Clinical and cholangiographic evaluation of bile duct carcinoma

40 cases of bile duct carcinoma gathered over a 6-year period at Kosin Medical College were reviewed and theirclinical and cholangiographic findings were as follows: 1. There were 29 males and 11 females (the ratio of men towomen, 2.6:1) ranging from 37 to 74 years of age. The majority (70% of cases) were in 4th & 5th decades. 2.Clinical symptoms and signs: jaundice in 95%, RUQ or epigastric pain in 75%, pruritus in 52.5%, dark urine in 35%,weight loss in 32.5%, fever and chills in 22.5%, clay colored stool in 12.5%, and palpable mass in 12.5%. 3.Lab,findings: elevated serum total bilirubin(above 20.0mg% in 45%, 10.0-19.0mg% in 22.5%, 5.0-9.9mg% in 20%,1.3-4,9mg% in 5%), elevated alkaline phosphatase in 95%. Clonorchiasis were noted in 17.5%. 4. Histologic findingswere adenocarcinoma in most cases. 5. The location of bile duct carcinoma were common hepatic duct in 35%, commonbile duct in 32.5%, porta hepatis in 12.5%, junction with cystic duct in 10% and diffuse form in 10%. 6. In 33cases, PTC or post-operative cholangiographic examination were done. And the most frequent findings weredilatation of the proximal bile duct and abrupt narrowing or complete obstruction of distal lumen. In 27cases(82%), complete obstruction of bile duct was noted. Attempts were made to analyze the type of obstruction:Constricted type in 39%, Nipple type in 18%, round or flat type (smooth or slightly irregular) in 15%, andserratd type in 9%. Incomplete obstruction were noted in 6 cases(18%). Among them, abrupt narrowing of lumen wasnoted in 9% and diffuse narrowing in 9%. 7. ERCP was done in 7 cases. Findings were constricted type in 42.6%,constricted and slightly irregular type in 14.3%, downward convexity in 14.3%, diffuse irregular narrowing in14.3% and intraluminal filling defect in 14.3%.

Reevaluation of psoas sign analyzed by CT

The lateral margin of the psoas muscle, contrasted by retroperitoneal fat, is usually visualized o plainabdominal radiography. Failure to visualize all or segment of lateral margin of the psoas muscle, so called psoassing, has been emphasized as reliable finding of retroperitoneal pathology. But the significance of psoas sign hasbeen controversial. The authors reevaluated ‘psoas sign’ by comparing 160 abdominal radiography with CT. Theresults were as follows: 1. In 160 supine radiographys, good visualization was present in 106 cases(66.3%), faintvisualizatin in 24(15.0%), segmental nonvisualization in 18(11.3%), and completer nonvisualization in 12(7.5%). In113 erect radiographs, good visualization was present in only 36 cases(31.9%). 2. Asymmetric visualization waspresent in 84 out of 160 cases. In patient with scoliosis, lateral margin of convex side was seen more clearlythan concave side, and this finding was statistically significant (p<0.005). 3. Ascites did not directly influenceto psoa visualization contrary to common belief. 4. In 54 cases of faint or nonvisualization, normal was16(29.6%), intraperitoneal pathology was 16(29.6%), and retroperitoneal pathology was 22(40.7%). 1) In normalpatient, psoas contact with kidney or intestine and deformed psoas muscle were responsible for poor visualization. 2) The major cause of poor visualization in intraperitoneal pathology were psoas contact with displaced kidney byhepatomegaly, ascites with scanty retroperitoneal fat and derformed psaos muscle. 3) The major cause of poorvisualization in retroperitoneal pathology were psoas invasion by tumor or inflammation, psoas conntact withenlarged kidney or perirenal lesion. 5. In summary, the mechanism of faint or nonvisualization of psoas marginwere: 1) psoas contact with normal or pathologic organs 2) psoas invasion by tumor or inflammation 3) deformedpsoas muscle 4) scanty retroperitoneal fat

CT finding of primary lung cancer

Authors retrospectively analyzed the CT findings of 102 cases of histologically proven bronchogenic carcinomaduring last 4 years from January 1980 to July 1984 at Kosin Medical College. The results were as follows; 1. Thesex ratio was 86 males to 16 females and the greatest number (66.7%) of cases were seen in fourth and fifthdecades. 2. The distribution of histoligic types of primary lung cancer as follows: squamous cell carcinoma 66cases, Adenocarcinoma 10 cases, small cell carcinoma 7 cases, Large cell carcinoma 5 cases, bronchiloalveolar cellcarcinoma 1 case, Unclassifed 13 cases. 3. Location of primary lesions as follows: Right lung 61 cases, Left lung40 cases. In both lungs, the greatest number of cases were found in the upper lobes. Ratio between central andperippheral mass was 2.5:1, except adenocarcinoma(6:4). 4. CT findings were as follows; Hilar or central mass(75cases), Peipheral mass(26), Bronchial abnormalities such as narrowing, obstruction, or displacement (60),Thickening of the posterior wall of the right upper lobe bronchus, bronchus intermedius, or left mainbronchus(17), Post-obstructive changes; Atelectasis, Pneumonitis, Emphysema(34, 17, 1 respectively), Hilaradenopathy(21), Mediastinal lymph node enlargement(50). Mediastinal invasion(51), Pericardial thickening(5), SVCsyndrom with collateral vessels(3), Pleural effusion (27), Pleural thickening or invasion(14), Chest wallinvasion(2), distant metastasis(26). 5. In most of patients(92 cases), the size of mass above 3cm, but in 9 casesbelow 3cm. Margins of the masses were serrated or lobulated in most cases. In 5 cases, cavitary formations werenoted, walls of which were thick and irregular, and air-fluid level was noted in 1 case. In 2 cases, eccentriccalcification were noted within mass. 6. Among 51 cases of whom direct mediastinal invasion was suspected, 8 caseswere operated upon, and this revealed that the masses were not resectable. Among the patients in whom no direct mediastinal invasion was suggested, 12 cases were operated uppon, and this revealed that the masses wereresectable in all cases. 7. Staging was as follows: stage I, 2 cases, Stage II, 13 cases, stage III, 86 cases.