Chang-Ming Ling

Marjolin's ulcer : MR appearance

1All authors: Department of Medical Imaging, Buddhist Tzu Chi Medical Center, Hualien, No. 707, Section 3, Chung Yang Rd., Hualien, Taiwan 886. Address correspondence to P.-Y. Chang. alignant degeneration of untreated chronic wounds is a well-known complication. These rare, aggressive tumors that originate in chronically nonhealing wounds are called Marjolin’s ulcer [1]. A multidisciplinary approach is necessary in these patients. Here we report a case of Marjolin’s ulcer and the MRI findings.

Imaging of Renal Tuberculosis in Eastern Taiwan: Correlation with Clinical Course and Different Communities

Hualien, located in eastern Taiwan, is a relatively isolated district. The population is composed of different ethnic communities. Our hospital is the only medical center in eastern Taiwan, so is the most important referral hospital for epidemic diseases. After reviewing our collected cases of renal tuberculosis (TB), we observed a great diversity in staging and outcomes. The aim of this study was to classify different imaging presentations and clinical outcomes in the ethnic communities represented by these cases (non‐aboriginal and aboriginal). We retrospectively reviewed 22 cases from 1991 to 2001. We reviewed laboratory data, radiologic reports, and clinical outcomes. Before TB was proved by biopsy or culture, patients were not treated with an anti‐TB regimen. Roentgenography showed that 68% of patients had renal calcification, 59% had dilated calyces, 55% had lung involvement, and 41% had auto‐nephrectomy. The proportion of mild and severe forms was significantly different between aboriginal and non‐aboriginal groups (0.05 > p ≥ 0.00409). From this series, we recommend routine plain film roentgenography, including chest roentgenography and kidney, ureter, and bladder or abdominal roentgenography, followed by intravenous urography or computerized tomography as investigative tools for renal TB. Based on the significantly different outcomes of the disease between aboriginal and non‐aboriginal groups, a stronger health education program for the isolated district in eastern Taiwan is necessary.

Percutaneous Retrieval of Dislodged Port-A Catheters by Loop Retriever

Objective: Port-A catheter fracture with embolization is a serious complication. The percutaneous retrieval of intravascular foreign bodies avoids the need for surgery in this high risk population. We report on 14 patients who underwent percutaneous retrieval of dislodged Port-A catheters by loop retriever. Materials and Methods: Fourteen patients who had undergone percutaneous foreign body retrieval between 2002 and 2007 were evaluated retrospectively. In all procedures, retrieval of foreign bodies was performed using a 6.3-F angled wire loop retriever. Results: The percutaneous retrieval procedure was successful in all 14 patients. Repositioning of the foreign body was done in seven cases using an RC1 catheter for the intracardiac Port-A catheter fragments. Additional surgery was not required. No further complications, such as damage to the vascular wall, were noted. Conclusion: With the increasing use of indwelling catheters and interventional devices, we are frequently confronted with the problem of dislodged catheters. The percutaneous approach should be considered as the first choice when trying to resolve the problem of an embolized catheter in the cardiovascular system.

Chronically Rejected Renal Allograft Replaced by a Huge Organized Hematoma Mimicking Malignancy

A 44-year-old man received a cadaveric renal allograft, however, the allograft failed after 1 year owing to septic complications. Five years after the complications, the patient noted an enlarged mass in the lower left abdominal area accompanied by discomfort. Abdominal computed tomography (CT) revealed the failed kidney transplant had been replaced by a mass with multiple calcifications. The tumor showed heterogenous-enhancement, as well as some vascular structures that were noted within the tumor. Aortogram demonstrated a huge hypovascular lesion in the lower left abdominal area with displacement of adjacent arteries. He received transplant nephrectomy and histological examination of the tumor showed a hematoma with organization and calcification accompanied by thromboemolism in the blood vessels. A hematoma is a common acute or chronic complication of kidney transplantation. It can be secondary to graft rupture or injury to the vascular pedicle. It is not well known that a hematoma can develop and slow expansion and total replacement can occur after graft failure. CT is limited in helping to determine the definitive pre-operative diagnosis.

Treatment of Pseudoaneurysm of the Ileocolic Artery with Microcoil Embolization in a Post-ileostomy Patient

Pseudoaneurysms arising from branches of the superior mesenteric artery (SMA) are very rare. It is important to recognize and treat a pseudoaneurysm because of the risk of bleeding and even death. Angiography is the standard means for detecting intestinal and mesenteric hemorrhage. Endovascular treatment is a prompt and effective method for control of gastrointestinal hemorrhage. Status post-ileostomy with pseudoaneurysm formation and active bleeding has not been reported in the literature. We present the first case of ileocolic artery pseudoaneurysm post-ileostomy successfully treated by transcatheter arterial microcoil embolization.

Diagnosis of Tracheo-Esophageal Fsitula Three Dimensional Virtual Bronchoscope: Case Report

Acquired T-E (tracheo-esophageal) fistula is a complication of esophageal cercinoma. Esophagography with barium sulfate, or water soluble contrat medium and fiberoptic bronchoscopy are the traditinoal methods for the diagnosis of T-E fistula. In out department, the virtual bronchoscpy reconstruction technique has become a useful non-invasive method to provide anatomical information on the airway. We present two male patients (patient 1 & patient 2) of suspected T-E fistula formation with underlying primary and secondary esophageal carcimoma. They were diagnosed with thin slice spiral computer tomography (CT) with 3D virtual bronchoscopic reconstruction. Orifice of T-E fistula was noted in patient 1 but was not in patient 2. The follow-up fiber brochoscopy study and clinical outcome support our results. We find that virtual images reconstructed by computer offer satisfactory resolution.(Tzu Chi Med J 2003; 15:63-67)