Pectus Excavatum

Pectus excavatum in which the sternum is depressed and the anterior chest wall is concave in shape, is the most common congenital deformity to affect this region of the body. Various deformities involving depression or protrusion are caused by the degree and location of the sternal depression, and associated deformities such as a tilted sternum and anterior convexity of costal cartilages may occur. The most common associated disorders are Poland syndrome, Marfan syndrome and scoliosis.

Partial Splenic Embolization Therapy of Chronic Idiopathic Thrombocytopenic Purpura / 대한혈액학회지

BACKGROUND: Initial treatment of chronic idiopathic thrombocytopenic purpura (ITP) is generally done with corticosteroid. In case of refractory to corticosteroid or dependency, splenectomy seems to be the most effective and definitive treatment. Partial splenic embolization is an easier procedure with minimal morbidity. We evaluated the efficacy and complications of partial splenic embolization as treatment of chronic ITP refractory to corticosteroid or corticosteroid dependency. METHODS: Eight patients with chronic ITP and two systemic lupus erythematosus (SLE) patients with immunothrombocytopenia underwent partial splenic embolization. Embolization of 70~80% of the splenic volume was performed with endocoils or gelform particles without anesthesia by selective arterial catheterization and followed up for 4~50 months. The therapeutic effect of partial splenic embolzation was defined on the basis of the platelet count at the last follow-up after partial splenic embolzation : complete response, >100,000/nL,partial response, 100,000~50,000/nL and no response, <50,000/nL without medication. RESULTS: Partial splenic embolization brought a complete response in six of ten patients, a partial response in three, and no response in one. With a follow-up of 4~50 months, these responses were maintained in all except three patients. One patient was treated by splenectomy and one by partial splenic embolization again. Tolerance was good in all patients. Abdominal pain and fever was observed in 8 and 4 patients, respectively. One patient had a left pleural effusion with spontaneous resolution. No serious infection occurred. All patients were discharged within 6 days after partial splenic embolization. CONCLUSION: We conclude that partial splenic embolization may be useful and safe procedure and a good alternative to splenectomy in chronic ITP refractory to medical treatment.

MRI Finding of Reversible Pituitary Hyperplasia Due to Hypothyroidism: A Case Report

We report a case of reversible pituitary enlargement due to hypothyroidism in a 3-year-old male. OnT1-weighted images, the mass was located in the anterior lobe of the pituitary gland, and the signal intensity ofthe mass was equal to that of brain cortex. Gd-DTPA enhanced T1-weighted images showed homogeneous enhancement ofthe mass. After supplemental therapy with thyroid hormone for 8 months, MRI showed that the pituitary gland wasmarkedly smaller.

MRI Finding of Reversible Pituitary Hyperplasia Due to Hypothyroidism: A Case Report

We report a case of reversible pituitary enlargement due to hypothyroidism in a 3-year-old male. OnT1-weighted images, the mass was located in the anterior lobe of the pituitary gland, and the signal intensity ofthe mass was equal to that of brain cortex. Gd-DTPA enhanced T1-weighted images showed homogeneous enhancement ofthe mass. After supplemental therapy with thyroid hormone for 8 months, MRI showed that the pituitary gland wasmarkedly smaller.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.

Whirling Sign: An Imaging Finding Indicating Ovarian Torsion

PURPOSE: To present a diagnostic sign on MRI and US in patients with ovarian torsion. MATERIALS AND METHODS: We present characteristic imaging findings in eight patients with surgically-proven ovarian torsion. MRI was performed in four patients, CT in six and US in all patients; the procedures including eight transabdominal US(TAS) and three transvaginal US(TVS). In each study, imaging findings were analyzed for the appearance of twisted pedicle and the presence of a "whirling sign". RESULTS: The pedicle which indicates ovarian torsion was detected on MRI in all 4 patients, on TAS in 4/7, on TVS in 3/3, and on CT in 4/6. A specific "whirling sign" was detected on MRI in 2/4 patients, on TAS in 2/4, and on TVS in all three. On CT a "whirling sign" was not detected. CONCLUSION: The "whirling sign" on both MRI & US is a characteristic finding of ovarian torsion; in a patient with adnexal mass and complaining of lower abdominal pain, the presence of this sign is very useful for the diagnosis of ovarian torsion.

CT Finding of Right Retroperitoneal Space: Analysis of Extension of Right Perirenal Hematoma

PURPOSE: To understand the structure and character of the right retroperitoneal space by analysis of the extension of retroperitoneal hematoma in patients with traumatic right renal injuries. MATERIALS AND METHODS: We retrospectively reviewed CT scans of 13 patients with right retroperitoneal hematomas caused by right renal injury. At the renal level, we analyzed the relation of a hematoma contacting psoas muscle with other retroperitoneal compartmental hematomas. At the suprarenal level, a perirenal hematoma and a hematoma contacting the diaphragm were analyzed according to their relation with intrahepatic IVC and pericaval hematoma. RESULTS: Below renal hilar level, all hematomas contacting psoas muscle, observed in eight cases, were connected with retrorenal extension of anterior pararenal hematoma. At the suprarenal level, intrahepatic pericaval hematomas were not, in all 13 cases, connected with a hematoma contacting the diaphragm, but with a perirenal hematoma. At the upper suprarenal level, the only pericaval hematomas containing a medial component of perirenal hematoma extended superiorly to the upper one third of the tenth thoracic vertebral body. CONCLUSION: The anterior renal fascia envelops perirenal space except in its medial aspect. In the upper suprarenal region, the anterior and posterior planes of the anterior renal fascia unite to fuse with diaphragmatic fascia, but along the medial aspect they fuse with intrahepatic pericaval connective tissue and posteromedial diaphragm, respectively.

MR imaging of avacular necrosis of the femoral head

We evalusted the magnetic resonance imaging (MRI) findings of the femoral heads in 20 normal and 45 abnormal patients. The bone marrow in the healthy adults consisted of a combination of hematopoietic and fatty marrow, which showed age-related dirtribation, that is the component of fatty marrow was increased and the marrow vascularity was dereased with age. Avascular necrosis (AVN) showed a decreased bone marrow signal within an normal appearing femoral head on T1 and T2-weighted images. In addition, we could see inhomogenous low signal intensity (31 cases), a ring of low intensity with central normal signal intensity (25cases), focal low signal intensity (12 cases), or a band of low signal intensity (4 cases). MRI findings were abnormal in 10 cases with normal radiographic findings as well as in all the cases with abnormal ones. In conclusion, MRI should be the choice of the imaging modality for the evaluation of early bone marrow chages of AVN.

Active solitary tuberculoma of the lung:CT and clinical findings

To present CT and clinical features of active tuberculomas, we analyzed retrospectively CT findings of 14 tuberculomas (n=14) in 13 patients which appeared as solitary pulmonary nodules on plain radiographs and evaluated the response of tuberculomas to antituberculous chemotherapy. Nine tuberculomas (64%) were ovoid in shape and 10 (72%) showed smooth margin. Twelve(86%) tuberculomas were shown as low density lesions on unenhanced or enhanced CT scans. Calcification and cavitation were noted in three (21%) and eight (57%) tuberculomas respectively. Seven (50%) tuberculomas were accompanied by satellite nodules. Acid-fast bacilli (AFB) was positive in all tuberculomas in sputum, lavage fluid, or percutaneous transhoracic needle aspiration (PTNA). Smear and culture of lavage fluid and PTNA aspirate were superior to the detection of AFB than sputum examination. Follow-up study with antituberculous chemotherapy in 14 tuberculomas resulted in complete disappearance in three, decrease in size in seven, and no visible change in the remaining four. These observations suggest that tuberculomas are well-defined, ovoid, and low-density nodules containing calcifications and/or cavitations. Tuberculomas are relatively indolent even with threatment.

Normal and abnormal azygoesophageal recess: radiograph and CT correlation

We obtained sixty normal chest postero-anterior(PA) radiographs with high kilovoltage technique(90-110kVp), 10 radiographs from the consecutive normal persons in each decade from twenties to seventies to analyze normal course and appearance of azygoesophageal recess (AER) line. (AER) line. CT scans from sixty consecutive normal persons were correlated with the radiographs to see how the line is formed and what structure the line abuts. In 20 patients with a lesion in AER area(10 with subcarinal lymphadenopathy of various size, five with left atrial enlargement, three with lesions in the esophagus, and two with dilated azygos vein), radiographic and CT correlation was done with main attention to the pattern of displacement of the azygoesophageal line. In normal chest PA radiographs, AER was shown as a straight line in young adults. As age increased, it was seen as a smooth are with convexity to the left. Sigmoid shape with midline cross was noted in an aged person. At the level of the right main bronchus on CT, AER was noted along the right lateral aspect to the vertebral margin in young adults. It extended medially as age increased. Caudally the recess extended more medially. The azygos vein usually bordered the recess. The esophagus or mediastinal fat sometimes bordered the recess in caudal level. In normal persons, the recess appeared deeper on plain radiographs than on CT. On plain radiographs, there were no changes in contour of AER with subcarinal lymphadenopathy of less than 2.5cm in diameter. However right sided and downward displacement of AER line just below the carina was noted with lymphadenopathy of more than 2.5cm in diameter. With left atrial enlargement, obliteration of the line was noted at T8-10 level. Focal right sided bulging of the line was noted with esophageal cancer Dilatation of azygos vein caused the line to appear with right sided displacement. In conclusion, AER line can be delineated with various features on radiographs with high KVP technique, depending on the age of normal persons and the formation of the line can be explained with CT. Displacement and change in the contour of the line can be seen with various mediastinal diseases.

Epicardiac fat lump in the left atrioventricular groove: CT and MR findings

Fat can be prominet around the aortic root and within the right atrioventricular (AV) groove (1). At times, the fat can be globular, suggesting a mass especially on echocardiography. Computed tomography (CT) and masnetic resonance (MR) images are well suited for characterization of fat in and around the heart (1, 2). This report illustrates CT and MR findings of a very unusual case of prominent fat lump in the left AV groove.