The Effect of Lung Volume on the Size and Volume of Pulmonary Subsolid Nodules on CT: Intraindividual Comparison between Total Lung Capacity and Tidal Volume

Purpose@#To examine the effect of lung volume on the size and volume of pulmonary subsolid nodules (SSNs) measured on CT. @*Materials and Methods@#A total of 42 SSNs from 31 patients were included. CT examination was first performed at total lung capacity (TLC), and a section containing the nodule was additionally scanned at tidal volume (TV). The diameter and volume of each SSN, as well as the crosssectional lung area containing the nodule, were measured. The significance of the changes in measurements between TLC and TV within the same individuals was evaluated. @*Results@#The lung area and the diameter and volume of SSNs decreased significantly at TV by 12.7 cm2 , 0.5 mm, and 46.4 mm3 on average, respectively (p < 0.001), compared to those at TLC. Changes in lung area between TV and TLC were positively correlated with the change in SSN diameter (p = 0.027) and volume (p = 0.014). However, after correction (by considering the change in lung area), the changes in SSN diameter (p = 0.124) and volume (p = 0.062) were not significantly different. @*Conclusion@#SSN size and volume can be significantly affected by lung volume during CT scans of the same individuals.

Spontaneous regression of cardiac sarcoidosis resulting in total occlusion of coronary artery and ventricular aneurysm

No abstract available.

Spontaneous regression of cardiac sarcoidosis resulting in total occlusion of coronary artery and ventricular aneurysm

No abstract available.

A Single Thorax (Buffalo Chest) / 결핵

A-59-year old man was admitted to the hospital with a 2-month history of the right pleuritic chest discomfort and mild dyspnea. Seven years earlier, he was operated on left pneumonectomy for squamous cell carcinoma of left upper lobe (Stage IIb, T2N1M0). The computed tomographic scan revealed an anterior herniation of the right lung in the left hemithorax. A single thorax after receiving pneumonectomy is called a "buffalo chest" because the absence of an anatomical separation of the two hemithoraxes resembles that of the North American buffalo or bison. A possible pneumothorax should be catastrophic for the patient, so he should be closely monitored regarding any invasive procedure or trauma. He improved after symptomatic treatment.

Endobronchial Metastasis of Hepatocellular Carcinoma

Endobronchial metastasis (EBM) secondary to extrathoracic malignancies is rare among the various modes of pulmonary metastases. Of the many types of extrathoracic tumors capable of EBM, only one case of EBM from hepatocellular carcinoma has been reported, but radiologic findings were not described. We present the radiologic findings of surgically proven EBM in a patient with hepatocellular carcinoma. A chest radiograph revealed a tubular mass-like opacity in the right suprahilar region combined with mild volume decrease of the right upper lobe. Fiberoptic bronchoscopy had erroneously led to a diagnosis of endobronchial aspergilloma. The metastatic lesion was manifested as a branching pattern of enhanced endobronchial mass at the anterior segment of the right upper lobe on computed tomography.

A Case of Giant Emphysema Mimicking Pneumothorax in Chest X-Ray / 결핵

A 49-year-old male presented with a giant bullous emphysematous lung mimicking a pneumothorax. The initial chest X-ray revealed that the left lung was totally collapsed. A chest tube was inserted at the emergency room, after that an iatrogenic pneumothorax developed. The HRCT showed giant bullous emphysema mimicking a pneumothorax. The pneumothorax spontaneously resolved without special treatment. His bullous lung lesion had remained unchanged until last follow-up.

Evaluation of the Post-Shunt Status with Electron Beam Computed Tomography in Cyanotic Congenital Heart Disease

The assessment of the accuracy of Electron Beam Computed Tomography (EBCT) for the follow-up of pulmonary vascular system after the shunt operation in cyanotic congenital heart diseases was purpose of the study. The study group consists of 16 consecutive patients with cyanotic congenital heart disease who had Blalock-Taussig (BT) shunt (n=7), bi- directional cavo-pulmonary shunt (BCPS, n=7) and unifocalization (n=2). EBT images were obtained on systolic phase under EKG gating and after intravenous administration of contrast agent. We evaluated the shunt patency, anatomy of intrapericardial pulmonary artery, parenchymal pulmonary vessels and background lung attenuation for the pulmonary blood flow, and the presence of systemic arterial and venous collaterals. Angiography (n=12) and echocardiography (n=16) were used as the gold standards. EBCT was consistent with angiogram in detecting the shunt patency and in depicting the anatomy of the intrapericardial pulmonary artery. Occlusion of the BT shunts was not detected in 2 patients by echocardiography. Diffuse or focally decreased pulmonary flow on EBCT in 8 patients was consistent with the pulmonary hemodynamics pattern revealed by cardiac catheterization. Uneven attenuation between lobes was related with multifocal supply of pulmonary flow or occlusion of lobar pulmonary arteries. Systemic collateral arteries were observed in 5 at the corresponding site of the decreased pulmonary flow. Systemic venous collaterals seen in all patients following BCPS were eventually draining to the inferior vena cava in 5 and to the left atrium in 2. EBCT provided accurate information of the pulmonary vascular system after shunt and has unique advantage over echocardiography in assessing patency of BT shunt or unifocalization tubes within the pleural space, the estimation of regional difference in pulmonary hemodynamics, and the detection of systemic collateral vessels. Therefore EBCT may provide useful information about the timing of definitive correction and the need for a second shunt or an interventional procedure prior to total repair.

Usefulness of PC Based 3D Volume Rendering Technique in the Evaluation of Suspected Aneurysm on Brain MRA

PURPOSE: To evaluate usefulness of volume rendering technique using 3D visualization software on PC in patients with suspected intracranial aneurysm on brain MRA. MATERIALS AND METHODS: We analyzed prospectively 21 patients with suspected aneurysms on the routine MIP images which were obtained 15 degree increment along axial and sagittal plane, among 135 patients in whom brain MRA was done due to stroke symptoms for recent 5 months. The locations were the anterior communicating artery (A-com) in 8 patients, the posterior communicating artery (P-com) in 3, the ICA bifurcation in 5, the MCA bifurcation in 4, and the basilar tip in one. Male to female ratio was 14:7 and mean age was 62 years. MRA source images were sent to PC through LAN, and the existence of aneurysm was evaluated with volume rendering technique using 3D visualization software on PC. The presence or absence of aneurysm on MIP and volume rendering images was decided by the consensus of two radiologists. RESULTS: We found the aneurysms with volume rendering technique, from 1 patient among 8 patients with suspected aneurysm at A-com and also 1 patient among 3 patients with suspected aneurysm at P-com on routine MIP images. Confirmative angiography and interventional procedures were done in these 2 patients. The causes for mimicking the aneurysm on MIP were flow displacement artifact in 9, normal P-com infundibulum in 2, and overlapped or narrowed vessels in 8 patients, and among them confirmative angiography was done in 2 patients. CONCLUSION: Volume rendering technique using visualization software on PC is useful to scrutinize the suspected aneurysm on routine MIP images and to avoid further invasive angiography.

MRI Differential Diagnosis of Complete and Partial Tears of the Anterior Cruciate Ligament of the Knee: The Usefulness of Oblique Coronal T2-Weighted Image

PURPOSE: To assess the usefulness of T2-weighted oblique coronal MR imaging (T2OCI) in the differential diagnosis of complete and partial tears of the anterior cruciate ligament (ACL) of the knee. MATERIALS AND METHODS: Thirty-three patients with ACL tear (16 complete and 17 partial tears), comfirmed by arthroscopy, were included in this study. Conventional MR imaging and T2OCI were performed, and the findings were retrospectively reviewed by two radiologists in terms of continuity, shape, axis and internal signal intensity of the ligament. Each finding was tested if there were stastistically significant differences in its prevalence between partial and complete tears. The diagnostic accuracy of T2OCI and conventional MR imaging in the detection of partial and complete tears of the ACL were compared. RESULTS: Conventional MR imaging revealed no statistically significant finding for differential diagnosis of complete and partial ACL tears. The reliable and statistically significant (p<0.001) findings of T2OCI were complete discontinuity of the ligament in cases involving complete ACL tears (14 of 16 complete tears and 2 of 17 partial tears) and the preservation of the band form for partial ACL tears (2 of 16 complete tears and 15 of 17 partial tears). The accuracy of T2OCI and conventional MR imaging was 88% and 70%, respectively. CONCLUSION: When ACL injury is vague on conventional MR images, a modality which is more useful in the differential diagnosis of partial and complete tears of the ACL, and in predicting the site of a tear, is T2-weighted oblique coronal imaging.

Malignant Gastrointestinal Stromal Tumor of Mesentery Origin: Case Report

A primary tumor of mesenteric origin is rare. We encountered a malignant gastrointestinal stromal tumor (GIST) of mesenteric origin that demonstrated severe necrosis, and report the CT findings and review the literature.

Unusual Presentation of Extralobar Pulmonary Sequestration: A Case Report

Extralobar pulmonary sequestration, a rare form of bronchopulmonary sequestration, is a congenital anomaly in which a portion of nonfunctioning lung tissue is surrounded by its own pleura and is supplied by a systemic artery. We describe a case of extralobar pulmonary sequestration with unusual features. CT scanning of the chest demonstrated a non-enhancing, hyperdense mass within the right major fissure, and thoracotomy revealed that the mass received blood from a branch of the right pulmonary artery and drained into the left atrium. The pathologic diagnosis was extralobar pulmonary sequestration.

Coronary Artery Calcium Score using Electron Beam Tomography in the Patients with Acute Obstructive Coronary Arterial Disease : Comparative Study with Asymptomatic High-Risk Group of Atherosclerosis and Chronic Obstructive Coronary Arterial Disease Group

PURPOSE: To compare, through enalysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrone between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. MATERIALS AND METHODS: The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD group (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex, and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. RESULTS: The mean CAC score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.006). The mean CAC score at the sixth decade was also significantly different between group I (81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC+1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly higher than in groups I and II. Multiple regression analysis showed that the CAC score was related to age, diabetes mellitus and hypertension in group I, diabetes mellitus only in group II, but no particular factor in group III. CONCLUSION: The CAC score of the acute coronary syndrome group tended to be lower than that of the chronic CAOD group. It appears to be difficult to predict acute coronary syndrome on the basis of CAC alone. Compared with the asymptomatic high-risk group of atherosclerosis patients, the acute coronary syndrome group, whose members are younger and have a higher incidence of smoking, has a relatively high CAC score.

CT and MR Findings of Primary Cardiac Lymphoma: Report upon 2 Cases and Review

Although primary cardiac lymphoma was a near fatal disease in the past, recent advances in imaging diagnosis and chemotherapy have dramatically improved survival. We describe the CT and MR findings of primary cardiac lymphoma in two immunocompetent subjects who recovered after chemotherapy. The primary cardiac lymphomas manifested as a poorly enhancing mass on CT, relatively hyperintense on a T2-weighted image and a heterogeneously enhanced mass on contrast-enhanced MR. The tumor also showed a predilection for right heart chambers and contiguous infiltration along adjacent structures.

The Role of CT in the Diagnosis of Bronchogenic Carcinoma not Detected by Plain Radiograph

PURPOSE: To evaluate the role of CT and CT features in the diagnosis of bronchogenic carcinomas not detected by plain radiography. MATERIALS AND METHODS: Eighteen patients [19 primary cancer lesions, M:F=16:2, aged 43 -75 (mean, 56.3)years] with lung cancer initially not detected by plain radiography were involved in this study. CT scanning was performed in all cases, and fibrobronchoscopy, and sputum cytology. each in 17. Lesions were divided into two groups: the central type, if on or proximal to the segmental bronchus, and the peripheral type, if distal to this. Plain radiographs were analysed for possible causes of occultness and for clinical characteristics including cell type, location, and size. We focused on the CT findings, comparing cases undetected by CT with those undetec6ted by bronchoscopy. RESULT: In the central type, the cause of occultness, as seen on plain radiographs, was small size, no secondary findings, or confusing shadow from hilar vessels. In the peripheral type, the cause was overlapping shadow due to normal structures of the chest, or combined diseases. Eight lesions were first detected by sputum cytology, 6 by bronchoscopy, and 5 by CT. Fourteen lesions were the central type (main bronchus 2, lobar bronchus 7, segmental bronchus 5), and five were peripheral. Central-type lesions were either squamous cell carcinoma (n =11), adenocarcinoma (n =1), small cell carcinoma (n =1), or large cell carcinoma (n =1). The peripheral type were either squamous cell carcinoma (n =2), adenocarcinoma (n =2), or large cell carcinoma (n =1). Size ranged from 0.2 to 4(mean, 2; central 1.7, peripheral 2.8) cm. Surgical resection was possible in 15 patients (16 cancers, including 13 at stage I). Only two were at a stage which rendered them unresectable. CT revealed 13 cancers, including all those which were peripheral. The findings were endobronchial nodule (n =4), bronchial wall thickening (n =1), perihilar mass (n =3), parenchymal mass (n =2), and subpleural mass (n =3). In six central-type cases [endobronchial mass (n =5), carcinoma in situ(n =1)], CT revealed no evidence of cancer. The mean size of these lesions was 1.1cm, and all were stage I. Bronchoscopy failed to detect five cases, including four peripheral cancers and one central. The mean size of these was 2.7 cm and all three adenocarcinomas were included in this group. In two of the five cases in which sputum cytology showed negative results, the existing condition was revealed by CT. CONCLUSION: For the detection of peripheral lung cancer, CT is better than bronchoscopy, though in cases of central lung cancer, in which CT plays a complementary role, bronchoscopy is better than complementary to bronchoscopy which is more excellent than CT in detecting central lung CT. In 68% of cases, CT revealed lung cancer which was not detected by plain radiography, and is therefore a suitable noninvasive screening method for the detection of this cancer.