The Spectrum of CT Findings of COVID-19 Pneumonia:Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair

Purpose@#To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). @*Materials and Methods@#From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study.A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher’s exact test. @*Results@#Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson’s chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher’s exact test). No fibrous changes in the lesions were observed on follow-up CT scans. @*Conclusion@#The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

The Spectrum of CT Findings of COVID-19 Pneumonia:Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair

Purpose@#To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). @*Materials and Methods@#From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study.A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher’s exact test. @*Results@#Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson’s chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher’s exact test). No fibrous changes in the lesions were observed on follow-up CT scans. @*Conclusion@#The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

Comparative Analysis of Image Quality and Adverse Events between Iopamidol 250 and Ioversol 320 in Hepatic Angiography for Transcatheter Arterial Chemoembolization

PURPOSE@#This study aimed to compare the image quality and adverse events between Iopamidol 250 and Ioversol 320 usage during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).@*MATERIALS AND METHODS@#Medical records and hepatic angiography from 113 patients who underwent TACE with Iopamidol 250 (44 patients) and Ioversol 320 (69 patients) were retrospectively reviewed. Vessel perception on hepatic angiography was graded into three categories by two radiologists for hepatic subsegmental arteries, the right gastroepiploic artery, right gastric artery, and pancreaticoduodenal artery. Imaging concordance was assessed by comparing the number of detected HCCs on hepatic angiography and CT. The adverse events before and after hepatic angiography were evaluated.@*RESULTS@#The mean vessel perception scores were 2.92 and 2.94 for Iopamidol 250 and Ioversol 320, respectively. The imaging concordance was 31 (70.5%) and 46 (66.7%) patients for Iopamidol 250 and Ioversol 320, respectively. There were no statistical differences in vessel perception or imaging concordance (p > 0.05). One and six patients experienced nausea for Iopamidol 250 and Ioversol 320, respectively. There was no statistical difference in adverse events (p = 0.24).@*CONCLUSION@#Iopamidol 250 can be used in hepatic angiography for TACE without significant difference in image quality or occurrence of adverse events from Ioversol 320.

Transcatheter Arterial Embolization of a Ruptured Superior Rectal Artery Aneurysm in Type 1 Neurofibromatosis: A Case Report

Neurofibromatosis type 1 (NF1) is a common autosomal-dominant disorder. Vasculopathies associated with NF1 are rare and can cause aneurysms, stenoses, and arteriovenous malformations. Aneurysms may rupture spontaneously, which could be fatal. Spontaneous mesenteric hemorrhage due to rupture of an inferior mesenteric artery aneurysm associated with NF1 has rarely been reported. Herein, we report a case of spontaneous rupture of a fusiform aneurysm in the superior rectal artery in a 56-year-old woman with NF1 who was successfully treated with transcatheter arterial embolization.

Interventional Treatment of Chemical Pleuritis and Hemothorax Caused by Iatrogenic Internal Jugular Vein Perforation after Central Venous Port System Implantation: A Case Report

The perforation of the intrathoracic internal jugular vein during the placement of an implantable central venous chemoport is a rare complication that is manifested by hemothorax or hemorrhagic shock. Furthermore, inappropriate instillation of a chemotherapeutic agent in the chemoport can cause chemical pleuritis, and the diagnosis of these complications prior to the instillation of chemotherapeutic agents and open thoracic surgery is mandatory. We report a patient with chemical pleuritis and hemothorax following an inappropriate instillation of a chemotherapeutic agent, through the perforated right internal jugular vein after placement of an implantable central venous chemoport. Treatment by embolization using coils and N-butyl cyanoacrylate, after percutaneous drainage, was successful.

Undifferentiated Pleomorphic Sarcoma of the Thoracic Aorta Presenting with Ruptured Saccular Aneurysm: A Case Report

Cases of undifferentiated pleomorphic sarcoma of the thoracic aorta are rare, and usually present with embolic events, renovascular hypertension, or back pain. Mural-based undifferentiated pleomorphic sarcomas that present as ruptured saccular aneurysms are extremely rare and are difficult to differentiate from mycotic aneurysms or penetrating atherosclerotic ulcers. Herein, we report a case of histopathologically proven undifferentiated pleomorphic sarcoma arising from the wall of the descending thoracic aorta that manifested as a mass after thoracic endovascular aortic repair for the treatment of a ruptured saccular aneurysm. We present findings obtained by CT and PET to provide helpful information for the accurate diagnosis and appropriate treatment of future cases.

Endovascular Exclusion of Hepatic Artery Pseudoaneurysm after Living-Donor Liver Transplantation with a Stent-Graft Using Conical Remodeling: A Case Report

Hepatic artery complications after liver transplantation include hepatic artery thrombosis, stenosis, pseudoaneurysm (PA), and others. Among these complications, hepatic artery PA is reported to have a low incidence, but it is associated with a devastating and often fatal outcome and a high risk of rupture. Herein, we present the case of a 56-year-old male patient who underwent living-donor liver transplantation because of alcoholic liver cirrhosis. A silent PA of the hepatic artery proper was detected incidentally on computed tomography scan during routine follow-up 15 days after surgery, and was successfully excluded by implantation of a coronary balloon-expandable stent-graft using ‘conical remodeling’ by two-step ballooning. This technique can be effectively used for PA of visceral arteries with tapering-small diameter, in which flow preservation is critical to patient care.

Clinical and Angiographic Features of Secondary Postpartum Hemorrhage and the Outcomes of Transcatheter Arterial Embolization

PURPOSE@#To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage.@*MATERIALS AND METHODS@#Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center.@*RESULTS@#Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months.@*CONCLUSION@#Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.

Ultrasound and MRI Findings of Intraneural Capillary Hemangioma of the Median Nerve Mimicking Traumatic Neuroma: A Case Report

Intraneural hemangioma of the median nerve is extremely rare. Only a few cases have been reported in literature. The researchers present ultrasound (US) and MRI findings of a case of 38-year-old-man with intraneural capillary hemangioma of the median nerve. The patient had a small, palpable mass in the volar aspect of the wrist and symptoms of carpal tunnel syndrome. US showed an infiltrative intraneural mass, without significant blood flow despite a compression test. The researchers initially misdiagnosed this mass as an in-continuity neuroma. The mass showed heterogeneous, but predominantly high signal intensity on T2-weighted image, as well as heterogeneous enhancement. The MRI findings were helpful for correct diagnosis on the retrospective review.

Impact of CT imaging on predicting the surgical management of acute diverticulitis

PURPOSE: The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment. METHODS: Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index. RESULTS: After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively). CONCLUSION: This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.

Effect of Acupuncture on Postoperative Ileus after Distal Gastrectomy for Gastric Cancer

PURPOSE: Acupuncture has recently been accepted as a treatment option for managing postoperative ileus (POI) and various functional gastrointestinal disorders. Therefore, we conducted a prospective randomized study to evaluate the effect of acupuncture on POI and other surgical outcomes in patients who underwent gastric surgery. MATERIALS AND METHODS: Thirty-six patients who underwent distal gastrectomy for gastric cancer from March to December 2015 were randomly assigned to acupuncture or non-acupuncture (NA) groups at 1:1 ratio. The acupuncture treatment was administered treatment once daily for 5 consecutive days starting at postoperative day 1. The primary outcome measure was the number of remnant sitz markers in the small intestine on abdominal radiograph. The secondary outcome measure was the surgical outcome, including the times to first flatus, first defecation, start of water intake, and start of soft diet, as well as length of hospital stay and laboratory findings. RESULTS: The acupuncture group had significantly fewer remnant sitz markers in the small intestine on postoperative days 3 and 5 compared to those in the NA group. A significant difference was observed in the numbers of remnant sitz markers in the small intestine with respect to group differences by time (P<0.0001). The acupuncture group showed relatively better surgical outcomes than those in the NA group, but the differences were not statistically significant. CONCLUSIONS: In this clinical trial, acupuncture promoted the passage of sitz markers, which may reflect the possibility of reducing POI after distal gastrectomy.

A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma / 대한소화기학회지

In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.

Non-invasive MR Demonstration of the Fistula between Pancreatic Pseudocyst and Portal Vein: A Case Report

Pancreatic pseudocyst rupture into the portal vein is a very rare complication and only three reported cases were confirmed using MRI. We report the case of a 50-year-old man with fistula formation between the pseudocyst and the portal vein, confirmed noninvasively by MRI. T2-weighted MR images and magnetic resonance cholangiopancreatography showed fluid signal intensity within the portal, superior mesenteric, and splenic veins, and a direct communication between the pseudocyst and the portal vein.

Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

Calcific Tendinitis of the Hand and Foot: A Report of Four Cases

Calcific tendinitis of hand and foot is rare and frequently misdiagnosed because of its rare incidence and its similar clinical presentation to other conditions such as infection. Awareness of the typical location as well as familiarity with the imaging findings is essential for making a correct diagnosis of this rare condition. We report four cases of calcific tendinitis of hand and foot, occurring in the flexor hallucis brevis, abductor digiti minimi, and abductor pollicis brevis.