Primary Pulmonary Malignant Melanoma Presenting as Bilateral Multiple Subsolid Nodules: A Case Report

Primary pulmonary malignant melanoma is an extremely rare type of melanoma. The radiologic features of primary pulmonary malignant melanoma are nonspecific; however, it almost always presents as a well-demarcated round or lobulated solitary solid nodule or mass. Herein, we report the case of a 78-year-old male with primary pulmonary malignant melanoma that was mistaken for primary pulmonary adenocarcinoma with lepidic growth and was seen as bilateral multiple subsolid nodules on CT.

A Rare Case of Cardiac Neurofibroma in a Patient with Neurofibromatosis Type 1:Radiologic Findings

Neurofibromatosis type 1 (NF1) is a relatively common inherited disorder characterized by the formation of neurofibromas, pigmentary abnormalities of the skin, Lisch nodules of the iris, and skeletal abnormalities. Multiple cutaneous neurofibromas are benign nerve sheath tumors and the main manifestation of NF1. Cardiac neurofibroma associated with NF1 is very rare, and few cases have been reported in the literature. Herein, we present the CT and MRI findings of a surgically confirmed left ventricular neurofibroma in a 32-year-old female with NF1.

A Rare Case of Cardiac Neurofibroma in a Patient with Neurofibromatosis Type 1:Radiologic Findings

Neurofibromatosis type 1 (NF1) is a relatively common inherited disorder characterized by the formation of neurofibromas, pigmentary abnormalities of the skin, Lisch nodules of the iris, and skeletal abnormalities. Multiple cutaneous neurofibromas are benign nerve sheath tumors and the main manifestation of NF1. Cardiac neurofibroma associated with NF1 is very rare, and few cases have been reported in the literature. Herein, we present the CT and MRI findings of a surgically confirmed left ventricular neurofibroma in a 32-year-old female with NF1.

Usefulness of Mobile Computed Tomography in Patients with Coronavirus Disease 2019 Pneumonia: A Case Series

The coronavirus disease (COVID-19) outbreak has reached global pandemic status as announced by the World HealthOrganization, which currently recommends reverse transcription polymerase chain reaction (RT-PCR) as the standard diagnostictool. However, although the RT-PCR test results may be found negative, there are cases that are found positive for COVID-19pneumonia on computed tomography (CT) scan. CT is also useful in assessing the severity of COVID-19 pneumonia. Whenclinicians desire a CT scan of a patient with COVID-19 to monitor treatment response, a safe method for patient transport isnecessary. To address the engagement of medical resources necessary to transport a patient with COVID-19, our institutionhas implemented the use of mobile CT. Therefore, we report two cases of COVID-19 pneumonia evaluated by using mobilecone-beam CT. Although mobile cone-beam CT had some limitations regarding its image quality such as scatter noise, motionand streak artifacts, and limited field of view compared with conventional multi-detector CT, both cases had acceptable imagequality to establish the diagnosis of COVID-19 pneumonia. We report the usefulness of mobile cone-beam CT in patients withCOVID-19 pneumonia.

Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula

Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.

The Ratio of Descending Aortic Enhancement to Main Pulmonary Artery Enhancement Measured on Pulmonary CT Angiography as a Finding to Predict Poor Outcome in Patients with Massive or Submassive Pulmonary Embolism / 결핵및호흡기질환

BACKGROUND: The purpose of this study was to evaluate whether measuring the ratio of descending aortic enhancement (DAE) to main pulmonary artery enhancement (MPAE) on pulmonary computed tomography angiography (PCTA) can predict poor outcome in patients with acute massive or submassive pulmonary embolism (PE). METHODS: We retrospectively, reviewed computed tomgraphy findings and charts of 37 patients with acute PE and right ventricular dysfunction. We divided the enrolled patients into 3 groups; group Ia (n=8), comprised of patients with major adverse event (MAE); group Ib (n=5), consisted of those with PE-related MAE; and group II (n=29), those without MAE. We analyzed the right ventricular diameter (RVD)/left ventricular diameter (LVD) and DAE/MPAE on PCTA. RESULTS: For observer 1, RVD/LVD in group Ia (1.9+/-0.36 vs. 1.44+/-0.38, p=0.009) and group Ib (1.87+/-0.37 vs. 1.44+/-0.38, p=0.044) were significantly higher than that of group II. For observer 2, RVD/LVD in group Ia (1.71+/-0.18 vs. 1.41+/-0.47, p=0.027) was significantly greater than that of group II, but RVD/LVD of group Ib was not (1.68+/-0.2 vs. 1.41+/-0.47, p=0.093). For both observers, there was a significant difference of DAE/MPAE between group Ib and group II (0.32+/-0.15 vs. 0.64+/-0.24, p=0.005; 0.34+/-0.16 vs. 0.64+/-0.22, p=0.004), but no significant difference of DAE/MPAE between group Ia and group II (0.51+/-0.3 vs. 0.64+/-0.24, p=0.268; 0.53+/-0.29 vs. 0.64+/-0.22, p=0.302). Intra-class correlation coefficient (ICC) for the measurement of DAE/MPAE (ICC=0.97) was higher than that of RVD/LVD (ICC=0.74). CONCLUSION: DAE/MPAE measured on PCTA may predict PE-related poor outcomes in patients with massive or submassive PE with an excellent inter-observer agreement.

Phyllodes Tumors and Fibroepithelial Lesions with Cellular Stroma of the Breast and Diagnosed by Sonographically Guided Core Needle Biopsy: A Comparison Between the Results of Excision Biopsy and the Sonographic Findings

PURPOSE: The purpose of this study was to analyze the histologic concordance of sonographically guided core needle biopsy for phyllodes tumors or fibroepithelial lesions with cellular stroma of the breast by comparing this with the outcomes of excision biopsy and to identify any sonographic features that are helpful to predict phyllodes tumors. MATERIALS AND METHODS: We retrospectively reviewed 60 breast masses that were diagnosed as phyllodes tumors (n = 43) or fibroepithelial lesions with cellular stroma (n = 17) on a sonographically guided core needle biopsy. The tumors were all subsequently excised by surgery. The sonographic features were compared between the phyllodes tumors and the non-phyllodes tumors according to the results of excision biopsy. RESULTS: By the results on excision biopsy, there were 48 (80%) phyllodes tumors and 12 (20%) non-phyllodes tumors. Phyllodes tumors were diagnosed at a rate of 90.7% (39/43) for the nodules with phyllodes tumors on the sonographically guided core needle biopsy, and at a rate of 52.9% (9/17) for the nodules with fibroepithelial lesions with cellular stroma on the sonographically guided core needle biopsy. On sonography, heterogeneous internal echotexture (58% vs. 17%, respectively, p = 0.0239), clefts (56% vs. 17%, respectively, p = 0.0331) and horizontal linear striations (71% vs. 33%, respectively, p = 0.0221) were significantly more frequent in the phyllodes tumors than that in the non-phyllodes tumors. CONCLUSION: Identification of a heterogeneous-internal echotexture, clefts and horizontal linear striations on sonography might help differentiate phyllodes tumors from non-phyllodes tumors.

A Survey on the Actual Condition of the Use of Powered Wheelchair and Scooter

OBJECTIVE: To evaluate the efficiency of powered wheelchair and scooter and to investigate the factors affecting the accidents and injuries. METHOD: We investigated 90 subjects with mobility disability who had used powered wheelchair or scooter more than a year. The subjects responded to a questionnaire of the 34 items. RESULTS: Seventy (77.7%) of respondents used powered wheelchair or scooter more than 3 days a week. More than 50% of them regarded the obstacles such as curbs or thresholds as the most common hindering factor to outside mobility. The causes of breakdown were due to battery, wheel, gear box and motor. About a third of 58 respondents were dissatisfied with the result of repair. The high cost of the repair was regarded as the leading cause of dissatisfaction. Contusions were the most common, with abrasion and sprain accounting for most of the remainder. Of the 18 users who were affected by injuries, only 11.1% wore a safety seatbelt. Only 25 of 89 respondents had a safety education. CONCLUSION: Our study showed that the efficiency of power wheelchair and scooter was relatively high. But the obstacles such as curbs, recurrent breakdown, and concerns about the accident were regarded as the hindering factors to the outside mobility. The degree of satisfaction to the safety education is relatively low, so more systemic and practical programs need to be devised.

Mammary Fibromatosis: Sonographic Features and Pathologic Correlations

PURPOSE: The purpose of this study was to determine if the sonographic features of mammary fibromatosis had correlation with the pathologic findings. MATERIALS AND METHODS: We identified four cases of fibromatosis of the breast at our institution over a 10-year period. The patients were all women, and they ranged from 25 to 48 years of age (mean, 34.3 years). All four patients complained of palpable breast masses and were subsequently diagnosed with mammary fibromatosis. We retrospectively reviewed their imaging findings. RESULTS: Mammography obtained in one patient revealed architectural distortion. On sonography, all four cases showed spiculated, irregular, hypoechoic masses that could not be differentiated from malignant lesions. After surgical excision and vacuum-assisted biopsy of the masses in four patients, there was no recurrence on clinical or sonographic follow-up over a 13-36 month period. CONCLUSION: Although mammary fibromatosis is a very rare condition, it should be included in the differential diagnosis when an un-calcified, spiculated, irregular and hypoechoic masses are encountered on breast sonography.

Epidural Emphysema Associated with Subcutaneous Emphysema after Chest Tube Placement: A Case Report / 결핵및호흡기질환

Spinal epidural emphysema is rare and has been described secondary to following medical intervention, such as lumbar puncture and epidural analgesia, pneumothorax or pneumomediastinum, degenerative disk disease, epidural abscess, and trauma. Rarely, it occurs after chest tube placement. We report a case of spinal epidural emphysema incidentally noted on HRCT after chest tube placement.

Usefulness of Multi-Detector Computed Tomography before Bronchoscopy and/or Bronchial Arterial Embolization for Hemoptysis / 결핵및호흡기질환

BACKGROUND: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. METHODS: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. RESULTS: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. CONCLUSION: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.

Current Concepts in Cardiac CT Angiography for Patients With Acute Chest Pain

This article presents specific examples of delayed diagnosis of acute coronary syndrome, acute aortic dissection, and pulmonary embolism resulting from evaluating patients with nonspecific acute chest pain who did not undergo immediate dedicated coronary CT angiography (CTA) or triple rule-out protocol (TRO). These concrete examples of delayed diagnosis may advance the concept of using cardiac CTA (i.e., dedicated coronary CTA versus TRO) to triage patients with nonspecific acute chest pain. This article also provides an overall understanding of how to choose the most appropriate examination based on the specific clinical situation in the emergency department (i.e., dedicated coronary CTA versus TRO versus dedicated pulmonary or aortic CTA), how to interpret the CTA results, and the pros and cons of biphasic versus triphasic administration of intravenous contrast material during TRO examination. A precise understanding of various cardiac CTA protocols will improve the diagnostic performance of radiologists while minimizing hazards related to radiation exposure and contrast use.

A Case of Primary Leiomyosarcoma with Prominent Osteoclast-like Giant Cell of Lung with Cardiac Invasion / 결핵및호흡기질환

The incidence of a pulmonary leiomyosarcoma as a primary lung tumor is quite rare. We report a case of primary leiomyosarcoma with a cardiac invasion in a 76 year old man. He was admitted due to left anterior chest wall pain for one month. Chest computed tomography showed a 9x8x10cm sized , large round mass in the left upper and lower lobes, and an amorphous low density lesion within the left atrium. Chest magnetic resonance imaging showed a large round mass in the left upper and lower lobes with growth into the left atrium. A diagnosis of leiomyosarcoma with prominent osteoclast-like giant cells was made based on the microscopic and immunohistochemical findings of a permanent specimen by explothoracotomy. The pathologic features of the tumor showed round mononuclear hyperchromatic cells and multinucleated giant cells that resembled osteoclasts. The immunohistochemical staining showed that the giant cells are positive for CD68 but negative for the muscle markers while the round cells were positive for the muscle marker. The patient refused further treatment and died after two months.

Arthrosonography of the Shoulder Joint for Evaluation of the Glenoid Labrum, Glenoid Rim and Humeral Head: Comparison with Conventional Ultrasonography and MR Arthrography

PURPOSE: To compare the diagnostic role of arthrosonography, conventional ultrasonography and MR arthrography in the assessment of glenoid labral tear, glenoid rim fracture and humeral head fracture of the shoulder joint. MATERIALS AND METHODS: The findings of arthrosonography, conventional ultrasonography and MR arthrography were prospectively evaluated in 62 consecutive patients with chronic pain or a history of recurrent dislocation of the shoulder joint. The glenoid labrum was arbitrarily divided into four quadrants: anterosuperior, anteroinferior, posterosuperior, and posteroinferior, and for each, visibility at arthrosonography and conventional ultrasonography was subjectively scored as one of four grades. By means of statistical analysis, the two techniques were then compared. Twenty-six patients subsequently underwent arthroscopy, and the presence or absence of labral tear, glenoid rim fracture and humeral head fracture was determined. The sensitivity and specificity of each modality were separately calculated for each of the three types of shoulder joint injury, and observed differences in these findings were statistically analysed. RESULTS: For all individual quadrants of the labrum, visibility at arthrosonography was higher than at conventional ultrasonography (p.05), though its specificity was significantly higher (p=.003). In this respect, there was no significant difference in sensitivity or specificity between arthrosonography and MR arthrography (p>.05). For the detection of glenoid rim and humeral head fracture, there were no statistical differences in sensitivity and specificity between the three imaging modalities (p> .05). CONCLUSION: Compared with conventional ultrasonography, arthrosonography provides higher visibility of the labrum, thus improving the capacity of ultrasonography to detect labral tear. Arthrosonography could therefore be useful in the diagnosis of labral tear, glenoid rim fracture and humeral head fracture, and may thus partially replace MR arthrography.

Delayed Detection of Sacral Insufficiency Fractures

Many conditions may weaken bone and predispose to insufficiency fractures, including corticosteroids, radiation therapy, and rheumatoid arthritis, but osteoporosis is the main risk factor. Sacral insufficiency fractures (SIF) that usually present as nonspecific pelvic pain or low back pain are often overlooked in the elderly women with osteoporosis who have sustained minimal or no trauma. Diagnosis of SIF is difficult since the onset is mild, and usually discomfort is attributed to degenerative lumbar spine disease, spinal stenosis, vertebral compression fracture, or neoplasm. So a high index of clinical suspicion of SIF is required to avoid unnecessary diagnostic procedures. In most patients with SIF, bed rest, non-weight bearing ambulation, symptomatic treatment, and therapy for osteoporosis resulted in rapid improvement, and long-term follow-up of this fractures shows usually benign outcome. We are reporting a case of delayed detection of sacral fractures in osteoporotic woman.

Carcinoma Originating from Aberrant Breast Tissue of the Right Upper Anterior Chest Wall : A Case Report

Aberrant breast tissue is usually found in proximity to the normal breast, that is, in the axillary, sternal or clavicular regions. Carcinoma occurs more frequently in the aberrant tissue of the axilla than the extra-axillary site though the overall incidence of tumors of aberrant breast tissue is low. To our knowledge, studies regarding the carcinoma of aberrant breast tissue of the extra-axillary site have been reported rarely. Here we report a recent case of carcinoma originating from the extra-axillary aberrant breast tissue, presenting as a subcutaneous nodule on the right upper anterior chest wall. It is suggested that subcutaneous nodules of uncertain origin around the periphery of the breast should be suspected for breast carcinoma as a differential diagnosis and treated properly.

Inflammatory Pseudotumor of the Liver: CT Findings

PURPOSE: To evaluate the CT features of inflammatory pseudotumor of the liver with histopathologiccorrelation. MATERIALS AND METHODS: The CT features of 14 cases (ten patients) with pathologically proveninflammatory hepatic pseudotumor were retrospectively analyzed and correlated with resected and biopsy specimens. RESULTS: The size of lesions ranged between 2.0 and 7.0cm (mean, 3.7cm); On unenhanced CT, the masses were seenas ill-defined hypodense lesions, while on contrast-enhanced CT they were heterogeneous and multiseptated, withenhancement of internal septa and peripheral wall (n=10). In four lesions, central low density and peripheralhomogeneous enhancement were seen. On histopathological correlation, the central hypoattenuated area correspondedto chronic inflammalory cell infiltrates with foamy histiocytes, plasmacytes, and lymphocytes, while thehyperattenuated peripheral wall and internal septa represented dense fibrosis. CONCLUSION: In patients in whon CTshows a heterogeneous enhancing mass, inflammatory pseudotumor of the liver should be included in differentialdiagnosis.

Transcatheter Arterial Embolization for Control of Hemoptysis in Pulmonary Tuberculosis: Analysis of Prognostic Factors

PURPOSE: To evaluate the effectiveness of transcatheter arterial embolization(TAE) and the relationshipbetween therapeutic effect and prognostic factors after this procedure. MATERIALS AND METHODS: Fifty-fivepatients with hemoptysis caused by pulmonary tuberculosis(TB) underwent TAE. We reviewed medical records of thehistory and activity of pulmonary TB, and the extent of treatment, and assessed plain chest PA for the extent oflesions ; we also evaluated the angiographic findings of embolized arteries, and embolic agents. The initialsuccess rate, as shown by immediate response, and recurrence during follow-up, were then observed. Using theChi-square test, differences in these findings were analysed. RESULTS: Immediate control of hemoptysis wasachieved in 46 of 55 patients(84%); 24 of 46(52.2%), experienced recurrence. Initial failure and partial responserates were higher in patients with active pulmonary TB(p<0.05) than in those in whom the condition was inactive.The recurrence rate was higher among those who had had pulmonary TB for between one and ten years (p<0.05). Therewas, however, no significant correlation between therapeutic effect and the extent of anti-TB treatment, theextent of lesions seen on plain chest PA, angiographic findings, embolized arteries, and embolic agents. CONCLUSION: The initial success rate of TAE was 84% and the recurrence rate was as high as 52.2%. Both activityand duration of pulmonary TB were prognostic factors in immediate response and recurrence.