A Pictorial Review of Radiologic Findings of Foreign Bodies in the Thorax

Thoracic foreign bodies (FBs) are serious and relatively frequent in emergency departments. Thoracic FBs may occur in association with aspiration, ingestion, trauma, or iatrogenic causes. Imaging plays an important role in the identification of FBs and their dimensions, structures, and locations, before the initiation of interventional treatment. To guide proper clinical management, radiologists should be aware of the radiologic presentations and the consequences of thoracic FBs. In this pictorial essay, we reviewed the optimal imaging settings to identify FBs in the thorax, classified thoracic FBs into four types according to their etiology, and reviewed the characteristic imaging features and the possible complications.

Validation of Deep-Learning Image Reconstruction for Low-Dose Chest Computed Tomography Scan: Emphasis on Image Quality and Noise

Objective@#Iterative reconstruction degrades image quality. Thus, further advances in image reconstruction are necessary to overcome some limitations of this technique in low-dose computed tomography (LDCT) scan of the chest. Deep-learning image reconstruction (DLIR) is a new method used to reduce dose while maintaining image quality. The purposes of this study was to evaluate image quality and noise of LDCT scan images reconstructed with DLIR and compare with those of images reconstructed with the adaptive statistical iterative reconstruction-Veo at a level of 30% (ASiR-V 30%). @*Materials and Methods@#This retrospective study included 58 patients who underwent LDCT scan for lung cancer screening.Datasets were reconstructed with ASiR-V 30% and DLIR at medium and high levels (DLIR-M and DLIR-H, respectively). The objective image signal and noise, which represented mean attenuation value and standard deviation in Hounsfield units for the lungs, mediastinum, liver, and background air, and subjective image contrast, image noise, and conspicuity of structures were evaluated. The differences between CT scan images subjected to ASiR-V 30%, DLIR-M, and DLIR-H were evaluated. @*Results@#Based on the objective analysis, the image signals did not significantly differ among ASiR-V 30%, DLIR-M, and DLIR-H (p = 0.949, 0.737, 0.366, and 0.358 in the lungs, mediastinum, liver, and background air, respectively). However, the noise was significantly lower in DLIR-M and DLIR-H than in ASiR-V 30% (all p < 0.001). DLIR had higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) than ASiR-V 30% (p = 0.027, < 0.001, and < 0.001 in the SNR of the lungs, mediastinum, and liver, respectively; all p < 0.001 in the CNR). According to the subjective analysis, DLIR had higher image contrast and lower image noise than ASiR-V 30% (all p < 0.001). DLIR was superior to ASiR-V 30% in identifying the pulmonary arteries and veins, trachea and bronchi, lymph nodes, and pleura and pericardium (all p < 0.001). @*Conclusion@#DLIR significantly reduced the image noise in chest LDCT scan images compared with ASiR-V 30% while maintaining superior image quality.

Basaloid Squamous Cell Carcinoma of the Lung: Two Case Reports with CT Imaging Findings

Basaloid squamous cell carcinoma of the lung is now considered a subtype of squamous cell carcinoma as per the 2015 WHO classification and remains a relatively unknown type of lung cancer due to its rarity. Here we report two cases of basaloid squamous cell carcinoma of the lung and their CT findings to clarify some of the radiologic features of this type of cancer. Two patients aged 85 and 68 years with lung basaloid squamous cell carcinoma visited our institution and underwent surgical resection. On CT, the lesions were 3.1 and 2.8 cm in size, respectively, well-defined, round in shape with lobulated margins and prominent intratumoral necrosis. The latter case was followed after operation for 20 months, and there was no recurrence of the disease on CT. Although very rare, basaloid squamous cell carcinoma should be considered a subtype of lung cancer in tumors sharing these CT findings.

Chest CT Features of Cystic Fibrosis in Korea: Comparison with Non-Cystic Fibrosis Diseases

OBJECTIVE: Cystic fibrosis (CF) is a rare congenital disease in Korea, and its clinical and imaging findings are unclear. The objective of our study was to describe the clinical and CT features of CF in Korea and compare its features with those of other diseases mimicking CF. MATERIALS AND METHODS: From November 1994 to December 2014, a presumptive diagnosis of CF was made in 23 patients based on clinical or radiological examination. After the exclusion of 10 patients without diagnostic confirmation, 13 patients were included in the study. A diagnosis of CF was made with the CF gene study. CT findings were evaluated for the presence and distribution of parenchymal abnormalities including bronchiectasis, tree-in-bud (TIB) pattern, mucus plugging, consolidation, and mosaic attenuation. RESULTS: Of the 13 patients, 7 (median age, 15 years) were confirmed as CF, 4 (median age, 19 years) had primary ciliary dyskinesia, 1 had bronchiectasis of unknown cause, and 1 had chronic asthma. CT of patients with CF showed bilateral bronchiectasis, TIB pattern, mosaic attenuation, and mucus plugging in all patients, with upper lung predominance (57%). In CT of the non-CF patients, bilateral bronchiectasis, TIB pattern, mosaic attenuation, and mucus plugging were also predominant features, with lower lung predominance (50%). CONCLUSION: Korean patients with CF showed bilateral bronchiectasis, cellular bronchiolitis, mucus plugging, and mosaic attenuation, which overlapped with those of non-CF patients. CF gene study is recommended for the definitive diagnosis of CF in patients with these clinical and imaging features.

Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Adaptive Statistical Iterative Reconstruction-Applied Ultra-Low-Dose CT with Radiography-Comparable Radiation Dose: Usefulness for Lung Nodule Detection

OBJECTIVE: To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules. MATERIALS AND METHODS: Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically. RESULTS: Converted effective doses in SCT and ULDCT were 2.81 +/- 0.92 and 0.17 +/- 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, < 0.01, 0.038, and < 0.868 for observers 1, 2, 3, 4, and 5, respectively). The sensitivity of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT in three out of the five observers (p < 0.01 for three observers, and p = 0.064 and 0.146 for two observers). In jackknife alternative free-response receiver operating characteristic analysis, the mean values of figure-of-merit (FOM) for FBP, ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00). CONCLUSION: Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT.

T2 Values of Femoral Cartilage of the Knee Joint: Comparison between Pre-Contrast and Post-Contrast Images

OBJECTIVE: To retrospectively evaluate the relationship between T2 values of pre- and post-contrast magnetic resonance (MR) images of femoral cartilage in patients with varying degrees of osteoarthritis. MATERIALS AND METHODS: A total of 19 patients underwent delayed gadolinium-enhanced MRI of cartilage. Six regions of interest for T2 value measurement were obtained from pre- and post-contrast T2-weighted, sagittal, multi-slice, multi-echo, source images in each subject. Regions with modified Noyes classification grade 2B and 3 were excluded. Comparison of T2 values between pre- and post-contrast images and T2 values among regions with the grade 0, 1 and 2A groups were statistically analyzed. RESULTS: Of a total of 114 regions, 79 regions showing grade 0 (n = 46), 1 (n = 18), or 2A (n = 15) were analyzed. The overall and individual T2 values of post-contrast images were significantly lower than those of pre-contrast images (overall, 35.3 +/- 9.2 [mean +/- SD] vs. 29.9 +/- 8.2, p < 0.01; range of individual, 28.9-37.6 vs. 27.1-36.4, p < 0.01). Pearson correlation coefficients showed a strong positive correlation between pre- and post-contrast images (rho-Pearson = 0.712-0.905). T2 values of pre- and post-contrast images of the grade 0 group were significantly lower than those of the grade 1/2A group (pre T2, p = 0.003; post T2, p = 0.006). CONCLUSION: T2 values of the femoral cartilage of the knee joint are significantly lower on post-contrast images than on pre-contrast images. Furthermore, these T2 values have a strong positive correlation between pre- and post-contrast images.

Synchronous Triple Primary Lung Cancers: A Case Report

Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging, despite of the routine use of bronchoscopy and computed tomography (CT) of the chest. Herein we report a case of synchronous triple primary cancers of the right lung in a 72-year-old male patient in whom each tumor presented distinct CT imaging findings.

Solid Pseudopapillary Tumor of the Pancreas with Hepatic Metastasis: Spontaneous Regression Over 10-Year Follow-Up Period

A solid-pseudopapillary tumor (SPT) of the pancreas is known as a low grade malignant tumor with a good prognosis; therefore, surgical intervention is necessary. A 14-year-old boy presented with a large pancreatic SPT and three hepatic metastases. The patient and his family refused surgery. Two serial follow-up CT scans over a period of 13 years demonstrated almost complete disappearance of the pancreatic tumor and three hepatic metastases without relevant treatment. Although there have been a few reports of spontaneous healing of SPT, there has been no report regarding spontaneous disappearance of SPT and distant metastasis. Herein, we report on the spontaneous regression of a large SPT and the disappearance of three hepatic metastases.

Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.

Human Parvovirus B19 Infection in Patients with Fibromyalgia / 대한류마티스학회지

OBJECTIVE: The association of parvovirus B19 infection with many rheumatologic disease, including systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, polymyositis has been suggested, although the exact relationship between the infection and these disorders is not understood. Several cases of fibromyalgia have been reported after parvovirus B19 infection, but systemic investigation of parvovirus B19 infection in Korean patients with fibromyalgia has not been performed. This study was designed to investigate the clinical significance of human parvovirus B19 infection in Korean patients with fibromyalgia. METHODS: Serum from 54 patients with fibromyalgia and 61 age and sex matched healthy controls were tested for IgM and IgG anti-parvovirus B19 antibodies by two different commercially available ELISA kits and presence of parovovirus B19 DNA was measured by PCR. RESUTLS: IgM antibodies to parvovirus B19 were detected 1 fibromyalgia patient in one assay and 1 patient in the other assay. No controls had positive IgM antibodies. No difference was seen between fibromyalgia patients and controls with the IgG andtibodies to parvovirus B19 in two different assays. Parvovirus B19 DNA was detected in 3 fibromyalgia patients, but not in controls. CONCLUSION: Our data showed that fibromyalgia could be triggerd by parvovirus B19 infection, but parvovirus B19 is unlikely to play a significant role in the pathogenesis of Korean patients with fibromyalgia.

A Case of Parvovirus B19 Related Arthropathy Associated with Antinuclear Antibody, Anti-Ro/SSA and Anti-La/SSB / 대한류마티스학회지

Parvovirus B19 has been recently identified as the cause of various diseases such as erythema infectiosum, transient aplastic crisis in patients with chronic hemolytic anemias, hydrops fetalis, bone marrow suppression in immunocompromised hosts, and lastly acute and chronic arthropathy mimicking rheumatoid arthritis (RA) and occasionally, systemic lupus erythematosus (SLE). We describe a female patient who presented with fever, chills, polyarthralgia, serologic and PCR evidence of presence of Parvovirus B19, and expression of antinuclear antibody, anti- Ro/SSA and anti-La/SSB. There has been no clinical findings suggestive or diagnostic of any diffuse connective tissue diseases in this patient. Although there has been reports of Parvovirus B19 infection mimicking RA and SLE with manifestations of various autoimmune antibodies including rheumatoid factor, antinuclear antibody, anti-dsDNA, antilymphocyte antibody, and antiphospholipid antibody, there has not been any report of anti-Ro/SSA and anti-La/SSB expression in the setting of parvoviral arthropathy and this is the first case report.

Behcet's Disease Presenting with Clinical Manifestations of Moyamoya Disease / 대한류마티스학회지

Central nervous system involvement of Behcet's disease (BD) shows various neuropsychiatric manifestations. The differential diagnosis may include many other systemic or neurologic diseases. Moyamoya disease (MD) is a progressive cerebrovascular occlusive disease of unknown etiology with a high incidence in Korea and Japan. HLA-B51 is significantly associated with both MD and BD. We first report a case of BD associated with MD in a 32-year-old woman with transient ischemic attacks of left hemiparesis and episodic dizziness. She was diagnosed as having BD manifested with oral ulcer, genital ulcer, erythema nodosum and positivity of pathergy reaction and HLA-B51. There was no evidence of cerebral infarction or hemorrhage in brain MRI. MR angiogram and 4-vessel angiography showed occlusion of bilateral internal carotid arteries and the development of collateral circulation, suggestive of MD. Bypass surgery was successfully performed. When evaluating the manifestations of MD, a chronic inflammatory disease, such as BD, needs to be considered as the underlying disease, especially in prevalent area of both diseases.

A Case of Coexistent Benign Joint Hypermobility Syndrome and Ankylosing Spondylitis / 대한류마티스학회지

Benign Joint Hypermobility Syndrome (BJHS) is characterized by generalized ligamentous laxity, with associated tendency to recurrent sprain and dislocation. Whereas ankylosing spondylitis (AS) is characterized by ankylosis and loss of mobility of the affected joints by fibrosis and ossification of cartilage and enthesis. The association of these two pathologies is rare. We report on a 18-year old man with a joint hypermobility and laxity as well as accompanying 18-month history of back pain at the lumbar spine, both knee and left buttock pain. At physical examination the patient presented 5 points of Nine-Point Beighton hypermobility score and limitation of movement in the lumbar spine due to back pain. Magnetic resonance imaging of the pelvis showed bilateral sacroiliitis and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated and HLA B27 was positive. Transthoracic echocardiography and opthalmologic examination excluded other cause of joint hypermobility. We diagnosed co-existent BJHS and AS.

The Expression of Vascular Endothelial Growth Factor (VEGF)in Aplastic Anemia / 대한혈액학회지

BACKGROUND: Vascular endothelial growth factor (VEGF) is a potent angiogenic peptide with biologic effects that include regulation of hematopoietic stem cell development, extracellular matrix remodeling, and inflammatory cytokine generation. VEGF plasma levels are elevated in circulation during tumor growth and bone marrow proliferative status. In this study, to investigate the role of VEGF expression in patients with aplastic anemia (AA), VEGF protein expression and microvessel density (MVD) were evaluated. METHODS: Immunohistochemical staining for detecting VEGF protein was performed by the labeled avidin-biotin method on the formalin-fixed and paraffin embedded bone marrow biopsy samples of 25 patients with severe AA and 10 normal controls. Microvessels were scored in at least 3 areas (x200 fields) of the highest MVD in representative sections of each bone marrow biopsy specimen using immunohistochemistry for CD34 antigen. RESULTS: In AA, megakaryocytes and histiocytes expressed less intense cytoplasmic VEGF than in control (P < 0.05). However, plasma cells had higher VEGF immunoreactivity in AA than in control. MVD was significantly lower in patients with AA (21.43+/-7.24), compared to controls (27.65+/-3.44) (P < 0.05). MVD had a strong correlation with bone marrow cellularity. Also, the degree of VEGF immunoreactivity was correlated with bone marrow cellularity and MVD. CONCLUSION: Angiogenesis as assessed by MVD and VEGF expression seems to have a role in the pathogenesis of AA.

A case of eosinophilic perimyositis / 대한내과학회지

Eosinophilic perimyositis is an infrequent form of inflammatory muscle disease associated with peripheral blood, bone marrow and/or tissue eosinophilia. The diagnosis is fundamentally based on histological findings. Biopsy of muscle revealed local eosinophilic infiltration into muscle and necrosis of muscle fascicles. Clinical manifestations of eosinophilic perimyositis include myalgia, subcutaneous induration and erythema of skin. There were no consensus on the treatment, but patients with idiopathic eosinophilic myositis have been treated with a variety of modalities, including nonsteroidal antiinflammatory drugs and corticosteroids. Regardless of the treatment, the overall prognosis is good. Eosinophilic myositis was reported in 1980 and rarely thereafter, but there were no case reports in Korea. Recently, we experienced a patient with eosinophilic perimyositis with fibromyalgia and present here with a brief review of the literatures.

A Case of Ischemic Colitis as a Complication of Colonoscopy / 대한소화기내시경학회지

A 50-year-old man was undergone colonoscopy because of chronic lower abdominal pain for six months. No significant abnormalities was found through colonoscopy. Two days later, the patient returned to the hospital, complaining severe lower abdominal pain with hematochezia. On physical examination, his abdomen was soft to palpation, with mild tenderness on lower abdomen. Colonoscopy was performed again, which showed segmentally diffuse hyperemic and hemorrhagic mucosa resembling ischemic colitis in the sigmoid colon. He was put under our conservative treatment. Following up the colonoscopy on the third day of hospitalization, mucosal lesion displayed a remarkable improvement. Currently, he was discharged and is now under observation as an outpatient. The case of patient status complication with ischemic colitis after atraumatic colonoscopy was previously found only in caucasian patients. We are hereby reporting same case of a patient.

Evaluation of Genedia HBsAg Rapid and Genedia Anti-HBs Rapid for the Screening of HBsAg and Anti-HBs / 대한임상병리학회지

BACKGROUND: We evaluated a rapid screening kit for the detection of hepatitis surface antigen (HBsAg) and antibody (anti-HBs) using an immunochromatographic method. MATERIALS AND METHODS: We selected 499 serum specimens for the evaluation. Each specimen was tested by enzyme immunoassay (EIA; Cobas Core, Roche, Switzerland), reverse passive hemagglutination (RPHA; Serodia HBs, Asan, Korea) for HBsAg, passive hemagglutination (PHA; Serodia Anti-HBs, Asan, Korea) for anti-HBs, and with the Genedia HBsAg and Anti-HBs Rapid (Green Cross Corp., Korea) kits. Results of each assay were compared with those of the EIA. RESULTS: The sensitivities and specificities of the Genedia HBsAg Rapid kit were 98.0% and 100%, and those for the Genedia Anti-HBs Rapid kit were 95.3% and 98.0%, respectively. These were higher than those for RPHA (96.0% and 100%), and PHA (83.2% and 96.0%). Concordance rates between EIA and Genedia HBsAg Rapid, Genedia Anti-HBs Rapid, RPHA, and PHA were 98.8%, 96.4%, 97.6%, and 88.4%, respectively. Extending the incubation time from the recommended 30 minutes to 2 hours increased the sensitivities of the Genedia kits. CONCLUSION: The Genedia HBsAg and Anti-HBs Rapid kits are simple, sensitive, and inexpensive assays suitable for screening or use in emergency situations.

Percutaneous Pinning for Intra-articular Calcaneal Fracture / 대한정형외과학회잡지

Calcaneus was the most commonly involved bone among the tarsal bone fracture. Many different methods have been tried for the treatment of fractures of the calcaneus in order to search for better results. But there is no general agreement on the treatment of the fracture of the calcaneus, especially involving the subtalar joint. From Jan. 1986 to Jan. 1990, 25 feet in 20 patients of calcaneal fractures involving the subtalar joint were treated by closed reduction & percutaneous pinning at the Dept. of Orthopedic Surgery, Chosun University Hospital and the results were as follows; 1. Of these intra-articular fractures, 15 fractures were tongue type and 10 fractures were joint depression type by Essex-Lopresti classification. 2. According to the Salama unit system, the results of treatment were excellent or good in 11 cases of 15 tongue types and 6 cases of 10 joint depression types. 3. The results were excellent in which reduction is achieved near anatomical reduction. 4. Even if the joint depression type fracture which is not severely comminuted, the treatment with closed reduction & percutaneous pinning is thought to be good method.