Solitary Hemorrhagic Brain Metastasis from Pulmonary Blastoma: A Case Report

Pulmonary blastoma is a rare primary lung malignancy consisting of mesenchymal and epithelial components resembling the fetal lung. We report a case of pulmonary blastoma with solitary hemorrhagic brain metastasis in a 32-year-old man. This metastatic lesion was composed mainly of hemorrhagic high density and central necrotic low density areas; on CT it showed partial contrast enhancement and was thus impossible to distinguish from other hemorrhagic lesions.

Acute Aortic Intramural Hematoma

PURPOSE: To evaluate the radiologic findings of acute intramural hematoma of the aorta, and the clinical follow up thereof. MATERIALS AND METHODS: Among 34 cases confirmed clinically and radiologically as aortic dissection, an analysis was carried out based on 15 cases in which intramural hematoma without false lumen was demonstrated, on initial CT, 12 cases of in which follow up CT was used and five cases involving an aortogram. Elements such as the shape of the thickened aortic wall, ulcer-like intimal defects, and intimal calcification were examined. Changes in these elements were also examined on follow up CT. RESULTS: DeBackey types I and III accounted for one and 14 cases. respectively. Initial precontrast CT demonstrated continuous, crescentic high attenuation areas along the wall of the descending aorta. In postcontrast scans, the crescentic areas were of relatively lower-attenuation and appeared along the aorta wall. Displaced intimal calcifications were seen in nine of fifteen patients. There was no intimal flap on all five aortogram, while aortic wall thickening and atherosclerotic change were demonstrated in four cases and in one case, case, respectively. Focal ulcers were seen in three cases. Ulcer-like intimal defects were demonstrated in a total of eleven cases (eight on CT, two on aortogram, and one on both). In ten of the twelve cases seen on follow up CT, the thickness of the intramural hematoma was seen to be reduced. Among the 15 cases, the operation was performed in two cases, and the remaining 13 received conservative treatment. In ten cases observed for more than twelve months, a recurrence of symptoms did not occur. CONCLUSION: Eccentric aortic wall thickening in patients who complain of acute chest pain is the result of acute aortic dissection with intramural hematoma, or a penetrating atherosclerotic ulcer of the aorta.The latter may be differentiated from the former by the presence of on ulcer-like intimal defect. When both diseases are limited to the descending aorta, conservative treatment may be effective, unless patients experience persistent or recurrent chest pain, or unless intramural hematoma progresses further.

MRI of Intracranial Meningiomas: Correlations with T2 Signal Intensity and Histopathologic Findings

PURPOSE: To correlate histologic subtypes with MR signal intensity in meniagioma and to find etiologic factors responsible for the signal characteristics of T2WI. MATERIALS AND METHODS: We. reviewed MRIs and histopathologic studies in 35 cases of meningioma. MR signal intenisty was measured with respect to cerebral cortex(gray matter) as hypointense, isointense, or hyperintense. Pathologically, meningioma was classified into subtypes, acording to the new WHO classification of brain tumors. The degree of cellularity, collagen, and vascularity was graded from 1 to 3, and presence or absence of psammoma bodies, microcysts, micronecrosis and microhemorrhage was obeserved. Multiple linear regression analysis was done to find relationship between the pathologic findings and MR signal intensity of T2WI. RESULTS: Even in the same subtype, cellularity, collagen and vascularty of the tumor were different. T1WI was not useful in discriminating pathologic subtype because most tumors were isointense or hypointense to the cortex regardless of histologic type. Most tumors showed various signal intensity on T2WI, but T2WI were not useful, either. Exceptionally, all five cases of microcystic meningiomas were hyperintense on T2W1. In analysing the relationship between MR signal intensity and pathologic factor, increased collagen content produced decreased signal intensity(P<0.01) and the existence of microcyst resulted in high signal intensity(P<0.01). Cellularity, vascularity, microcalcification, micronecrosis and microhemorrhage had no relationship with signal intensity on T2WI. CONCLUSION: Except for the five microcystic meningiomas with hyperintenty on T2WI there was no relationship between MR signal intensity and subtype of meningiomas. Pathologic factors influencing T2 signal intensity were microcyst and collagen. Even in the same subtypes of meningiomas, the T2 signal intensity was different. This may be due to different ratio of microcyst and collagen.

Unilateral Absence of a Pulmonary Artery: Report of 3 cases

Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PD

Transthoracic Fine Needle Aspiration Biopsy: Diagnostic Rate and Complications in 1000 Cases

PURPOSE: Transthoracic fine needle aspiration biopsy is a widely practiced technique in the investigation of the lung and mediastinal masses because of its safety, reliability and accuracy. We report the diagnostic accuracy of the transthoracic fine needle aspiration biopsy and the frequency of its complications which required treatment. MATERIALS AND METHODS: We analyzed 1000 transthoracic needle aspiration biopsies whcih were performed in 986 patients with 993 chest lesions. Aspiration biopsies were obtained with Westcott needles (20G or 22G) under the fluoroscopic guidance. Final diagnosis was made with operation, bronchoscopy, sputum study, biopsy of other sites and the clinical course of the patient. We analyzed diagnostic yields of aspiration biopsy and the frequency of the complication requiring treatment. RESULTS: The sensitivity was 87.6% in benign diseases and 95.8% in malignant diseases. Pneumothorax was the most frequent complication, which required pig-tail catheter insertion in 36 cases or thoracostomy in six cases. In 36 cases, minimal hemoptysis developed which did not require treatments. CONCLUSION: We obtained relatively high sensitivities of malignant and benign lesions using transthoracic fine needle aspiration biopsy and the frequency of the complications requiring treatment was very low. Transthoracic fine needle aspiration biopsy is a valuable diagnostic method in the thoracic lesions.