Anomalous Middle Cardiac Vein Draining into the Left Atrium

No abstract available.

Breast Metastases from Extramammary Malignancies: Typical and Atypical Ultrasound Features

Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast.

Predictors of Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Retrospective Review / 대한내분비외과학회지

PURPOSE: Cervical lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC) is associated with an increased recurrence rate and distant metastases. In this study, we analyzed the predictive factors of lateral metastasis in patients with PTMC. METHODS: We retrospectively reviewed the medical records of 1,030 patients with PTMC who underwent thyroidectomy. The clinicopathological characteristics and radiological findings upon ultrasonography (US) and computed tomography (CT) were then analyzed to evaluate the predictability of lateral metastasis of PTMC. RESULTS: The overall rate of lateral metastasis was 3.3% for the 1,030 patients with PTMC. All patients underwent central lymph node dissection (CLND), and 119 of these patients (11.6%) underwent either prophylactic or therapeutic selective neck dissection (SND). Among patients who underwent lateral node evaluation, 28.6% had lateral metastasis. We found that lateral metastasis was associated with larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, and positive expression of thyroid peroxidase. Positive findings of CLN and lateral metastases on ultrasonography (US) and computed tomography (CT) were significantly associated with lateral metastasis. CONCLUSION: This study demonstrated that, for patients with PTMC, larger tumor size, extrathyroidal extension, multiple tumors, bilateral tumors, CLN metastasis, positive expression of thyroid peroxidase, and positive CLN and lateral metastases identified on US and CT were significantly associated with lateral metastasis. Further studies with a large prospective study and longer follow-up are needed to clarify the predictive value of these factors.

Biliary Cast Formation with Sclerosing Cholangitis in Critically Ill Patient: Case Report and Literature Review

Sclerosing cholangitis in critically ill patients (SC-CIP) is a rare condition that is not familiar to many radiologists. In addition, the associated imaging findings have not been described in the radiological literature. We report a case of biliary cast formation with SC-CIP and describe the radiological findings of CT, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiography (ERC). A diagnosis of SC-CIP should be considered in intensive care unit (ICU) patients with persistent cholestasis during or after a primary illness. The typical CT, MRCP and ERC findings include new biliary casts in the intrahepatic duct with multiple irregular strictures, dilatations, and relative sparing of the common bile duct.

Calcific Tendinitis of the Hand and Foot: A Report of Four Cases

Calcific tendinitis of hand and foot is rare and frequently misdiagnosed because of its rare incidence and its similar clinical presentation to other conditions such as infection. Awareness of the typical location as well as familiarity with the imaging findings is essential for making a correct diagnosis of this rare condition. We report four cases of calcific tendinitis of hand and foot, occurring in the flexor hallucis brevis, abductor digiti minimi, and abductor pollicis brevis.

A Case of Acute Bilateral Renal Infarction Associated with Protein S Deficiency / 대한신장학회지

Acute renal infarction usually occurs in patients with trauma, atrial fibrillation, atherosclerosis, vasculitis, and valvular heart disease. However, it may occur, though rarely, in patients with hypercoagulable states such as protein C and protein S deficiency. We report here a case of acute bilateral renal infarction associated with type II protein S deficiency without a demonstrable underlying cause. A 48-year-old male was presented to the emergency room with an abrupt, persistent pain at the left flank area. Three-dimensional abdominal computed tomography revealed wedge-shaped, well demarcated, low density lesions in both the kidneys, which were consistent with occlusions of segmental branches of both the renal arteries. Protein S activity by clot-based assay was 43% (73.7-146.3%). The patient was treated with intravenous heparin and later warfarin. He has remained symptom-free on warfarin therapy with preserved renal function during the follow-up of 5 weeks.

Mesenteric Lymphadenopathy in Childhood Epidemic Aseptic Meningitis: Sonographic Features and Clinical Significance

PURPOSE: To evaluate the sonographic features of mesenteric lymphadenopathy in childhood epidemic aseptic meningitis and to assess their clinical significance. MATERIALS AND METHODS: Thirty-three patients (25 male, 8 female; mean age, 8.6 years) with a diagnosis of aseptic meningitis were prospectively evaluated with abdominal ultrasonography for the presence of enlarged mesen-teric nodes. The size and number of enlarged mesenteric lymph nodes were analyzed in relationship with the pa-tient's age, between the patients with abdominal pain or diarrhea (16 cases, 48%) and asymptomatic patients(17 cases, 52%). RESULTS: Mesenteric lymphadenopathy was seen in 31 patients (94%), all 16 symptomatic and 15 of the 17 asymp-tomatic patients. The number of enlarged nodes was most prevalent between 6 -10, seen in 16 patients (52%) and the largest node ranged in size from 4 to 8 mm. Among the 31 patients with mesenteric lymphadenopathy, the mean size of the largest node was statistically different between the symptomatic (6.0 mm) and asympto-matic (5.0 mm) groups (p = 0.021). The number of enlarged nodes and the patient's age were not statistically d-ifferent between the two groups. CONCLUSION: Mesenteric lymphadenopathy was seen in almost all cases of childhood epidemic aseptic meningitis, and may be related to the mesenteric lymphadenitis caused by enterovirus.

Genetic Diversity among Virulent Mega Plasmids pXO1 and pXO2 of Bacillus anthracis Isolated in Korea

We compared genetic variations in virulence mega plasmids pXO1 and pXO2 of twenty-seven Bacillus anthracis strains from Korean patients and environmental samples together with those of Bacillus anthracis Sterne, Pasteur and A2012 standard strains. Genetic variations were analyzed in twenty-three variable regions (ten and thirteen variablenumber tandem repeats and insertion/deletions in pXO1 and pXO2, respectively). The pXO1 plasmids were classified into 7 groups and pXO2 plasmids to 12 groups. Discrete phylogenic lineages could be differentiated between environmental and clinical strains by UPGMA (unweighted pair group method with average) method. In addition, clinical strains showed more variations than environmental isolates. The pXO2 plasmid appeared genetically more unstable than pXO1. A general plasmid genotype could be suggested for Korean soil isolates since they mostly clustered into a representative group.