Chronic Subdural Hematoma with Sedimentation Level on CT: Correlation with Clinical and Operative Findings

PURPOSE: The purpose of this study is to correlate CT findings of the patients with chronic subdural hematoma(SDH) showing a sedimentation level with their clinical and operative findings. MATERIALS AND METHODS: We selected 9 patients who showed a sedimentation level within the hematoma after reviewing the CT findings of 55 patients with SDH. We also analyzed their age, initial symptoms, cause of head injury, latent period, the level of consciousness on admission, CT findings, and operative findings. RESULTS: All of the 9 patients were aged persons(over 52 years). They had a history of acute exacerbation of neurologic symptoms. Five of them had an apparent history of head trauma more than one month before the exacerbation. The CT scans showed unilateral, crescent-shaped subdural fluid collection with a sedimentation level except a case of bilateral SDH and 2 cases of planoconvex-shaped SDH. The interface of the sedimentation level was sharp in 3 cases and indistinct in 6 cases. None had bleeding tendency and the hemoglobin level was slightly decreased in 2 patients. All patients revealed membrane of the hematoma during operation. The upper portion of the sedimentation was liquefied blood and the lower portion was fresh blood clots. We could observe fresh RBC's in the hematoma microscopically. CONCLUSION: A sedimentation level in chronic SDH was operatively proved to represent rebleeding, and was clinically manifested as an acute exacerbation of symptoms.

Computed Tomographic Findings of Liver Injury in Adults: Role of CT Classification on Management

PURPOSE: We studied to compare computed tomographic(CT) findings of liver injury with management methods in adults and, moreover, to present the CT basis for the management. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 43 adults diagnosed as liver injury during a 66-month period. Thirty-eight patients were hemodynamically stable. Thirty-two of them were managed conservatively, whereas six managed operatively. Five unstable patients underwent emergency operation. We classified CT findings according to the severity of liver injuries(ie, hematoma, laceration, and periportal tracking) and hemperitoneum, ranging from grade 1 to 5 and from 0 to 3+, respectively. Thus, we compared the CT classificafions with their management(ie, operation rate), especially hemodynamically stable patients. RESULTS: Operation rates of all patients and hemodynamically stable patients were 26% and 16%, respectively. Operation rate at each grade of liver injury was low, especially in hemodynamically stable, despite relatively high operation rate in grade 4. Operation rate of 3+ hemoperitoneum was 100%, including hemodynamically stable patients, in contrast to otherwise low operation rate of others. CONCLUSION: Most liver injury in adults, including grade 4, were managed conservatively, especially hemodynamically stable. Though large amount of hemoperitoneum(ie, 3+) required operation, most hemoperitoeum were managed conservatively. Thus, CT findings of liver injury is helpful in the decision for the management method.

Evaluation of the efficacy of simple skull examination in head trauma

In evaluation of head trauma, simple skull examinations have been almost routinely requested in emergency room, regardless of historical, physical or neurologic findings, for fear of an unexpected fracture and medicolegal problem. Considering the low yield rate of positive radiologic findings for skull fracture and poor correlation of skull fracture with intracranial sequelae, simple skull examinations in head trauma patients, especially in those with minor trauma, is overutilized without reasonable clinical criteria of application. A retrospective review of 1,101 patients was performed to evaluate the efficacy of simple skull examination at the point of diagnosis and treatment, and to predict the risk for skull fracture and significant intracranial sequelae by clinical findings. Eighty-six patients(7.8%) had skull fractures including two basilar fractures and 12 depressed fractures. 116 patients(10.5%) had significant intracranial sequelae and 62 of these had skull fractures. Of 1,101 patients, 237 had the clinical findings of "high-yield" features and 70 of these had skull fractures and 99 had intracranial sequelae, so high-yield fractures are very indicative for the skull fracture and intracramal sequelae. Only in nine patients(0.08%0 the managements were altered after simple skull examination in that two with basilar fractures were treated with antibiotics and seven with depressed fractures were undergone neurosurgical precedures. Patients who were not admitted nor required further study or treatment because of minor head traumadidn't have any skull fractures or intracranial sequelae in our series, and 62 of 116 patients with intracranial sequelae showed normal skull findings indicating that normal findings can create false sense of security.

UD diagnosis of idiopathic pyloris stenosis

No abstract available.

High-resolution ultrasonographic findings in thyroid nodules

Ultrasonograhy, it's excellent ability of differentiating cystic from solid lesion and depicting detailedarchitecture, proved itself useful in the diagnosis of thyroid pathologies. Adanced high resolution equipmentsmade hidden small lesion detected and finer structure clearly seen. They seemed to throw light on the histologicaldiagnosis of thyroid diseases, especially differentiation of benignancy and malignancy. Author reviewed picturesof high-resolution ultrasonography of thyroid disease(24 ases0 and correlated them witn proven pathologicalfindings. The results were as follows: 1. Multiplicity of lesion favors benignancy(4 cases). 2. Well definedmargin favors benignancy(14/17), while ill defined margin favors malignancy(3/4), and lesion of no margin favorsthyroiditis(3/3). 3. Surrounding halo favors benignancy(7 cases). 4. Hypoechogenicity were found in most ofmalignancy and thyroiditis. Cystic components in solid nodule were common findings in bening and malignantlesions. Calcification was not found in malignancy.

The radiological evaluation of pulmonary metastases from gastric carcinoma

Twenty cases of pulmonary metastases from pathologically proven stomach carcinoma were studies with specialreference to the clinico-radiological findings and the grades of cell-differentiation of stomach carcinoma. Theywere calssifed into five types based on the pattern of chest X-ray findings according to the reportedclassifications of metastatic pulmonary carcinoma. The radiological appearance of pulmoanry metastases formstomach carcinoma was didffferent from that of usual pulmonary metastatic cancers. The Type IV metastatic form(Type IV-Progressive increasing interstitial lung markings and then infiltration of pulmonary parenchyme with orwithout evidence of pleural effusion.) was most commonly seen in stomach carcinoma particularly in poorlydifferentiated cell type and more associates with respiratory symptoms than others.

Collateral circulations in inferior vena cava obstruction

Obstruction of the inferior vena cava(IVC) is an uncommon condition, and the collateral pathway variesaccording to the level, extent, duration and the cause of obstruction. Membranous obstruction of IVC in itshepatic portion might be one of the principal cause among Korean, though not reported till now. Analytical studywas perfomred in 26 cases of IVC obstruction with various cause. 1. The level of the obstruction showed relativelyeven distribution as follows, upper caval in 11 cases, middle caval in 6 cases and infrarenal in 9 cases. 2. Themain cause of upper caval obstruction was membranous obstruction . 3. As a whole, the main collateral pathway wasthe central route(22 case:85%). 4. Characteristic collateral pathway unique to upper caval obstruction wastranshepatic vanous collateral, developed between the obstructed segment and unobstructed segment of IVC. 5.Scalloping of left cardiac border produced by pericardiophrenic venous collateral was characteristic simple chestX-ray finding in IVC obstruction.

Radiological analysis of polyostotic fibrous dysplasia in skeletal system

Over a period of recent 3 years, the 5 cases of polyostotic fibrous dysplasia were proven histologically atNational Medical Center, and they were evaluated and analysed radiologically and clinically. The results were asfollows; 1. The age of 5 patients ranged from 12 to 21. 2. In general, clinical symptoms of thses patients werepain of affected sites and swelling, fracture, walking disturbance of lower extremities. 3. The order of frequentsite of polyostotic fibrous dysplasia was skull (4 cases), femur( 3 cases), maxilla (2 cases), humerus, tibia,rib, radius, metacarpal bone and phalanx. 4. The characteristic radiological findings of polyostotic fibrousdysplasia were multicystic lesions with ground glass appearance, osteoslcerosis, cortical thinning and pathologicfracture and deformity of long bones. Particularly, in the extremities, multicystic radiolucencies, groud glass appearance, shepherd's crook and coxa vara deformities were noticed, and in teh skull and maxilla, sclerotic changes wee principally demonstrated.

Ultrasonographic evaluations of placenta previa

Diagnostic ultrasound has become one of the most useful tools in the practice of obstetics. It has been ofparticular utility in the placental localization. We analyzed 34 patients of placenta previa scanned byultrasound. The reults were as follows; 1. The age of patient ranged from 22 to 39 years, showing the highestincidence in 26 to 30 years. 2. The accuracy of correct localization was 70.6%. 3. Among 13 cases diagnosed byultrasound as total placenta previa, 2 cases were partial placenta previa and 1 was low-lying placenta at the timeof delivery. 4. Among 9 cases diagnosed by ultrasound as partial placenta previa, 1 case was total palcenta previaand 1 case was low-lying placenta and 1 case was upper segment placenta. 5. Among 10 cases diagnosed by utrasoundas low-lying placenta, 2 cases were partial placenta previa. 6. Among 2 cases diagnosed by utlrasound as uppersegment placenta, 1 case was total placental previa and 1 case was partial placenta previa. 7. Among 9 cases doneserial ultrasoud, 3 cases revealed that the placenta migrates toward fundus in the course of pregnancy, Therefore,the palcental scanning should be repeated in the last month before term to decide the mode of delivery.conclusively, ultrasonography is the imaging modality of choice in the evaluation of placental localization becuseit provides speedy and repeatable way without any known risk to both mother and fetus itself. Careful performanceand accurate interpretation shold be needed for more correct palcental localization.

Computed tomography of intracerebral hemorrhage

CT is the most accurate and reliable method for the diagnosis of intracerebral and intraventricularhemorrhage. The precise anatomic extent of the hematoma, associated cerebral edema, ventricular deformity anddisplacement, and hydrocephalus are all readily assessed. Aside from head trauma, the principal cause ofintracerbral hematoma is hypertensive vascular disease. Although hematomas from various causes may present similarCT appearances frequetnly the correct etiology may be suggested by considereation of patient's age, clinicalhistory, and the location of the hematoma. The analytical study was performed in 180 cases of intracerebralhamorrhages by CT from Oct. 1981 to Jan. 1983. The results were as follows; 1. The most prevalent age group was6th decade(37.2%) Male was prevalent to female at the ration of 1.6 to 1. 2. The most common symptom and sign wasmental distrubance (48.7%), motor weakness(23%), headache(10.6%), nausea and vomiting (9.8%). 3. The causes ofhemorrhage were hypertension (53.9%), head trauma (30.6%), aneurysm(6.1%) and A-V malformation (7.2%). 4. Thefrequent locations of hemorrhage were basal ganglia and thalamus(40.4%), lobes(35%), ventricles(21.8%). 5. Thedistribution of hemorrhage was intracerebral hemorrhage(65.6%), intracerebral and intraventricularhemorrhage(30.3%), intraventricular hemorrhage(4.4%).

Unusual features of extraarticular skeletal tuberculosis: new classification and differential diagnosis

Twenty two cases of extraarticular skeletal tuberculosis which showed unusual radiological features arereported and classifed into several categories with discussion on the differential diagnosis. Radiologicalpatterns of skeletal tuberculosis is so variable that with any kind of skeletal changes the possibility of theskeletal tuberculosis should not be excluded because of lack of its classical patterns.

An analysis of splenoportographic findings in portal hypertension

Splenoportography has been proved as a useful method for the evaluation of circulatory distrubances in portalhypertension. Authors analyzed the various aspects of these disturbances on splenoportography in 22 cases thatwere performed under the clinical suspicion of portal hypertension during recent 6 years, from May, 1976 to July,1982 at the Department of Radiology, National Medical Center. The results were as follows; 1. Liver cirrhosis wasthe most frequent cause of intrahepatic obstruction type in portal hypertenstion (86%). 2. The portal pressure wasmore than 400 mmH2O in 67% of the cases (range; 300-540 mmH2O). 3. In the majority of the cses, the higher theportal pressure was, the more dilated splenic and portal veins were. The diameter of portal vein was more than15mm in 79%, more than 21 mm in 47% of the cases (range; 10-26mm). The diameter of splenic vein was more than 15mmin 48% of the cases (range; 7-23mm). Especially the diameter of splenic vein was larger than that of portal veinin 20% of the cases. 4. There was no definite correlation between the development of collateral circulation andthe diameter of splenic and portal veins. 5. The filling of collateral circulation was definite sign of portalhypertenstion, though not regular. In portal hypertension, the collateral circulation was formed via coronary vein(91%), short gastric vein (64%), inferior mesenteric vein(36%). 6. Splenic-hilum time was delayed in 64% of thecases. Intrahepatic portal vein emptying time was more than 6 seconds in all the cases. 7. Most of the cases (91%)could be diagnosed as portal hypertension with vasculogram and hepatogram.

Clinical and computerized tomographic evaluation of cerebrovascular accident

Cerebrovascular accident (CVA) is the most common cause of neurologic disorder accompanying grave prognosisand its mortality above 50%. Prior to introduction of the CT, the diagnosis have been depended on clinicalfindings and spinal puncture. Radiologic diagnostic methods, such as angiography, ventriculography andradioisotope scanning are invasive and less sentitive in diagnosis of CVA than CT. The size, location andextension of the intracranial pathology and ventricular penetration are accureately and rapidly portrayed by CT.Consequently, CT plays impotant role in effective tratement and evaluation of prognosis in CVA. Authors analyzed63 cases of diagnosed CVA who were performed CT scan in Korea General Hospital from November 1981 to April 1982.The results were as follows. 1. The most prevalent age group of CVA was 6th decade, and then 7th and 5th decadesin decreasing order. The sex ration between male and female was 1.2:1. 2. The causes of CVA were hypertensivehemorrhage (50.8%), vascular occlusive disease(22.2%), anurysm ruture (4.8%), arteriovenous malformation (3.2%)and hemorrhage of unknown etiology (19.0%). 3. The most common site of hemorrhage was basal ganglia (34.6%) andthen thalamus(21.8%) and cerebral lobes(20.5%). In infarction, the common sites were the lobes(64.7%) and thebasal ganglia (35.3%) 4. Round or oval shaped hematomas of high density (85.9%) were frequent findings ofhemorrhage and mass effect occured in 75.6%. 5. All infarctions were low in density ; Most of the lesion wasinhomogeneous(70.6%) and the rests were homogeneous. Mass effects were seen in 29.4%.

Isolated dextrogastria

Isolated situs in versus of the stomach with otherwise normal position of the thoracic and abdominal vescera isan extremely rare anomaly occurring in two distinct forms. Majority of cases are associated with eventration of the diaphragm and are reported as being confused with spontaneous pneumothorax of pyopneumothorax at base of the right lung. The right sided stomach may produce interesting and confusing changes in liver scan. We have experienced 2 cases of the isolated dextrogastria.