Relapsing polychondritis diagnosed by Tc-99m MDP bone scintigraphy.

PURPOSE: Relapsing polychondritis is a generalized recurring disease of cartilage that involves joints, trachea, bronchi, laryngeal cartilages, costal cartilages, and cartilages of the ear and nose. It is associated with autoimmune diseases, including Hashimoto disease in some cases. METHODS: The authors evaluated a 29-year-old man with relapsing polychondritis who had symptoms and signs of a common cold for 2 months and anterior chest pain near the sternum for 1 month. RESULTS: After the diagnosis, the authors found that the patient had a history of thyroid therapy for hyperthyroidism 15 years before. Tc-99m MDP bone scintigraphy performed to evaluate anterior chest pain showed diffusely increased accumulation of radioactivity in all costocartilages and sternoclavicular joints. Based on that information, relapsing polychondritis was diagnosed. Ga-67 citrate scintigraphy was preformed to determine the optimum biopsy site of the cartilage. The diagnosis was histologically supported by the results of the open biopsy. CONCLUSIONS: In this case, Tc-99m MDP bone scintigraphy was useful for diagnosing relapsing polychondritis, and Ga-67 citrate scintigraphy was helpful in determining the biopsy site.

Obui-himo syndrome.

Normal variants of the venous system are relatively common and rarely cause severe symptoms. We report the case of a 5-month-old baby who displayed cyanotic color and swelling of arms whenever she was carried on the mother's back with a special band "Obui-himo". It was demonstrated by venography that the symptoms were caused by the absence of a cephalic vein and compression of axillary veins with the Obui-himo. In any country with a custom similar to the Obui-himo, these symptoms, if clinically encountered, are an indication that venography should be performed.

Hepatic arteriography in patients with hepatocellular carcinoma: change in findings caused by balloon occlusion of tumor-draining hepatic veins.

OBJECTIVE: A previous study suggested that temporary occlusion of a segment of the hepatic vein causes an increase in arterial flow and retrograde portal flow in the occluded segment. Such occlusions might improve the efficacy of arterial infusion therapy. Accordingly, we studied the change in blood flow visible on hepatic arteriograms when a segment of the hepatic vein is temporarily occluded in patients with hepatocellular carcinoma. MATERIALS AND METHODS: The study group consisted of 24 patients with nodular-type hepatocellular carcinoma. Conventional hepatic arteriography was followed by hepatic arteriography performed using a balloon catheter to occlude the hepatic vein that was most closely associated with the tumor. Visualization of the tumor-draining veins, portal vein branches, the degree of tumor vascularity, and the density of the hepatogram on the hepatic arteriogram were retrospectively compared before and during venous occlusion. The veins were evaluated visually; an increase of tumor vascularity was defined as an increase in the number of countable tumor vessels during occlusion, and a dense hepatogram was considered to be a definite sinusoidgram induced by venous occlusion. RESULTS: Conventional hepatic arteriography showed the tumor-draining veins to be branches of the portal vein in only two of the 24 patients (8%). Hepatic arteriography during venous occlusion, however, showed the tumor-draining veins to be branches of the portal vein in four of the patients (17%). An increase in the degree of tumor vascularity with venous occlusion was observed only in a patient with an initial arteriohepatic vein shunt. Dense hepatogram and hepatofugal opacification of the portal vein branches in the occluded, tumor-bearing segment were obtained in 10 patients (42%). Eight of these did not have liver cirrhosis, whereas all of the remaining 14 patients did (p < .001). CONCLUSION: Our results suggest that occlusion of a segment of the hepatic vein may be useful during arterial infusion of hepatocellular carcinoma.

Cavernous hemangioma with arterioportal and arterio-hepatic vein shunts coexisting with hepatocellular carcinoma.

A patient with hepatocellular carcinoma (HCC) and coexisting hepatic cavernous hemangiomas with arterioportal and arterio-hepatic vein shunts is reported. Antegrade and retrograde opacifications of portal vein radicles and filling of a branch of the right hepatic vein verging on cavernous hemangiomas were observed in the late arterial phase of hepatic arteriography in addition to HCC. Unenhanced CT scans performed eight days after the arterial infusion of Lipiodol showed clearly the location of the tumors and the shunting vessels. To the authors' knowledge, this is the first reported case of cavernous hemangioma with arterioportal and arterio-hepatic vein shunts accompanied by hepatocellular carcinoma.