A Case of Acute Perithyroiditis with Transient Thyrotoxicosis in Childhood / 대한내분비학회지

Acute thyroiditis is a rare disease because of the sufficient supply of blood vessels and lymphatics in thyroid tissue, the high concentration of iodide in the thyroid tissue and the nearly completely isolated structure of the thyroid gland from the surrounding tissue via its capsule. The most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. Computed tomography (CT) and magnetic resonance imaging (MRI) can show a low echogenic mass encircling thyroid gland and swelling of the perithyroidal tissue in acute suppurative thyroiditis. We experienced a case of acute perithyroiditis with thyrotoxicosis that developed in a 13-year old boy and he was diagnosed by the CT findings. The patient had complained of a low graded fever and neck swelling. The laboratory diagnosis and clinical course was like that of subacute thyroiditis, but the CT finding showed a show low echogenic mass encircling the thyroid glands and swelling of the perithyroidal tissue. Therefore, we diagnosed this patient with acute perithyroiditis. After treatment with antibiotics, he displayed clinical improvement and was discharged.

Usefulness of Perfusion CT in Progressive Massive Fibrosis

PURPOSE: We wanted to evaluate the usefulness of perfusion CT for the diagnosis of progressive massive fibrosis. MATERIALS AND METHODS: We retrospectively analyzed the perfusion CT images of 20 lesions that showed progressive massive fibrosis in 13 patients. Using 16 channel multi-detector CT, a dynamic study was performed with the multiple spiral acquisition technique at 0 (precontrast), 15, 30, 45, 60, 90, 120, 180, and 300 seconds after contrast injection. The perfusion image was reformatted using these source images; it was scored on the volume map and washout map by visual inspection and then compared with 20 lesions of lung cancer. RESULTS: The volume map showed either middle or low perfusion for 19 among the 20 lesions. The washout map also showed a weak or moderate washout pattern. The kappa values (>0.818) for the inter-reader agreement reached statistical significance (p<0.01). High perfusion on the volume map was seen in 1 case (5%) in the PMF group and in 19 cases (95%) in the lung cancer group. Intense washout on the washout map was seen in 1 case (5%) in the PMF group and in 14 cases (70%) in the lung cancer group. There was a significant difference between the two groups (x2=32.129, p<0.01). CONCLUSION: Perfusion CT consisting of the volume map and washout map can be a useful method for the differential diagnosis between PMF and lung cancer.

Correlation between Radiologically Identified Osteitis and Prognosis in Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We studied the correlation between radiologically identified bony osteitis and prognosis of the functional endoscopic sinus surgery in chronic rhinosinusitis patients. SUBJECTS AND METHOD: A retrospective review of medical records were carried out on 77 patients who had been diagnosed as chronic paranasal sinusitis and undergone endoscopic sinus surgery from 2002 through 2003 at our institution. Computed tomography scans were used for grading according to the Lund-Mackay radiologic grading system and diagnosis the pansinusitis coexistence. Medical records were used for grading according to the Lund-Mackay surgical grading system and for follow-up observation and age. Statistical analysis was done for correlation between radiologically identified indices and post-operative prognosis. RESULTS: The study revealed that radiologically identified bony osteitis need a longer post-operative medical management period and also found that if pansinusitis coexist with osteitis, poorer outcome would be accompanied. CONCLUSION: This study provides further evidence that radiologically identified bony osteitis and pansinusitis may act as poor prognostic factors.

A Case of Myxolipoma in Parapharyngeal Space: First Report of a Case / 대한이비인후과학회지

Myxolipomas, or myxoid lipomas, are unusual histologic types of lipoma in which components of the tumor are replaced by mucoid substances. Lipomas of the parapharyngeal space are extremely rare with only a few cases having been reported. The presence of myxolipoma in the parapharyngeal space has not yet been reported in the literature. We present the first report of a 14-year-old female with myxolipoma in the left parapharyngeal space which was excised via a transcervical approach.

Embryonal Rhabdomyosarcoma of the Posterior Mediastinum: A Case Report

A rhabdomysarcoma originating during childhood is an easily-detected soft tissue sarcoma which frequently occurs in the head, and neck, or genitourinary system. It has been reported that in the mediastinum its rate of occurrence is 1 percent, though the rate at which it occurs in the posterior mediastinumhas not been reported. We recently encountered a case of embryonal rhabdomyosarcoma of the posterior mediastinum in a 12-year-old girl with neurofibromatosis type 1. Initial chest X-rays revealed a well-marginated round mass, with destruction of the right posterior rib. CT scans indicated the presence of an iso-dense mass which after contrast infusion showed heterogeneous enhancement. T1-and T2-weighted MR images showed, respectively, slight and heterogenous hyperintensity, with invasion of the thoracic spine and compression of the spinal cord. After surgery, embryonal rhabdomyosarcoma of the posterior mediastinum was pathologically confirmed.

Squamous Cell Carcinoma of Temporal Bone: Four Case Reports

We report the CT findings of four cases of squamous cell carcinoma, paying special attention to the epicenter of the lesion and the pattern of bony destruction. All four patients had a past history of chronic otitis media. Squamous cell carcinoma affected mainly the hypotympanum and inferior wall of the external auditary canal, and in all cases revealed an irregular pattern of bony destruction. Irregular destruction of the tegmen tympani occurred in two cases. In cases of squamous cell carcinoma, CT findings suggesting involvement of the promontary are usually noted.

CT Findings of the Angiomatous Polyp in the Nasal Cavity and Paranasal Sinus

PURPOSE: To assess the characteristic CT findings of the angiomatous polyp. MATERIALS AND METHODS: Fivecases of pathologically-proven angiomatous polyp were retrospectively evaluated. All underwent CT scanning, butin only four cases were postcontrast CT scans obtained. In analysing CT findings we focused on adjacent bonychange, and the extent and enhancement pattern of the mass. RESULTS: All but one case involved the maxillarysinus, showing thickening of the posterolateral wall and erosion or destruction of the medial wall. As forinvolvement of the anterior wall of this sinus, bony destruction was seen in one case, and thickening in three. Infour cases the tumor involved the maxillary sinus and nasal cavity, and two cases showed nasopharyngeal extension.No case involved the pterygopalatine fossa, however. On contrast enhanced CT scans(n=4), all cases showedenhancement as strong as blood vessels, and a multiple focal punctate or tubular pattern. CONCLUSION: Angiomatouspolyp tends to show bone thickening rather than bone destruction, not to involve the pterygopalatine fossa, and toreveal a strong punctate or tubular enhancement pattern. These findings may be helpful in the differentialdiagnosis of angiomatous polyp from other tumors such as maxillary cancer, angiofibroma and nasal polyp

The Efficacy of Transcatheter Arterial Embolization(TAE) in Children With Blunt Splenic Injury

PURPOSE: To evaluate the efficacy of transcatheter arterial embolization(TAE) in children with blunt splenicinjury. MATERIALS AND METHODS: The results of transcatheter splenic arterial embolization in nine children whosuffered splenic injury after blunt abdominal trauma were retrospectively studied. This injury was demonstrated byCT, and the findings were evaluated according to the classification of Mirvis et al. ; two patients were grade 3and seven were grade 4. All were carefully observed in intensive care before embolization. TAE was performed if apatient satisfied the following criteria : (1) transfusion and/or fluid replacement required to maintainhemodynamic stability ; or (2) rapid Hb/Hct decrease ; or (3) both. Splenic function was subsequently estimatedaccording to the results of 99mTc-sulfur colloid scintigraphy and/or CT scanning. RESULT: TAE was suscessful inall nine children. Two were embolized with a coil only, three with gelfoam, and four with gelfoam and a coil.Seven were embolized in the main trunk of the splenic artery and others in both the main trunk and its branches.Splenic function was preserved in all nine children, during follow-up, none suffered rebleeding. CONCLUSION: TAEof the splenic artery can be a safe and effective nonsurgical approach to the management of blunt splenic injuryin children, and can preserve splenic function.

Three Cases of Tuberculous Otitis Media

We report the imaging features of three cases of tuberculous otitis media. All three patients underwenttemporal bone CT scanning, and in two, additional MRI scanning was performed. The three cases showed soft tissuedensity in the external auditory canal, and in two, destruction of the trabeculation and internal cortex of themastoid bone was noted. In two patients with facial palsy, erosion of the facial canal was seen. On MRI, abundantgranulomatous tissue was noted in the middle ear cavity and mastoid air cells. In one case, abnormal enhancementof the cochlea, and of the facial and eighth cranial nerve in the internal acoustic canal was seen. Another caseshowed enhancement of the vestibule and lateral semicircular canal. If radiologic evaluation of chronic otitismedia reveals destruction of the tegmen and trabeculation of the mastoid bone, together with abundant granulationtissue and enhancement of the internal ear, tuberculous otitis media may be included in the differentialdiagnosis.

A Case of Spontaneous Resolution of Idiopathic Mediastinal Fibrosis / 결핵

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.

Usefulness of CT and ERCP in Traumatic Pancreatic Injury

PURPOSE: To evaluate the usefulness of CT and ERCP in the diagnosis of traumatic pancreatic injury, and the degree of such injury. MATERIALS AND METHODS: Using CT (n=30) and ERCP (n=8), we retrospectively analyzed 30 cases of surgically proven traumatic pancreatic injury. Both CT and surgical findings were evaluated according to intra-and extra- pancreatic change and assigned to one of five grades, according to their pattern. ERCP findings were categorized as normal mass effect, parenchymal staining, or extravasation of contrast material. In all 30 cases CT and ERCP findings were compared with surgical findings. RESULTS: Pancreatic enlargement was the most common finding of intrapancreatic change in 21(67%) cases (67%). In 20 of 30 cases, there was good correlation between the CT grade and surgical grading. Of the remaining ten cases, seven cases (23%) were underestimated and three(10%) were overestimated. CT grade III or IV suggest pancreatic duct injury ; in two of 13 cases with this grade, such injury was not seen on surgery, however. Of the eight cases in which ERCP was performed, two were normal, one showed mass effect, one showed parenchymal staining, and four, all of which showed pancreatic duct injury on surgery, showed extravasation of contrast material. Two of these four cases were CT grade II, but on surgery, proven duct injury was seen. CONCLUSION: In cases of pancreatic duct injury, ERCP is superior to CT; where such injury is suspected, it should therefore be used to determine whether or not the injury is in fact present.

The Role of Three-Dimensional Imaging in Evaluation of the Sinonasal Mass

PURPOSE: To investigate the role of 3D imaging in the sinonasal mass. MATERIALS AND METHODS: Twenty patients with sinonasal mass(squamous cell carcinoma[n=6], spindle cell carcinoma[n=1}, angiomatous polyp[n=1}, giant cell reparative granuloma[n=1}, non-Hodgkin's lymphoma[n=1}, melanoma[n=1}, angiofibroma[n=1}, pyocele[n=1}, inverted papilloma[n=1}) were studied with spiral CT. Reconstruction of surface rendered 3D images and segmentations were performed and compared with the 2D image. RESULTS: The 3D images enabled easy understanding of the characteristics of the mass in 12 casese. The 3D images displayed pathway of tumor extension in 5 cases and werehelpful in assessing the primary site of the mass in 3 cases. In two cases with encasement of ICA by the mass, assesment of relationship between the mass and vessels were possible through the segmentation. CONCLUSION: The 3D image, as an adjunct to the 2D image, can help to evaluate the virtual appearance of bony change, the degree of extension of mass, the spreading route, the evaluation of origin site. It also provides valuable 3-dimensional conception of the mass, especially for the surgeon.

Tuberculous Abscess of the Thyroid Gland: A Case Report of CT Demonstration

We report a case of tuberculous abscess of thyroid gland in 32-years old female. On CT scan, multiple peripheral enhancing low density abscess were found in the right thyroid gland. Abscess cavity with skin and subcutaneous manifestations were also noted in the right anterior neck. This was confirmed as chronicgranulomatous caseous necrosis and acid-fast bacilli were identified by Ziehl-Neelsen stain.

Evaluation of the Solitary Pulmonary Nodule by Spiral Computed Tomography with Contrast Enhancement / 결핵

BACKGROUND: Clinical and Radiographic studies to differentiate benign from malignant pulmonary nodules have previously focused on clinical status and the morphologic and the computed tomographic attenuation characteristics of the lung nodules. Distinctive differences in the vascularity and pathophysiology of malignant versus benign pulmonary nodules were identified. We evaluated the diagnostic method for differentiating malignant from benign solitary pulmonary nodule by contrast enhancement on the spiral CT. METHOD: Sixteen patients with solitary pulmonary nodule were examined(Tuberculoma 8, primary lung cancer 8). Serial thin section on the spiral CT was performed before and after(45second, 2min, 5min) the onset of the injection of 100mL of nonionic contrast material(2mL/sec). RESULTS: There was no difference in size of nodule and pre-contrast CT number (Hounsfield unit) between benign and malignant nodules. At forty-five second after the onset of the injection, malignant neoplasms(19.6+/-7.9 HU) enhanced significantly more than tuberculomas(4.9+/-9.4 HU, p=0.008). At 2 minute and 5 minute after, malignant neoplasms(34.0+/-19.2HU, 340+/-15.4HU) enhanced significantly more than tuberculomas (6.7+/-9.7HU, p=0.007 and 7.7+/-11.5HU, p=0.011). On cut-off value 20HU(contrast enhancement) 2 minute after the injection of contrast media, sensitivity was 87% and specificity was 87%. No correlation between the contrast enhancement and size of the nodules was observed. CONCLUSION: Studies with the use of an intravenously administered noniodinated contrast medium in examining the enhancement properties of lung nodules was performed. The contrast enhancement was useful in differential diagnosis of solitary pulmonary nodules.

CT Findings of Laryngeal Tuberculosis: Comparison with Laryngeal Carcinoma

PURPOSE: To determine the value of CT(Computerized Tomography) in the diagnosis of laryngeal tuberculosis and to assess to what extent its characteristic findings different from those of aryngeal carcinoma. Materials and Methods : CT scans of twelve patients with laryngeal tuberculosis were reviewed and compared with those of fifteen patients with laryngeal cancer, retrospectively. Clinical symptoms, laryngoscopic examinations and the presence of pulmonary tuberculosis on chest radiographs were also reviewed. RESULTS: In laryngeal tuberculosis, bilater alsymmetric or asymmetric involvement was noted in nine(75%) patients, while unilateral involvement was seen in three(25%). This was significantly different from laryngeal cancer in which unilateral involvement was noted in twelve patients(80%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frquent finding in tuberculosis(n=6, 50%). No deep submucosal infiltration of preepiglottic and paralaryngeal fat spacesis seen in tuberculosis in spite of large areas of involvement of laryngeal mucosa, while twelve patients(80%) with laryngeal cancer showed thickened deep infiltration which resulted in a submucosal mass. CONCLUSION: CT was useful in the diagnosis of laryngeal tuberculosis and its CT findings wee characterized by bilateral involvement, thickening of the free margin of the epiglottis and good preservation of preepiglottic and paralaryngeal fatspaces in spite of large areas of involvement.

Comparative Analysis Among X-ray Mammographic Findings, Nuclear and Histologic Grading, and TNM Staging of Breast Carcinoma

PURPOSE: The purpose of this study was to evaluate the prognosis of breast carcinoma by comparison with X-ray mammographic findings, nuclear and histologic grade, and TNM staging. MATERIALS AND METHODS: We retrospectively reviewed 114 cases(113 patients) of breast carcinoma, analysing X-ray mammographic findings of all cases with regard to mass, calcification, and spiculation. In 80 cases of scirrhous invasive ductal breast carcinoma, Black's nuclear and Bloom-Richardson's histologic grade were also evaluated. Mammographic findings and nuclear and histologic grade were compared with TNM staging which might suggest the prognosis of breast carcinoma. RESULTS: X-ray mammographic findings (mass, calcification and spiculation) did not significantly correlate with T staging, but the clinical staging of the spiculation was advanced. These X-ray findings did not significantly correlate with the nuclear grading and the histologic grading. Nuclear grade did not correlate with T and M staging, but correlated significantly with N staging and clinical stage(p<0.05). Histologic grade did not significantly correlate with TNM staging. CONCLUSION: The clinical staging of spiculation was advanced and nuclear grade correlated significantly with N stage and clinical staging. X-ray mammographic findings did not directly correlate with nuclear and histologic grading, but combined studies of the evaluation of mammographic findings and nuclear and histologic grade were useful for prognosing breast carcinoma.

Analysis of X-ray Mammographic Findings of Breast Carcinoma according to Histopathologic Classification

PURPOSE: This study was undertaken to investigate X-ray mammographic findings which correlated with histopathologic classification of breast carcinomas. MATERIALS AND METHODS: In 114 cases (113 patients) weeviewed X-ray mammographic findings of breast carcinoma and their histopathologic classification, and the findings were analysed to define mass, calcification, and spiculation. RESULTS: According to histopathologic classifications of breast carcinomas, infiltrating ductal carcinoma was the most common(78.9%). X-rays mammographyrevealed that irregular mass was found in 43.9% of cases, calcification in 47.4 %, and radiating spiculation in75.4%. Mass with spiculation accounted for 41.2%, and mass with calcification and spiculation for 34.2%. A commonfinding of ductal carcinoma in situ was an ill-defined mass with malignant clustered microcalcification. Infiltrating ductal and infiltrating lobular carcinomas showed irregular masses with spiculation and colloid or medullary carcinomas had well-defined masses. CONCLUSION: Mass with spiculation, and mass with calcification and spiculation were common findings of breast carcinoma. The differences in X-ray mammographic findings among each different histopathologic type of breast carcinoma are helpful for differential diagnosis.

Arterial Embolization for Management of Hemoptysis in Pulmonary Tuberculosis: Factors of Rebleeding

PURPOSE: To evaluate the effectiveness of arterial embolization in reducing hemoptysis in pulmonary tuberculosis, and rebleeding factors after embolization. MATERIALS AND METHODS: Fifty-nine patients with massiveor recurrent hemoptysis from pulmonary tuberculosis were underwent percutaneous transcatheter embolotherapy and thirteen were subsequentyly operated on. In 46 patients, we retrospectively analyzed on plain chest PA the extent of pulmonary tuberculosis lesions, the period from initial diagnosis to embolization, and angiographic findings. the extent of lesions shown on plain chest PA were classified into minimal, moderately advanced, and far advanced. If there was no evidence of rebleeding after the first embolization, this was regarded as initial success in thecontrol of hemoptysis. Angiographic findings were classified into hypervascularity, shunt, aneurysmal dilatation,and extravasation. Using the chi-square test, differences in these findings between rebleeding and non-rebleeding cases were analysed. RESULTS: Immediate control of hemoptysis was achieved in 27 (58.7%) of 46 patients. Hemoptysis recurred in 19 (41.3%) of 46 patients followed up. Rebleeding cases showed more nonbronchial systemiccollateral vessels and shunt than non-rebleeding cases (p<0.05). More advanced lesions of pulmonary tuberculosison plain chest PA showed an increased rebleeding rate after embolization, but this was not statistically significant There was no correlation between the period from initial diabnosis of pulmonary tuberculosis to embolization and the rate of rebleeding. But the longer the period, the greater the number of nonbronchial systemic collateral vessels. CONCLUSION: In cases with more advanced lesions of pulmonary tuberculosis on plainchest PA and a long period from initial diagnosis of pulmonary tuberculosis to embolization, angiographic findings showed numerous nonbronchial systemic collateral vessels but increases in the rebleeding rate were statistically not significant. The greater the number of nonbronchial systemic collateral vessels and shunt, the higher there bleeding rate after embolization.

CT Findings of Small Bowel Rupture after Abdominal Trauma

PURPOSE: The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel rupture after abdominal trauma is controversal. This study was conducted to ascertain CT finding of small bowel rupture result from abdominal trauma. MATERIALS AND METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel rupture was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel rupture including pneumoperitoneum or retroperitoneal air, discontinuity of the bowel wall and extravasation of oral contrast materials were observed in 33 cases(83%). Intraperitoneal or retroperitoneal free air was seen in 31 cases(78%) and intraperitoneal or retroperitoneal free fluid collection was seen in 38 patients(95%). Small bowel wall was thickened in 31 cases(78%), bowel wall was enhanced in 12 cases(30%) and bowel wall discontinuity and extravasation of oral contrast material was seen in 5 cases, respectively. CONCLUSION: The CT scan is sensitive and effective modality for evaluation of small bowel rupture after abdominal trauma, because of high detectability of diagnostic and suggestive CT findings.

Arterial Embolization for Management of Hemoptysis

PURPOSE: Our purpose in this study is to evaluate the effectiveness of bronchial and nonbronchial systemic arteries for the control of hemoptysis. MATERIALS AND METHODS: Seventy patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolotherapy between 1991 and 1993. Retrospectively we reviewed 77 cases of bronchial artery embotization and 32 cases of nonbronchial systemic artery embolization in the 70 patients. RESULTS: Immdiate control of hemoptysis was achieved in 33 of 39 patients with massive hemoptysis(84.6%) and 20 of 24 patients with recurrent hemopt ysis(83.3%). In 32 cases, nonbronchial systemic arteries contributed significantly to areas of pathologic pulmonary tissue and frequently were the major arterial supply. CONCLUSION: Bronchial artery embolization is an effective and life saving procedure in non-surgical candidates. Recognition and occlusion of nonbronchial systemic arteries that feed to hypervascular pulmonary lesions is essential for successful percutaneous embolotherapy of hemoptysis.