A Rare Case of Zinner's Syndrome with Ectopic Prostate and Triorchidism

Zinner's syndrome is a rare congenital abnormality of the mesonephric duct. Unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction are the triad of maldevelopment of the mesonephric duct which comprises Zinner's syndrome. It is an extremely rare case, in that approximately 100 cases only have been reported worldwide. We discovered a rare developmental anomaly with other mesonephric duct-associated abnormalities, Zinner's syndrome with a presumed ectopic prostate and triorchidism and do report here.

Arteriovenous Malformation of the Distal Ileum in a 14-Year-Old Girl with Recurrent Abdominal Pain: A Case Report

Arteriovenous malformation (AVM) is a lesion involving a high-flow vascular malformation, which is one of the causes of massive gastrointestinal bleeding. In the pediatric population, AVM is quite rare in the gastrointestinal tract, and the most common primary site is the colon. A small bowel is a rare primary site of AVM, and only 1 case has been reported in Korea. Here, we report on a case of AVM found in the distal ileum of a 14-year-old girl who complained about recurrent lower abdominal pain only without a gastrointestinal hemorrhage. In the previous research literature, a small bowel AVM can be diagnosed through detecting the existence of an enhancing nidus of the intestinal wall at the arterial phase, accompanied by an early draining vein as it appeared on a dynamic contrast-enhanced abdominal computed tomography. In our case, the pathologically confirmed AVM of the distal ileum showed a dot-like enhancement within the thick low-attenuating submucosal layer of the terminal ileum.

Radiologic Findings in Extrapancreatic Solid Pseudopapillary Tumor with Aggressive Behavior: a Case Report

Solid pseudopapillary tumor (SPT) is a low grade malignant tumor in the pancreas, and extrapancreatic SPT is extremely rare. We report a case of a 61-year-old woman who complained abdominal pain with diffuse tenderness. She was diagnosed with extrapancreatic SPT with extensive peritoneal dissemination and hepatic metastases. Although a few cases have reported imaging findings of extrapancreatic SPT, there have been no reports of extrapancreatic SPT with aggressive tumor behavior and dismal prognosis. Although imaging features closely resembled those of classical pancreatic SPTs, malignant transformation of extrapancreatic SPT should be considered when focal discontinuity of the tumor capsule with ill-defined margin and invasion of adjacent structures were identified.

Effect of Prostate Biopsy Hemorrhage on MRDW and MRS Imaging

PURPOSE: To retrospectively evaluate the effect of post-prostate-biopsy hemorrhage on the interpretation of magnetic resonance diffusion-weighted (MRDW) and magnetic resonance spectroscopic (MRS) imaging in the detection of prostate cancer. We also investigated the optimal timing for magnetic resonance examination after prostate biopsy. MATERIALS AND METHODS: We reviewed the records of 135 men. All patients underwent prostate magnetic resonance imaging (MRI). The prostate was divided into eight regions according to the biopsy site. Subsequently, we measured hemorrhage on apparent diffusion coefficient (ADC) values and (choline+creatinine)/citrate ([Cho+Cr]/Cit) ratios in the same regions on the MRI. We investigated the effect of hemorrhage at ADC values and (Cho+Cr)/Cit ratios on MRI and the relationship between prostate biopsy results and MRI findings. RESULTS: The mean patient age was 68.7 years and the mean time between biopsy and MRI was 23.5 days. The total hemorrhagic score demonstrated no significant associations with intervals from biopsy to MRI. Higher hemorrhagic scores were associated with higher ADC values, prostate cancer, and noncancer groups, respectively (p<0.001). ADC values were lower in tumors than in normal tissue (p<0.001), and ADC values were inversely correlated with tumor Gleason score in biopsy cores (p<0.001). However, (Cho+Cr)/Cit ratios did not exhibit any association with prostate biopsy results and hemorrhage. CONCLUSIONS: Hemorrhage had no significant associations with the interval from biopsy to MRI. ADC values may help to detect prostate cancer and predict the aggressiveness of cancer; however, it is important to consider the bias effect of hemorrhage on the interpretation of MRDW imaging given that hemorrhage affects ADC values.

Double Intussusception in a Preterm Infant / 대한주산의학회잡지

Intussusception is a common surgical disorder in infancy. Intussusception in preterm infant is very rare and about 40 cases have been reported. Furthermore, double intussusception is extremely rare in children and there seems to be no such a case reported in preterm infant. We report a case of idiopathic double intussusception in the preterm infant, who was born at 25 weeks' gestation, underwent an explolaparotomy for bowel perforation on 39 days of life, and during the operation, an ileo-ileo-colic intussusception was found without a leading point.

Solitary Necrotic Nodule of the Liver Mimicking Metastasis in Patient with Early Gastric Cancer: 3T MRI and PET/CT Findings

Solitary necrotic nodule (SNN) of the liver is a very uncommon benign lesion, and it is detected incidentally as a rule. It is important to differentiate SNN radiologically from various single hepatic nodules because SNN mimics hepatic metastasis, especially in staging work up of known primary malignancy. The reported imaging findings of SNN are well-defined nodule without enhancement or with subtle peripheral enhancement. There has been no report about the target-like SNN of the liver and about the imaging finding of 3T magnetic resonance imaging and positron emission tomography. We report a case of targetlike SNN of the liver, mimicking hepatic metastasis, with findings of various imaging modalities and try to find a cause of this nodule according to the pathologic and literature review.

Contrast Extravasation into an Acute Spontaneous Intracerebral Hematoma: Multidetector CT Angiographic Findings and Clinical Implications

PURPOSE: The purpose of this study was to evaluate multidetector row CT (MDCT) angiographic findings and their clinical significance for contrast extravasation into a spontaneous intracerebral hematoma (ICH). MATERIALS AND METHODS: MDCT angiographic studies and clinical records of 115 patients with spontaneous ICH were retrospectively reviewed. Cases were divided into two groups according to the presence or absence of contrast extravasation. The cases in the two groups were compared to determine the differences in radiological and clinical findings. The contrast extravasation group was divided into two subgroups according to radiological findings as follows: single or multiple dot-like contrast extravasation (Type A) and beaded-tubular (with or without dot-like extravasation) contrast extravasation (Type B). RESULTS: Contrast extravasation was seen in 38 patients (33%). It was associated with a larger hematoma volume, more frequent intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH), a shorter time interval from onset to the time of the CT scan, lower Glasgow coma scale (GCS), and a higher mortality rate. Type A and B contrast extravasation were observed in 16 (42%) and 22 (58%) patients, respectively. The rate of IVH and the clinical outcome of patients with Type B showed a significant correlation. CONCLUSION: Two types of contrast extravasation into an ICH show a significant difference in the rate of IVH and in clinical outcome. Detecting the presence of contrast extravasation and classifying them according to the morphologic patterns are important in predicting a prognosis.

Intradural Extramedullary Capillary Hemangioma with Long Segment of Transient Cord Edema: A Case Report

We present a case of intradural extramedullary capillary hemangioma of the thoracic spine with a long segment of transient cord edema. Spinal capillary hemangiomas are extremely rare vascular tumors and only a few cases have been reported. On the MR images, the mass showed hypointensity on the T1-weighted images, hyperintensity on the T2-weighted images relative to the spinal cord, and strong homogeneous enhancement on the contrast-enhanced T1-weighted images. The T2-weighted images showed a long segment of ill-defined hyperintense area in the spinal cord which was completely resolved after surgery.

Diffusion-Weighted MR Imaging in Acute Wernicke's Encephalopathy Associated with Pseudomembranous Colitis: A Case Report and Review of the Literature

Wernicke's encephalopathy is a common complication of thiamine deficiency among chronic alcoholics. However, there have been few reports about MR imaging findings, including the diffusion-weighted changes of this neurologic disorder, in nonalcoholic patients. We present here a rare case of acute Wernicke's encephalopathy that developed in a patient who received prolonged total parenteral nutrition for his pseudomembranous colitis. The MR imaging, including the diffusion-weighted imaging, was performed at the onset of disease and during follow-up. The diagnosis was made by the characteristic MR imaging findings and it was supported by the clinical features. The initial and follow-up MR imaging findings with diffusion-weighted imaging changes are described and correlated with the clinical status.

A Case of Nonsecretory Multiple Myeloma with Atypical Imaging Features

Multiple myeloma usually shows homogeneous enhancement on contrast-enhanced Magnetic Resonance imaging (MRI), and is accompanied by a monoclonal gammopathy in serum or urine. We report a case of nonsecretory myeloma, the diagnosis was difficult due to the absence of a monoclonal gammopathy and the presence of atypical imaging features.

Ultrasound-Guided Radiofrequency Ablation of Thyroid Gland: A Preliminary Study in Dogs

PURPOSE: The purpose of this study was to evaluate the possibility of using radiofrequency ablation as the treatment modality for the benign or malignant thyroid nodules in humans. Therefore, we examined the results of using radiofrequency ablation on the thyroid glands in dogs, in respect of the extent of the ablated tissue and the complications. MATERIALS AND METHODS: Five dogs (10 lobes of the thyroid glands) were included in this study. US-guided radiofrequency ablation was undertaken with a 10mm, uncovered 17 gauge cool-tip needle. The power and duration was 20 wattage and 1 minute in five thyroid lobes (group 1) and 20 wattage and 2 minutes in another 5 thyroid lobes (group 2). The ultrasound scans and the pre-and post-enhancement CT scans were undertaken before and immediately after the procedures, and at 24 hours, 72 hours and 1 week later. The US and CT findings of the ablated tissue and complications were evaluated. Blood sampling was done at the pre-procedure time and 1 week later for evaluating the functional status of the thyroid gland. Laryngoscopy was done at the pre-procedure and post-procedure times, and at 24 hours, 72 hours and 1 week later for the evaluation of any recurrent laryngeal nerve palsy. RESULTS: The echo pattern of the ablated thyroid gland at immediately after the radiofrequency ablation appeared as poorly marginated and hyperechoic. On the US obtained 24 hours after radiofrequency ablation, the echo pattern of the ablated thyroid gland was hypoechoic. The maximum diameters after RFA were 9.4+/-0.5 mm in group I and 11.4+/-0.5 mm in group II. The pre-enhanced CT scan taken at immediately after the radiofrequency ablation showed ill defined hypodense areas in the ablated thyroid gland. Differentiation between the normal and abnormal portions of the thyroid gland was difficult on the contrast enhanced CT scan. Complications induced by radiofrequency ablation were one recurrent laryngeal nerve palsy, two perforations of esophagus and five thickenings of the esophageal wall. In summary, the radiofrequency ablation therapy for the benign or malignant thyroid nodules located in anterior aspect (within a 5 mm radius) of the thyroid gland in human suggests this is an effective treatment, through this was an animal study performed on dogs.

Inflammatory Pseudotumor Involving the Pulmonary Artery: Case Report

Pulmonary inflammatory pseudotumor is the most common primary lung mass seen in children, but extraparenchymal involvement is relatively rare. We report here on a case of inflammatory pseudotumor involving the mediastinum and the pulmonary artery. A 48-year-old man presented with enlargement of the right hilum on a simple chest radiograph. He had a history of exertional dyspnea for 1 year. A non-homogeneous enhancing mass was noted in the right pulmonary artery on computed tomography. Mediastinotomy and pulmonary artery angiography with a forcep biopsy revealed inflammatory pseudotumor of the mediastinum and pulmonary artery.

A Comparative Study of Intra-arterial and Intramuscular Administration of phVEGF165 in a Chronic Ischemic Model of Rabbit Hindlimb

PURPOSE: To obtain phVEGF165 for angiogenesis and to compare the effects of its intra-arterial and intramuscular administration in a chronic ischemic rabbit hindimb model. MATERIALS AND METHODS: Chronic ischemic models were constructed in the left hindlimb of rabbits and divided into control (n=6), intra-arterial (n=7) and intramuscular groups (n=5). Plasmid DNA (phVEGF165) expressing vascular endothelial growth factor (VEGF) was obtained from HL60 cells, and transfection into CHO cells and western blot analysis of the medium, as well as proliferation assay of CPAE cells were performed. Two weeks after construction of the models, 500 mug phVEGF165 was injected into both the left common iliac artery and thigh muscles. Angiography was performed and the number of vessels counted, and ELISA was used to determine the quantity of VEGF in blood samples. Wilcoxon signed rank test was employed for statistical analysis. RESULTS: VEGF165 was expressed on western blot of the culture medium. Proliferation assay showed that optical densities were 0.73+/-0.043 in the control study and 1.09+/-0.015 in phVEGF165. The angiographic scores were 1.32+/-0.13 (pre-gene therapy) and 1.30+/-0.07 (post-gene therapy) in the control group, 1.42+/-0.15 and 1.59+/-0.09 in the intra-arterial group, 1.59+/-0.27 and 1.14+/-0.12 in the intramuscular group. The differences were not statistically significant. In the intra-arterial group, serum VEGF levels were 39.96+/-1.08 pg/ml (pregene therapy), 44.99+/-2.13 pg/ml (4th day), 48.18+/-1.49 pg/ml (1st week), 45.70+/-3.77 pg/ml (2nd week), and 46.54+/-5.47 pg/ml (3rd week), but in the control and intramuscular groups there were no increases. CONCLUSION: phVEGF165 affected the proliferation of CPAE cells. There was no difference in angiographic scores and serum VEGF levels between intra-arterial and intramuscular administrations.

Hepatic CT Enhancement: Comparison between Dimeric and Monomeric Nonionic Contrast Agents in Rabbits

PURPOSE: To determine the hepatic and vascular enhancement profiles with nonionic dimeric, iodixanol, contrast agent in the rabbit and to compare them with nonionic monomeric, ioversol, contrast agent. MATERIALS AND METHODS: Seven rabbits initially underwent hepatic dynamic CT scan with either iodixanol or ioversol, followed by repeated CT scan with other unused contrast agent with one week interval between scans. Pre and post contrast attenuation values of hepatic parenchyma, aorta and portal vein were measured sequentially. The mean enhancement of the hepatic parenchyma, aorta and portal vein were compared between two agents. The mean peak enhancement and peak enhancement time of the liver, aorta, and portal vein were also compared. RESULTS: The attenuation values of ioversol showed a greater mean hepatic enhancement than iodixanol from 18 seconds to 39 seconds after injection (from late arterial phase to early portal venous phase) with a statistical significance (p<0.05). The mean peak enhancement of hepatic parenchyma, aorta and portal vein was also greater using ioversol than iodixanol, but the mean peak enhancement times of ioversol and iodixanol were nearly identical. CONCLUSION: Ioversol may have the greater effects than iodixanol on hepatic tumor conspicuity, especially from late arterial phase to early portal veneous phase.

Development of the Single Nodular VX-2 Carcinoma Model in Rabbit Liver: Tissue Chip Implantation under Ultrasonographic Guidance

PURPOSE: To implant tissue chips in New Zealand rabbits, and thus redurce the frequency with which scattered VX2 carcinoma nodules and early metastasis develop in these animals. MATERIALS AND METHODS: VX2-carcinoma tissue chips of two different sizes were implanted under ultrasonographic guidance. In each of 12 New Zealand rabbits (group 1), there 1-mm tissue chips were implanted in the liver using an 18-gauge needle, and in the same way, one 3-mm chip with an added gelfoam pellet was implanted in the proximal lumen of the liver of each of ten other New Zealand rabbits (group 2). Three weeks after implantation, the animals underwent dvalphase CT scanning and were sacrificed, and the Number and size of tumor nodules, and metastasis were evaluated either macro-or microscopically. RESULTS: In ten rabbits in group I, a total of 21 nodules (16 in the liver, 5 in the peritoneal wall) were observed, which in nine rabbits in group 2, a total of ten nodules-all in the liver-were present. CT scans depicted tumor nodules in 50% of group-I rabbits, and in 29% those in group 2. Mean tumor diameter was 12 +/-9 mm in group 1 and 6.4 +/-3 mm in group 2. Histologic examination indicated the presence of nodular VX2 carcinoma, with varying degrees of central necrosis, a feature more prominent in group 2. CONCLUSION: To provide a well-localized tumor nodule in rabbit liver, tissue chip implantation of VX2 carcinoma, especially with added gelfoam, is a good alternative to intraparenchymal injection of tumor suspension.

A Case of Necrotizing Liver Abscess and Bile Duct Necrosis Following Hepatic Arterial Chemoembolization in Hepatocelluar Carcinoma / 대한간학회지

Transcatheter arterial chemoembolization (TACE) is widely used in the treatment of hepatocellular carcinomas. We report a case of mult iple liver abscess with bile duct necrosis following gallbladder infarction after TACE in a patient with hepatocellular carcinoma. A 62-year old man, wit h four cm sized hepatocellular carcinoma in right lobe, was treat ed by TACE for six times during 18 months. Two days after the last TACE, acute cholecystitis occurred and antibiotics were used until the recovery of cholecystitis. After two months, abdominal CT scan revealed a gas containing liver abscess and percutaneous transhepatic drainage was performed. Cholangiography via drainage cathet er showed findings of bile duct necrosis. Ant ibiotics sensit ive to the causative organism were administered intravenously. However, the abscess persisted despite of treatment for three mont hs.

CT Findings of Post Urinary Dive rsion: Normal Findings and Detection of Cancer Recurrence

PURPOSE: To determine normal postoperative CT findings and tumor recurrence in patients who have under-goneradical cystectomy and urinary diversion. MATERIALS AND METHODS: We retrospectively reviewed the postoperative CTscans of 51 patients who had un-dergone radical cystectomy with urinary diversion, and in analysis speciallyemphasised normal postoperative CT findings and recurrent cancer in the surgical bed. Among these 51 patients, 43had undergone incontinent urinary diversion(Bricker operation), while for six, diversion had been continent (Kockprocedure). Attempts were also made to characterise the CT findings of each procedure according to the location ofthe ileal pouch, the pattern of contrast collection within the pouch, and the morphology of the ileocutaneostomysite. RESULTS: Each urinary diversion procedure demonstrated characteristic postoperative CT appearances. TheBricker procedure revealed a contrast-filled ileal conduit in the right lower quadrant excreting into theileocu-taneostomy site, while the Kock procedure demonstrated layering of contrast and urine within the pouch aswell as artificially intussuscepted afferent and efferent ileal loops at the anastomotic sites. Thirty-three smallsoft tissue density lesions in the surgical bed were seen in 19 patients (37%). Thirty one were bilateral (n=28)or unilateral (n=3) triangular or oval shaped soft-tissue-density lesions and two were unilateral irregular shapedlesions. Follow-up CT scans showed that all triangular or oval-shaped lesions were smaller (n=8) or show no changein size (n=23) ; they were thought to represent postoperative fibrosis or granulation tissue. Two cases ofirregular-shaped soft-tissue-density lesions were seen on follow-up CT scans to be larger, and these wereconfirmed by percutaneous biopsy to be recurrent cancer. CONCLUSION: It is important for the radiologist to befamiliar with normal postoperative CT findings of various urinary diversion procedures as well as to recognize arelatively high incidence (37%) of small soft tissue den-sity lesions in a surgical bed. In our study, smalltriangular or oval-shaped soft-tissue-density lesions in the sur-gical bed (especially when these were bilateral)were thought to represent postoperative fibrosis or granulation tissue, and close follow-up by means of CTscanning rather than an invasive procedure is therefore warranted.

Shoulder Impingement Syndrome: Evaluation of the Causes with MRI

PURPOSE: Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. MATERIALS AND METHODS: A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. RESULTS: Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. CONCLUSION: Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69 % of patients, the condition was due to more than one cause.

Changes of Tuberculous Cavities after Antituberculous Therapy: Analysis with High-Resolution CT

PURPOSE: To evaluate changes in tuberculous cavities, one of the major factors used to determine the activityof tubereulosis, by high-resolution CT(HRCT) in active pulmonary tuberculosis patients after antituberculoustherapy. MATERIALS AND METHODS: The HRCT findings of 41 patients with active tuberculosis were analyzed withparticular emphasis on the appearance of tuberculous cavities before and after therapy. We measured the largestdiameter and maximal wall thickness of the cavities, as well as accompanying changes occurring during follow-up.The mean interval between initial and follow-up study was 8.7 months(minimum:4.1, maximum:33.2;S.D.: +/-5.0) andthe mean duration of antituberculous therapy was 7.5 months(minimum:4.7, maximum:14.8;S.D.: RESULTS: Among 41patients, 54 cavities were found on initial HRCT. Thirty one(57.4%) of these disappeared during follow up HRCTwith residual changes such as residual fibrotic scar(n=15), granuloma(10), paracicatrical emphysema(7),calcification(3), traction bronchiectasis(3), consolidation(3) and bullous emphysema(1). Twenty three of thecavities(42.6%) decreased in size and wall thickness, but did not disappear completely during follow-upexamination. Mean largest diameter and maximal thickness of 23 cavities were 32.0mm(+/-13.9) and 7.9mm(+/-4.8) oninitial HRCT, falling to 20.9mm(+/-12.5) and 4.1mm(+/-2.6), respectively, during follow-up HRCT. Among four patientswho underwent a second follow-up, the largest diameter and maximal thickness of the cavities decreasedcontinuously. In two patients, however, the cavities did not did not disappeas, though in the other two they haddisappeared by the time follow-up HRCT was performed a second time. CONCLUSION: During follow-up HRCT afterantituberculous therapy(mean duration of 7.5 months), 57.4%(31/54) of cavities were seen to have disappeared, withresidual changes such as fibrotic scars, granulomas, paracicatrical emphysema and calcification ; 42.6% of thecavitivies still remained, however, with retractive and fibrotic change. Such fibrotic and retractive changesshould not, therefore, be taken as indicative of active tuberculosis, especially in patients who have successfullycompleted their medication.

High CT Attenuation of Liver Due to Accumulation of Amiodarone: Report of Two Cases

Amiodarone is an antiarrhythmic drug containing 37% iodine by weight ; during long-term therapy the drugaccumulates in the liver, lung and various other organs. We describe two cases in which high attenuation of theliver due to the accumulation of amiodarone was seen on abdominal CT.