Use of Reversed Iliac Leg Stent-Graft for the Treatment of Isolated Aneurysm of Internal Iliac Artery

This is to report the technique of reversed iliac leg stent-graft in endovascular treatment for isolated internal iliac artery (IIA) aneurysm, which had significant size discrepancy between the common iliac artery (CIA) and external iliac artery (EIA) in 3 patients from different hospitals. Three patients were a 85- and two 82-year-old men. Treated were right IIA aneurysms, sized 6.5x6.2 cm, 5.0x4.0 cm, and 4.1 cm in longest diameter, respectively. The diameters of the right CIA and right EIA measured 21 mm/11 mm, 15 mm/11 mm, and 20 mm/10 mm, respectively. In all cases, reversed iliac leg stent-grafts were prepared on-site; unsheathed and mounted upside-down manually, and deployed in each right CIA. Post-stent-graft angiograms showed complete exclusion of the aneurysms, except for minimal type 1 endoleak in one case. This technique is a useful treatment option in patients with isolated IIA aneurysm.

The Standization of Clinical Information for the Korean Hepatocellular Carcinoma Registry

Obtaining the basic statistical data on cancer diseases is essential to plan cancer research and to determine the proper tools to use for diagnosing and treating cancer. By using the national wide cancer registry, more accurate data has been collected and more informative cancerrelated statistical data can be calculated such as the occurrence rate, the death rate, the survival rate and so on. In Korea, the primary liver cancer registry has been active since 2003, and the clinical data from 10,886 patients has been collected. Unfortunately there are time and security limitations for recording and sharing this data and so a more convenient system is required. Therefore, we have revised the original primary hepatoma cancer registry to give a summary of research itself and an analysis of patients' data for the government's national wide evaluation and management of primary hepatoma.

Malignant Mesothelioma Presenting as Large Neck Mass / 결핵및호흡기질환

Malignant mesothelioma is the most common primary malignant tumor involving pleura, but its diagnosis is difficult to determine by pathology in addition to the fact that it is rare. We present an unusual case of malignant mesothelioma, which initially presented as large neck mass contrary to the more common presentation of a rind like growth along the pleura demonstrated on imaging and by pathologic findings.

A case of Zollinger-Ellison syndrome: localization of gastrinoma by selective intra-arterial calcium injection / 대한내과학회지

Zollinger-Ellison syndrome is a very rare disease that's caused by tumor having gastrin-producing cells, and this is accompanied by hypergastrinemia leading to gastric acid hypersecretion, peptic ulcer and their complications. A 60-year-old man presented with epigastric pain and soreness he had experienced for 7 days. The endoscopic findings showed reflux esophagitis and multiple active ulcers at the antrum, the duodenal bulb and the 2nd and 3rd portions of the duodenum. The fasting serum gastrin level was markedly elevated above 1,470 pg/mL and this was consistent with the findings of gastrinoma. We confirmed the presence of gastrinoma via the abdomen CT scan and selective intra-arterial calcium injection. This is the first Korean case report of gastrinoma that was localized by selective intra-arterial calcium injection.

Hypertensive Heart Failure with Severe Arteriosclerotic Stenosis of the Descending Aorta

We report a case of hypertensive heart failure with severe stenosis of the descending aorta. The patient had hypertension; however, he had not previously received any antihypertensive treatment. After receiving antihypertensive therapy for 2 weeks, he was admitted to our hospital for acute heart failure. Computed tomography (CT) and magnetic resonance imaging (MRI) showed severe arteriosclerotic stenosis of the descending aorta above the renal artery bifurcation. He underwent aortic resection and grafting. After surgery, his condition improved, and he was discharged.

A Case of Pulmonary Artery Involvement as the First Manifestation of Takayasu's Arteritis / 결핵

Takayasu's arteritis is a chronic inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Pulmonary artery is often involved in Takayasu's arteritis, but only a few cases have been reported in which pulmonary artery involvement occurred as the initial clinical manifestation. We report one patient who was referred to our institution with the provisional diagnosis of chronic thromboembolic pulmonary hypertension and subsequently diagnosed with Takayasu's arteritis involving the pulmonary artery.

Effects of Subintimal Angioplasty in Patients with Ischemic Arterial Disease of Lower Extremities

PURPOSE: Although subintimal angioplasty (SIA) has been advocated to treat chronic lower extremity arterial occlusions, numerous reports have described differences in its results. We evaluated the effect of SIA in a group of patients with severe lower extremity arterial occlusive disease. METHOD: During a 5-month period, 6 limbs in 4 patients with arterial occlusions (mean length, 17.7 cm; range, 9 to 27 cm) were treated with SIA. Three limbs had gangrene, and all patients had resting pain. There were two external iliac-superficial femoral, two superficial femoral-popliteal and two femoral-popliteal-tibial artery lesions. With fluoroscopic guidance, via an antegrade common femoral artery puncture, a subintimal dissection plane was created across the occlusion with standard hydrophilic guidewire and catheter. The arterial lumen was reentered distal to the occlusion, and the recanalized segment was balloon (3 to 6 mm) dilated. RESULT: SIA was technically successful in all 6 limbs (100%). Pain was completely resolved and all areas of gangrene were healed. The mean increase in ankle-brachial index after SIA was 0.51 (range, 0.25 to 0.71). There was no significant complication related with SIA and all arteries were patent during 3.6-months mean follow-up period. CONCLUSION: SIA for long occlusions of the crural arteries is safe and effective and can be an excellent alternative to reconstructive surgery in elderly and frail patients.

Pachydermoperiostosis (Primary Hypertrophic Osteoarthropathy): Case Report

We report a case involving a young male with the complete form of primary hypertrophic osteoarthropathy. He presented with the typical features of the condition: thickening and furrowing of the skin of the forehead and scalp, and digital clubbing of the hands and feet. Plain radiographs of the long bones of the extremities depicted bilateral irregular, shaggy, cortical diaphyseal thickening. T1- and T2-weighted magnetic resonance imaging(MRI) of the femur demonstrated low-signal-intensity cortical thickening. Bone scintigraphy revealed no photon uptake in the long bones.

Lymphoepithelial Cyst of the Pancreas: A Case Report

Lymphoepithelial cyst of the pancreas is a very rare lesion of unknown etiology. It is difficult, on the basis of radiologic images, to differentiate between lymphoepithelial cyst and pancreatic pseudocyst or other cystic neoplasms, particularly if these are mucinous. We describe the sonographic and CT findings in a case of surgically proven lymphoepithelial cyst of the pancreas.

The Frequency and the Degree of Fusion of the Lung on High-Resolution CT

PURPOSE: To evaluate the frequency and degree of fusion of the lung, as seen on high-resolution CT(HRCT). MATERIALS AND METHODS: In 210 patients high-resolution CT scans from the apex to the diaphragm were obtained at 1mm collimation and 7mm interval. We retrospectively analysed the frequency and degree of fusion of the lung bordering each interlobar fissure. Fusion of the lung was defined when fissure appeared without complete lobar separation. The degree of lung fusion was classified as mild (less than 1/3 of the fissure), moderate (greater than 1/3 and less than 2/3 of fissure), or severe (greater than 2/3 of the fissure). RESULT: In 90 of 210 patients, all fissures were identified. In 73 of these 90 (81.1%), lung fusion was noted, the most frequent site of this being between the right upper and right middle lobe (53.3%). The least frequent site was between the upper portion of the left upper and left lower lobe (32.2%). Am mild degree of fusion was most frequently found between the right middle and right lower lobe (83.9%), while a severe degree was most frequentl between the right middle and right upper lobe (50.0%), followed by the lingular division and the left lower lobe (41.9% ). CONCLUSION: HRCT can be used to were able to evaluate the frequency and degree of interlobar lung fusion.

CT Angiogram Sign: Differentiation of Malignant and Benign Lung Consolidation

PURPOSE: To assess the frequency of the CT angiogram sign, as seen on spiral CT and to evaluate the usefulness of this sign in the differentiation of benign and malignant lung disease. MATERIALS AND METHODS: Sixty patients with lung consolidation, as seen on mediastinal window setting were studied retrospectively and the frequency of the CT angiogram sign was determined. In cases in which the sign was present, the following points were analysed; 1) discontinuity of vessels; 2) the avascular zone; 3) abnormal vessels, 4) displacement of pulmonary vessels, 5) separation of bronchovascular bundles. RESULTS: Of sixty patients with lung consolidation, 48 patients showed the CT angiogram sign; its frequency showed no significant statistical differences between benign and malignant disease(p>0.05). There were, however statistically significant differences between discontinuity of vessels (malignant, 46 %; benign, 15 %; p=0.030) the avascular zone(malignant, 63 %; benign, 20%;p=0.003) and separation of bronchovascular bun-dles (malignant, 60%; benign, 4 %; p=0.001). In the case of abnormal vessels (malignant, 32 %; benign 16 %; p=1.588) and displacement of pulmonary vessels (malignant, 37 %; benign, 16 %; p=2.737) there were no statistically significant differences. CONCLUSION: The CT angiogram sign, as seen on spiral CT was nonspecific Where the sign is present, angiogram sign, discontinuity of vessels, the avascular zone and separation of bronchovascular bundles may be useful signs for the diagnosis of central lung cancer with obstructive pneumonitis.

CT Angiogram Sign: Differentiation of Malignant and Benign Lung Consolidation

PURPOSE: To assess the frequency of the CT angiogram sign, as seen on spiral CT and to evaluate the usefulness of this sign in the differentiation of benign and malignant lung disease. MATERIALS AND METHODS: Sixty patients with lung consolidation, as seen on mediastinal window setting were studied retrospectively and the frequency of the CT angiogram sign was determined. In cases in which the sign was present, the following points were analysed; 1) discontinuity of vessels; 2) the avascular zone; 3) abnormal vessels, 4) displacement of pulmonary vessels, 5) separation of bronchovascular bundles. RESULTS: Of sixty patients with lung consolidation, 48 patients showed the CT angiogram sign; its frequency showed no significant statistical differences between benign and malignant disease(p>0.05). There were, however statistically significant differences between discontinuity of vessels (malignant, 46 %; benign, 15 %; p=0.030) the avascular zone(malignant, 63 %; benign, 20%;p=0.003) and separation of bronchovascular bun-dles (malignant, 60%; benign, 4 %; p=0.001). In the case of abnormal vessels (malignant, 32 %; benign 16 %; p=1.588) and displacement of pulmonary vessels (malignant, 37 %; benign, 16 %; p=2.737) there were no statistically significant differences. CONCLUSION: The CT angiogram sign, as seen on spiral CT was nonspecific Where the sign is present, angiogram sign, discontinuity of vessels, the avascular zone and separation of bronchovascular bundles may be useful signs for the diagnosis of central lung cancer with obstructive pneumonitis.

CT Features of Peritonitis associated with Continuous Ambulatory Peritoneal Dialysis

PURPOSE: To evaluate the CT findings of peritonitis associated with continuous ambulatory peritonealdialysis(CAPD). MATERIALS AND METHODS: We retrospectively analyzed CT scans of 14 symptomatic patients withperitonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomitingin one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, weevaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern ofenhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omentalchange. RESULTS: On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainlyin the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity (n=13), including thelesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anteriorperitoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five.Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five ofthese, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticularopacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. CONCLUSION:Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, andcocoon formation appear to be CT features of CAPD peritonitis.

Primary Appendiceal Lymphoma Presenting as Acute Appendicitis: A Case Report

Because primary lymphoma of the appendix is a very rare disorder and commonly presented as acute appendicitis,it is seldom diagnosed by preoperative imaging study. We encountered a patient with pathologically proved primaryappendiceal lymphoma associated with acute and chronic appendicitis. Ultrasonogram revealed a non-compressiblesausage-shaped hypoechoic mass with a linear hyperechoic center caused by mucosa-lumen interface in right lowerquadrant. Post-contrast CT examination showed a markedly enlarged target-like appendix with obliteration of thelumen; the outer layer showed higher attenuation than the central portion. There were also multiple strands in theperiappendiceal fat and thickening of adjacent lateroconal fascia and colonic wall, and this suggested acuteappendicitis associated with appendiceal lymphoma.

CT and MR Findings of Placental Site Trophoblastic Tumor: A Report of Two Cases

Placental site trophoblastic tumor(PSTT) is a very rare form of gestational trophoblastic disease; weencountered two cases. MR imaging of the first patient revealed a solid uterine mass, slightly hyperintense tonormal myometrium on T1-weighted images and hyperintense on T2-weighted images. After intravenous gadoliniuminfusion, the mass was more enhanced than normal myometrium, and PSTT was confirmed pathologically after totalhysterectomy. In the second patient, PSTT was proven pathologically after laparoscopic left adnexectomy and wedgeresection of the right ovary. Postoperative enhanced CT scans revealed a well-enhanced right ovarian mass andextensive metastasis to the liver, pancreas, both adrenals, the stomach, lung and brain, but no mass was detectedin the uterus. Many of these metastatic lesions were infiltrating low density masses associated with highlyenhanced tubular or serpiginous structures, while some were of very high density.

Prophylactic Placement of Titanium Greenfield Vena Cava Filter before Surgical Removal of the Huge Leiomyoma Uteri Associated with Deep Vein Thrombosis: A case report

This is a case report of the prophylactically placed titanium Greenfield vena cava filter to prevent development of pulmonary thromboembolism for the surgical removal of huge leiomyoma uteri associated with deep vein thrombosis. The patient is a 39 year old female who suffered from swelling and pain in both lower extremities for 5 days. She has realized a huge mass in her pelvic cavity and abdomen since 3 years ago and has felt it growing since 1 year ago. CT discloses a heterogeneously enhanced huge mass containing cystic changes and secondary thrombosis in L iliac and L femoral veins due to compression by the mass. Deep vein thrombosis is detected in ascending venogram of the L leg. A titanium Greenfield vena cava filter was placed with transjugular approach in infrarenal portion of the inferior vena cava. After that the mass was surgically removed. No pulmonary symptom concerning pulmonary thromboembolism has developed following the surgery, but swelling and pain have developed in R leg. Follow-up CT shows new diffuse thrombosis in lower inferior vena cava and R iliac veins below the filter inferiorly, extending to R leg. Antithrombotic treatment was started with heparin and Coumadin.

A case of combined gastrojejunal and gastrocolic fistula secondary to gastric cancer

A rare case of gastric cancer associated with gastrojejunal and gastrocolic fistula is presented. A 56-year-old man who had been diagnosed with advanced gastric cancer(Borrmann's type III) 5 months previously was admitted due to watery diarrhea and frequent vomiting for 2 weeks. Fluoroscopic examination was visualized two abnormal passage of contrast medium from the stomach, one to the colon, and the other to the jejunum. Gastrofiberscopy revealed that the tumor on the great curvature of the body appeared to penetrate into the colon, while the other one on the antrum directly invaded into the jejunum. The patient was treated conservatively with total parenteral nutrition and pain control.

Combined Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection for Treatment of Hepatocellular Carcinoma: Preliminary Study

PURPOSE: Transcatheter arterial chemoembolization (TACE) and subsequent percutaneous ethanol injection (PEi) was attempted in 8 patients with 9 hepatocellular carcinomas (HCCs) for complete tumor necrosis of HCCs less than 5cm in greatest diameter. MATERIALS AND METHODS: PEI was performed with 2-8ml of absolute (99.9%) ethanol two weeks after TACE under CT or ultrasound guidance. For each patient PEI was done twice to four times within 4-10 days of each procedure. After completion of a series of PEI, follow up examination (range:3 months-l.5 year period) was done with angiography, CT or ultrasound and correlated with serum alpha-fetoprotein (AFP) level. RESULTS: On follow up anglograms, the lesions completely disappeared or decreased in size without tumor vessels or staining in 5 of 6 patients. On follow up CT of 6 patients, the lipiodol-laden HCCs were surrounded by non-enhancing low density and the losion sizes were slightly decreased or not changed. These are suggestive of necrosis of tumor itself and adjacent liver parenchyma. The tumors could not be detected on follow up ultrasound examination in 2 patients. Serum AFP was decreased in 7 patients and was well corresponded to the results of imaging modalities. CONCLUSION: The authors concluded that the combined TACE and PEI is an appropriate treatment for small HCCs having high surgical risks.

Impact of clinical history on film interpretation

We performed a study to determine whether clinical history gives a positive or negative influence on X-ray film interpretation. One hundred and nine patient's radiograms, consisting of 55 normal and 54 abnormal cases (136 abnormalities), were interpreted twice by three pairs of residents in radiology and a pair of qualified radiologists, without clinical history first and with clinical history next. The interpreters recorded diagnosis and confidence level of normal or abnormal findings on a six-point scale. Analysis of receiver operating characteristic (ROC) curves showed that knowledge of clinical history improved diagnostic accuracy. Residents, especially beginners, should be advised to obtain clinical history whenever they read radiograms.

Clinical analysis of diagnostic method in obscure origin of gastrointestinal bleeding

No abstract available.