The Vascular Pedicle Width seen on Chest PA in Normal Korean Adults

PURPOSE: We wanted to measure the vascular pedicle width (VPW) in normal Korean adults and correlate the VPW with the body physique and we also wanted to establish the index for normal VPWs, which could be utilized in reading chest PAs. MATERIALS AND METHODS: The VPW was measured on the posteroanterior (PA) chest radiographs of 262 normal Korean adults (134 men and 128 women, age range: 22-88 years, mean age: 45.2 years), who visited the hospital for a general health examination. The relationship between the VPW and the height and the Body Mass Index (BMI) was evaluated. Correlations between height and the thoracic spine length (TSL) and between the BMI and the lateral chest wall thickness (CWT) were analyzed as well. RESULTS: The mean VPW was 47.4 (+/-6.4) mm. The VPW was positively correlated with the height (p<0.01) and the BMI (p<0.01) of the subject. The patient's height was well correlated with the TSL, and the BMI was correlated with the CWT (r=0.75, r=0.76). The table for the normal VPWs according to patient's TSL and CWT was established. CONCLUSION: By measuring the TSL and the CWT on chest PA, which reflect the height and BMI, respectively, and by utilizing the provided table for the normal VPW, we can determine the normality of a patient's VPW.

Use of High-dose Steroid in a Case of Scrub Typhus with Acutely Progressive Local Neurologic Symptoms / 감염

Scrub typhus, which is caused by Orientia tsutsugamushi, is systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in scrub typhus as in other rickettsial disease. A 54-year-old woman, who was receiving doxycycline under the diagnosis of scrub typhus, developed rapidly progressive neurologic symptoms. During the treatment, abnormal mental function, abnormal lateral gaze, paralysis in upper extremities and dysphasia occurred in the patient. To investigate CNS involvement in the patients, CSF profile (cell count and levels of protein and glucose) and brain radiologic image (brain CT, brain MRI) were concurrently examined. And ampicillin and high-dose steroid were empirically added to her treatment with doxycycline. With use of high-dose steroid, the initial neurologic symptoms such as restlessness and irritability and other disorders like abnormal lateral gaze and paralysis in upper extremities were recovered. And also any other neurologic sequelae did not appear. We could observe the clinical improvements of abnormal neurologic symptoms and signs after use of high-dose steroid in the Orientia tsutsugamushi infected patients. A further intensive study about the steroid therapy in Orientia tsutusgamushi infected patients with focal neurologic symptoms is required.

Magnetic Resonance Imaging of Infectious Myositis

PURPOSE: To describe the findings of magnetic resonance imaging in infectious myositis and to determine theirvalue for differentiation between tuberculous and bacterial myositis. MATERIALS AND METHODS: Magnetic resonanceimages of ten proven cases of infectious myositis, (five tuberculous and five bacterial) were retrospectivelyreviewed in the light of clinical and laboratory findings. On the basis of magnetic resonance images, signalintensity of the mass, the presence or absence of an abscess, signal intensity of the peripheral wall, patterns ofcontrast enhancement, and associated findings were evaluated. RESULTS: Compared with those of bacterial myositis,the symptoms of tuberculous myositis lasted longer but there were no definite local inflammatory signs. In threeof five cases of bacterial myositis there were specific medical records ; trauma in two cases and systemic lupuserythematosus in one. All tuberculous myositis cases involved a single muscle, but bacterial myositis affectedmultiple muscles in three cases(60%). All but one case showed a mass in the involved muscles. In one bacterialcase, there was diffuse swelling in the involved muscle. On T1-weighted images, eight infectious cases showed lowsignal intensity ; two, of the bacterial type, showed subtle increased signal intensity. All cases demonstratedhigh signal intensity on T2-weighted images. The signal intensity of peripheral wall was slightly increased onT1-weighted images, but low on T2-weighted. In four cases there was associated cellulitis, and in one case each,adjacent joint effusion and deep vein thrombosis were seen. After gadolinium infusion, peripheral rim enhancementwas noted in nine cases and heterogeneous enhancement in one. CONCLUSION: After magnetic resonance imaging ofinfectious myositis, the characteristic finding was an abscessed lesion, with the peripheral wall showing highsignal intensity on T1-weighted images and low signal intensity on T2 weighted. Although we found it difficult todifferentiate bacterial from tuberculous myositis, magnetic resonance imaging findings and clinical manifestationsmay help in this respect.