Atypical Developmental Venous Anomaly Associated with Single Arteriovenous Fistula and Intracerebral Hemorrhage: a Case Demonstrated by Superselective Angiography

We present a case of developmental venous anomaly associated with arteriovenous fistula supplied by a single arterial feeder adjacent to a large acute intracerebral hemorrhage. The arteriovenous fistula was successfully obliterated by superselective embolization while completely preserving the developmental venous anomaly. Two similar cases, including superselective angiographic findings, have been reported in the literature; however, we describe herein superselective angiographic findings in more detail and demonstrate the arteriovenous shunt more clearly than the previous reports. In addition, a literature review was performed to discuss the association of a developmental venous anomaly with vascular lesions.

Polypoid cystitis in an adult without history of catheterization

Polypoid cystitis is a benign exophytic mucosal lesion of the bladder. Differentiating it from papillary transitional cell carcinoma is difficult due to their similar characteristics. Although indwelling catheter is the main well-known cause of polypoid cystitis, some case reports unrelated to catheterization have been described. However, the radiological findings of polypoid cystitis have rarely been reported. We hereby describe polypoid cystitis in a 20-year-old man without a history of catheterization along with the computed tomographic findings

Sequential Magnetic Resonance Imaging Finding of Intramedullary Spinal Cord Abscess including Diffusion Weighted Image: a Case Report

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. We describe the magnetic resonance imaging (MRI) findings, including the diffusion-weighted imaging (DWI) findings, of ISCA in a 78-year-old man. The initial conventional MRI of the thoracic spine demonstrated a subtle enhancing nodule accompanied by significant edema. On the follow-up MRI after seven days, the nodule appeared as a ring-enhancing nodule. The non-enhancing central portion of the nodule appeared hyperintense on DWI with a decreased apparent diffusion coefficient (ADC) value on the ADC map. We performed myelotomy and surgical drainage, and thick, yellowish pus was drained.

Antioxidant activity and analysis of proanthocyanidins from pine (Pinus densiflora) needles

In this study, we evaluated the antioxidant activity of pine needle extracts prepared with hot water, ethanol, hexane, hot water-hexane (HWH), and hot water-ethanol (HWE), using the DPPH (1,1-diphenyl-2-picrylhydrazyl) radical method. The hot water extract possessed superior antioxidant activity than the other extracts. We also compared the antioxidant activity of pine needle extracts through ROS inhibition activity in a cellular system using MC3T3 E-1 cells. The hot water extract exhibited the lowest ROS production. The pattern of HPLC analysis of each extract indicated that the hot water extract contained the highest proanthocyanidin level. The pine needle hot-water extract was then isolated and fractionated with Sephadex LH-20 column chromatography to determine the major contributor to its antioxidant activity. The No.7 and 12 fractions had high antioxidant activities, that is, the highest contents of proanthocyanidins and catechins, respectively. These results indicate that the antioxidant activity of procyanidins from the hot water extract of pine needles is positively related to not only polymeric proanthocyanidins but also to monomeric catechins. Moreover, the antioxidant activity of the pine needle hot water extract was similar to well-known antioxidants, such as vitamin C. This suggests that pine needle proanthocyanidins and catechins might be of interest for use as alternative antioxidants.

Planimetric Measurement of the Regurgitant Orifice Area Using Multidetector CT for Aortic Regurgitation: a Comparison with the Use of Echocardiography

OBJECTIVE: This study compared the area of the regurgitant orifice, as measured by the use of multidetector-row CT (MDCT), with the severity of aortic regurgitation (AR) as determined by the use of echocardiography for AR. MATERIALS AND METHODS: In this study, 45 AR patients underwent electrocardiography-gated 40-slice or 64-slice MDCT and transthoracic or transesophageal echocardiography. We reconstructed CT data sets during mid-systolic to enddiastolic phases in 10% steps (20% and 35-95% of the R-R interval), planimetrically measuring the abnormally opened aortic valve area during diastole on CT reformatted images and comparing the area of the aortic regurgitant orifice (ARO) so measured with the severity of AR, as determined by echocardiography. RESULTS: In the 14 patients found to have mild AR, the ARO area was 0.18+/-0.13 cm2 (range, 0.04-0.54 cm2). In the 15 moderate AR patients, the ARO area was 0.36 +/- 0.23 cm2 (range, 0.09-0.81 cm2). In the 16 severe AR patients, the ARO area was 1.00 +/- 0.51 cm2 (range, 0.23-1.84 cm2). Receiver-operator characteristic curve analysis determined a sensitivity of 85% and a specificity of 82%, for a cutoff of 0.47 cm2, to distinguish severe AR from less than severe AR with the use of CT (area under the curve = 0.91; 95% confidence interval, 0.84-1.00; p < 0.001). CONCLUSION: Planimetric measurement of the ARO area using MDCT is useful for the quantitative evaluation of the severity of aortic regurgitation.

Gastroduodenal Intussusception Caused by a Peutz-Jeghers Polyp in a Young Child: A Case Report

Gastroduodenal intussusception is a rare condition caused by the prolapse of a gastric tumor with subsequent invagination of a portion of the gastric wall into the duodenum. Various gastric lesions including adenoma, lipoma, leiomyoma, hamartoma, adenocarcinoma, gastrointestinal stromal tumor (GIST), and as in our case a Peutz-Jeghers polyp, can serve as a lead point of intussusception. Only three cases of gastroduodenal intussusception secondary to a Peutz-Jeghers polyp have been reported. We experienced a case of gastroduodenal intussusception in a 36-month-old boy who presented with intermittent nonbilious vomiting, abdominal pain, and anemia. An abdominal ultrasound and contrast enhanced CT scan showed gastrointestinal intussusception and a mass-like lesion in the second portion of duodenum. A laparotomy revealed a 7x8 cm sized mass at the gastric body, which was pathologically confirmed as a Peutz-Jeghers polyp.

The Treatment of a Giant Mediastinal Bronchial Artery Aneurysm by Transarterial Coil Embolization: A Case Report

Cases of bronchial artery aneurysms (BAAs) are rare; to the best of our knowledge, only 50 cases have been reported in the literature to date. BAAs require optimal treatment due to the possibility of life-threatening hemorrhaging if the aneurysm was to rupture. BAAs are usually treated by surgical resection of the aneurysmal artery. However, when the patient is unstable due to massive or recurrent hemoptysis, a bronchial artery embolization is a useful alternative treatment method. We report a case of a giant mediastinal bronchial artery aneurysm that was treated by coil embolization.

A Congenital Cystic Adenomatoid Malformation with Intact Pulmonary Vascularities

Congenital cystic adenomatoid malformation (CCAM) is a rare pulmonary disease. It is thought to represent the abnormal proliferation of immature alveoli and other mesenchymal components secondary to abrupt halting of terminal alveolus formation after 16 weeks of gestation. Radiographic parameters such as size, number, and content are variable. On grayscale ultrasound, anechoic, thin-walled cysts are usually noted in pleural or cardiodiaphragmatic locations. To our knowledge, there has been no report of a CCAM showing normal pulmonary vascularities. We report a case of CCAM with normal pulmonary vascularities found within the hypodense lesions on dynamic chest CT.

Methods of Counting Ribs on Chest CT: The Modified Sternomanubrial Approach

PURPOSE: The purpose of this study was to evaluate the accuracy of each method of counting ribs on chest CT and to propose a new method: the anterior approach with using the sternocostal joints. MATERIALS AND METHODS: CT scans of 38 rib lesions of 27 patients were analyzed (fracture: 25, metastasis: 11, benign bone disease: 2). Each lesion was independently counted by three radiologists with using three different methods for counting ribs: the sternoclavicular approach, the xiphisternal approach and the modified sternomanubrial approach. The rib lesions were divided into three parts for evaluation of each method according to the location of the lesion as follows: the upper part (between the first and fourth thoracic vertebra), the middle part (between the fifth and eighth) and the lower part (between the ninth and twelfth). RESULTS: The most accurate method was a modified sternomanubrial approach (99.1%). The accuracies of a xiphisternal approach and a sternoclavicular approach were 95.6% and 88.6%, respectively. A modified sternomanubrial approach showed the highest accuracies in all three parts (100%, 100% and 97.9%, respectively). CONCLUSION: We propose a new method for counting ribs, the modified sternomanubrial approach, which was more accurate than the known methods in any parts of the bony thorax, and it may be an easier and quicker method than the others in clinical practice.

Computed Tomographic Appearance of the Anterior Diaphragm: Evaluation with 64-slice MDCT

PURPOSE: To re-evaluate the appearance of the anterior diaphragm by the use of MDCT. MATERIALS AND METHODS: We performed a retrospective review of 81 consecutive patients that underwent chest CT by using 64 channel MDCT. We classified the anterior diaphragm as three types (types 1-3) based on 5 mm axial scans: a line behind the xiphoid, a discontinuity and opening anteriorly, and the presence of broad and poorly defined bands. We also classified the anterior diaphragm as three types (types A-C) using 2 mm sagittal reformation images, based on the shape of the anterior diaphragmatic fibers traveling from the base of the pericardium to the xiphoid: a downward slope, an upward slope, and a flat shape, and compared the two groups using a correlation determined by statistical analysis. RESULTS: We could classify the appearance of the anterior diaphragm for all cases on the axial scans and sagittal reformation images. The number of types 1, 2, 3 on the axial scans was 30.9%, 38.3%, and 30.9% and the number of types A, B, C on the sagittal reformation images was 33.3%, 22.2%, and 44.4%, respectively. Type A was seen for 92% of type 1 cases, type C was seen for 88% of type 3 cases, and type B was seen for 54.8% of type 2 cases. The types seen between the axial and sagittal reformation images showed a significant agreement (r=0.868, p < 0.01). CONCLUSION: The shape of the anterior diaphragm correlated with the relationship between the base of the pericardium and the xiphoid.

Hidradenitis Suppurativa Presenting with a Posterior Neck Mass: A Case Report

Hidradenitis suppurativa is a rare disorder that is characterized by recurrent chronic skin infections and the formation of sinus tracts and considerable scaring. A 37-year-old man presented with a hard posterior neck mass. Multiple pus-producing sinuses were detected in the skin covering the mass. MRI demonstrated an ill-defined, soft tissue mass with multiple variable sized cystic lesions. The soft tissue mass measured 12x10x4 cm in the subcutaneous fat layer, it contained multifocal cystic lesions that revealed higher signal intensity on both the T1- and T2-weighted images, as compared with the adjacent neck muscles. The mass was not enhanced on the post-contrast T1 weighted images. Some of the cystic lesions extended to the skin. The mass was removed surgically and confirmed to be hidradenitis suppurativa.

Subcutaneous Fat Necrosis of the Newborn: A Case Report

Subcutaneous fat necrosis in the newborn is an uncommon transient disorder of the subcutaneous adipose tissue that develops after birth. We describe the characteristic ultrasonography and CT findings of a case of pathologically confirmed subcutaneous fat necrosis located at the subcutaneous fat layer of the neck, back, and shoulders with a review of the literature.

Differential Diagnosis of a Follicular Carcinoma and Papillary Carcinoma of the Thyroid Gland Based on Sonographic Findings

PURPOSE: The purpose of this study was to evaluate and compare the sonographic findings of a conventional papillary carcinoma, follicular carcinoma and a follicular variant of a papillary carcinoma. MATERIALS and METHODS: A total of 308 nodules from 231 patients that were diagnosed with a papillary carcinoma and a follicular carcinoma by surgery after sonography were analyzed. The nodules consisted of a conventional papillary carcinoma (255, 83%), a follicular variant of a papillary carcinoma (25, 8%), and a follicualar carcinoma (28, 9%). We compared and analyzed the sonographic findings of each nodule for content, margin, echotexture, shape, calcification and halo sign. RESULTS: A conventional papillary carcinoma showed significant different sonographic findings than a follicular carcinoma and a follicular variant of a papillary carcinoma for an ill-defined or well-defined spiculated margin (63.1%), marked hypoechogenicity (85.9%) and microcalcification (49%). A follicular carcinoma showed a significant difference than a conventional papillary carcinoma for a well-defined smooth margin (92.9%), iso, hypo- or hyperechogenicity (89.3%), wider than tall shape (100%) and halo sign (82.1%). The follicular variant of a papillary carcinoma showed similar findings to a follicular carcinoma except for marked hypoechogenicity (44%, p = 0.006) and taller than wide shape (16%, p = 0.027). CONCLUSION: The follicular carcinoma and follicular variant of a papillary carcinoma showed similar sonographic findings, but findings of a conventional papillary carcinoma were different.

Anatomic Landmarks of Fluoroscopy Guided Puncture of the Pulseless Femoral Artery

PURPOSE: We wanted to improve puncturing the pulseless femoral artery by evaluating the anatomic landmarks that suggest the course of the femoral artery on fluoroscopy. MATERIALS AND METHODS: We analyzed 37 hemipelvis spot images that were centered on the arterial sheath after puncture of the femoral artery. The inguinal angles were measured between the inguinal line connecting the anterior superior iliac spine and the symphysis pubis, and the line of the arterial sheath. Inguinal ligament ratios were measured as the distance from the symphysis pubis to the arterial sheath to the length of the inguinal ligament on the inguinal line. The femoral head ratios were measured as the distance from the medial margin of the femur head to the arterial sheath to the transverse length of the femur head. RESULTS: The mean inguinal angle was 66.5degree (+/-7.8degree) and the mean inguinal ligament ratio was 0.42 (+/-0.03). The mean femoral head ratio was 0.08 (+/-0.18). In comparing the men and women, there was no significant difference in the inguinal angle and the femoral head ratio, but the inguinal distance ratio was larger in women (men: 0.41+/-0.033, women: 0.44+/-0.031, p < 0.05). CONCLUSION: The femoral artery generally courses just lateral to the medial margin of the femur head (femoral head ratio: 0.08) and the medial 40% of the inguinal ligament (inguinal ligament ratio: 0.42). So, consideration of these relations may be helpful for puncturing the pulseless femoral artery.

Analysis of the Factor which Affect to Acquisiton Rate of Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodules

PURPOSE: The purpose of this study is to evaluate the acquisition rate of adequate specimens in the ultrasoundguided percutaneous needle aspiration biopsy (US-PCNB) of thyroid nodules and to find the factors influencing the acquisition rate. MATERIALS AND METHODS: We conducted a prospective study in 132 patients who had a total of 215 nodules. Aspiration biopsy was performed with 21-gauge fine needles for 111 nodules (62 patients) and with 20-gauge cutting needles for 104 nodules (70 patients). We calculated the overall acquisition rate of adequate specimens of US-PCNB and compared the acquisition rates according to the kind of needle, and the size, nature and palpability of the nodules. RESULTS: The total acquisition rate of adequate specimens was 87.4%. There was no difference in the acquisition rate between the 20-gauge cutting needle and the 21-gauge needle. The acquisition rate of the solid nodules (90.2%) was higher than that of the cystic nodules (78.8%). However, the size and palpability of the nodules did not significantly affect the acquisition rate of the specimens. CONCLUSION: The acquisition rate of adequate specimens in the US-PCNB of thyroid nodules was high. The acquisition rate of the solid nodules was higher than that of the cystic nodules. However, there was no statistically significant difference in the acquisition rate according to the kind of needle, or the size and palpability of the nodules.