A Case of Minute Intraductal Papillary Mucinous Tumor of the Pancreas Presenting with Recurrent Acute Pancreatitis / 대한소화기내시경학회지

Intraductal papillary mucinous tumors (IPMT) of the pancreas is a lesion consisting of mucin-producing cells with neoplastic potential. This unique group of tumors is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. Now IPMT of the pancreas also includes intraductal papillary neoplasms that do not hypersecrete mucin. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are mild in severity. Recently, we was experienced a case of a minute IPMT causing repeated bouts of acute pancreatitis in a 75 year-old man. An endoscopic retrograde pancreatogram revealed a filling defect at the neck of the main pancreatic duct. A near-total pancreatectomy was performed and a minute (3x7 mm) IPMT of borderline malignancy was found in a branch duct at the pancreatic head. Surprisingly, despite the resective surgery the patient died of carcinomatosis. 8.5 months after the operation. This case of a minute but aggressive IPMT of the pancreas is herein reported with a review of the relevant literature.

CT Findings of Orbital Blow-out Fracture

PURPOSE: To evaluate the usefulness and radiologic findings of CT in the diagnosis of orbital blow-outfracture. MATERIALS AND METHODS: Forty-four patients with orbital blow-out fractures diagnosed by clinicalfindings and CT were evaluated retrospectively. On CT images, we evaluated the site and frequency of fracture,herniation of orbital fat, extraocular muscle abnormality, intraorbital hematoma, and intrasinus hemorrhage. RESULTS: Forty-eight sites of orbital wall fractures were seen. Of these, 25(52.1%) were observed at the medialwall and 18(37.5%) at the inferior wall. Combined fracture of the medial and inferior wall was seen in fivecases(10.4%), and orbital fat herniation to adjacent sinuses in 25. Associated extraocular muscle abnormalitieswere seen at the medial rectus (n=20) and inferior rectus muscle(n=18). Intrasinus hemorrhage was seen in 15cases, and intraorbital hematoma in five. CONCLUSION: CT is a useful diagnostic modality for the evaluation oforbital blow-out fracture and associated soft tissue abnormalities.

The Role of CT Discography in Far Lateral Disk Herniation

PURPOSE: To evaluate the value and the radiologic findings of CT discography in the diagnosis of the far lateral disk herniation. MATERIALS AND METHODS: We retrospectively reviewed 7 cases of surgically proven far lateral lumbar disc herniation. CT discography was performed for all cases. Four cases underwent conventional CT and three cases MRI as a primary diagnostic imaging method. Far lateral diac herniation was divided into 3 groups by location;Intraforaminal herniation, extraforaminal herniation, and mixed type. We analyzed the findings of CT discography including location and extent of far lateral disc herniation. RESULTS: In all 7 cases, CT discography clearly demonstrated the filling of contrast media in laterally-protruded disc material. Intraforaminal and extraforminal types were seen in 2 cases each, and mixed type in 3 cases. Subligamentous herniated nucleus pulposus was present in 6 cases and extruded disc in 1 case. Far lateral disc herniation was located at L4-5 in 5 cases and L5-S1 in 2 cases. CONCLUSION: CT discography can help establishing accurate preoperative diagnosis for far lateral disc herniation.