Multidetector CT Findings of Solid Organ Injury Based on 2018 Updated American Association for the Surgery of Trauma Organ Injury Scaling System

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

Multidetector CT Findings of Solid Organ Injury Based on 2018 Updated American Association for the Surgery of Trauma Organ Injury Scaling System

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

Typical and Atypical Manifestations of Intrathoracic Sarcoidosis

Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Pulmonary Actinomycosis: CT Studies of Diagnostic and Post-treatment Findings

PURPOSE: To investigate the value of the computed tomography (CT) in the study of diagnostic and post-treatment findings of pulmonary actinomycosis. MATERIALS AND METHODS: Clinical data and CT findings were retrospectively analyzed in 10 patients with histopathologically confirmed pulmonary actinomycosis. We analyzed the initial CT findings in search of patterns and distributions which suggest possible lung abnormalities and found the pleura, chest wall, and lymphadenopathy to be involved as part of the indicators of lung abnormalities. We analyzed follow-up CT findings for changes in the lungs after antibiotic therapy and recurrence after surgery. RESULTS: Of the 10 patients analyzed by CT for lung lesions, seven had been diagnosed with alcoholism and nine were male. The initial CTs (n=10) indicated that all the pulmonary lesions were solitary without chest wall involvement. However, a transfissural extension was observed in 20% of the study population (n=2). Furthermore, peripheral lung distribution and adjacent pleural thickening was observed in 70% of the study population (n=7). Within the consolidation (n=6) or mass (n=4), a central low density with peripheral enhancement was seen in 70% of the study population (n=7). A follow-up CT of the seven cases following antiobiotic therapy revealed that four cases showed minimal improvement or aggravation of their lung lesions, whereas three cases showed resolution or improvement. The improvement of the central low density was related to the improvement of consolidation or mass. Furthermore the presence of fibrosis was observed after the resolution of pulmonary lesions (n=2). No relationship was found between the duration and response of antibiotic therapy. A follow-up CT (n=4) subsequent to a lung resection revealed the onset of chest wall actinomycosis and a thickened pleura in one case. CONCLUSION: The results of this study highlight the value of the CT in pulmonary actinomycosis in order to diagnose and evaluate antibiotic responses, complications, or post-surgical recurrences of lung lesions.

Various Bronchial Fistulas: Pitfalls and Usefulness on CT. A Pictorial Review

The presence and type of bronchial fistulas connected with various organs within the thorax were examined. The types of bronchial fistulas include bronchopleural, bronchoesophageal, adenobronchial, bronchomediastinal, bronchovascular, and other variants. The bronchopleural fistula included a central bronchopleural and peripheral bronchopleural fistula, as well as a bronchoesophageal fistula consisting of congenital and acquired fistula. Generally, an adenobronchial fistula generated by pulmonary tuberculosis or corrosive esophagitis. These conditions may have originated from bronchomediastinal and bronchovascula fistula. The computed tomography results revealed the connection of the bronchial fistula with organs and causative diseases. In addition, applying multiplanar reformatted images provided a the accurate location of bronchial fistula. In this type of clinical atlas, the type of bronchial fistulas and their imagings were introduced.

Clinical Aspects of Necrotizing Pneumonitis Resulting from Mycoplasma pneumoniae Infection in Children / 소아알레르기및호흡기학회지

PURPOSE: Necrotizing pneumonitis is a complication of severe invasive lobar pneumonia characterized by necrotic foci in consolidated areas and its development may be due to excessive host cell-mediated immune response. Necrotizing pneumonitis caused by Mycoplasma pneumoniae (M. pneumoniae) in children and its successful treatment have been reported. We reviewed 5 cases to determine the disease course and outcome in pediatric patients with necrotizing pneumonitis resulting from M. pneumoniae infection. METHODS: Five patients with necrotizing pneumonitis caused by M. pneumoniae who were diagnosed and treated in the Department of Pediatrics, Uijeongbu St. Mary`s Hospital from January 2003 to December 2006 were reviewed in this study. Sex, age, clinical manifestations, laboratory and radiologic findings, treatments, and long-term follow-up outcomes of these patients were analysed retrospectively. RESULTS: One patient was a boy and others were girls. All were less than 5 years of age and had no immunocompromised conditions. Lower pH and glucose, higher protein and LDH were observed in pleural fluid. On the radiologic examinations, all had multilobar pneumonic involvements, especially in the right lobes and lower lobes. Necrotizing pneumonitis was diagnosed on chest CTs taken between two and 20 days following admission. The necrotic foci were identified as multiple low-attenuation changes within the contrast-enhanced consolidation areas mainly in the lower lobes of the affected side of lung. Cavitary necrosis was shown in 3 patients and persisted as pneumatoceles, which disappeared on the follow-up chest radiographs nearly up to 7 months following admission. Macrolide and broad-spectrum antibiotics were administered in all patients and chest tube drainage was performed in 2 patients. Systemic steroid therapy was added in 4 patients. Of those four, 2 patients, both under 2 years of age, improved more rapidly than others in clinical status and radiographic findings. In spite of steroid therapy, one patient died of acute respiratory distress syndrome. Consequently 4 patients were improved and discharged. Two patients who were under 2 ears were normalized and 2 patients who were 4 years of age showed remaining cavitation or fibrosis in the last follow-up chest radiographs. CONCLUSION: Our results may suggest though they are not yet proven nor have they been discussed extensively that younger patients show better prognoses than older children. Further well-designed and large scale studies may be warranted.

Clinical Characteristics of Pneumonia Occurred in Hemodialysis Patients / 대한신장학회지

PURPOSE: The most common infectious diseases in hemodialysis (HD) patients are sepsis and pneumonia. Although there are many data about sepsis in HD patients, pneumonia in HD patients is rarely reported. This study was conducted to compare clinical severity of pneumonia between HD patients and healthy persons. METHODS: This study enrolled 36 HD patients who were admitted for pneumonia. Age- and sex-matched 37 persons with pneumonia who did not have any other medical illness were included as a control. We compared clinical manifestations, laboratory and radiologic findings, complications, and clinical course between HD patients and controls. RESULTS: The positive rates of blood and sputum bacterial culture in the HD patients were higher than in those in the controls (blood; 17.6% vs. 2.7%, p=0.028, sputum; 30.3% vs. 5.4%, p=0.005). Compared to the controls, the HD patients had higher incidence of thrombocytopenia (25.0% vs. 0%, p=0.001) and hypoxia (41.7% vs. 2.7%, p=0.000). The number of the lobes involved was larger and higher incidence of bilateral lesions and parapneumonic effusions were observed in the HD patients. In addition, the HD patients had higher incidence of recurrence than the controls (16.7% vs. 0%, p=0.025). Pneumonia-related mortality rate tended to be higher in the HD patients than the controls but there was no statistical differences between the two groups (11.1% vs. 0%, p=0.054). CONCLUSION: This study shows that pneumonia in HD patients takes a more severe clinical course than in healthy persons. It seems that pneumonia in HD patients has a higher propensity to develop bacteremia.

Non-Malignant 18F-FDG Uptake in the Thorax by Positron Emission Tomography Computed Tomography Fusion Imaging

Fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) has been used exclusively to diagnose malignancies. However, increased FDG uptake is not always limited to malignant tissue. Many false positive findings for PET have been reported. Moreover, the use of PET/CT may allow the reassessment of previously recognized patterns of physiological bio-distribution of a tracer. In this report we demonstrate the physiological FDG uptake of normal structures in the thorax using PET/CT imaging and illustrate many benign pathological conditions with standardized uptake values greater than 2.5.

A Case of Tracheal Diverticula in a Hemoptysis Patient with Tuberculosis Sequela and Fungus Ball / 결핵및호흡기질환

We experienced a rare case of trachea diverticula combined with the sequela of tuberculosis and a fungus ball. The patient had complained of coughing and hemoptysis for a long time after experiencing tuberculosis. He was admitted due to hemoptysis and the aggravation of coughing. The CT scan showed a variable sized trachea diverticula combined with tuberculosis sequela and a fungus ball in the right lung fields. The diagnosis was made by bronchoscopy and a CT scan. After bronchial artery embolization and conservative treatment, the patient's symptoms improved and the patient was discharged.

The Analysis of Maxillary Sinus Aeration Dependent on Aging Process: Volume Assessment by Three Dimensional Reconstruction by High Resolutional CT Scanning / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the maxillary sinus volume in human depending on age and sex by using 3-dimensional reconstruction of computed tomography (3DR-CT). SUBJECTS AND METHOD: One hundred seventy three people (238 maxillary sinuses), who had taken paranasal sinus high resolution CT between December 2000 and November 2003, and had no evidence of inflammation or hypoplasia in CT finding, and had no specific history of surgery of paranasal sinus or maxillofacial trauma, were retrospectively analyzed. 3-dimensional reconstruction images were obtained using the surfacerendering technique with images by high-resolution CT on a personal computer. A software used for 3-dimensional reconstruction was Vwork 4.0 (CyberMedTM, Korea) used. The mean volume of maxillary sinus were evaluated in both sex. The ratio of maximal horizontal and half horizontal extension and the degree of descent of sinus below the nasal floor were evaluated. RESULTS: The development of maxillary sinus were found in males in their twenties and in teen females. The mean volume of maxillary sinus in an early adult were 24043 mm3 (Male) and 15859.5 mm3 (Female). There was a significant difference observed in the sinus volume (p<0.05) according to sex and the significant difference in the volume of maxillary sinus according to age groups between sex before reaching maximal volume. But there were no significant correlation among aging process, aeration of maxillay sinus after its maximal growth and the descent below the nasal floor. CONCLUSION: The growth of maxillary sinus is continued until the age of twenties in male and teens in female. Therefore, maxillay sinus operation affecting bony structures before those age may affect the sinus development; inferior meatal antrostomy also should be done after confirming the level of inferior extension of maxillary sinus below the nasal floor.

A Case of Aortic Arch Thrombus Associated with Acute Pyelonephritis in a Patient with Thrombocythemia / 대한신장학회잡지

Aortic thrombus is a rare but life threatening disorder. The usual causes of aortic thrombus are primary or secondary thrombocythemia, malignancy, atherosclerosis, trauma, and acute infectious disease. Here, we report a case of aortic arch thrombus associated with acute pyelonephritis in a patient with thrombocythemia. A 78-year-old woman was admitted with acute pyelonephritis. A complete blood cell count showed severe thrombocythemia with platelet count of 1, 340, 000/mm3. Chest CT scan demonstrated floating thrombus in the aortic arch. After antibiotic treatement, platelet count decreased to 770, 000/mm3 and aortic thrombus disappeared without thrombolytic therapy.

Three-Dimensional Reconstruction Based on Images from Spiral High-Resolution Computed Tomography of Temporal Bone: Anatomy and Clinical Application / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The intricate anatomy of the temporal bone has always been difficult to visualize. In this regard, the advantages of computer-assisted reconstruction of temporal bone based on image data from computed tomography (CT) are widely recognized. The goal of this study was to investigate the usefulness of three-dimensional (3D) reconstruction of computed tomography in determining the anatomy and topographic relationship of various important structures. SUBJECTS AND METHOD: For 40 ears of 20 patients with various otological diseases, 3D reconstruction based on image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithm on a personal computer. The scanning was carried out in axial plane with technical factors of 140 kV, 100 mAs, 1 mm thickness, and 1 second scanning time. A software (Vworks(TM) 4.0, CyberMed Inc, Korea) was used for image processing. RESULTS: We were able to demonstrate the 3D display of the middle and inner ear structures. The computer-assisted measurement of reconstructed structures demonstrated the anatomic details comprehensively, which improved the surgeon's understanding of their spatial relationship, and provided many details that could not be easily measured in vivo. CONCLUSION: The 3D reconstruction of temporal bone CT can be useful in demonstrating and thus understanding the anatomical structures of temporal bone. Also, its clinical applications are inestimable. But it is necessary to confirm the correlation between 3D reconstructed images and histologic sections through the validation study.

Clinical Characteristics and Risk Factors of Contrast Dye Nephrotoxicity in Patients Performing Arteriography / 대한신장학회잡지

BACKGROUND: Because of increasing incidence of astherosclerosis, the incidence of contrast nephrotoxicity is increasing in Korea. This study was designed to investigate the clinical characteristics and risk factors of contrast dye nephrotoxcity in patients performing arteriography. METHODS: This study included 511 adult patients who performed arteriography. We retrospectively evaluated the incidence, clinical course, and risk factors of contrast dye-induced acute renal failure via medical records. Acute renal failure was defined as a rise of serum creatinine more than 50% of baseline levels 2-3 days after exposure of contrast dye. RESULTS: Of the total 511 patients, 23 patients (4.5%) had acute renal failure. The mean age of these patients was 57+/-0 years and the number of male was 14. The mean duration between the exposure and development of acute renal failure was 2.0+/-.7 days. The serum creatinine level maximally increased to 3.2+/-.9 mg/dL at 6.3+/-.1 days after the exposure. Oliguria and pulmonary edema developed in 8 and 7 patients, respectively. Four patients needed hemodialysis treatment. Of the total 23 patients with acute renal failure, 19 patients recovered with conservative treatment and 3 patients died without recovery of renal function and 1 patients progressed end stage renal failure. Renal insufficiency and dosage of contrast dye were independent risk factors of development of acute renal failure. CONCIUSION: Contrast dye-induced acute renal failure occurred in 4.5% of patients performing arteriography. Most cases of acute renal failures completely recovered but 4 case needed hemodialysis and 1 case progressed to end stage renal failure. Renal insufficiency and dosage of contrast dye were independent risk factors of development of acute renal failure.

A Case of Asymptomatic Pseudoaneurysm of Thoracic Aorta in a Hemodialysis Patient with Sepsis / 대한신장학회잡지

Pseudoaneurysm of thoracic aorta is very rare but potentially fatal in hemodialysis patients. It results from blunt trauma, cardiovascular surgery, infection, and severe atherosclerosis. Here, we report a case of asymptomatic pseudoaneurysm of thoracic aorta in a hemodialysis patient with sepsis. A 58-year-old man was admitted with a week history of low grade fever and general weakness. He had experienced staphylococcus aureus sepsis with graft infection 6 month ago. Chest X-ray showed severe wall calcification of thoracic aorta and a newly developing round opacity in retrocardiac region. Blood culture demonstrated staphylococcus aureus. Chest computed tomography revealed a large pseudoaneurysm of descending thoracic aorta with disrupted wall calcification.

Central Venous Catheterization Via Persistent Left Superior Vena Cava

Although the use of central venous cannulation has been increasing in recent years, it can produce serious complications such as hemothorax, pneumothorax, arterial puncture, and malposition of the catheter. Therefore, post-procedure chest radiograph must be obtained to confirm correct placement of the catheter and to exclude pneumothorax or hemothorax. We experienced an abnormal course of left subclavian catheter along the left border of the heart on post-procedure chest radiograph. Here we report a case of persistent left superior vena cava detected by hemodialysis catheterization in a patient with acute renal failure after ruptured abdominal aortic aneurysm.

Spontaneous Renal Rupture in Patients on Chronic Hemodialysis / 대한신장학회잡지

BACKGROUND: Because of high incidence of acquired renal cyst and renal malignancy, it is suggested that spontaneous renal rupture more frequently occurs in patients receiving long-term hemodialysis than general population. This study was performed to evaluate the clinical characteristics of spontaneous renal rupture in hemodialysis patients. METHODS: This retrospective study enrolled 12 hemodialysis patients who developed spontaneous renal rupture. We investigated primary renal disease, duration of dialysis, clinical symptoms and signs, radiologic findings, treatment modalities, and histologic findings. RESULTS: The mean age of the patients was 54+/-10 years old and the number of male was 9. Primary renal disease consisted of autosomal dominant polycystic kidney disease (PCKD) (n=5), chronic glomerulonephritis (n=2), diabetic nephropathy (n=1), hypertensive nephropathy (n=1), unknown cause (n=3). Presenting symptoms and signs were sudden onset of flank pain in 9 patients and gross hematuria with mild flank pain in 3 patients. Mean duration from initiation of hemodialysis to development of spontaneous renal rupture was 53+/-36 months. Abdominal computed tomography showed subcapsular or perinephric hematoma in all patients. Of the 7 non-PCKD patients, 6 patients had multiple acquired renal cysts. Surgical exploration was undertaken in 9 patients. Pathologic examination demonstrated small sized-renal cell carcinoma in 2 of 9 patients. Three patients were only treated with conservative management including blood transfusion. All 12 patients recovered without recurrence. CONCLUSION: This study demonstrated that genetic or acquired renal cyst was an important cause of spontaneous renal rupture in hemodialysis patients and presenting manifestations were sudden onset of flank pain and gross hematuria.

Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.

A Case of Rectal Varix Bleeding Treated with Endoscopic Variceal Ligation / 대한소화기내시경학회지

Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Among ectopic varices, rectal varices are infrequent but potentially serious complication. The etiology and pathogenesis of rectal varices remains controversial. Several kinds of treatment have been performed but standard treatment for rectal varices has not been established. Herein we report a case of rectal varix bleeding treated with endoscopic variceal ligation (EVL) and then evaluated by transrectal color doppler ultrasonography.

Spontaneous Rupture of Renal Artery Aneurysm in a Patient with Untreated Hypertension / 대한신장학회잡지

Spontaneous rupture of renal artery aneurysm is a rare, but life threatening complication with high mortality. The etiology of non-traumatic renal artery aneurysm is fibromuscular dysplasia, atherosclerosis, vasculitis, and pregnancy. We here report a case of spontaneous rupture of renal artery aneurysm in a patient with untreated hypertension. A 39-year-old non-pregnant woman complained of sudden onset of right flank and lower quadrant abdominal pain. Ultrasonography showed large fluid collection in right lower abdomen. Emergency laparotomy demonstrated huge retroperitoneal hematoma due to spontaneous rupture of right renal artery aneurysm. Microscopic examination of the aneurysmal wall revealed intimal hyperplasia without atherosclerotic change.