Sonographic Features of Dual Ectopic Thyroid: Report of Two Cases

Ectopic thyroid is an uncommon congenital abnormality, but ectopic thyroid tissue can be present anywhere along the course of the thyroglossal duct and the embryologic descent from the base of the tongue. We report here on two cases with the ultrasonograpic findings of dual ectopy of the thyroid, and these findings were well correlated with the findings of nuclear scintigraphy.

Pictorial Review of Diffuse Central Airway Diseases: Focus on CT Findings / 결핵및호흡기질환

Various diseases can diffusely involve central airways, including the trachea and main stem bronchi. Central airway abnormalities are frequently not apparent or are overlooked on chest radiographs, even though the patient may have significant symptoms. Recent advances in spiral and multi-detector computed tomography (CT) with multi-planar reconstruction and three-dimensional demonstration, including virtual bronchoscopy, allow for excellent display of central airway anatomy and abnormalities with visualization of accurate locations of lesions. Early detection and proper diagnosis of airway diseases based on various radiographic findings will help determine appropriate treatment, including surgical planning and evaluation of treatment response. Herein we describe and illustrate the imaging findings of a wide spectra of diffuse central airway diseases.

Pictorial Review of Diffuse Central Airway Diseases: Focus on CT Findings / 결핵및호흡기질환

Various diseases can diffusely involve central airways, including the trachea and main stem bronchi. Central airway abnormalities are frequently not apparent or are overlooked on chest radiographs, even though the patient may have significant symptoms. Recent advances in spiral and multi-detector computed tomography (CT) with multi-planar reconstruction and three-dimensional demonstration, including virtual bronchoscopy, allow for excellent display of central airway anatomy and abnormalities with visualization of accurate locations of lesions. Early detection and proper diagnosis of airway diseases based on various radiographic findings will help determine appropriate treatment, including surgical planning and evaluation of treatment response. Herein we describe and illustrate the imaging findings of a wide spectra of diffuse central airway diseases.

Acute Diffuse Phlegmonous Esophagogastritis: A Case Report

Acute phlegmonous infection of the gastrointestinal tract is characterized by purulent inflammation of the submucosa and muscular layer with sparing of the mucosa. The authors report a rare case of acute diffuse phlegmonous esophagogastritis, which was well diagnosed based on the typical chest computed tomographic (CT) findings and was successfully treated. A 48-yr-old man presented with left chest pain and dyspnea for three days. Chest radiograph on admission showed mediastinal widening and bilateral pleural effusion. The patient became febrile and the amount of left pleural effusion is increased on follow-up chest radiograph. Left closed thoracostomy was performed with pus drainage. A CT diagnosis of acute phlegmonous esophagogastritis was suggested and a surgery was decided due to worsening of clinical condition of the patient and radiologic findings. Esophageal myotomies were performed and the submucosal layer was filled with thick, cheesy materials. The patient was successfully discharged with no postoperative complication.

Concurrent Occurrence of Type II and Type III Endoleak of Abdominal Aortic Aneurysm Stent Graft: A Case Report

Endoleak is an important complication following stent grafts for abdominal aortic aneurysms. Here we describe ultrasonography findings in an 86-year-old man including doppler ultrasonography and CT scan in an unusual and interesting case of the concurrent occurrence of a type II endoleak that originated from the left accessory renal artery and a type III endoleak due to shaft fracture of the stent.

High-Resolution Ultrasonography (US) of Appendiceal Specimens: Differentiation of Acute Non-perforated Appendicitis from Perforated Appendicitis

PURPOSE: To analyze surgical specimens from patients with acute non-perforated and perforated appendicitis using high-resolution ultrasonography (US), and to correlate the US features with the pathologic findings. MATERIALS and METHODS: One hundred and six surgical appendix specimens obtained from patients with suspected acute appendicitis were evaluated. The following US features were evaluated for differentiating acute non-perforated appendicitis from perforated appendicitis: circumferential loss of the echogenic submucosal layer, disruption of the serosal layer, asymmetrical wall thickening, the sum of opposing walls > or = 9 mm and the presence of appendicoliths. The sensitivity and specificity of the US findings for diagnosing perforated appendicitis were determined. RESULTS: All US features were detected significantly more often in the perforated appendicitis group of specimens. The disruption of the serosal layer was the most significant independent predictor of perforation (p or = 9 mm, and the presence of appendicoliths individually was 84.6%, 69.2%, 61.5%, 73.1% and 46.2%, respectively. The specificity for all of these findings was 86.3%, 98.7%, 95.0%, 85.0% and 85.0%, respectively. CONCLUSION: High-resolution US of appendiceal specimens was very useful for differentiating acute non-perforated from perforated appendicitis.

CT Gastrography Findings of a Gastric Collision Tumor that Consisted of an Adenocarcinoma and Neuroendocrine Tumor: A Case Report

Concurrent occurrence of an adenocarcinoma and carcinoid tumor in the stomach has been observed infrequently; moreover, a gastric collision tumor of both tumor types has rarely been seen. We describe a case of a gastric collision tumor following the differential diagnosis from observing the morphological patterns more closely using CT gastrography. The patient presented with a gastric collision tumor that consisted of an adenocarcinoma and carcinoid tumor in the antrum of the stomach.

Differentiation of Benign and Malignant Cystic Lesions of the Breast according to Sonographic Findings

PURPOSE: To classify the ultrasonographic findings of cystic lesions of the breast and correlated them with the pathology, to evaluate the characteristic features of cystic masses in benign and malignant tumors, and to determine the appropriate level of patient management according to the ultrasonographic findings. MATERIALS AND METHODS: From June 2002 through to June 2004, the ultrasonographic findings of 113 pathological proven cystic breast lesions were reviewed retrospectively. The cystic lesions were classified as simple acysts, clustered cysts, cysts with thin septa, complicated cysts, cystic masses with a thick wall/ septa or nodules, and complex solid and cystic masses. The ultrasonographic findings of each type of cystic lesion of the breast were compared with the pathology and evaluated according to whether they were benign or malignant. RESULTS: Of the 113 lesions, there were 17 simple cysts, 10 clustered cysts and 19 cysts with thin septa. Twenty four cases of complicated cysts were found to be benign. Five (31.3%) of the 16 cases of cystic masses with a thick wall / septa or nodules and 17 (63%) of the 27 cases of complex solid and cystic masses were found to be malignant. The shape and margin of the 43 cases of cystic masses with a solid component were analyzed. Seventeen out of 36 sonographical round or oval shaped masses and 10 out of 27 sonographical circumscribed margins were found to be malignant. CONCLUSION: The simple cysts, clustered cysts, cyst with thin septa and non-symptomatic complicated cysts detected by sonography were all benign. Symptomatic complicated cysts should be aspirated and treated appropriately. Cystic masses with a solid component should be examined by a biopsy with a pathological confirmation.

A Case of Complete Regression of Hepatocellular Carcinoma during Administration of COX-2 Inhibitor / 대한간학회지

Overexpression of cyclooxygenase-2 (COX-2) has been associated with hepatocarcinogenesis. Inhibitors of COX-2 have proapoptotic and antiproliferative effects on malignant tumors and inhibit tumor invasion to the surrounding tissues. We report here a case of complete regression of advanced hepatocellular carcinoma (HCC) during COX-2 inhibitor administration. An eighty-year-old female was diagnosed as an advanced HCC, which was associated with HCV infection. She received COX-2 inhibitor for 3 months due to degenerative arthritis of both knees. Tumor enhancement on arterial phase CT completely disappeared without specific treatment for the HCC, and the tumor size decreased on the follow-up CT scan.

Subtle Pleural Metastasis without Large Effusion in Lung Cancer Patients: Preoperative Detection on CT

OBJECTIVE: We wanted to describe the retrospective CT features of subtle pleural metastasis without large effusion that would suggest inoperable lung cancer. MATERIALS AND METHODS: We enrolled 14 patients who had open thoracotomy attempted for lung cancer, but they were proven to be inoperable due to pleural metastasis. Our study also included 20 control patients who were proven as having no pleural metastasis. We retrospectively evaluated the nodularity and thickening of the pleura and the associated pleural effusion on the preoperative chest CT scans. We reviewed the histologic cancer types, the size, shape and location of the lung cancer and the associated mediastinal lymphadenopathy. RESULTS: Subtle pleural nodularity or focal thickening was noted in seven patients (50%) having pleural metastasis and also in three patients (15%) of control group who were without pleural metastasis. More than one of the pleural changes such as subtle pleural nodularity, focal thickening or effusion was identified in eight (57%) patients having pleural metastasis and also in three patients (15%) of the control group, and these findings were significantly less frequent in the control group patients than for the patients with pleural metastasis (p = 0.02). The histologic types of primary lung cancer in patients with pleural metastasis revealed as adenocarcinoma in 10 patients (71%) and squamous cell carcinoma in four patients (29%). The location, size and shape of the primary lung cancer and the associated mediastinal lymphadenopathy showed no significant correlation with pleural metastasis. CONCLUSION: If any subtle pleural nodularity or thickening is found on preoperative chest CT scans of patients with lung cancer, the possibility of pleural metastasis should be considered.

Usefulness of Thromboaspiration with Desilets-Hoffman Sheath in Thrombosed Hemodialysis Access Graft

PURPOSE: The purpose of this study was to evaluate the feasibility, efficacy and safety of percutaneous thromboaspiration with a Desilets-Hoffman Sheath compared with the previously established percutaneous mechanical thrombectomy technique in cases of occluded dialysis graft. MATERIALS AND METHODS: One hundred and sixty eight patients (103 women, 65 men; mean age, 54.7 years; mean graft age, 20.9 months) with 225 episodes of dialysis graft thrombosis underwent percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath using the crossing catheter or single puncture technique. The technical success rate, procedure time, and complication and patency rates were analyzed. RESULTS:Technical success was achieved in 200 of the 225 procedures (88.9%). The average duration of the intervention was 74.3+/-35 minutes. The primary patency rate was 63.1% at 3 months, 44.2% at 6 months and 26.3% at 1 year. Major complications occurred in 4% of the cases (4 venous ruptures; 4 arterial embolisms; 1 arterial rupture) and minor complications occurred in 13.8% of the cases (26 minor venous ruptures; 4 intragraft ruptures; 1 venous dissection). These results were quite similar to those obtained with the previous mechanical thrombectomy technique. CONCLUSION: Percutaneous thromboaspiration of occluded dialysis grafts with a Desilets-Hoffman Sheath is an effective and safe method.

MR Imaging of Diabetic Mastopathy: A Case Report / 한국유방암학회지

Diabetic mastopathy is a rare disease that occurs in long-term insulin-dependent diabetic patient. It manifests as a hard palpable breast mass that may be clinically indistinguishable from a breast carcinoma. Mammography shows a non-specific, dense, heterogenous glandular opacity in both breasts. Sonography shows a markedly hypoechoic, ill-marginated mass with a posterior acoustic shadowing. We present the mammography, ultrasonography and MRI findings of a 54-year-old woman with diabetic mastopathy.

Progression of Desmoid Tumors in Familial Polyposis: A Case Report

Multiple large bowel polyps are the hallmark of familial adenomatous polyposis (FAP), and many progress to colorectal cancer. Desmoid tumors are more common in patients with FAP than in other people, occurring, particularly, in those who have previously undergone prophylatic total colectomy. In such patients, desmoid tumors are a common cause of death. In an FAP patient without extracolic manifestation, who has undergone prophylatic surgery, multifocal desmoid tumors occur periodically. We report the serial radiologic findings of progressive desmoid tumors in FAP, drawing attention to the related findings of previous research.

HRCT Findings of Asthmatic Children under Maintenance Therapy

PURPOSE: The purpose of this study was to evaluate the HRCT findings of bronchial asthma during maintenance bronchodilator therapy and to determine whether there were irreversible bronchial changes occurred in pediatric patients with this condition. MATERIALS AND METHODS: HRCT findings of the lung in 21 asthmatic children [14 boys and 7 girls aged between 3.5 and 13.8 (mean : 7.7) years] who were receiving maintenance bronchodilator therapy were retrospectively studied. At the time of CT examination, 16 were receiving nonsteroid bronchodilator therapy only, and five were receiving both bronchodilator and steroid therapy. Thirteen patients were defined as allergic and eight were nonallergic. The clinical severity of chronic asthma was graded as severe in seven cases, and moderate in 14. The duration of the disease ranged from 4 months to 6 years (mean 3.2 years). HRCT was performed in 19 cases for evalvation of the atelectasis, hyperinflation, and prominent bronchovascular bundles seen on plain radiographs, and in two cases for evaluation following acute exacerbation. A CT W-2000 scanner (Hitachi Medical Co. Tokyo, Japan) was used during the end inspiratory phase, and in addition, ten patients were scanned during the expiratory phase. Scans were reviewed for evidence of bronchial thickening, bronchiectasis, emphysema, abnormal density, mucus plugs, and other morphological abnormalities. The presence of bronchial wall thickening or air trapping was evaluated according to the duration, severity and type of asthma. RESULTS: Among the 21 patients, 7(33.3%) had normal HRCT findings, while in 14 (66.7%), bronchial wall thickening was demonstrated. Eleven of the 14 patients with bronchial wall thickening (78.6%) also had air trapping. No patient was suffering from bronchiectasis or emphysema. There were no statistically significant correlations between the presence of bronchial wall thickening or air trapping and the duration of the disease, its severity, or type of asthma. There was, however, a statistically significant correlation between bronchial wall thickening and air trapping (p < . 0 5 ). CONCLUSION: In asthmatic children who were under maintenance therapy, the most frequent HRCT findings were bronchial wall thickening and air trapping, with significant correlation between the presence of these two phenomena. No destructive lesion such as bronchiectasis or emphysema was found in these asthmatic children, however, and this is probably due to the short duration of the disease, and different disease processes.

Volume Changes of Thy roid Nodules after Thy roxine Suppression Therapy: The Usefulness in Predicting Malignancy

PURPOSE: To evaluate the usefulness of volume change after thyroxine suppression therapy in predicting the malignancy of thyroid nodules. MATERIALS AND METHODS: We analyzed 28 cases of thyroid nodules diagnosed as benign by aspiration cytology or biopsy before thyroxine suppression therapy and which did not decrease more than 50% in volume after therapy. Using Ultrasonography we measured the volume of nodules before and after thyroxine suppression therapy and then determined volume change by calculating nodule volume suppression rate (NVSR) and comparing this beween benign and malignant nodules. All cases were surgically confirmed. N V S R ( % ) = nodule volume after treatment x 1 0 0 nodule volume before treatment RESULTS: Seventeen (60.7%) of 28 thyroid nodules which showed less than 50 % NVSR after thyroxine therapy were shown by surgical resection to be malignant, while 11(39.3 %) were benign. The malignant cases were papillary carcinoma (n=9) and follicular carcinoma (n=8), while benign cases were either follicular adenoma (n=7) or adenomatous hyperplasia (n=4). The mean volume of malignant thyroid nodules was 5.2 +/- 4 .5cm3 before thyroxine suppression therapy and 5.9 +/- 4 .5 cm3 after therapy, and that of benign nodules, 12.1 +/- 10.3 cm3 before therapy and 10.1 +/- 9.9 cm3 after. NVSR was 127.2 +/- 46.2 % in malignant nodul es and 79.4 +/- 21.0% in benign nodules, with no significant difference between the two groups (P < 0.05). CONCLUSION: Although further studies may be required, fine needle aspiration cytology or biopsy showed that among benign thyroid nodules which did not decrease more than 50 % in volume after thyroid therapy, the incidence of malignancy revealed by surgical resection was more than 60 %. Surgical exporation of these nodules is therefore highly recommended.

CT for Preoperative Prediction of Axillary Lymph-Node Status in Patients with Breast Cancer

BACKGROUND: The clinical staging may serve to guide initial therapy based on all available preoperative data, such as history, physical and laboratory examinations, and biopsy material. Computed tomography is one of the most attractive methods of evaluating the clinical state of patients with breast cancer. In cases where the lymph nodes are enlarged, CT of the chest can accurately detect the level of axillary lymph nodes involvement. CT may also simultaneously play a role in evaluating the mediastinum and the supraclavicular areas for adenopathy, primary tumors and lung metastases. The aim of this study was to determine the appropriate size criteria for metastatic axillary lymph nodes on CT and to evaluate the validity of using CT to detect axillary lymph-node metastases due to breast cancer. METHODS: CT examination of the chest was performed before axillary lymph node dissection in 98 patients with breast cancer. We measured the sizes of the lymph nodes according to the short-axis diameters seen on CT. We estimated the sensitivity, the specificity, the ROC curve, and the predictability of CT based on lymph-node sizes. RESULTS: The diagnostic criterion for node metastases was 5 mm. At the 5 mm point, the accuracy of CT for axillary metastases was 70% with a sensitivity of 89%, a specificity of 60%, a negative predictive value of 90%, and a positive predictive value of 56%. CONCLUSIONS: In conclusion, CT is not an accurate assessment in the diagnosis of axillary lymph-nodemetastases due to breast cancer. However, CT data can be interpreted with sufficient sensitivity and negative predictability for CT to serve as a screening test.

Benign versus Malignant Lymphadenopathy: The Usefulness of Color Doppler Sonography

PURPOSE: To evaluate the vascular pattern of lymph nodes, and the usefulness of color Doppler sonogaphy indifferentiating benign from malignant superficial lymphadenopathy. MATERIALS AND METHODS: Twenty-six patientswere pathologically and clinically confirmed to be suffering from benign reactive lymphadenitis and tuberculosis(n=16) or lymphoma and malignant lymphadenitis (n=10). Lymph node shape was assessed by the ratio of longitudinaldiameter to transverse diameter(L/T), and patients were thus assigned to one of two groups : L/T >or =2, or L/Tor =2,and 3 L/T<2. while in nine of the ten malignant nodes, L/T<2 was noted. Among 16 benign reactive nodes, hilarvascularity was central in 13, eccentric in one, and absent in two. Among the ten malignant nodes, thecorresponding totals were nil, four, and Six. The hilar vascular pattern showed statistically significantdifferentiation between malignant and benign node (p<.05). Among 16 benign reactive nodes, 13 were grade 0, twowere grade I, and one was grade II, while among ten malignant nodes, two were grade 0 and eight were grade I. Onthe basis of vascular pattern, the difference between benign and malignant nodes was statistically significant(p<.05). CONCLUSION: L/T ratio<2, absent or eccentric hilar vascularity, and the presence of peripheralvascularity are suggestive of malignant lymph node. The shape of LN and pattern revealed by an analysis of nodalvascularity using color Doppler sonography are useful in differential diagnosis of benign and malignantlymphadenopathy.

Bone Changes in Phenylketonuria

PURPOSE: While treating 14 phenylketonuria(PKU) patients, we evaluated bone density, changes in bone age, andbony changes such as spiculation or metaphyseal widening. MATERIALS AND METHODS: A total of 14 PKU patients agedbetween 1 month and 14 years(mean, 6.4 years) were under dietary treatment. Eight and eleven patients underwentradiography of the left hand and wrist and bone densitometry(BMD) of the lumbar spine, respectively. The resultswere reviewed with regard to abnormal bony changes, delayed bone age, and osteopenia. Patients were assigned toeither the early or late treatment group, depending on whether or not dietary therapy was started before 3 monthsof age. Those in whom a blood phenylalanine level of under 10 mg/dl was maintained were assigned to the 'goodcontrol' group; others were classified as 'variable control'. The findings of radiographs of the left hand andlumbar BMD were evaluated in relation to the time of dietary therapy, and adequacy of treatment. RESULTS: Onlumbar BMD, four of 11 patients (36%) showed reduced bone density of more than 1 S.D. None of the 11 who underwentradiography of the left hand showed bony abnormalities such as spiculation or metaphyseal widening. In four of the11, bone age was less than chronological age by at least one year. According to Fisher's exact test there was norelation between delayed bone age , osteoporosis and the time and adequacy of dietary therapy (p >0.05). CONCLUSION: None of the 14 PKU patients who underwent dietary therapy had bony abnormalities such as spiculationor metaphyseal widening. In four of the 11, bone age was at least one year less than chronological age, and onlumbar BMD, osteoporosis was seen. For the evaluation of bone change in PKU patients, plain radiography and BMDare thus complementary.

Fine Needle Aspiration Cytology of Matrix Producing Carcinoma of the Breast / 대한세포병리학회지

Matrix producing carcinoma of the breast is a variant of heterologous metaplastic carcinoma which is defined as "overt carcinoma with direct transition to a cartilagenous and/or osseous stromal matrix without an intervening spindle cell zone or osteoclastic cells". This tumor is very rare, occuring in less than 0.2% of total breast carcinoma, but the prognosis is better than other metaplastic carcinoma. We experienced a case of fine needle aspiration(FNA) cytologic finding of matrix producing carcinoma of the breast. A 75-year old woman, who presented a right huge breast mass(9x8cm) during 10months, was examined. Mammography reveals right lateral mass with even density without calcification. Breast ultrasonography shows multifocal hypoechogenic cystic change in the huge mass, suggesting resolving hematoma or carcinoma or sarcoma with necrosis. On cytologic finding of FNA, myxoid matrix was the dominant feature and the rest of the material was composed of scanty isolated atypical cells with large irregular nuclei. The histologic finding was moderately differentiated adenocarcinoma with abundant cartilagenous matrix and focal squamous metaplasia.

Acquired Cystic Kindey Disease in Dialysis and Renal Transplant Patients: Ultrasonography and CT Analysis

PURPOSE: To evaluate by US and CT the incidence and complications of acquired cystic kidney disease (ACKD) in dialysis and renal transplant patients and to compare the effectiveness of US and CT in the diagnosis of this entity. MATERIALS AND METHODS: This study was prospectively performed in 70 dialysis patients and 13 renal transplant patients, and excluded any with multiple renal cysts or polycystic kidney disease, on as seen on initial films. US were obtained in all patients, and CT scans were randomly obtained in 27 who had been on dialysis for 3 years or more; all these US and CT scans were analyzed, with particular emphasis on whether or not cysts were present. In order to correlate the numbers of cysts with duration of dialysis, all patients were assigned to one of three groups, according to the number of cysts found (group 1, 0; group 2, 1-4; group 3, >4).Only group 3 was diagnosed as suffering from ACKD. In order to compare the cyst-detection capability of US with that of CT, 27 dialysis patients who had undergone US and CT were divided into four groups according to the numberof cysts found (grade 1, 0; grade 2, 1-4; grade 3, 5-10; grade 4, >10). RESULTS: Seventy dialysis patients were divided according to the results of US, as follows : group 1, 20%; group 2, 47.1%; group 3, 32.9%. The mean duration of dialysis in group 1 (31.9 months) was statistically different from that in group 2 (50.6 months) and in group 3 (95.8 months) (p<0.000). Thirteen renal transplant patients were divided as follows : group1, 61.5%; group 2, 38.5%; group 3, 0%. In dialysis patients with ACKD, complications noted were renal cell carcinoma(n=1), hemorrhagic cysts(n=2), and hematomas(n=2) Among the 27 dialysis patients who underwent CT, this and US showed an equal grade of cystic change in 53.7%, while CT showed a higher grade in 46.3%. The detection rate of ACKD in these 27 patients was 46% on US and 63% on CT. CONCLUSION: A prolongation of dialysis corresponded to an increased incidence of ACKD; renal neoplasm and hemorrhage may occur in dialysis patients, but ACKD and its complications did not develop in renal transplant patients. In long-term dyalysis patients, regular follow-up studies of kidneys using US or CT are therefore needed. CT was superior to US in diagnosing ACKD.