Clinical Manifestations of Novel Stressinduced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Emergency Department, Retrospective Study

PURPOSE: "Stress-induced cardiomyopathy"or "Takotsubo cardiomyopathy", which mimics acute myocardial infarction (AMI), has recently been reported, particularly in Japan. However, little is known about the characteristics of this syndrome. We retrospectively evaluated twenty-three cases of this novel syndrome. METHODS: We analyzed twenty-three patients(7 men and 16 women) who fulfilled the following inclusion criteria: 1) age >18 years old; 2) no previous cardiac disease, especially coronary artery disease; 3) acute onset of symptoms; 4) ST segment elevation or depression and/or T-wave inversion on ECG; 5) cardiac enzyme elevation; 6) regional wall motion abnormality in the echocardiogram or left ventriculogram; 7) no significant stenosis in the coronary angiogram. RESULTS: The most common stressful conditions that preceded the chest pain were: emotional stress (n=8, 34.8%), medical illness (n=7, 30.4%), accident (n=3, 13.1%), and recovery from surgery (n=3, 13.1%). The average initial creatinine kinase MB fraction and cardiac troponin I level were 32.2+/-51.7 ng/ml and 4.11+/-19.7 ng/ml, respectively. ECG changes [ST-segment elevation or depression (n=10, 43.5%) and T-wave inversion (n=19, 82.6%)] were usually found, whereas in contrast a Q wave was rarely found (n=3, 13.4%). The average left ventricular ejection fraction (LVEF) was decreased to 43.2+/-12.2% and regional wall motion abnormality [apex only (n=11, 47.8%), global (n=7, 30.4%)] was found on the initial echocardiograms. Upon follow-up echocardiograms, the average LVEF was improved to 60.6+/-5.8% and regional wall motion abnormality was normalized in all patients. CONCLUSION: Stress-induced cardiomyopathy, mimicking AMI, is triggered by psychologically and physically stressful events. This condition is characterized by a distinctive form of systolic dysfunction and favorable outcomes with medical therapy.

Quantitative Spiral CT: Clinical Usefulness in Prediction of Postoperative Lung Function in Patients with Pulmonary Resection

PURPOSE: We evaluated the usefulness of quantitative spiral CT to predict postoperative lung function in patients undergoing pulmonary resection. MATERIALS AND METHODS: Fourteen patients in whom pneumonectomy or segmentectomy were performed underwent preoperative chest spiral CT and pulmonary function test(PFT). Six patients underwent postoperative follow-up PFT. Ten patients underwent preoperative radioisotope(RI) lung perfusion scan. Preoperative CT data were postprocessed with contiguous pixel method ranged from -9107HU to -500HU to quantify total functional lung volume(TFLV) and regional volume to be resected(RFLV). Postoperative lung function was predicted by following formula;Predicted postoperative PFT value=preoperative PFT x 1-RFLV/TFLV). CT predicted value was compared with postoperative measured PFT value and those value of RI perfusion scan. RESULTS: CT predicted values were very close to postoperative measured value and RI predicted value, and were correlated well with postoperative measured values (FVC: r=0.988, P<0.001 ;FEV1: r=0.994, P<0.001) and RI predicted values (FVC :r=0.976, P<0.001 ;FEVl: r=0.974, p<0.001). CONCLUSION: Quantitative spiral CT was useful to predict postoperative lung function and could be an effective alternative to RI perfusion scan.

MR Findings of Recurred Giant Cell Tumor

PURPOSE: To describe MR findings of recurred giant cell tumor of bone. MATERIALS AND METHODS: MR imagings of ten cases of pathologically proven recurrence of giant cell tumor were retrospectively analyzed. Location of recurrence, multiplicity of recurred tumor, signal intensity and homogeneity, pattern of gadolinium enhancement, soft tissue and articular surface involvement were evaluated. RESULTS: Tumors were located in peripheral portion of previous operation site(80%). Six cases recurred as multiple lesions. Tumor showed low signal intensity on T1 weighted images(100%), high signal intensity on T2 weighted images(100%) and inhomogeneous peripheral rim enhancing pattern(75%). Soft tissue and articular surface involvement were also demonstrated. CONCLUSION: We concluded that characteristic MR findings of recurred giant cell tumor could be helpful in early detection and precise evaluation of tumor recurrence.

Masticator Space Lesions: MRI and CT Findings

PURPOSE: We evaluated the MR and CT findings of the masticator space lesions in order to identify the differences among the malignant and benign tumors and infectious conditions. MATERIALS AND METHODS: MR and CT findings in 46 cases with proven masticator space lesions were reviewed retrospectively. We analysed the involvement of masticator muscles, adjacent spaces, orbit and intracrahium, homogeneity, necrosis, cystic changes, growth patterns, calcifications, enhancement patterns, MR signal intensity, and CT attenuation. RESULTS: Among the 29 cases of malignant tumors, seven cases were mandibular tumors including four chondrosarcomas, and 22 cases were extramandibular tumors. Malignant tumors of mandibular origin showed large masses with severe bone destruction and epicenter of mandible. Extramandiblular malignant tumors showed the epicenter out of the mandible and less severe bone destruction than mandibular tumors: Among the nine benign tumors, four cases were ameloblastomas which showed the well-defined masses and the expansion of the mandible, and four cases were extramandibular tumors which showed well-marginated extramandibular masses with no bone destruction. Among the eight infectious conditions, five cases were mandibular osteomyelitis with or without abscess formations, and the other three cases were infections from adjacent soft tissue or limited to the soft tissue. CONCLUSION: By careful observations of growth patterns, involvement of the masticator and adjacent spaces, bone changes, and epicenter of the lesions, one can discriminate a mandibular lesion from an extramandibular lesion. With this approach, it is thought to be easier to suggest a dignosis among a wide spectrum of masticator lesions.

Radiological Features of Viral Infection of Lower Respiratory Tract in Infants and Children' Infection by Common Viruse Other than RS Virus

PURPOSE: There have been repoty on radiological features of lower respiratory track infection in infants and children caused by RSV(respiratory syncytial virus) in KOREA. The aims of this study were to summarize radiological features of lower respiratory tract infection caused by common viral agents other than RSV and to find any specific radiological features which might provide clue to the etiologic diagnosis. MATERIALS AND METHODS: We retrospectively analyzed radiological features in 51 children with symptoms of lower respiratory tract infection and identification of viral agents(except RSV). They included parainfluenza (n=22), adenovirus(n=16), influenza A(n--11), influenza B(n=2) virus infections. The mean age of the patients was 23 months. RESULTS: Major radiological findings of viral lower respiratory tract infection were bilateral parahilar peribronchial infiltration(62%), bilateral overaeration(60%), atelectasis(59%)(segmental or subsegmental atelectasis(43%), Iobar atelectasis(16%)) and patchy or confluent consolidation(20%). Pleural effusion was seen in only one case and hilar adenopathy was not observed in any of them. In the cares of adeno virus, consolidation was seen in 5 cases(31%) including 3 cases919%) of extensive confluent consolidations and overaerations were less frequent findings(44%) than in other viruses. In 24 patients with radiological follow up for more than 1 week, consolidation improved most rapidly, while was persistent atelectasis. CONCLUSION: The major radiologic features in vital lower respiratory tract infection(except RSV) were overinflation, bilateral peribronchial infiltration and atelectasis. In adenoviral infection, confluent consolidations which are usually seen in bacterial pneumonia were more common findings than in other viral lower respiratory tract infections.