A Case of a Bezoar Found in a Normal Duodenal Bulb / 대한소화기내시경학회지

A 50-year-old man who had suffered from chronic indigestion complained of upper abdominal pain and vomiting which had persisted for 4 days. Consequently, he had eaten two persimmons before sleeping detected each day for five days. An irregular multinodular villous filling defect was in the duodenal bulb on, the UGI series, which had its location and changed its position. It was difficult to differentiate a papillary gastric polyp or villous tumor from the duodenal bezoar, but the patient's history of having eaten persimmons was helpful. The endoscopic and pathologic study confirmed a phytobezoar which was located in the normal duodenal bulb. Subsequently we are reporting this case having reviewed the related literature of the phytobezoar which was found in the normal duodenal bulb.

Nontraumatic Spontaneous Rupture of the Kidney: Etiology and CT Findings

PURPOSE: To evaluate the usefulness of CT scanning in determining the etiology of spontaneous rupture of the kidney. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of spontaneous rupture of the kidney in eleven patients, Four were male and seven were female, and they were aged between 20 and 71 (mean, 46.6) years. Both pre- and post-contrast enhanced CT scanning was performed in all patients. RESULTS: Spontaneous renal rupture was induced in seven cases by neoplasms (three angiomyolipomas, three renal cell carcinomas, and one metastatic choriocarcinoma), in three cases by infection or inflammation (acute and chronic pyelonephritis, and renal abscess), and in one, by renal cyst. Common CT findings of rupture of the kidney were the accumulation of high density fluid in the perirenal and anterior pararenal space, and in homogeneous irregular low density of renal parenchyma and the rupture site. Angoimyolipoma showed fat and an angiomatous component in the lesion, while acute and chronic pyelonephrities revealed thinning of the renal parenchyma and an irregular renal outline. Renal cell carcinoma showed a dense soft tissue mass in the parenchyma. Well-defined, round low-density lesions were noted in the case of renal cyst and renal abscess. CONCLUSION: CT is very useful in diagnosing and determining the etiology of non-traumatic spontaneous rupture of the kidney and plays an important role in the evaluation of emergency cases.

Endoanal Ultrasound in Benign Anal Disorders: Findings and Usefulness

PURPOSE: To evaluate the usefulness of endoanal ultrasonography and to determine the imaging features of patients with fecal incontinence, anal abscess or anal fistula. MATERIALS AND METHODS: Twenty five patients underwent endoanal ultrasonography between October 1995 and July 1996. Ten of these were fecal incontinence cases, eight had an anal abscess, and seven, an anal fistula. The incontinence grading scale (IGS) was used for clinical grading of fecal incontinence and pudendal nerve terminal motor latency (PNTML) for pudendal nerve injury. Endoanal ultrasonographic features and operative findings were retrospectively reviewed. RESULTS: Endoanal ultrasonography revealed defective sphincteric muscles in all three patients with myogenic fecal incontinence, but in six of seven cases with neurogenic fecal incontinence, these muscles were not defective. Myogenic and neurogenic incontience showed different findings (p=0.033). In comparison with surgical findings, endoanal ultrasonography was 88% accurate in anal abscess cases and 86% accurate in those of anal fistula. CONCLUSION: Endoanal ultrasonography in conjunction with PNTML was very useful for the detection of the site and severity of sphincteric muscle defect and diagnosis of the etiology of fecal incontinence. Through analysis of the site and type of lesion, the procedure can also serve as a guide to the surgical treatment of patients with anal abscess or fistula.

Necrotizing Fasciitis: Plain Radiographic and CT Findings

PURPOSE: To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. MATERIALS AND METHODS: We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. RESULTS: On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gasshadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer infour cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focallow density lesion suggestive of focal abscess was not visualized. CONCLUSION: Plain radiography is useful forearly diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

Chronic Eosinophilic Pneumonia: A Case Report

Chronic eosinophilic pneumonia is a rare diasease characterized by chronic infiltration of the lung with ~eosinophils, usually associated with peripheral eosinophilia. In 65% of cases, the chest rad Ogroaph shows typiical nonsegmental air-space consolidation confined to the outer third of the lung and in 25)/0 of case "photographic negative of pulmonary edema". Typical lung manifestations with 'peripheral eosinophiliSa' tahrcharacteristic of chronic eosinophilic pneumonia. In the remaining cases, radiographic findings are nonspecific and require lung biopsy for confirmation. We repot a case of chronic eosinophilic pneumonia in which chest radiograph and CT scans revealed bilateral patchy or diffuse opacity with nodules scattered throughout the lungs.