MR Imaging Finding of Xanthogranulomatous Cholecystitis: A Case Report

We describe a case of xanthogranulomatous cholecystitis in which there was close correlation between MR andhistopathological finding and review the previous literature. On both T1-and T2-weighted MR images, multiplegallstones and diffuse wall thickening of the gallbladder were seen, with multiple hyperintense intra-muralnodules. The nodules were pathologically confirmed as anthogranuloma.

Hemodialysis Shunts-related Subclavian Vein Stenosis: Treatment with Self-expandable Metallic Stent

PURPOSE: To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-relatedsubclavian vein stenosis. MATERIALS AND METHODS: Self-expandable metallic stent was placed in nine patients withhemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stentplacement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis afterangioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and themeasurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. RESULTS: The stenoticsites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomicnarrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%; a resultingcomplication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this wasremoved by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosisdeveloped in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases weretreated by balloon dilatation. CONCLUSION: In hemodialytic shunt-related subclavian vein stenosis, treatmentinvolving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has notresponded to angioplasty with a high patency rate.

Transcatheter Arterial Embolizations of Arterial Bleeding in Patients with Pelvic Bone Fracture

PURPOSE: To evaluate the usefulness of transcatheter arterial embolization (TAE) of arterial bleeding in patients with pelvic bone fracture. MATERIALS AND METHODS: We retrospectively evaluated 13 injured arteries of seven patients with pelvic bone fracture. In order to evaluate the sites and types of arterial injuries, angiography was performed, followed by TAE using Gelfoam and a coil. The parameter of technical success is non-visualization of extravasation and pseudoaneurysm in injured arteries. We investigated (1) the survival rate and complications of TAE; (2) the relationship of arterial injuries to findings, as seen on plain film; and (3) the influence of BP on arrival and the time interval between trauma and TAE on prognosis. RESULTS: Angiography revealed (1) extravasation of contrast media in four patients; (2) extravasation and pseudoaneurysm in two; and (3) extravasation and abrupt cut-off of an artery in one. The injured arteries involved( n=13), were the internal iliac (n=3), superior gluteal (n=3), inferior gluteal (n=2), obturator (n=2), ili-olumbar (n=2), and internal pudendal (n=1). TAE was technically successful and in no case were there complications. Vital signs improved in four patients, but three others died due to hypovolemia. In five patients the site of arterial injury, as seen on plain films, was consistent pelvic bone fracture but in one patient more severe arterial injury was noted at the contralateral side of more severe pelvic bone fracture, and in one other arterial injury was observed only at the contralateral side of pelvic bone fracture. In this study, BP at arrival was a more important prognostic indication than was the time interval between trauma and TAE. CONCLUSION: For the management of arterial bleeding after blunt pelvic trauma, TAE is the procedure of choice.

MR Evaluation of Pyo genic Osteomyelitis Involving the Epiphyses

PURPOSE: The purpose of this study was to analyze of the MR findings of the pyogenic osteomyelitis involving the epiphyses of the long bones in childhood. MATERIALS AND METHODS: Eleven childen with pyogenic osteomyelitis involving the epiphyses of the long bones were evaluated by MRI. A diagnosis of pyogenic osteomyelitis was established by biopsy and culture in eight cases and during follow-up after antibiotic treatment in three. We analyzed the involved bone, initial location, pattern, degree of growth plate involvement, degree of epiphyseal involvement, surrounding change and plain radiographic findings. RESULTS: The involved bones were the proximal femur in four cases, distal femur in two, proximal tibia in two, distal tibia in one, distal fibula in one and proximal humerus in one. The initial site of the lesion was the metaphysis in ten cases and epiphysis in one. The lesion pattern was the Brodie's abscess in six cases and osteomyelitis in five. The degree of growth plate involvement was 16-20% in five case and 5% or less in four ; the degree of epiphyseal involvement was 5% or less in four cases, 6-10% in four and 11-15% in two. All cases showed low or intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and contrast enhancement. Joint effusion adjacent to the lesion was detected in five cases. Radiographic findings of the involved epiphysis were normal in six cases, but indicated osteolytic lesion in four cases and sclerosis in one. CONCLUSION: Pyogenic osteomyelitis involving the epiphyses of the long bones in childhood usually developed from metaphyseal osteomyelitis and was combined with destruction of the growth plate.

MR Evaluation of Pyo genic Osteomyelitis Involving the Epiphyses

PURPOSE: The purpose of this study was to analyze of the MR findings of the pyogenic osteomyelitis involving the epiphyses of the long bones in childhood. MATERIALS AND METHODS: Eleven childen with pyogenic osteomyelitis involving the epiphyses of the long bones were evaluated by MRI. A diagnosis of pyogenic osteomyelitis was established by biopsy and culture in eight cases and during follow-up after antibiotic treatment in three. We analyzed the involved bone, initial location, pattern, degree of growth plate involvement, degree of epiphyseal involvement, surrounding change and plain radiographic findings. RESULTS: The involved bones were the proximal femur in four cases, distal femur in two, proximal tibia in two, distal tibia in one, distal fibula in one and proximal humerus in one. The initial site of the lesion was the metaphysis in ten cases and epiphysis in one. The lesion pattern was the Brodie's abscess in six cases and osteomyelitis in five. The degree of growth plate involvement was 16-20% in five case and 5% or less in four ; the degree of epiphyseal involvement was 5% or less in four cases, 6-10% in four and 11-15% in two. All cases showed low or intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and contrast enhancement. Joint effusion adjacent to the lesion was detected in five cases. Radiographic findings of the involved epiphysis were normal in six cases, but indicated osteolytic lesion in four cases and sclerosis in one. CONCLUSION: Pyogenic osteomyelitis involving the epiphyses of the long bones in childhood usually developed from metaphyseal osteomyelitis and was combined with destruction of the growth plate.

Significance of Transcatheter Arterial Embolization in the Treatment of Pseudoaneurysm ComplicatingPancreatitis

PURPOSE: To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysmcomplicating pancreatitis. MATERIALS AND METHODS: This study was based on a retrospective analysis of eightcases, in which TAE for the control of pseudoaneurysm complicating pancreatitis was attempted. All patients weremales, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitisand one case was the result of acute pancreatitis. All patients underwent diagnostic angiography andsuperselective embolization. RESULTS: Arteries in which pseudoaneurysm had occurred were the gastroduodenal(n=5), inferior pancreaticoduodenal (n=1), superior mesenteric artery root (n=1), and the celiac axis (n=1). Sixcases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmalneck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysmswere completely resolved within three to six months of embolization. One of the other two remained as apseudocyst, while in the other, also a pseudocyst, surgery was performed. CONCLUSION: Because TAE in patientswith pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of apseudocyst, TAE is the preferred pre-surgical treatment mode.