CT Findings of Change of the Maxillary Sinus after Caldwell-Luc Operation

PURPOSE: This study describes the CT findings of changes in the maxillary sinus after the Caldwell-Luc procedure. MATERIALS AND METHODS: The maxillary sinus-related findings in 35 cases among 20 patients(17 cases in 10 males and 18 cases in 10 females)who had undrgone the Caldwell-Luc procedure mean 14.6 years earlier were reviewed. CT scans were obtained in the axial and coronal planes, with 5mm thickness. By means of the t test, changes in the size of the bony wall of the maxillary sinus, as well as antral volume change, were compared with the normal maxillary sinus group(41 male and 23 female cases). Males and females were compared separately, and surgical bony defect of nasolabial antrotomy and nasoantral window, fibroosseous proliferation, compartmentation and mucosal thickening of the postoperative maxillary sinus were evaluated, as were findings of chronic or recurrent maxillary sinusitis and postoperative complications. RESULTS: Naso-labial antrotomy was clearly identified in 27 of 35 cases, and irregular bony surface in the remaining eight, as were 27 bony defects and one irregular bony margin among a total of 28 cases of nasoantral window. Due to shortening of the height of the orbit, reductions in maxillary width, nasoantral communication width and anteroposterior diameter of the maxilla, and widening of the width of the inferior meatus, the maxillary sinus tended to become hypoplastic and centripetally contracted. Reduced cavitary volume of the maxillary sinus was noted(p<0.05), and fibro-osseous proliferation(n=29), compartmentation(n=11), and mu-cosal thickening(n=22) of the postoperative maxillary sinus were also seen. There were findings of chronic si-nusitis(n=22), as well as complications of postoperative mucocele(n=3) and oroantral fistula(n=2) of the maxillary sinus. CONCLUSION: The characteristic maxillary sinus-related findings seen after the Caldwell-Luc procedure are helpful in distinguishing postoperative change from recurrent paranasal diseases and resulting complications.

Radiologic Findings of Ovarian Fibrothe

PURPOSE: To evaluate the radiologic features of fibrothecoma of the ovary, which is a rare solid tumor originating from the ovarian sex cord-stroma. MATERIALS AND METHODS: The radiologic findings of 29 patients with pathologically-proven fibrothecoma of the ovary were retrospectively evaluated for bilaterality, size, shape, margin, echogenecity, CT attenuation, signal intensity on magnetic resonance imaging, calcification, and amount of ascites. RESULTS: All fibrothecomas were unilateral, and had well defined margins. The diameter of the mass was 4-18(mean, 9.6)cms. Elghteen of 29 tumors were round or oval with a smooth margin, and eleven were lobulated. The internal architecture of the tumor was purely solid in 21 patients, predominantly solid in six, and pre-dominantly cystic in two. A broad spectrum of sonographic features was apparent, including a homogeneously hypoechoic mass (with posterior shadowing in four cases, and without posterior shadowing in ten), a homoge-neously hyperechoic mass in seven cases, an anechoic mass with septatations in two, and a mixed echoic mass in six. On precontrast CT scans, the mass was isodense to the uterine myometrium in eight of nine cases, while on postcontrast scans the lesion was slightly hypodense to the myometrium in seven cases and isodense in one. On T1-weighted MR images, nine of ten cases showed a relatively homogeneous low signal intensity, while on T2-weighted images, signal intensity was homogeneously low in two patients and predominantly low with focal high intensity in seven of the other eight. On gadolinium-enhanced T1-weighted images, most tu-mors showed slight heterogeneous enhancement. Calcifications were present in two cases, and in two others there was a large amount of ascites. CONCLUSION: The characteristic finding of ovarian fibrothecomas is a well-defined, oval or lobulated homoge-neously solid mass, which on CT scans enhances less than uterine myometrium and demonstrates a predomi-nantly low signal intensity on both T1- and T2-weighted images. However, a predominantly solid mass with cystic components or a predominantly cystic mass may also be presented.

Ultrasonographic and CT Findings of Hepatosplenic Tuberculosis

PURPOSE: To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis MATERIALS AND METHODS: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions ofthe liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement oftuberculosis were analyzed. RESULTS: There were three cases of hepatic tuberculosis, seven of splenictuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CTfindings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low densitymass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonarytuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis suchas lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervicallymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. CONCLUSION: Ultrasonography and CT werevaluable in the detection and diagnosis of hepatosplenic tuberculosis

Complications of Endoscopic Sphincterotomy: CT Grading and Its Clinical Significance

PURPOSE: To evaluate the CT grading of complications developing after endoscopic sphincterotomy (EST), and their clinical course. MATERIALS AND METHODS: We retrospectively evaluated CT in 19 patients in whom pancreatitis or duodenal perforation developed after EST in 594 patients. The CT grading of pancreatitis was classified as mild, moderate or severe, according to the extent of peripancreatic infiltration; duodenal perforation was classified as mild, moderate or severe grade, according to the extent of fluid collection. We attempted to correlate CT grade with the average duration of hospitalization after EST, treatment method and mortality. RESULTS: Post-EST complications detected on CT were pancreatitis (ten patients, 1.7%) and duodenal perforation (nine patients, 1.5%). In those with pancreatitis, hospitalization after EST lasted an average of nine days in mild cases (n=2), 21 days in moderate (n=1) and 41 days in severe (n=7). Nine of ten patients with pancreatitis were treated conservatively, while the other, whose grade was severe, underwent percutaneous drainage. Eight of these ten recovered; the two who died were severe grade patients, one having been treated conservatively and the other by percutaneous drainage. In patients with duodenal perforation, hospitalization after EST lasted an average of 13 days in mild cases (n=2), 16 days in moderate (n=2) and 37 days in severe (n=5). Four of nine patients with duodenal perforation were treated conservatively, while the other five (severe, four; moderate, one) underwent percutaneous drainage. One patient, graded as severe, expired, but the remaining eight rocovered. Percutaneous drainage was performed mostly in severe grade cases, and among patients thus graded, only three (3/594; 0.5%) died. CONCLUSION: CT is considered useful for predicting the clinical course and prognosis of complications occurring after EST.

Angiosarcoma of the Liver: A Case Report

We report a case of histopathologically confirmed hepatic angiosarcoma. A 29-year old patient was admitted with fever and palpable tender mass in the right upper abdomen. On ultrasonography, a large, well circumscribed mixed echoic mass was seen in the right lobe of the liver. On CT scan, irregular enhancement was seen mainly in the peripheral portion of the mass ; the central portion was not enhanced. The mass showed low signal intensity on T1W1, and high signal intensity on T2WI. Peripheral nodular enhancement was noted on Gd-enhanced MR images; In the peripheral portion of the mass,

Thallium 201 Thyroid Scan: Differential Diagnosis of Benign and Malignant Nodules

PURPOSE: To evaluate useful findings and diagnostic value of TI-201 thyroid scan in differentiating benign from malignant nodules. MATERIAL AND METHOD: We studied 77 cold thyroid nodules proven histologically(27 malignat and 50 benign). Early (5--15rain) and delayed images(3--5hours) were obtained after intravenous injection of thallium 201. In these nodules, we retrospectively analyzed the degree of TI-201 uptake in early and delayed images, histopathologic type, size, and presence or absence of cystic change in the sonograms of 22 malignant nodules. RESULTS: Useful finding for diagnosis of malignant nodules was strong uptake of TI-201 in early and delayed images(specificity:98%, sensitivity:63%, positive predictive value:94.4%). Useful finding for benign nodules was no uptake of TI-201 in delayed image(specificity :88.9%, sensitivity :68%, positive predictive value :91.9%). The accuracy of TI-201 thyroid scan in differentiating benign from malignant nodules was 66.2%. The nodules with strong TI-201 uptake in early image and low TI-201 uptake in delayed image were malignant in 29.4%. Cystic changes were found in 40% of malignant nodules with atypical TI-201 uptake. TI-201 thyroid scan showed high specificity in follicutar neoplasm and adenomatous goiter in which differentiation of benignancy and malignancy is difficult with only cytologic examination. CONCLUSION: We consider that TI-201 thyroid scan is valuable in differentiating benign from malignant nodules and when combined with fine needle aspiration and ultrasound examination, it will enable more accurate differential diagnosis between benign and malignant thyroid nodules.

Intussusception in Childhood: The Role of Plain Abdominal Radiographs

PURPOSE: The purposes of this study were to evaluate the plain radiologic findings of the childhood intussusception and to evaluate the role of plain abdominal films in predicting the success of air or barium reduction. SUBJECTS AND METHODS: We retrospectively reviewed 140 cases with the diagnosis of intussusception in children. The radiological signs that included soft tissue mass, dilatation of small bowel suggesting obstruction, crescent sign, and target sign were evaluated in terms of frequency. The relationship between radiological findings and outcome of reduction was analyzed. The site of soft tissue mass or crescent sign seen on plain radiographs was correlated with the position of the apex of the intussusceptum seen at the beginning of barium enema. The degree of dilated small bowel was evaluated by calculating the proportion of air-filled small bowel occupying peritoneal cavity and measuring the maximal diameter of dilated bowel lumen. The radiological finding for small bowel obstruction is determined by observation of the degree of small bowel dilatation and/or air-fulid levels. RESULTS: Ninety-two cases out of 140 showed one or more radiographic signs. Two most common signs were soft tissue mass and small bowel obstruction. The success rate of air or barium reduction was significantly lower in patients with most severe degree of dilatation of small bowel and/or more than 7 air-fulid levels on erect view. The suspected location of intussusception on plain radiographs correlated well with the true location of intussusception seen in the first few seconds of barium reduction. CONCLUSION: Plain abdominal radiography is useful in the diagnosis of intussusception and provides helpful informations for the reduction procedure as well as for the exclusion of the contraindications such as bowel perforation.

CT Features of Second Branchial Cleft Cysts: Emphasis on the Locations of Lesionst

PURPOSE: The purpose of this study was to evaluate the CT features of second branchial cleft cysts. MATERIALS AND METHODS: We retrospectively analyzed the computed tomographic images in nine cases of second branchial cleft cyst which was confirmed pathologically. Emphasis was on localization of the masses to fascial spaces as defined by the deep cervical fasica. RESULTS: In all nine cases, the lerions were located in the submandibular and carotid spaces. Among these cases, six(67%) had simultaneous involvement of the other contiguous spaces, such as anterior and posterior cervical spaces. All cases had round or oval, unilocular, cystic masses with partial or complete rim enhancement. In eight cases(89%), smooth and thin walls were observed. In one case, thick wall and septations were noted. No definite calcifications were noted in all cases. The internal contents of cystic masses showed relatively homogeneous appearance, and CT number ranged from 20 to 35.2 Hounsfield unit(HU)(mean, 28.4HU). CONCLUSION: CT diagnosis of second branchial cleft cyst would be easily obtained from recognition of frequent simultaneous involvement of the other contiguous spaces, along with a typical location and characteristic morphology.

Embolization of gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis: a case report

Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils.