Massive Empyema Associated With Transient Hypogammaglobulinemia of Infancy and IgA Deficiency

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study.

A Case of Tuberculous Psoas Abscess Caused by Tuberculous Lymphadenopathy / 결핵및호흡기질환

A tuberculous psoas abscess is a frequently described complication of tuberculous spondylitis. Although rare, a tuberculous psoas abscess can develop without any demonstrable spinal involvement. In patients with no evidence of sponylitis, the abscess may result from direct spread from the involved lymph node or via a hematogeous route. The treatment of a psoas abscess is either drug therapy or surgical intervention in conjunction with drug therapy. Image-guided percutaneous drainage in conjunction with drug therapy is also a safe and effective treatment for a tuberculous psoas abscess. We report an unusual case of bilateral tuberculous psoas abscesses without any concomitant spinal involvement. The tuberculous psoas abscess may have formed by fistulization between the necrotic lymph node and psoas sheath. The diagnosis was confirmed by computed tomography and a histology examination of the biopsy sample. The patient improved after administering anti-tuberculous agents for 2 years along with surgical and percutaneous drainage of the abscess.

Ultrasonography-guided Balloon Angioplasty in an Autogenous Arteriovenous Fistula: Preliminary Results

PURPOSE: Percutaneous trasnluminal angioplasty (PTA) of a malfunctioning arteriovenous fistula (AVF) in hemodialysis patients requires the use of contrast angiography and fluoroscopy guidance. We attempted to perform this procedure under duplex ultrasound guidance to reduce the amount of contrast agent administered and to reduce the radiation dose during the interventional procedures. MATERIALS and METHODS: From September 2006 to February 2007, 45 patients received interventional treatment due to malfunctioning hemodialysis access in our hospital. Among the patients, we selected 10 patients diagnosed with stenosis of an autogenous arteriovenous fistula based on a physical examination. There were six males and four females aged 51-78 years (mean age, 59 years). Seven of these patients had a Brescia-Cinimo type fistula and three patients had a basilic vein transposition. All procedures were performed in the angiography suite. All procedures that required angioplasty were performed under duplex ultrasound guidance and then contrast angiography was performed to confirm the final patency of the vessels. Conventional angioplasty was also performed under fluoroscopy guidance for any lesions that required an additional angioplasty. The volume flow before and after the PTA and procedure time were recorded. Clinical success was defined as the performance of one or more successful hemodialysis sessions after treatment. RESULTS: Eight of ten patients did not require an additional angioplasty by conventional angiography after the duplex- guided angioplasty. One case showed recoiling of stenosis after the duplex-guided PTA and another case was missed at duplex scanning due to the extremely short nature of the recoiling of stenosis. The mean volume flow before and after PTA was 167 ml/min (range, 80-259 ml/min) and 394.2 ml/min (range, 120-586 ml/min), respectively. No complications associated with the duplex-guide procedure occurred. In nine cases, PTA enabled hemodialysis to be conducted more than one time. In one case, hemodialysis was not possible to perform due to an inadequate maturation of a fistula. The mean duration of the procedure was 38 minutes (range, 23-50 minutes). CONCLUSION: Duplex-guided percutaneous angioplasty of autogenous AVF stenosis in hemodialysis patients is technically feasible and can be used as an ancillary method in addition to the use of the conventional fluoroscopy- guided method.

The Effect of Imaging Parameters of Diffusion Tensor Imaging on Fractional Anisotropy

PURPOSE: To evaluate the effect of changes of parameters of diffusion tensor imaging (DTI), including slice thickness/slice number, b-value and the direction number of a diffusion gradient on fractional anisotropy (FA). MATERIALS AND METHODS: Three groups of normal volunteers underwent brain diffusion tensor imaging with the use of three different imaging parameters as follows: a different slice thickness/slice number (6 mm/20 slices and 2.33 mm/54 slices), a different b-value (800 s/mm2/1000 s/mm2) and a different number of directions of the diffusion gradient (6 and 15 directions). The signal to noise ratio (SNR) and FA were measured by a ROI measurement at the anterior corona radiata, superior corona radiata, putamen and corpus callosum. We compared the mean SNR and FA in each group by the use of the paired T-test. RESULTS: The SNR decreased and the FA increased significantly according to the increase of the slice number (6 mm/20 slices vs. 2.33 mm/54 slices). The SNR of DTI with 15 diffusion gradient directions was significantly higher than DTI with six directions, without a difference of FA. There were no significant changes of the SNR and FA of DTI according to the b-value. CONCLUSION: It is essential and useful in the clinical application of DTI to understand the effect of imaging parameters on FA.

Successful Resolution of Left Renal Artery Stenosis by Interventional Renal Angioplasty with Stent in a Patient with Renal Insufficiency Underlying Ischemic Nephropathy / 대한신장학회잡지

Ischemic nephropathy is defined as renal dysfunction due to renal hypoperfusion mainly through renal artery stenosis. It is a common cause of chronic renal failure in old patients with atherosclerosis and is also a potentially correctable cause of renal failure if diagnosed earlier. We experienced a case of sudden Rt. main renal artery occlusion and renal failure after femoral artery angioplasty in an aged male patient with underlying atherosclerotic bilateral renovascular stenosis associated with ischemic nephropathy. He received successful Lt. renal artery angioplasty with stenting and restored Lt. renal artery blood flow. His blood pressure was more easily controlled with fewer antihypertensive drugs after renal artery revascularization. His renal function was recovered to his baseline level and became stabilized thereafter. Early diagnosis of ischemic nephropathy with MRA and timely renal angioplasty with stenting are beneficial to avoiding progression to irreversible renal failure.

Brain Diffusion Tensor MR Imaging

The development of MR imaging techniques during the past decade has enabled researchers to use MR imaging as a noninvasive tool for evaluating structural and physiologic states in biologic tissues by measuring the diffusion process of water molecules. More recently, diffusion tensor MR imaging (DTI) technique based on the dependency of molecular diffusion on the orientation of white matter fiber tracts has been used to analyze the trajectory, shape, fiber structure, location, topology and connectivity of neuronal fiber pathways in living humans. Numerous efforts have been made by MR physicists, brain scientists, and medical doctors to advance MR techniques and computer-based algorithms which result in more accurate quantification of diffusion tensor and the generation of white matter fiber tract maps and to determine the pathophysiology of brain disease by DTI and useful clinical applications of DTI. In this article, we describe the tensor theory used to characterize molecular diffusion in white matter and a process of measuring tensor elements using diffusion-sensitive MR images to fiber mapping. We then provide review of current literature and some clinical examples that have been published and are on-going.

Intracapsular and Paraarticular Chondroma of the Knee: Case Report

We report here on a case of intracapsular and paraarticular chondroma of the left knee in a patient with a 6-month history of knee pain and swelling. Magnetic resonance image (MRI) revealed a well-defined solid mass with central hemorrhagic necrosis in the infrapatellar area of the knee.

Spindle-Cell Carcinoma of Esophagus: A Case Report

Spindle-cell carcinoma of the esophagus is a rare malignant tumor composed of both carcinomatous and sarcomatous elements, and has generated many terminology problems. It is characterized by a bulky polypoid intraluminal mass with a lobulated surface located in the middle third of the esophagus. Local expansion of this organ is observed. The lesion may be pedunculated but despite its bulk, causes little obstruction. We report the imaging findings of a case of spindle-cell carcinoma arising in the upper esophagus.

Reversible Posterior Leukoencephalopathy Syndrome

PURPOSE: To review reversible posterior leukoencephalopathy syndrome. MATERIALS AND METHODS: We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. RESULTS: Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement; in one, enhancement was mild, and in two, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions; in two, small infarctions remained but the extent of the lesions had decreased. CONCLUSION: Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immonosuppresive therapy. The characteristic MR finding is edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the need for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.

Warthin's Tumor of Extraparotid Location in Neck: A Case Report

Warthin's tumor is a benign lesion of the salivary and principally-parotid gland. An extraparotid location is rare. We report a case of Warthin 's tumor which was located in the neck, far from the parotid gland.

CT Findings of Right Paraduodenal Hernia Presenting as Acute Small Bowel Obstruction

Because it is rare, acute small bowel obstruction due to right paraduodenal hernia is an entity with which radiologists are not entirely familiar. Its clinical importance, however, lies in the fat that delayed diagnosis leads to significantly increased morbidity and mortality rates. We report a case of small bowel obstruction due to right paraduodenal hernia in which all the known characteristic findings were demonstrated.

Clinical Significance of the Corpus Callosum in Cerebral Palsy

PURPOSE: To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. MATERIALS AND METHODS: Fifty-two children [30 boys and 22 girls aged between six and 96 (median, 19) months in whom cerebal palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebal palsy were classified as hemiplegia(n =14), spastic diplegia(n=22), or spastic quadriplegia(n=16), and according to the severity of motor palsy, the condition was also classified as mild(n=26), moderate(n=13), or severe(n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. RESULTS: Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p < 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p< 0.05). CONCLUSION: There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Ultrasonographic Findings of Carpal Tunnel Syndrome

PURPOSE: To describe the ultrasonographic (US) findings of carpal tunnel syndrome (CTS) and to evaluate the diagnostic value of US in CTS. MATERIALS AND METHODS: Forty-four wrists of 26 patients aged 35 to 67 (mean, 52) years with CTS who were electrophysiologically diagnosed, and 30 wrists of 15 normal control subjects aged 33-62(mean, 48 years) were studied using US with a 7.5MHz linear transducer. Axial images of these wrists in the neutral position were obtained at the level of the distal radius, pisiform, and hook of hamate. The following measurements were taken: at each level, cross sectional area (CSA) and flattening ratio (FR) of the median nerve; at the hamate level, bowing of the flexor retinaculum (palmar displacement: PD); during passive flexion and extension of the index finger, transverse sliding of the median nerve. RESULTS: CSA at each level was significantly higher in patients than in controls (p=0.0001): 9.29 +/-2. 63 mm 2(mean +/-S.D.) vs 5.45 +/-1.98 mm 2 at the distal raidus; 10.68 +/-3.38 mm 2 vs 6.55 +/-2.01 mm 2 at the pisiform; 1 0 . 8 8 +/-2.78 mm2, vs 6.34 +/-2.00 mm2 at the hamate. FR was significantly higher in patients(2.37+/-0.56) than in controls (2.06 +/-0.36) only at the level of the hamate (p=0.0064). In additi on, PD of the flexor retinaculum was also significantly higher in patients (3.44 +/-0.90 mm) than in controls (2.20 +/-0.55mm) (p=0.0001). The sliding distance of median nerve during passive flexion and extension of the index finger was, however, significantly lower in patients (0.98 +/-1.03 mm) than in controls (1.65 +/-1.22 mm) (p=0.0180). CONCLUSION: For the diagnosis of CTS, US proved useful. Significant ultrasonographic findings in CTS were swelling of the median nerve, increased flattening ratio of the median nerve at the distal carpal tunnel, increased bowing of the flexor retinaculum, and decreased mobility of the median nerve during motion of the index finger.