Bae Young Lee

The sternalis muscles: incidence and imaging findings on MDCT.

Objective We studied the incidence and appearance of the sternalis muscles on multidetector computed tomography (MDCT) to permit the differentiation of the sternalis from significant pathologic condition. Methods We retrospectively evaluated consecutive contrast-enhanced 16 row MDCT scans of the chest obtained in 1387 Korean patients (790 males and 597 females) between September 2003 and January 2005. All computed tomography scans were obtained in the supine position. Age ranges were 16 to 87 years and average was 59.2 years. Imaging analysis was based upon distribution (unilateral or bilateral, size, shape, and location). Statistical differences were evaluated by χ2 tests and Independent Samples t tests. Results The sternalis muscle was present in 86 (6.2%) of 1387 patients. This muscle was more common in female (44 of 597, 7.3%) than in male (42 of 790, 5.3%) patients, but statistical significance was not noted (P=0.058). Twenty-three patients showed bilateral sternalis muscles. Among 63 patients with unilateral sternalis muscles, 28 patients showed left sternalis muscles and 35 patients showed right sternalis muscles. Unilateral distribution was more common. The height, AP diameter, and width of the sternalis muscle were not significantly different between unilateral and bilateral muscles (P=0.182, 0.911, and 0.114, respectively). The height and AP diameter showed no significant difference between male and female (P=0.470, 0.329, respectively) patients, but the width was wider in male (P<0.001) patients. All sternalis muscles showed flat appearance, except for 1 case. The sternalis muscles were located longitudinally in parasternal position in all cases. Conclusions The sternalis muscle is an unusual normal variant of the chest wall musculature running parallel to the sternum with various sizes and most sternalis muscles are flat on MDCT. Unilateral distribution is more common, and the size of muscle is larger in males. Its incidence is 6.2% in Korean population. Radiologists should be familiar with the image findings of the sternalis muscle to avoid any confusing pathologic lesions and facilitate its clinical use such as flap.

Calcified Chronic Pericardial Fat Necrosis in Localized Lipomatosis of Pericardium

WEB This is a Web exclusive article. ericardial fat necrosis is an infrequent clinical entity first reported by Jackson et al. [1] in 1957. Only 19 cases have been reported in the English-language literature [1–3]. In all reported cases, patients presented with a sudden onset of chest pain and fatty masses without calcification. On routine radiography, most pericardial fat necrosis was interpreted as a juxtacardiac mass. CT findings have been reported in three cases as fat-attenuation masses [1–3]. However, our patient complained of longstanding pitting edema of the leg and intermittent dizziness without chest pain. On radiography, eccentric overgrowth of pericardial fat with fat necrosis was noted, and calcified flecks were seen around the pericardial fat necrosis. These unique clinical and radiologic findings have not been reported in the literature.

Pseudomyxoma peritonei: extraperitoneal spread to the pleural cavity and lung.

Abdominal and pelvic recurrence of pseudomyxoma peritonei after the surgery is occasionally seen but extraperitoneal spread and hematogeneous metastases are rare. This case of pseudomyxoma peritonei provides interesting radiologic findings of extraperitoneal spread, which occurred after an extremely long interval from initial diagnosis.

18F-fluorodeoxyglucose positron emission tomography in patients with recurrent ovarian cancer: in comparison with vascularity, Ki-67, p53, and histologic grade

The aim of this study was to assess the correlation between 18F-fluorodeoxyglucose positron emission tomography (FDG PET) positivity of tumor recurrence and vascularity, Ki-67, p53, and histologic grade in patients with ovarian cancer. Nineteen patients with recurrent ovarian cancer underwent FDG PET before second-look surgery. Archival paraffin-embedded tissue materials were used to assess histologic grade including architectural pattern, mitotic activity, and nuclear pleomorphism; intratumor microvessel density (MVD); Ki-67; and p53. Univariate analysis was used to evaluate the correlation between FDG PET positivity and each biomarker. Stepwise logistic regression analysis was used to determine the best parameter to explain FDG PET positivity. MVD revealed significant positive correlation with FDG PET positivity (p=0.0341). There was no significant correlation between FDG PET positivity and Ki-67 or p53 (p=0.4040, p=0.6027). Mitotic activity yielded statistically significant positive correlations with FDG PET positivity (p=0.0448) although histologic grade revealed no positive correlation (p=1). Stepwise logistic regression analysis revealed MVD to be the strongest parameter for FDG PET positivity (OR=0.696, 95% CI 0.487–0.993, p=0.0458). In conclusion, FDG PET positivity revealed positive correlation with MVD and mitotic activity. MVD was the strongest parameter in predicting positive tumor recurrence on FDG PET.

Anomalous right coronary artery originated from left coronary sinus with interarterial course: evaluation of the proximal segment on multidetector row computed tomography with clinical correlation.

Purpose: Anomalous origin of the right coronary artery (RCA) with an interarterial course is a potentially life-threatening anomaly. Clinical significance could depend on its orifice and interarterial course. We evaluated the anomalous RCA on multidetector row computed tomography (MDCT) with clinical correlation. Materials and Methods: Twenty-five electrocardiography-gated MDCT cases of 24 patients (mean [SD] age, 58.2 [12.3] years; 12 men and 12 women) with anomalous origin of RCA from left coronary sinus with an interarterial course were retrospectively reviewed in 3 hospitals. The cases were evaluated for the location of orifice, a takeoff angle from coronary sinus, mean diameters of RCA (orifice, interarterial, and reference), and the ratio of the diameters of RCA (orifice-reference and interarterial-reference) on MDCT with clinical correlation. Results: The orifice and the interarterial course of all anomalous RCAs were well visualized on MDCT. The narrowest portion of RCA was more frequent in the orifice (16/25 cases) than the interarterial course (6 cases). Three cases revealed the same diameter between the orifice and the interarterial course. The location of the orifice was not correlated with the diameters of anomalous RCA. Takeoff angles were correlated with the relative narrowing of the orifice of anomalous RCA (P = 0.001) and the relative narrowing of the interarterial course (P = 0.007). Only 1 patient showed significant luminal narrowing (>50% stenosis), and this patient showed a minimal takeoff angle and a persistent symptom. The symptom of this patient had disappeared after operation, and postoperative MDCT revealed an increased takeoff angle and no significant luminal narrowing. The other patients showed no significant luminal narrowing. Symptoms were not correlated with the takeoff angle and relative luminal narrowing (orifice-reference and interarterial-reference; P = 0.923, P = 0.915, and P = 0.703). Conclusions: The takeoff angles of anomalous RCA with an interarterial course are correlated with the relative narrowing of luminal diameters at the orifice and the interarterial course. Most cases show a benign nature. Evaluation of the proximal structure of anomalous RCA with an interarterial course could be important in a treatment plan.

Risk factors for the development of reexpansion pulmonary edema in patients with spontaneous pneumothorax

BackgroundReexpansion pulmonary edema (REPE) is known as a rare and fatal complication after tube thoracostomy.ObjectivesWe investigated the risk factors for the development of REPE in patients with spontaneous pneumothorax.MethodsWe selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between August 1, 2003 and December 31, 2011. The patients’ electronic medical records, including operative notes and chest x-ray and computed tomography scans, were reviewed.ResultsREPE developed in 49 of the 306 patients (16.0%). REPE was more common in patients with diabetes (14.3% vs 3.9%, P = 0.004) or tension pneumothorax (46.8% vs 16.2%, P = 0.000). The pneumothorax was larger in patients with REPE than without REPE (57.0 ± 16.0% vs 34.2 ± 17.6%, P = 0.000), and the incidence of REPE increased with the size of pneumothorax. On multivariate analysis, diabetes mellitus [(odds ratio (OR) = 9.93, P = 0.003), and the size of pneumothorax (OR = 1.07, P = 0.000) were independent risk factors of REPE.ConclusionsThe presence of diabetes increases the risk of REPE development in patients with spontaneous pneumothorax. The risk of REPE also increases significantly with the size of pneumothorax.

Erdheim-Chester Disease With Lung Involvement Mimicking Pulmonary Lymphangitic Carcinomatosis

Erdheim-Chester disease (ECD) is a rare proliferative non-Langerhans cell histiocytosis of multiple organs with unknown etiology. Around 20% of ECD cases are reported to be associated with lung involvement and there are very few cases manifested solely by nonspecific respiratory symptoms. A 50-year-old woman presented with dry cough and dyspnea for 2 weeks. Chest computed tomography (CT) revealed diffuse interlobular septal and fissural thickening with perilymphatic and subpleural nodular opacities, suggesting pulmonary lymphangitic spread of metastatic carcinoma. Bone scintigraphy and positron emission tomography/CT showed multiple skeletal and lymph node involvement. The patient underwent surgical lung biopsy and the pathologic feature was consistent with ECD. We describe this case to emphasize that ECD should be included in the differential diagnosis of cases suspected to have lymphangitic lung carcinomatosis. Moreover, the findings of positron emission tomography/CT scan, which showed hot uptakes in the affected areas, are also described.

Intrapulmonary recurrence after computed tomography-guided percutaneous needle biopsy of stage I lung cancer

Tumor seeding, along the needle tract after percutaneous needle biopsy, is a rare condition and most of the reported cases are implantation metastasis, which occurred in the chest wall or the pleura. We present a case of implantation metastasis that occurred in the pulmonary parenchyma, after a computed tomography-guided percutaneous needle biopsy (CT-PNB) of stage I lung cancer.

Myocardial infarction in a young female with reninoma induced hypertension and myocardial bridging

We present a case of myocardial infarction in a young female with reninoma induced hypertension and myocardial bridging. Reninoma is a rare and curable cause of secondary hypertension. Currently developed multi-detector computed tomography (MDCT) has permitted better evaluation of myocardial infarction and myocardial bridging. Myocardial infarction associated with reninoma and myocardial bridging has not been reported, and we report this interesting case.

A case of pneumomediastinum and parapneumonic effusions following pharyngeal perforation caused by shouting.

Spontaneous pneumomediastinum is an uncommon disorder, and usually affects young men and has a benign course. Common triggers are asthma, the smoking of illicit drugs, the Valsalva maneuver, and respiratory infections. Most cases are usually due to alveolar rupture into the pulmonary interstitium caused by excess pressure. The air dissects to the hilum along the peribronchovascular sheaths and spreads into the mediastinum. However, pneumomediastinum following pharyngeal perforation is very rare, and has only been reported in relation to dental procedures, head and neck surgery, or trauma. We report a case of pneumomediastinum that developed in a 43-year-old patient with pharyngeal perforation after shouting. His course was complicated by mediastinitis and parapneumonic effusions.