Spontaneously Regressed Bilateral Scapulothoracic Bursitis / 대한정형외과학회잡지

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.

Polypoid Cystitis Mimicking Bladder Tumor: A Case Report

Polypoid cystitis without a history of catheterization is rare. We report a case in which the condition occurred in a 16-year-old girl complaining of dysuria, urgency, frequency, and a residual urine sensation. Cystography revealed a large intravesical filling defect with bladder distension, while sonography and CT demonstrated a large, inhomogeneously enhancing solid mass in the urinary bladder.

Temporal Bone CT Findings of Tuberculous Otitis Media: Comparison with Chronic Otitis Media

PURPOSE: To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppurative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. MATERIALS AND METHODS: We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. RESULTS: Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. CONCLUSION: Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.

Value of Noncontrast Spiral CT for Suspected Acute Appendicitis

PURPOSE: To assess the diagnostic accuracy and clinical efficacy of noncontrast spiral CT in patients withsuspected acute appendicitis. MATERIALS AND METHODS: Over a six-month period, 100 patients with suspected acuteappendicitis were prospectively evaluated with noncontrast spiral CT. All scans were obtained from the lower bodyof L3 to the symphysis pubis, with 5mm or 10mm collimation and pitich of 1 or 1.5, and without intravenous or oralcontrast material. Diagnosis was established by means of surgical or clinical follow-up. Prospective diagnosisbased on CT findings was compared with surgical results and clinical follow-up. RESULTS: Acute appendicitis wasconfirmed in 47 of 100 patients. On the basis of the basis of the CT findings, SI patients were prospectivelyinterpreted as positive for appendicitis, but in six the diagnosis was false-positive. Two of the 47 with acuteappendicitis were prospectively interpreted as normal. The preoperative diagnosis of acute appendicitis was, thus,45 true-positive, 47 true-negative, six falsepositive and two false-negative, yielding a sensitivity of 96%, aspecificity of 89%, an accurace of 92%, a positive predictive value of 88%, and a negative predictive value of96%. Using CT, an alternative diagnosis was established in 14 patients. CONCLUSION: Noncontrast spiral CT is auseful technique for diagnosing acute appendicitis.

Ngiodysplasia in Gaint Diverticulum of Transverse Duodenum Causing Massive Gastrointestinal Bleeding: A Case Report

The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographicexamination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5cm of the ampulla of Vater. The majority of duodenal diverticula are asymptomatic, but insome cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in thethird and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum,revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.

Ultrasound-Guided Renal Biopsy with Automated Biopsy Gun Technique: Efficacy and Complications

PURPOSE: To evaluate the diagnostic yield and complications of percutaneous ultrasound-guided renal biopsyusing a biopsy gun in patients with diffuse renal disease. MATERIALS AND METHODS: Using an automated biopsy gunmounted with a 16G needle, biopsies were performed on 90 patients with diffuse renal disease. In a total of 95biopsies, diagnostic yield, the mean number of glomeruli and frequency of complication were retrospectivelyanalysed. RESULTS: Tissue adequate for histological diagnosis was obtained in 92% of procedures. Mean glomerularyield was 8.3, and complications were seen in 26% of the procedures, 25% of these were minor, and 1% were major. CONCLUSION: For the diagnosis of diffuse renal disease, utrasound-guided percutaneous renal biopsy using anautomated biopsy gun is accurate and safe.

CT and MR Findings of Ovarian Fibroma

PURPOSE: To evaluate the charateristic CT and MR findings of primary ovarian fibromas. MATERIALS AND METHODS: We retrospectively reviewed 11 cases which had undergone precontrast and postcontrast scanning, and two in which cases T1-weighted (WI) and postcontrast T1WI and T2WI images had been done. All cases were pathologically confirmed after surgical resection. These masses were analysed on the basis of clinical symptom, age, size (longest diameter), laterality, margin, attenuation (unenhanced and enhanced), signal intensity (SI), calcification, and amount of the ascites. RESULTS: The patients' mean age was 46.6 (range, 22-81) years, and the longest diameter was 14.8 (range, 8-28)cm. All tumors were unilateral, and eight were located in the left ovary and five in the right ovary. In all cases, the tumor margin was well-defined; seven were lobulated, four were oval, one was round, and one was nodularly marginated. On CT scan, the masses showed mildl to moderate heterogenous enhancement with irregular lower density portions. The amount of the ascites was marked in three cases (23%) mild in two (15%), and minimal in three cases. Calcifications were seen in 3 of 11 CT cases (27%), and in one, this was extensive. On MR scans, signal intensity (SI) of the masses on T1WI was isoSI, relativetive to the uterine myometrium, and heterogeneously enhanced after infusion of contrast media. On T2WI, SI was slightly lower that of the uterine myometrium with internal high SI portions. CONCLUSION: The characteristic finding of ovarian fibroma is a unilateral, well-defined, oval or lobulated, solid mass with or without ascites and calcification. On CT scan, tumor has mild to moderate heterogeneous enhancement. On MR scan, SI of mass is isoSI on T1WI with heterogeneous enhancement, and low SI on T2WI due to fibrous component.

Aspergillus Osteomyelitis of the spine: A Case Report

We report a case of Aspergillus osteomyelitis of the spine in a 52-year-old female with back pain. Anteroposterior and lateral roentgenograms showed narrowing of the intervertebral disc space of T12-L1 with irregular vertebral endplates. MRI showed spondylodiscitis at T12-L1. Although tuberculous spondylitis is far more prevalent that fungal spondylitis, it is difficult to differentiate one from the other radiographically.