Multiloculated Cystic Type Renal Epithelioid Angiomyolipoma Mimicking Renal Cell Carcinoma: A Case Report

Renal epithelioid angiomyolipoma (EAML) is a rare variant of angiomyolipoma (AML), with a prominent epithelioid component. EAML usually presents as a large heterogeneous soft tissue lesion with intratumoral hemorrhage and variable necrosis or cystic changes. We present a case of multiloculated cystic renal EAML mimicking renal cell carcinoma in a 64-year-old female.Intracystic massive hemorrhage, hyperattenuating wall and septa on an unenhanced study, and enlarged intratumoral vessels can be helpful imaging features for distinguishing renal EAML from renal cell carcinoma.

Unusual Manifestation of Immunoglobulin G4-Related Disease Involving the Retroperitoneum:A Case Report

Immunoglobulin G4 (IgG4)-related disease is a systemic disease characterized by dense lymphoplasmacytic infiltrates with abundant IgG4-positive plasma cells and fibroblast proliferation. The retroperitoneal involvement of IgG4-related disease usually appears as a soft-tissue mass covering the abdominal aorta or entrapping the ureters, resulting in hydronephrosis. Here, we present a case of IgG4-related disease with retroperitoneal involvement in a 75-yearold woman with an unusual manifestation. A preoperative computed tomography (CT) scan revealed an irregular infiltrative retroperitoneal mass invading the normal anatomic barriers, raising the suspicion of malignancy or inflammation. Contrast-enhanced CT revealed a homogeneous progressive enhancement of the mass.

Multiloculated Cystic Type Renal Epithelioid Angiomyolipoma Mimicking Renal Cell Carcinoma: A Case Report

Renal epithelioid angiomyolipoma (EAML) is a rare variant of angiomyolipoma (AML), with a prominent epithelioid component. EAML usually presents as a large heterogeneous soft tissue lesion with intratumoral hemorrhage and variable necrosis or cystic changes. We present a case of multiloculated cystic renal EAML mimicking renal cell carcinoma in a 64-year-old female.Intracystic massive hemorrhage, hyperattenuating wall and septa on an unenhanced study, and enlarged intratumoral vessels can be helpful imaging features for distinguishing renal EAML from renal cell carcinoma.

Unusual Manifestation of Immunoglobulin G4-Related Disease Involving the Retroperitoneum:A Case Report

Immunoglobulin G4 (IgG4)-related disease is a systemic disease characterized by dense lymphoplasmacytic infiltrates with abundant IgG4-positive plasma cells and fibroblast proliferation. The retroperitoneal involvement of IgG4-related disease usually appears as a soft-tissue mass covering the abdominal aorta or entrapping the ureters, resulting in hydronephrosis. Here, we present a case of IgG4-related disease with retroperitoneal involvement in a 75-yearold woman with an unusual manifestation. A preoperative computed tomography (CT) scan revealed an irregular infiltrative retroperitoneal mass invading the normal anatomic barriers, raising the suspicion of malignancy or inflammation. Contrast-enhanced CT revealed a homogeneous progressive enhancement of the mass.

Necrosis of Hepatocellular Carcinoma Caused by Iatrogenic Hepatic Artery Dissection during Transcatheter Arterial Chemoembolization

Transcatheter arterial chemoembolization (TACE) improves the survival rate in patients with hepatocellular carcinoma (HCC). Despite the low probability, iatrogenic hepatic arterial dissections during interventional procedure are rarely created by the technical difficulties. Direct trauma from the guidewire, the tip of the catheter, or the jet of contrast injection can contribute to iatrogenic hepatic arterial dissections. We report one case of a female who had HCC necrosis caused by iatrogenic hepatic arterial dissection during TACE. Ischemia resulting from iatrogenic hepatic arterial dissection during TACE was smilar to the result of transarterial embolization for HCC on our case. To our knowledge, none of the similar cases was reported in previously published literatures.

Entirely Replaced Left Gastric Artery from the Left Hepatic Artery: A Case Report

Arteries originating from the celiac axis have numerous anatomical variations. When performing interventional and surgical procedures, it is important to be aware of these variations to have better outcomes and to prevent iatrogenic complications. We report on a case of a 62-year-old man who came to our institution to receive transarterial chemoembolization for hepatocellular carcinoma. The computed tomography and angiography revealed a rare anatomic variation: the entire left gastric artery originated from the left hepatic artery with no other accessory feature of the left gastric artery from celiac axis or aorta was seen. To our knowledge, this is the first report on the entirely replaced left gastric artery from the left hepatic artery that was confirmed by utilizing both computed tomographic and angiographic images.

Pyomyoma after Uterine Artery Embolization for Postpartum Hemorrhage Misdiagnosed as Uterine Necrosis

A 34-year-old female patient underwent uterine artery embolization (UAE) to control massive postpartum hemorrhage. The interventional radiologist was not informed of the patient's significant history of uterine myoma. Although no significant signs of complications or “red flags” were observed during the procedure, follow-up computed tomography performed four weeks later revealed evidence of a large, globe-like fluid collection with air bubbles in the uterus. The finding and pathology was initially diagnosed as uterine necrosis, which led not to interventional percutaneous drainage; instead, dilation and curettage with resectoscope was performed. The surgical and pathological diagnosis was “expulsion of pyomyoma in the uterine cavity.” Awareness and precise knowledge of imaging findings of pyomyoma and uterine necrosis are important for early diagnosis and treatment of UAE-related complications.

Urinary arsenic species concentration in residents living near abandoned metal mines in South Korea

BACKGROUND: Arsenic is a carcinogenic heavy metal that has a species-dependent health effects and abandoned metal mines are a source of significant arsenic exposure. Therefore, the aims of this study were to analyze urinary arsenic species and their concentration in residents living near abandoned metal mines and to monitor the environmental health effects of abandoned metal mines in Korea. METHODS: This study was performed in 2014 to assess urinary arsenic excretion patterns of residents living near abandoned metal mines in South Korea. Demographic data such as gender, age, mine working history, period of residency, dietary patterns, smoking and alcohol use, and type of potable water consumed were obtaining using a questionnaire. Informed consent was also obtained from all study subjects (n = 119). Urinary arsenic species were quantified using high performance liquid chromatography (HPLC) and inductively coupled plasma mass spectrometry (ICP/MS). RESULTS: The geometric mean of urinary arsenic (sum of dimethylarsinic acid, monomethylarsonic acid, As3+, and As5+) concentration was determined to be 131.98 μg/L (geometric mean; 95% CI, 116.72–149.23) while urinary inorganic arsenic (As3+ and As5+) concentration was 0.81 μg/L (95% CI, 0.53–1.23). 66.3% (n = 79) and 21.8% (n = 26) of these samples exceeded ATSDR reference values for urinary arsenic (>100 μg/L) and inorganic arsenic (>10 μg/L), respectively. Mean urinary arsenic concentrations (geometric mean, GM) were higher in women then in men, and increased with age. Of the five regions evaluated, while four regions had inorganic arsenic concentrations less than 0.40 μg/L, one region showed a significantly higher concentration (GM 15.48 μg/L; 95% CI, 7.51–31.91) which investigates further studies to identify etiological factors. CONCLUSION: We propose that the observed elevation in urinary arsenic concentration in residents living near abandoned metal mines may be due to environmental contamination from the abandoned metal mine. TRIAL REGISTRATION: Not Applicable (We do not have health care intervention on human participants).

Current status and future of radiofrequency ablation for hepatocellular carcinoma

Radiofrequency ablation, one of the most common locoregional therapies for unresectable hepatocellular carcinoma (HCC) in Korea, has become an excellent alternative to curative surgery with advantages of minimal invasiveness, favorable complications, and low morbidity. The therapeutic efficacy of radiofrequency ablation (RFA) has been shown to be comparable to that of surgical resection for early-stage HCC. Long-term outcomes for HCC after radiofrequency ablation reported in large series studies were an overall survival of 54 - 60.2% at 5 years and 27.3 - 33% at 10 years. Recent technical developments in radiofrequency ablation include more effective separable clustered electrodes, hydrodissection techniques such as artificial ascites or pleural effusion, ultrasound - magnetic resonanace image fusion guidance, Sonazoid-enhanced ultrasonography guidance, and combined therapy with transarterial chemoembolization and sorafenib. In summary, radiofrequency ablation plays a key role in nonsurgical therapy and multidisciplinary approaches that aim to increase the survival rate of patients of hepatocellular carcinoma.

Xanthogranulomatous Pancreatitis Presents as a Solid Tumor Mass: A Case Report

Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.

Mesothelial Cyst of the Round Ligament Mimicking a Metastasis: a Case Report

A mesothelial cyst of the round ligament is a rare cause of an inguinal mass. Clinically, it is frequently misdiagnosed as one of commoner diseases such as an inguinal hernia, femoral hernia, lipoma, and lymphadenopathy upon physical examination. Some previous reports elaborated the sonographic features of a mesothelial cyst of the round ligament. However, to our knowledge, few reports have described the CT features of a mesothelial cyst. We illustrated here the sonographic and multidetector CT features of a case of a mesothelial cyst of the round ligament that presented as an inguinal palpable mass and mimicked a metastasis in a patient with a Sertoli-Leydig cell tumor of the ovary.

Ultrasound Findings of Lymphoid Hyperplasia of the Appendix in Children: Differentiation from Acute Appendicitis

PURPOSE: To evaluate the ultrasound (US) findings that can help differentiate lymphoid hyperplasia in the appendix from acute appendicitis. MATERIALS AND METHODS: A total of 1230 patients (below 20 years old) suspected of having appendicitis received an appendectomy between November, 1999, and March, 2008, with US findings in 27 patients with pathologically proven lymphoid hyperplasia of the appendix. Of 167 patients that received an appendectomy from January, 2007, to December, 2007, 52 patients with acute appendicitis were retrospectively reviewed as a control group. Retrospective review of US images was performed by two radiologists who were blinded to the pathologic results. The review was based on 12 ultrasonographic criteria derived from reports on the diagnostic findings of the appendicitis. RESULTS: Compared with acute appendicitis, lymphoid hyperplasia in appendix had a smaller diameter (7.14+/-1.22 mm vs 9.37+/-1.80 mm, p < 0.001) and less wall thickening (1.38+/-0.36 mm vs 1.74 +/- 0.56 mm, p =0.001). Periappendicular inflammation (p < 0.001), intraluminal air (p = 0.006), round shape in transverse scan (p = 0.002), increased blood flow on color Doppler US (p = 0.03) were also different. CONCLUSIONS: US is a useful modality to differentiate lymphoid hyperplasia in the appendix from acute appendicitis.

Pseudo-Renal Failure; Urinary Ascites and Uremia due to Bladder Rupture / 대한신장학회지

The main feature of acute renal failure is a decline in the glomerular filtration rate. However, urine leakage into the peritoneal cavity due to bladder rupture may cause pseudo-renal failure. This is a situation in which renal function is normal, along with the presence of elevated serum creatinine. A 47-year-old woman presented with abdominal distension and pretibial pitting edema on both lower extremities. She had no traumatic history. She did not complain of abdominal pain, and exhibit neither oliguria nor anuria. Her blood urea nitrogen (BUN) and serum creatinine was 105 and 11.2 mg/dL. Ascites showed that urea nitrogen and creatinine were 160 and 29 mg/dL, respectively. We confirmed bladder rupture by an abdominal CT scan and retrograde cystography. She underwent an emergency laparotomy to repair the ruptured bladder. Azotemia was normalized 2 days after the operation. Here we present a rare case of uremia due to bladder rupture.

Primary Mucinous Adenocarcinoma of a Seminal Vesicle Cyst Associated with Ectopic Ureter and Ipsilateral Renal Agenesis: a Case Report

Primary adenocarcinoma of the seminal vesicles is a rare neoplasm. Congenital seminal vesicle cysts are commonly associated with unilateral renal agenesis or dysgenesis. To the best of our knowledge, mucinous adenocarcinoma of the seminal vesicle cyst that's associated with an ectopic ureter opening into the seminal vesicle and ipsilateral renal agenesis has not been described in the radiological literature. We report here on the radiological findings of a primary adenocarcinoma of a seminal vesicle cyst in this condition.

Cystic Solitary Fibrous Tumor Arising From the Left Occipital Meninges: A Case Report

Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm of a spindle-cell origin, and it usually involves the pleura. It's occurrence in various organs of the body has recently been described. Meningeal SFT is very rare. Radiologically, it is a strongly enhancing solid mass and is undistinguishable from fibrous meningioma and hemangiopericytoma. Yet we report here on a case of SFT with massive cystic degeneration that arose from the meninges of the left occipital region.

MR Findings of Subcutaneous Panniculitis-like T-Cell Lymphoma: A Case Report

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cancer and it is widely regarded as being distinct from the other subtypes of peripheral T-cell lymphoma. SPTCL commonly presents with subcutaneous nodules that resembles panniculitis. The clinicopathologic features of SPTCL have recently been described. However, only a few cases with their CT and sonographic findings have been reported in the radiologic literature. We illustrate here the MR findings of this rare tumor in one case that presented with a popliteal mass.

Clinical Significance of Follow-up CT after Ultrasonographyfor Acute Appendicitis in Children / 대한소아소화기영양학회지

PURPOSE: The ultrasonography (USG) and computed tomography (CT) are popular diagnostic tools for the diagnosis of acute appendicitis in children, but there are many debates about their clinical significance. The purpose of this study is to clarify the clinical significance of USG, CT and follow-up CT performed subsequently to USG, especially in perforated acute appendicitis in children. METHODS: We have reviewed 419 cases of surgically confirmed acute appendicitis in children under the age of sixteen, who had been treated in Inje University Ilsan Paik Hospital from March 2002 to February 2006. All the clinical data including the results of USG and CT were collected and analyzed. RESULTS: Sensitivity, specificity, positive and negative predictive values of USG were 98.7%, 96.8%, 98.1%, 97.8% in non-perforation group and 90.8%, 100%, 100%, 81.9% in perforation group. Those of CT were 96.4%, 100%, 100%, 96.5% and 86.6%, 100%, 100%, 87.5% respectively. Those of follow-up CT after USG were 100%, 100%, 100%, 100% and 87.5%, 100%, 100%, 92.0% respectively. The duration of using antibiotics in seven patients showed positive correlation with the interval between two imaging studies (r=0.0472, p=0.019). There was no statistical significance of correlation when these imaging studies performed within 30 hours together. CONCLUSION: In most of the cases, single choice between USG and CT would be enough to diagnose the acute appendicitis in children. But, it may be helpful to perform CT as early as possible subsequently to USG when there is discrepancy between initial USG and clinical impression.

Primary Extraskeletal Mesenchymal Chondrosarcoma Arising from the Pancreas

We report here on a case of primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas. A 41-year-old man was evaluated by CT to find the cause of his abdominal pain. The CT scans showed a heterogeneously enhancing necrotic mass with numerous areas of coarse calcification, and this was located in the left side of the retroperitoneal space and involved the body and tail of the pancreas. Portal venography via the celiac axis also showed invasion of the splenic vein. Following excision of the mass, it was pathologically confirmed to be primary extraskeletal mesenchymal chondrosarcoma that arose from the pancreas.

Primary Systemic Amyloidosis Presenting as Swollen Dense Breast: A Case Report

Breast involvement of primary systemic amyloidosis is rare. This is a rare case of breast amyloidosis presenting as a diffuse infiltrative lesion. We present the mammographic, ultrasound, and MR findings of a systemic primary amyloidosis involving the breast with diffuse infiltrative pattern.

Clinical Evaluation of the JPEG2000 Compression Rate of CT and MR Images for Long Term Archiving in PACS

PURPOSE: We wanted to evaluate an acceptable compression rate of JPEG2000 for long term archiving of CT and MR images in PACS. MATERIALS AND METHODS: Nine CT images and 9 MR images that had small or minimal lesions were randomly selected from the PACS at our institute. All the images are compressed with rates of 5:1, 10:1, 20:1, 40:1 and 80:1 by the JPEG2000 compression protocol. Pairs of original and compressed images were compared by 9 radiologists who were working independently. We designed a JPEG2000 viewing program for comparing two images on one monitor system for performing easy and quick evaluation. All the observers performed the comparison study twice on 5 mega pixel grey scale LCD monitors and 2 mega pixel color LCD monitors, rspectively. The PSNR (Peak Signal to Noise Ratio) values were calculated for making quantitative comparisons. RESULTS: On MR and CT, all the images with 5:1 compression images showed no difference from the original images by all 9 observers and only one observer could detect a image difference on one CT image for 10:1 compression on only the 5 mega pixel monitor. For the 20:1 compression rate, clinically significant image deterioration was found in 50% of the images on the 5M pixel monitor study, and in 30% of the images on the 2M pixel monitor. PSNR values larger than 44 dB were calculated for all the compressed images. CONCLUSION: The clinically acceptable image compression rate for long term archiving by the JPEG2000 compression protocol is 10:1 for MR and CT, and if this is applied to PACS, it would reduce the cost and responsibility of the system.