Ultrasonography of Gynecologic Causes of Acute Pelvic Pain

Acute pelvic pain is one of the most common complaints of woman presenting in the emergency department. When gynecologic disorders are suspected, ultrasonography (US) is the modality of choice, enabling rapid diagnosis and decision making with regard to appropriate management. Frequent gynecologic etiologies include a large or enlarging simple ovarian cyst, hemorrhagic ovarian cyst or rupture of an ovarian cyst, acute pelvic inflammatory disease, and ovarian torsion. Endometriosis, uterine leiomyoma, and peritoneal inclusion cyst can also present as acute pelvic pain. Gynecologic disorders that cause acute pelvic pain frequently show characteristic ultrasonographic findings that enable specific diagnosis. In this review, the authors review ultrasonographic findings of gynecologic causes of acute pelvic pain.

In Utero Development of the Fetal Gall Bladder in the Korean Population

OBJECTIVE: To provide reference ranges of the fetal gall bladder in the Korean population. MATERIALS AND METHODS: Fetal gall bladder development was evaluated in well-dated, non-anomalous fetuses in the Korean population between February and April 2003 and the visualization rate and reference values were determined from the obtained data. RESULTS: The visualization rate of the fetal gall bladder increased as gestation advanced to a plateau above 90%, which was maintained between 16 and 34 weeks. The measured parameters from the fetal gall bladder had a significant positive relationship with gestational age (p = 0.000 for all cases), and the correlation of length and area with the gestational age (r = 0.741 and r = 0.690, respectively) was better than the correlation of width, height, and volume with gestational age. The repeatability coefficients and coefficients of variation between the two operators were 5.56 mm and 12.9% for the length and 344.11 mm(2) and 33.52% for the area. The median length of the fetal gall bladder in the Korean population was not significantly different from the mean length of gall bladders in the Caucasian and African-American populations (p = 0.915). CONCLUSION: We have provided reference values for the fetal gall bladder throughout the gestation period in the Korean population.

The Granulosa Cell Tumor of The Ovary in Postmenopausal Women - Do They Have the Any Unique features ? / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The aim of this study was to describe the unique transvaginal sonographic(TVS) findings and clinical manifestations attributes of adult ovarian granulosa cell tumor(GCT) in postmenopausal women. METHODS: Data for 7 postmenopausal women with pathological proven adult ovarian GCT were respectively reviewed in Samsung Cheil Women's Hospital, between 1996 and 1999. Characteristics of transvaginal sonographic findings, pathological findings and clinical manifestations were analyzed. RESULT: On the basis of TVS findings, 7 cases of adult ovarian GCT were varied, but grossly categorized into 2 morphologic patterns: semisolid mass with scattered cystic components (n=3), muliticystic mass resembling typical hemorrhagic cyst (n=4). There are characteristics of TVS imaging of GCT that various size and stage of hemorrhage presents in the tumor. Endometrial transvaginal sonographic findings were normal atrophic EM (n=1), less than 5 mm with fluid collection (n=1), more than 5 mm with or without abnormal echogenicity (n=5). Clinical manifestations were, combination or alone, abnormal uterine bleeding (n=all), abdominal pain (n=1), mass palpation(n=3). Histopathologically most tumors were mixed, such as microfollicular, marcofollicular, trabecular pattern and also varied histologic appearance and tumor cell arrangement. CONCLUSION: TVS findings and combined presenting symptoms in postmenopausal women that raise suspicion of adult ovarian GCT include a relatively large ovarian mass (especially with hemorrhage) with a complex consistency, thickened endometrium and abnormal uterine bleeding without horomone replacement therapy. So it is possible to differentiate on basis of TVS imaging and symptoms between GCT and epithelial tumors of the ovary in postmenopausal women.

MRI and CT Findings of Intracranial Neurosyphilis

PURPOSE: To evaluate the CT and MRI findings of neurosyphilis. MATERIALS AND METHODS: We retrospectivelyreviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL,TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. RESULTS: The MRI and CTfindings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy(n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershedzone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%),followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferiorcerebellar artery territory (11.1%), The size of the lesion varied from 1cm to larger than one lobe. One patientshowed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. CONCLUSION: The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebralarterial territory.

Squamous Cell Carcinoma Arising in the Wall of Epidermoid Cyst of Axilla: A case report

PURPOSE: Epidormoid cysts are benign epithelial cysts often ocurring within the skin of face and trunk. But carcinomatous change is rare. The authors experienced a case of squamous cell carcinoma arising from the wall of epidermoid cyst of axilla and report the radiologic and pathologic findings with a brief review of the literatures. METHODS AND MATERIALS: Plain chest radiograph, US and enhanced CT of axilla were takened. We analyzed radiologic findings of squamous cell carcinoma in the wall of epidermoid cyst of axilla and correlated with pathologic findings. RESULTS: Plain chest radiograph revealed a huge axiilary mass without bony destruction or calcification. showed a heterogenous hyperechoic mass with eccentrical cystic lesion. Outer margin of the mass was irregular. No posterior acoustic enhancement was seen. Postcontrast CT scan showed a circumscribed complex mass with irregular enhancing rim. During operation mass was located within subcutaneous layer and internal contents of the mass were brown, necrotic keratinous debries. CONCLUSION: Differentiation from solid tumor was difficult. But intradermal or subcutaneous location and rapid growing were characteristic.

The predictability of the Tc-99m pyrophosphate scan and statistical evaluation of the trade-off point

The technetium (Tc)-99m pyrophosphate scans have been used to diagnose acute myocardial infarctions and to confirm the equivocal cases. Many articles have been reported about its diagnostic performance and pitfalls. But there has been no evaluation of its predictability according to the grades of the radioactivity land statistical evaluation of the trade-off point, i.e., grade 2 and the area under the receiver operating characteristic curve. To achieve the goals, we reviewed 252 cases of Tc-99m pyrophosphate scans (acute transmural infarction [n=99], acute subendocardial infarction [n=7], unstable angina[n=16], old myocardial infarction [n=19] others [n=111]). The predictabilities of the scan are 98% in grade 4, 84% in grade 3, 83% in grade 2, 53% in grade 1 and 18% in non-uptake. The usual trade-off point, grade 2 is not statistically significant(Z=1.945, P=0.0259>0.01). The area under the receiver operating characteristic curve(Az) is 0.885. Our study shows that the probable main cause of the false negative cases is the time interval between the onset of symptoms and the test.