Morphological changes of the epiglottis with aging: a radiological study

In man the epiglottis is a thin lamella of yellow elastic cartilage. The upper part is free and is known asleaf and lower part participates in the formation of the anterior wall of the vestibule of the larynx. Theipithelial covering extends forwards onto the base of the tongue over the medial glossoepiglottic folds. The sidesof epiglottis are connected with the cartilages of Wrisberg and arytenoid cartilage by the aryepiglottic fold. Inview of these anatomical complexities, the function and physiology of the epiglottis have been debated sinceMagendi(1815), who proposed the theory that the epiglottis acts as a flap valve to prevent food entering thewindpipe, and who found that he could remove the free part of the epiglottis in dog without spoiling the dog.Follwoing the introduction of laryngoscopy(Garcia, 1815; Liston, 1840; Czermark, 1861) and modern cineradiographicequipments in 1950's, the anatomy and physiology of epiglottis has become much clearrer. Age as it is seen on thelateral x-ray of the neck. In the present study we have made an attempt to systematically analyze aging changes ofthe epiglottis in the lateral x-ray of the neck in 245 healthy adults. The age ranged from 16 to 65 years old.Based on our observation the epiglottis was classified into type A, B, and C according to their curvatures. Thus,type A represented those with posterior curvature, type B those with straight epiglottis and type C anteriorcurvature. Type C was sudivided into I, II and III according to the degree of curvature. Thus, type C-I, C-II andC-III represented mild, moderated and marked anterior curvature, respectively. Type A epiglottis was found in thesecond, third and fourth decades and type C-III in the older age group. Type A was least comon and type C mostprevalent. It seems that the epiglottis inclines anteriorly with backward curvature with age (p<0.0001).

Post-lobectomy changes of plain chest x-ray findings: with an emphasis on differential diagnosis between upper and lower lobectomy

After a lobectomy the apearance of the chest roentgenogram may return so nearly to normal that it isfrequently very difficult to tell which lobe has been moved without refering to the thoracic surgeon's record. Thereriew of literature failed to disclose previous articles concerning the differential diagnosis between upper andlower lobectomy. Clues of a lobectomy may be found in the rib cage, hilar shadows, pleura and disphragms, but they do not specifically incidate which lobe has been removed. In the present study we anlaysed anatomico-spatialchanges of the pulmonary basal arteries, hilar point, vascular redistribution, diaphragm and rib cage on the plainchest films taken before and after a lobectomy in 33 cases seen at the Dept. of Radiology, St. Mary's Hospoital, Catholic Medical College. Firstly we observed the pulmonary basal artery after a lobectomy on plain chest film. In 12 cases of upper lobectomy the pulmonary basal artery was easily identified in every case. However in all of 21cases of lower lobectomy, the pulmonary basal artery was not identified. Next, a shift of the hilar point waschecked after a lobectomy. Regarding to vascular redistribution, the blood vessels was counted at upper and lowerlung fields by simon's method before and after a lobectomy, respectively. Finally, the level of the diaphragm wascompared in the pre. and post-opeative films and resected rib was scrutinized. The present study revealed that themost reliable sign to indicate specifically which lobe has been resected is persistence or disappearance of thepulmonary basal artery. Then i.e. in upper lobectomy the pulmonary basal artery was easily identified, but inlower lobectomy the pulmoanry basal artery was not dectable. Other findings such as vascular redistribution,elevated diaphragm and resected rib were not specific.

Dispartity among cholangiograms: a case of spontaneous disappearance of a large stone from the common bile duct and intrahepatic-duct diaphragm associated with multiple intrahepatic stones

Disparity among cholangiograms is rarely observed. The causes of disparity include spontaneous disappearance of gall stone, incomplete filling of smaller branch, technical problems, interpretative errors, and overriding of evidence. 5pontaneous disappearance of gall stone is rare but has been well documented in both radioligic and clinical literatures. Recently we have experienced spontaneous disappearance of a large stone in the common bile duct and this formsthe basis of the present case report. The patient, 53-year-old female, was admitted on January 18, 1982 to 5t. Mary's Hospital, Catholic Medical College because of repeated episodes of pain in the epigastrium and the right upper quadrant for the past 2 months. On admission, physical examination revealed tenderness in the epigastrium and the right μpper quadrant. Laboratory tests revealed bilirubin 2.2 mgfdl and alkaline phosphatase 76 .5 KA/dl. A percutaneous transhepatic cholagiogram(PTC} performed 2 days later revealed a large stone measuring 16 × 26mm in size in the distal CBD. The CBD and CHD proximal to the stone were moderately dilated. Most of the intrahepatic ducts were well delineated without fi lJ ing defect or evidence of stone. However, the in ferior segment of the posterior branch of the right intrahepatic duct (IPRH) was not delineated. The ending of the nonvisualized segment was rather abrupt. The patient suffered severe abdominal pain 2 days after PTC, and was treated with Buscopanø compositum. The attack ceased 20 hours after the onset of colicky abdominal pain. An operation was performed 4 days after PTC. To our surprise there was no stone in the distal CBD. The gallbladder was resected and a T-tube has been placed. A table cholangiogram confirmed disappearance of the stone, but IPRH was agin not opacified except for a short ditance just after bifurcation from the main branch. Eight days after surgery a follow-up T-tube cholangiogram was performed. No residual stone was found in the extrahepatic bile duct. However, IPRH which was not opacifled until then became distinctly visualized demonstrating multiple intra-ductal radiolucent stones, There was a diaphragm-like structure obstructing the lumen and confining the stones located proximally to the site obstructed in the precedent cholangiograms, The radiologic and clinical importances of our observation in this case are four fold: 1. Gall stone up to the diameter of 14 × 23mm can pass through the papilla spontaneously, 2. Repeat diagnostic imaging is imperative when patient became asymptomatic after severe colicky abdominal pain before the intended operation, 3. Without optimal delineation of intrahepatic biliaη radicles, residual stone or stones cannot be exciuded in the cholangiograms, 4. And finally, to avoid misdiagnosis a comprehensive knowledge of normal anatomy of cholangiogram is required.