Two Cases of Ectopic Gallstones Treated by Endoscopic Therapy / 대한소화기내시경학회지

Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.

Imaging Findings of Intragastric Gallstone and Bouveret's Syndrome

Gallstone ileus is a well-known complication of cholelithiasis, but is relatively rare. Most ectopic gallstones are located in the small bowel; they are rarely found in the stomach and duodenum. We describe the imaging findings of a case of intragastric gallstone, as well as a case in which duodenal obstruction was caused by a large gallstone (Bouveret's syndrome).

Laryngeal Schwannoma: A Case Report

Laryngeal schwannoma is extremely rare. We report the CT and MRI findings of a case occurring in a 65-year-oldwoman, and describe the pathologic correlation. Pre-contrast CT scanning revealed a right supraglot-tic mass witha slightly hyperdense central part and a hypodense peripheral part. Post-contrast CT scanning re-vealed anenhanced hyperdense central part and a rim-like hypodense peripheral part. The density of the pe-ripheral part waslower than that of muscle. The mass showed homogeneous low signal intensity on T1-weighted MR images, homogeneoushigh signal intensity on T2-weighted MR images, and an enhanced high signal intensity central part and a lowsignal intensity peripheral part on gadolinium enhanced T1-weighted images. The enhanced central part correlatedwith Antoni A areas and the peripheral part, showing low attenuation, correlated with Antoni B areas.

A case of acute eosinophilic pneumonia / 천식및알레르기

Acute eosinophilic pneumonia(AEP) was first described in 1989 and represents a clinical entity distinct from chronic eosinophilic pneumonia. AEP is characterized by acute respiratory insufficiency, hypoxemia, fever, diffuse radiographic infiltrates, and eosinophilia in bronchoalveolar lavage fluid or lung biopsies in the absence of infection, atopy, or asthma. Rapid response to corticosteroids is characteristic. We experienced a 47-year-old metal driller presenting typical clinical and radiological characteristics of AEP. We confirmed eosinophilic pneumonia with brochoalveolar lavage analysis and transbronchial lung biopsy. We report a case of AEP diagnosed by clinical, radiographic, and histologic findings with a brief review of the literature.

Lumbar MR Myelography with Constructive Interference in Steady State(CISS)-3DFT

PURPOSE: To evaluate the usefulness of 3DFT CISS MR myelography (MRM) by comparing it with 3DFT FISP MRM. MATERIALS AND METHODS: Thirty-four subjects consisting of normal volunteers and patients complaining of back pain underwent lumbar spine MRI, 3DFT CISS MRM, and 3DFT FISP MRM. The 3DFT FISP MRM and 3DFT CISS MRM images were analysed and in each case, the following were compared : sharpness of the dural sac; differentiation of nerve roots and CSF ; visualization of the nerve root sleeve and of dural sac compression. RESULTS: Image acquisition time of 3DFT CISS MRM was shorter than that of 3DFT FISP MRM, and the former was significantly superior to the latter in sharpness of the dural sac (86%, p=0.004), differentiation of nerve roots and CSF (74%, p=0.0168), andvisualization of dural sac compression (90%, p=0.0016). With regard to visualization of nerve root sleeves, 3DFT CISS MRM was superior to 3DFT FISP MRM, but not significantly (68%, p=0.0872). CONCLUSION: 3DFT CISS MRM requiresa shorter image acquisition time and gives a better image than 3DFT FISP MRM; we therefore consider it to be a useful MR method.

CT and MR Findings of the Inverted Papilloma

PURPOSE: The purpose of this study is to describe the CT and MR findings of inverted papilloma and to determine the specific differential finding between inverted papilloma with and without coexisting malignancy. MATERIALS AND METHODS: Twenty-two histopathologically proven inverted papillomas were included in this study; in six patients there was coexisting malignancy. Twenty-two CT images and eight MR images were retrospectively reviewed. RESULTS: On CT images, the inverted papillomas were seen as unilateral sinonasal masses with bone remodeling (n=15) rather than bone destruction (n=1) and showed iso- or slightly high attenvation. Three of the six malignant cases showed aggressive bone destruction and widespread extension into the orbit, intracranial and buccal spaces, and pterygopalatine fossa. On MR images, the inverted papillomas (n=3) were iso- (n=2) or slightly high (n=1) in signal intensity in relation to muscle on T1 weighted images, and high (n=3) on T2 weigihted images. Gadolinium enhanced images showed heterogenous moderate enhancement. In the cases of coexisting malignancy (n=5), the masses were iso- (n=5) on T1 weighted images, high (n=5) on T2 weighted images and also showed heterogenous moderate enhancement. CONCLUSION: Inverted papilloma should be considered in the differential diagnosis of a bulky unilateral nasal mass extending into the adjacent paranasal sinuses, especially in an elderly patient with chronic nasal obstruction. Although there were no specific differential findings in signal intensiy and enhancement pattern on CT and MR images between benign and malignant inverted papilloma, aggressive bone destruction and widespread extension beyond the sinonasal cavity are findings which are highly suggestive of coexisting malignancy.

CT Grading of Laryngeal Cancer According to the Degree of its Extension: Emphasis on T2 and T3 Tumors

PURPOSE: To analyze the degree of tumor extension in T2 and T3 laryngeal cancer, independently of vocal cord fixation, and to introduce a new CT grading system for use in preoperative T-stage assessment. MATERIALS AND METHODS: Retrospective analysis of degree of tumor extension was performed in 36 patients with laryngeal cancer (T2 glottic, 4 ; T2 supraglottic, 12 ; T3 glottic, 12 ; and T3 supraglottic, 8). T-stage was determined according to clinical and pathologic findings, and based on the TNM classification of AJCC (1992). The degree of tumor extension seen on CT was determined by the number of involved anatomic subsites and compared with T-stage and lymph node metastasis. On the basis of statistical analysis(Fisher's exact test) of those results, we suggest new CT grading system for laryngeal cancer. RESULTS: Fifteen of 20 supraglottic cancer patients showed six or less involved anatomic subsites ; twelve of these 15 (80%) were at stage T2 and three (20%) were T3. Four of the 15 showed lymph node metastasis. The five patients whose number of involved anatomic subsites was seven or more were all T3 ; four (80%) of these showed lymph node metastasis. The difference in the number of involved anatomic subsites in T2 and T3 tumor was statistically significantly different (p<0.05) ; the incidence of LN metastasis was more prevalent in the group with seven or more involved subsites. In glottic cancer, however, no statistically significant difference was observed between T2 and T3 tumors in the number of involved subsites. CONCLUSION: In supraglottic cancer, T1 and T4 stages are determined by degree of tumor extension, irrespective of vocal cord mobility ; T2 and T3 stages are suggested by the number of involved anatomic subsites, without reference to vocal cord mobility. A new CT grading system may thus be made, based on degree of tumor extension. In glottic cancer, however, laryngoscopy or dynamic study with spiral CT are needed for T-stage assessment.

Injection Method of Contrast Medium in Chest Spiral CT

PURPOSE: Authors studied the injection method of contrast medium in routine chest spiral CT scan to obtain the best image in the mediastinum. MATERIALS AND METHODS: Dynamic static scan had been performed in 5 normal volunteers as a pilot study. In consideration of the result of pilot study, Chest spiral CT was performed in 217 patients by three different methods. We used 100cc nonionic contrast medium. Average attenuation of great vessels in the mediastinum were assessed in various injection methods. Image quality was graded with three levels of score by two radiologists. RESULTS: Peak enhancement time of the great vessels on pilot at dynamic static scan were as follows :52 sec at ascending aorta, 45 sec at pulmonary artery, and 40 sec at SVC. In the study of spiral CT, the highest attenMarion in the great vessels was obtained after injection of 100cc of contrast medium(2cc/sec, with 35-40 second scan delay), althrough artifact from highly enhancing SVC was most common in this method. Image quality were highest in the scans obtained with other methods(3-2-1cc/sec for 10-15-40 seconds, with 40 second scan delay). CONCLUSION: For chest spiral CT, authors recommend that scans should be obtained after infusion of 70--80cc of contrast medium during 35--40sec to obtain maximal vascular enhacement of mediastinum.