The Frequency of Reexpansion Pulmonary Edema after Trocar and Hemostat Assisted Thoracostomy in Patients with Spontaneous Pneumothorax

PURPOSE: Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. MATERIALS AND METHODS: We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. RESULTS: Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24+/-10 vs. 26+/-14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. CONCLUSION: Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat-assisted drainage in patients with spontaneous pneumothorax.

A case of subepicardial aneurysm in the left ventricle after acute myocardial infarction / 대한내과학회지

A subepicardial aneurysm is a rare, life-threatening complication of acute myocardial infarction. Clinical and pathologic features include abrupt interruption of the myocardium, a narrow neck, and a propensity for progression to sudden transmural rupture. Echocardiography, magnetic resonance imaging, and computed tomography are diagnostic imaging tools used for identifying subepicardial aneurysms after acute myocardial infarction. Surgical repair is thought to be the best treatment modality for this type of aneurysm. Here, we report a case of a 72-year-old woman with subepicardial aneurysm of the left ventricle after acute myocardial infarction. She was treated using surgical repair without complications.

A Case of Pleural Effusion after Malposition of Central Venous Catheter / 결핵및호흡기질환

Central venous catheterization is used to provide a large amount of fluid, total parenteral nutrition and to administer antitumor agents with few complications reported. We report an uncommon case of pleural effusion that occurred after central venous catheterization. In many cases, the mechanism for the pleural effusion after central venous catheterization occurs through an injury to the superior vena cava by the continuous mechanical force of the catheter tip, the flow of large amount of fluid and an osmotic injury to the wall of the vein. This case is somewhat different in that the central catheter was placed in an aberrant vessel resulting in the pleural effusion. A post-placement chest roentgenogram and the correct approach of catheterization are important for preventing this complication.

A Case of Accelerated Silicosis Mimicking Miliary Pulmonary Tuberculosis / 결핵및호흡기질환

Silicosis is a chronic fibrosing lung disease that is initiated by prolonged and extensive exposure to respirable free crystalline silica. Accelerated silicosis is rare and is clinically identical to the classic form of silicosis with the exception that the time from initial exposure to the onset of the disease is shorter and the rate of disease progression is dramatically faster. We describe a case of accelerated silicosis, which mimicked miliary pulmonary tuberculosis. The patient had worked in a mine coal for a period of 9 years. Subsequently, he worked in construction dealing with cement and sand for 14 years until he visited this clinic. The clinical course was notable for the rapid progression of the radiological features of silicosis over a period of 2 months. Polarizing light microscopic studies of the biopsied specimens by a transbronchial lung biopsy showed polarizing particles, which were typical of silica. To the best of our knowledge, this is the first case report of accelerated silicosis in Korea.

Hypoxic - ischemic Encephalopathy in Term Infants: Correlation of Neurosonographic Findings in Basal Ganglia and Thalamus with Prognosis

PURPOSE: To evaluate abnormal neurosonographic (NSG) findings of thalami and basal ganglia in full term babies with hypoxic-ischemic encephalopathy and to correlate the findings with follow-up studies and prognosis. METHODS: We evaluated 13 full term babies with abnormal NSG findings of thalarni and basal ganglia. NSG was performed within 7 days after clinical abnormalities. Follow-up NSG was done in 11 cases; CT scan in 4 and MRI in 7. We classified NSG findings as diffuse, unilateral, and focal types according to increased echogenicity and evaluated prognosis based on follow-up studies and neurological sequelae. RESULTS: Nine cases of diffuse type had diffuse echogenic changes of bilateral thalami and basal ganglia, slit-like lateral ventricles suggesting cerebral edema, and increased parenchymal echogenicity. In diffuse type, follow-up studies showed more prominent echogencities and ventricular dilatations and cerebromalacia. One case of unilateral type caused by thromboembolism had unilateral echogenicity of right thalamus and basal ganglia with increased echogenicity of the ipsilateral cerebral hemisphere and compression of the lateral ventricle, suggesting cerebral infarction. Follow-up study showed unilateral cystic cerebromalacia. Three cases of focal type had a localized echogenic area in thalamus with lacunar infarction, which decreased in size during follow-up. Among nine cases of diffuse type, one died within 2 days, two were discharged against medical advice, and six had severe neurologic sequelae. One case of unilateral type had a moderate degree of neurologic sequelae. All 3 cases of focal type had normal development. CONCLUSION: Pattems of abnormal echogenicity in thalami and basal ganglia in fullterm infants with hypoxic-ischemic encephalopathy are correlated with the outcome and may be helpful for treatment planning.

Analysis of the Diagnostic Efficacy of Breast Imaging Studies in Pathologically Confirmed Cases: Comparison of T-scan with Mammography and Ultrasonography

PURPOSE: The purpose of this study was to compare the diagnostic efficacy of mammography, Ultrasonography(US) and T-scan in pathologically confirmed breast diseases. MATERIALS AND METHODS: Thirty-eight patients withpathologically confirmed breast diseases who had undergone T-scan and mammography and/or US were retrospectivelyreviewed. Cases were categorized as normal, benign, or malignant, and on the basis of disease entity and masssize, the results were compared with pathologic diagnosis. For the of t scans, the conductance ratio was alsoused. RESULTS: Twenty cases were benign and 18 were malignant. The sensitivity, specificity and positivepredictive value of mammography were 100%, 70%, 74%;respectively. For US, the corresponding figures were 100%,82%, 88%, and for T-scan, 33%, 85%, 67%. Between masses with a diameter of less than 2cm and more than 2cm, thesensitivity, specificity, and positive predictive value of mammography and US demonstrated no significantdifference, except in some cases ; for T-scan however, the respective results were 10%, 80%, 33% when lesion sizewas less than 2cm, and 56%, 90%, 83% when lesions were larger than 2cm. The diagnostic efficacy of T-scan was thusgreater for larger lesions than for smaller ones. With regard to the conductance ratio of T-scan no pathologicallymalignant lesions showed high suspicion of malignancy but 33% showed moderate suspicion. CONCLUSION: Mammographyand US were useful in diagnosing breast malignancy. T-scan was less efficient for the diagnosis of breastmalignancies smaller than 2cm, and of infiltrating ductal carcinoma and ductal carcinoma in situ. They may thus beconsidered a complementary to mammography and ultrasound examination.

Ultrafast Contrast-Enhanced MR Angiography of the Carotid Artery: Time Optimization for Discrimination of theArterial from the Venous Phase

PURPOSE: To investigate the optimal delay and acquisition time for discrimination of the arterial from thevenous phase in ultrafast 3D contrast-enhanced MR angiography of the carotid artery. MATERIALS AND METHODS: Wereviewed the MR angiographic findings of 233 patients in whom carotid stenosis and cerebrovascular disease weresuspected. On the basis of delay and acquisition time they were divided into four groups. In the first three,contrast material was injected manually, and after the optimal time, mechanical injection was used for the lastgroup. On the basis of signal intensity of the carotid artery, image quality was graded in four steps.Discrimination of the arterial from the venous phase was graded in three steps, based on the degree of venousenhancement. RESULTS: The best grade of image quality was 70% in the first group, 85% in the second, and 95% inthe third. In discrimination of the arterial-venous phase, the most definite grade was 50% in the first group, 62%in the second, and 75% in the third. Between manual and mechanical injection groups, there was no significantdifference in image quality and discrimination of the arterial-venous phase. CONCLUSION: These results suggestthat for ultrafast 3D contrast-enhanced MR angiography of the carotid artery, with manual injection of contrastmaterial, 8-second delay time and 7-second acqusistion time are optimal.