Clinical and contrast-enhanced image features in the prediction model for the detection of small hepatocellular carcinomas.

Purpose: To identify novel radiological features and clinical characteristics to improve diagnostic criteria for early detection of small hepatocellular carcinoma (HCC). Patients and Methods: We retrospectively recruited asymptomatic patients with no history of HCC but a high risk of HCC in whom a new, solitary, well-defined, solid nodule between 10 and 20 mm was detected through a screening ultrasound. We retrospectively collected all clinical data, and patients were examined using dynamic contrast-enhanced computed tomography or magnetic resonance imaging; subsequently, fine-needle biopsy was performed. A multivariate analysis of the predictors of small HCCs was performed by fitting a multiple logistic regression model with the stepwise variable selection method. Results: In total, 392 and 347 patients with a small liver nodule received a final pathologic confirmation of HCC and non-HCC, respectively. The estimated odds ratios and 95% confidence intervals of tumor size > 12.45 mm, age > 56.61 years, liver cirrhosis, hepatitis C virus (HCV) carrier status, ln alpha-fetoprotein (AFP) > 1.954, arterial phase enhancement, and portal or venous phase washout appearance without arterial phase enhancement were 2.0735 (1.4746-2.9155), 1.8878 (1.2949-2.7521), 1.6927 (1.1294-2.5369), 1.6186 (1.0347-2.5321), 2.0297 (1.3342-3.0876), 3.7451 (2.3845-5.8821), and 2.0327 (1.3500-3.0608), respectively. The area under the receiver operating characteristic curves for the diagnosis of small HCCs was 0.79 for arterial phase enhancement and 0.75 for portal or venous phase washout appearance without arterial phase enhancement. Conclusion: Clinical and contrast-enhanced image features are valuable in the prediction model for the detection and early diagnosis of small HCCs in patients with a high risk of HCC. In addition to negative portal or venous washout and negative arterial enhancement in images, age > 56.61 years, tumor size > 12.45 mm, HCV carrier status, and ln(AFP) > 1.954, are useful indicators for the early detection of small HCCs.

Segmental pulmonary artery transection after blunt trauma.

We herein describe a patient with segmental pulmonary artery transection after blunt trauma, which was diagnosed preoperatively by computed tomography. Bolus tracking contrast-enhanced computed tomography clearly depicted both aortic and pulmonary vasculatures. A one-step examination quickly disclosed aortic damage and injury to significant visceral organs. To the best of our knowledge, our patient appeared to be a unique case of pulmonary segmental artery transection after blunt injury, which was preoperatively diagnosed by computed tomography. Ultimately, successful surgical repair of the pulmonary artery was performed.

Primary cardiac fibroma in an infant: computed tomography and magnetic resonance imaging findings.

Cardiac fibromas (CFs) are benign primary tumors that typically occur during childhood and may be asymptomatic. However, due to the proximity of CFs to the cardiac structure, significant morbidity and mortality may also be anticipated. CFs do not show spontaneous regression and surgical resection generally remains the treatment of choice for these tumors in children. Thus, it is important to take aggressive steps to obtain accurate pretreatment image diagnosis. A full-term male infant was presented to our facility suffering from shortness of breath, after an episode of upper respiratory tract infection at age 1.5 months. Subsequent chest X-ray revealed widening of the mediastinum and trachea deviation. Cardiogenic pathology was suspected. Computed tomography and magnetic resonance imaging were performed, and we confirmed a diagnosis of benign CF. Thoracotomy biopsy of the tumor confirmed the pathological diagnosis.

Japanese viral encephalitis mimicking stroke with an initial manifestation of hemiplegia.

Japanese encephalitis (JE) is an endemic disease in Taiwan. After the program to vaccinate children against JE was implemented in 1968, the incidence of JE gradually started to decrease, but it is still an important infectious disease here. Neurological manifestations in JE vary highly during the initial stage of the disease. Focal neurological symptoms, such as hemiplegia, are rarely reported. A 46-year-old male with the initial presentation of abrupt hemiplegia and fever developed mental confusion after 1 day. No bacterial pathogen was isolated from the blood or cerebrospinal fluid (CSF). A diagnosis of JE was confirmed based on the presence of JE virus-specific immunoglobulin M in the CSF and serum samples. It is necessary to consider JE when a patient presents with abrupt hemiplegia with fever followed with mental confusion and seizure, especially if the patient comes from a JE-endemic area.

Intravenous paraquat poisoning.

Paraquat is a substance that is highly poisonous to humans. Oral ingestion is the most common pathway of poisoning. Intravenous paraquat poisoning is rare and is strongly associated with attempted suicide. The clinical presentations of such a scenario would appear to be quite different from those of oral ingestion. Herein, we present a case of an intravenous drug abuser who injected paraquat in an effort to commit suicide. He received hemoperfusion and intravenous cyclophosphamide treatment and parenteral pulse therapy with methylprednisolone. Nevertheless, he suffered from dyspnea at around 48 hours post-exposure. His condition improved transiently, but he eventually died from severe hypoxia. The findings from our case and those of previously reported cases indicate the grave prognosis and lack of effective management of intravenous paraquat poisoning.

Gray-scale and color Doppler ultrasonographic features of pleomorphic adenoma and Warthin's tumor in major salivary glands.

UNLABELLED: Our aim was to assess the specific ultrasonic characteristics of pleomorphic adenoma and Warthin's tumor in major salivary glands. METHODS: We retrospectively reviewed and analyzed the ultrasonographic (US) features of 19 pleomorphic adenomas in 16 patients and 29 Warthin's tumors in 20 patients. The features included tumor size, echotexture, boundary, and shape on gray-scale US imaging and grading and distribution of tumor vascularity on color Doppler ultrasound (CDU). RESULTS: All lesions were hypoechoic, and only 22.9% had a homogeneous echotexture. Most of the tumors (87.5%) were >or=10 mm, and 93.8% were well defined. On CDU, 91.7% had intermediate (+ and ++) grades of vascularity. Only two of 29 Warthin's tumors had the highest grade of vascularity (+++). Predominantly central blood flow was present in 58.6% of Warthin's tumors and 42.1% of pleomorphic adenomas. Lobulated margin (shape) was noted in 84.2% of pleomorphic adenomas and 51.7% of Warthin's tumors (P<.05). Anechoic cystic components were present in 13 (44.8%) of 29 Warthin's tumors and in only one pleomorphic adenoma (1/19, 5.3%) (P<.01). CONCLUSION: Most pleomorphic adenomas were lobulated. Internal anechoic cystic components were absent from pleomorphic adenomas but present in some Warthin's tumors. The grading and distribution of blood flow signals on CDU provided only limited additional diagnostic information for distinguishing pleomorphic adenomas from Warthin's tumors. Gray-scale ultrasonography is a useful method for evaluating and distinguishing pleomorphic adenomas from Warthin's tumors.

Retroperitoneal venous hemangioma.

Venous hemangioma is an extremely uncommon tumor. We report a 61-year-old woman with a surgically proven venous hemangioma in the retroperitoneum. Image studies, including sonography, computed tomography and angiography, revealed a heterogeneous mass lesion with firm adherence to the adjacent organs and engulfing the major vessels. Only subtotal resection of the tumor was done due to technical difficulty. Follow-up magnetic resonance imaging 7 months after surgery showed reduction in size and much delayed enhancement of the residual tumor. In conclusion, firm attachment to adjacent organs and much delayed enhancement are clues for the diagnosis of a venous hemangioma.