a surgical bypass gastrojejunostomy. We reviewed the medical records of the patients with gastric outlet obstruction secondary to far advanced gastric cancer that were diagnosed using a gastrofibroscope, UGI and abdominal CT, and were admitted to our institution between January 2000 and August 2006. The outcome of stent placement for gastric outlet obstruction was compared with palliative gastrojejunostomy during the same period. We excluded patients with recurrent gastric cancer and double cancer from this study. RESULTS: There were significant differences between the group of patients that underwent stenting and the group of patients that received a gastrojejunostomy regarding the age of patients (67+/-12 vs. 57+/-9, P<0.001) but not between the sex of the patients (M : F, 2 : 1 vs. 2 : 1, P=0.637). The most common complication of stenting was tumor ingrowth (16/100, 16%) and the second most common complication was stent migration (14/100). Failure of the procedure occurred in only three patients. Twenty-three patients underwent re-stenting and one patient required open conversion with a gastrojejunostomy. The median time to the first meal was 4+/-2 days in the stent group of patients and 6+/-2 days in the gastrojejunostomy group of patients (P=0.001). The median postoperative hospital stays were 9 days in the stent group of patients and 15 days in the gastrojejunostomy group of patients (P=0.003). The mean survival periods were 11 months in the stent group of patients and 10 months in the gastrojejunostomy group of patients (P=0.937). CONCLUSION: There were no significant differences in the mean survival rates. An earlier first meal and a shorter hospitalization stay were found in the stenting group of patients compared to the bypass gastrojejunostomy group of patients. However, re-stenting was a concern due to tumor ingrowth and stent migration.

A case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass / 대한내과학회지

Gastric carcinoid tumors have been regarded as rare neoplasms, accounting for just 0.3% of all gastric tumors and fewer than 2% of all carcinoid tumors. Recently, there has been an increase in the number of reported studies of gastric carcinoid tumors with the widespread use of gastroscopy and improvements in immunohistochemical methods. Gastric carcinoid tumors are classified into three types. For type III gastric carcinoids not associated with hypergastrinemia, which tend to be larger and demonstrate a biologically more aggressive behavior with metastasis, and also for sporadic lesions, excision with regional lymph node clearance has been recommended. Tumors that are less than 1cm in size are called minute carcinoids, which seldom give rise to regional lymph node metastasis, except in rare cases. We report here a rare case of a minute gastric carcinoid tumor with regional lymph node metastasis that was misdiagnosed as an intraabdominal mass in a 42-year-old woman. Furthermore, we review the available literature on this entity.

Usefulness of MR Cholangiopancreatography after Intravenous Morphine Administration

PURPOSE: We wanted to assess the usefulness of MRCP after intravenous morphine administration in the evaluation of the hepatopancreatic pancreatico-biliary ductal system. MATERIALS AND METHODS: We studied 15 patients who were suspected of having disease of hepatopancreatic ductal system and they did not have any obstructive lesion on ultrasonography and/or CT. MRCP was acquired before and after morphine administration (0.04 mg/kg, intravenously). Three radiologists scored the quality of the images of the anatomic structures in the hepatopancreatic ductal system. We directly compared the quality of the images obtained with using the two methods and the improvement of the artifacts by pulsatile vascular compression. RESULTS: The MRCP images obtained after intravenous morphine administration were better than those obtained before morphine administration for visualizing the hepatopancreatic ductal system. On direct comparison, the MRCP images obtained after morphine administration were better in 12 cases, equivocal in two cases, and the images before morphine administration were better in only one case. In three patients, MRCP before morphine injection showed signal loss at the duct across the pulsatile hepatic artery. In two of three patients, MRCP after morphine injection showed no signal loss in this ductal area. CONCLUSION: MRCP after intravenous morphine administration enables physicians to see the hepatopancreatic ductal system significantly better and the artifacts caused by pulsation of the hepatic artery can be avoided.

Covered Self-Expandable Metallic Stent Placement for a Post-operative Malignant Anastomotic Stricture Secondary to Recurrent Gastric Cancer

PURPOSE: To evaluate the technical feasibility and clinical effectiveness of stent placement for the treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer. MATERIALS AND METHODS: Under fluoroscopic guidance, one or two covered stents were placed in 20 consecutive patients (age range, 44-75 years) with an anastomotic stricture due to a recurrent gastric malignancy. Before stent placement, all patients had severe nausea and recurrent vomiting after ingestion. RESULTS: Stent placement was technically successful for all patients, and no procedural complications occurred. After stent placement, 18 of 20 (90.0%) patients were able to ingest at least a liquid diet and had a markedly decreased incidence of vomiting. During the follow-up of 2-116 weeks (mean, 25.5 weeks), stent migration occurred in two patients (10.0%) on one day after the procedure. All patients with stent migration were treated successfully by means of placing a second stent. Three patients showed a recurrence of the stricture due to tumor overgrowth; two of the patients were treated with coaxial placement of a second stent. Another patient refused additional management. CONCLUSION: Covered self-expandable metallic stent placement seems to be technically feasible and effective for palliative treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer.

Comparison of (18F)FDG PET/CT and CT/MRI for the Diagnosis of Recurrent or Metastatic Disease after Treatment: In Head and Neck Cancer Patients

PURPOSE: We evaluated the accuracy of 18FFDG PET/CT for the detection of recurrence or metastasis after treatment in patients with primary head and neck cancer, and compared the results with those of CT/MRI. MATERIALS AND METHODS: We studied 34 patients with the diagnosis of head and neck cancer, who underwent treatment and follow up with 18FFDG PET/CT and CT/MRI. The patients were divided into two subgroups based on the difference in follow-up time interval and the type of treatment. Accuracy was evaluated by follow-up information and histopathology findings. The results of the 18FFDG PET/CT and CT/MRI were compared by statistical analysis. RESULTS: For the 18FFDG PET/CT results, 19 FDG uptake lesions were detected in 17 patients. Among these lesions, 18 were confirmed as recurrent or metastatic lesions and one as an inflammatory reaction from radiation therapy. Four lesions that had high FDG uptake were not detected by the CT/MRI. The sensitivity and specificity were 100% and 94.4% for the 18FFDG PET/CT and 77.8% and 94.4% for the CT/MRI (p<0.05). For the subgroup that received radiation therapy, 18FFDG PET/CT was more sensitive than CT/MRI (sensitivity = 100% vs. 63.6%, p<0.05). CONCLUSION: The results of this study showed that 18FFDG PET/CT was a useful screening modality for detecting recurrent or metastatic disease after treatment of patients with head and neck cancer, especially post-radiation.

Malignant Nodular Hidradenoma: A Case Report

Malignant nodular hidradenoma is a rare skin appendageal tumor, and its imaging findings have not been previously described. We experienced the case of a large malignant nodular hidradenoma of the left upper arm in a 71-year-old woman. MRI revealed a large, lobular, poorly circumscribed, soft tissue mass at the left upper arm, and the mass showed homogeneous enhancement. 18F-FDG PET/CT showed hypermetabolic activity in the left upper arm mass with a maximal standard uptake value of 19.

A Case of Type 1 von Hippel-Lindau (VHL) Disease associated with VHL Germline Mutation / 대한내분비학회지

Von Hippel-Lindau (VHL) disease is an autosomal dominant neoplasia syndrome that result from a germline mutation in the VHL gene. Germline mutation in the VHL gene lead to the development of hemangioblastomas of the central nervous system and retina, cysts and clear cell carcinoma of the kidney, cyst adenomas of other organs, and pheochromocytoma. VHL is a tumor suppressor gene on the short arm of chromosome 3. VHL disease has been classified into two main clinical subtypes depending on the presence (type 2) or absence (type 1) of pheochromocytoma. Type 2 has been subdivided into three categories depending on the presence (type 2B) or absence (type 2A) of renal cell carcinoma, with type 2C being a rare subtype in which pheochromocytoma is the sole manifestation of VHL disease. Recently we experienced a family with VHL type 1 who carry C to T (Q73X) transition in codon 217 nonsense germline mutation in exon 1 of VHL gene. The authors report this case with literature review.

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

CT Findings of Gastrointestinal Stromal Tumor versus Lymphoma of the Small Intestine

PURPOSE: To compare CT features of gastrointestinal stromal tumors (GIST) with those of lymphomas in the small intestine. MATERIALS AND METHODS: CT findings of 11 pathologically confirmed GIST patients and 10 lymphoma patients were retrospectively reviewed. CT findings were analyzed with regard to location, size, margin, growth patterns, internal character, enhancement, invasion, vascular encasement, lymphadenopathy, intestinal obstruction and ascites. RESULTS:An extraluminal mass was present in 82% (9/11) of the GIST patients versus 30% (3/10) of the lymphoma patients. Circumferential wall thickening was observed in 80% (8/10) of the lymphoma patients (p.05). CONCLUSION: Features revealed by CT scans are highly useful in differentiating GIST from lymphoma of the small intestine. Extraluminal growth and internal necrosis or gas are more common in patients with GIST compared with lymphoma. CT features of circumferential wall thickening and associated lymphadenopathy are more common in patients with lymphoma.

Radiologic Findings of Extraosseous Ewing's Sarcoma

PURPOSE: The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. MATERIALS AND METHODS: Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. RESULTS:The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm (mean, 5.2 cm), were mainly well circumscribed and showed no evidence of calcification prior to treatment. Margins were well defined in four out of the six patients. Four patients had subcutaneous lesions and the other two patients had intramuscular lesions. Muscle (two patients) and bone invasion (one patient) were present. The masses were heterogenous low signal intensity on T1 weighted images and heterogeneous high signal intensity on T2 weighted images compared with muscle. Heterogeneous enhancement within the lesion was observed in all patients on CT and MRI. Whole body scintigraphy using Tc-99 m MIBI showed increased uptake in the masses of two patients. CONCLUSION: Extraosseous Ewing's sarcomas were frequently seen as a well-circumscribed ovoid mass with nonspecific findings on CT and MRI. Despite being a relative rare tumor, it should be included in the differential diagnosis of a non-calcified soft-tissue mass, especially in subcutaneous tissue.

Treatment of Malignant Gastroduodenal Obstruction with Using a Newly Designed Complex Expandable Nitinol Stent: Initial Experiences

PURPOSE: We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. MATERIALS AND METHODS: Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2 mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were investigated during the follow up period. RESULTS: Stent placement was successful in all the patients. After stent placement, the symptoms improved in all but one patient. During the follow up, stent migration occurred in one patient (3%) at 34 days after the procedure. Despite the stent migration, the patient was able to resume a soft diet. Six patients developed recurrent symptoms of obstruction with tumor overgrowth at a mean of 145 days after the procedure; all the patients underwent coaxial placement of an additional stent with good results. One patient showed recurrence of obstruction due to tumor in-growth, and this was treated by placement of a second stent. Two patients with stent placement in the duodenum suffered from jaundice 26 days and 65 days, respectively, after their procedures. CONCLUSION: Placement of the newly designed complex expandable nitinol stent seems to be effective for the palliative treatment of malignant gastroduodenal obstructions. The new stent also seems to help overcome the disadvantage of the increased migration observed for the covered stent.

A Case of Microscopic Polyangiitis Associated with Paranasal Sinusitis and Pulmonary Hemorrhage / 대한신장학회잡지

Microscopic polyangiitis is a systemic small-vessel vasculitis primarily associated with necrotizing glomerulonephritis and pulmonary capillaritis. This disease is determined by clinical manifestation, ANCA, and involved organ or renal biopsy. We describe a 49-year-old female presenting with chronic postnasal drip, progressive dyspnea and abrupt hemoptysis. Her serum p-ANCA was postitive, but c- ANCA was negative. Her chest X-ray and chest CT scan showed pulmonary hemorrhage, and the renal biopsy specimen revealed crescentic glomerulonephritis. She was diagnosed as having an ANCA-associated vasculitis, and more specifically, a microscopic polyangiitis accompanied with paranasal sinusitis. She was treated with intravenous methylprednisolone pulse therapy, followed by prednisolone and cyclophosphamide per oral tablets. She showed rapid progression of renal failure and died from sepsis after 2 months of treatment.

Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

PURPOSE: To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. MATERIALS AND METHODS: From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035" guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. RESULTS: Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation. CONCLUSION: Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe, feasible procedure that is well tolerated by patients and is relatively easy to perform.

Percutaneous Radiofrequency Ablation of Inoperable Primary Lung Cancer

PURPOSE: To present the initial experience of percutaneous radiofrequency ablation (RFA) of inoperable primary lung cancer, and to assess the technical feasibility and potential complications. MATERIALS AND METHODS: Twenty patients with inoperable lung cancer underwent percutaneous RFA. Nineteen of 20 patients had stage III or IV non-small cell lung cancer, and the remaining one had stage I lung cancer with pulmonary dysfunction. The mean tumor size was 4.6+/-0.4 cm (range, 1.8-8.4 cm). RFA was performed with a single (n=18) or cluster (n=2) cool-tip RF electrode and a generator under CT guidance using local anesthesia and conscious sedation. Twenty tumors were treated in 28 sessions. Patients were assessed by contrast-enhanced CT in all cases at 1 week, 1 month, and 3 months. Eleven patients received chemotherapy (n=10) or radiotherapy (n=1) after RFA. RESULTS: RFA was technically successful and well tolerated in all patients. Complete necrosis was attained in 7 lesions (35%), near complete (90-99%) necrosis in 10 lesions (50%), and partial (50-89%) necrosis in 3 lesions (15%). During the mean follow up of 202 days (21 to 481 days), tumor size was decreased in 13 patients, unchanged in 3, and increased in 4. In the latter four, additional RFA was performed. One patient underwent surgery three months after RFA and the histopathologic findings showed a large cavity with thin fibrotic wall suggestive of complete necrosis. During or after the procedure, pneumothorax (n=10), moderate pain (n=4), blood tinged sputum (n=2), and pneumonia (n=2) were developed. Chest tube drainage was required in only 1 patient due to severe pneumothorax. Other patients were managed conservatively. Seven patients died at 61 to 398 days (mean, 230 days) after RFA. The remaining 13 patients were alive 21 to 481 days (mean, 187 days) after RFA. CONCLUSION: RFA appears to be a technically feasible and relatively safe procedure for the cytoreductive treatment of inoperable, non-small cell lung cancer and warrants further investigation as a complementary treatment to chemotherapy or radiation therapy.

A New Liquid Embolic Agent(Embol) for Transcatheter Renal Artery Embolization: An Experimental Study in Rabbit

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. MATERIALS AND METHODS: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. RESULTS: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. CONCLUSION: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

Endobronchial Metastasis: CT Findings and Its Usefulness in Bronchoscopic Correlation

PURPOSE: To evaluate the CT findings of bronchial abnormalities in patients with endobronchial metastasis from extrapulmonary tumors, and to correlate these with the bronchoscopic findings. MATERIALS AND METHODS: The authors retrospectively reviewed the CT and bronchoscopic findings of 17 patients (M:F=9:8; mean age, 56 years) with histologically proven endobronchial metastasis from extrapulmonary primary tumors. Carcinoma of the uterine cervix (n = 5) was the most common primary site for endo-bronchial metastasis. CT findings of bronchial abnormalities with associated peribronchial and lung parenchymal lesions were analyzed and compared with the bronchoscopic findings. RESULTS: Among the 17 patients, 20 sites of bronchial abnormalities were visualized bronchoscopically. CT findings of bronchial abnormalities were smooth narrowing (n = 11), occlusion (n = 3), intraluminal mass (n= 4), and normal (n = 2). Peribronchial lesions(lymph node enlargement or parenchymal mass) were found in 12 cases. Bronchoscopy revealed bronchial narrowing due to a mucosal nodule or intraluminal polypoid mass in 16 cases, and total obstruction of the bronchus in four. With regard to the identification of bronchial abnormalities, the findings of CT and of bronchoscopy agreed in 17 cases and disagreed in three. While bronchoscopy was advantageous for detecting early mucosal abnormality, CT effectively evaluated the extent of a lesion beyond the stenosis or bronchial obstruction. CT was also useful for predicting the causes of bronchial abnormalities. CONCLUSION: CT is relatively accurate in evaluating bronchial abnormalities, and in patients with endo-bronchial metastases may be used as a complementary procedure to bronchoscopy for evaluating the extent of the lesion.