Chin-Yin Sheu

Distinguishing multiple rice body formation in chronic subacromial-subdeltoid bursitis from synovial chondromatosis

Abstract. Multiple rice body formation is a complication of chronic bursitis. Although it resembles synovial chondromatosis clinically and on imaging, the literature suggests that analysis of radiographic and MR appearances should allow discrimination. We report the imaging findings in a 41-year-old man presenting with rice body formation in chronic subacromial-subdeltoid bursitis. We found that the signal intensity of the rice bodies is helpful in making the diagnosis.

Primary synovial osteochondromatosis of the first metatarsophalangeal joint

Abstract. Synovial osteochondromatosis is an uncommon disorder, generally seen in large joints such as the knee, elbow, shoulder, hip and ankle. We report a 35-year-old man with synovial osteochondromatosis of the metatarsophalangeal joint of the great toe. Despite the rarity of the location, the radiographic appearance ought to suggest the diagnosis. Histological confirmation is required, since malignancy cannot be totally ruled out clinically and radiographically.

Pseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients

We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. However, the second patient survived. Aspergillus tracheobronchitis should be considered in immunocompromized patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.

Viral load and outcome in SARS infection: The role of personal protective equipment in the emergency department

Abstract This study was conducted to evaluate the effectiveness of personal protective equipment (PPE) against severe acute respiratory syndrome (SARS). Sixteen patients in a SARS cluster, including 4 health care workers (HCWs) and 12 non-HCWs were studied. We compared the initial viral load by nasopharyngeal swabs, clinical progression, and outcome of this cluster. The HCWs had a lower viral load. The non-HCWs had a higher mean C-reactive protein, lower oxygen saturation, and a higher incidence of intubation and death. Secondary household transmission developed in three of the non-HCWs’ families. One month after discharge, non-HCWs had more signs of fibrosis on high resolution computed tomography (HRCT) scan and an impaired pulmonary function test. Although most of the PPE do not confer absolute protection against SARS, it seems that they may lower exposure to the virus, leading to a lower risk of secondary transmission, and be associated with relatively mild disease and a better early outcome.

Spindle cell hemangioendothelioma of the pancreas treated with interferon-alpha2a.

To the Editor: Spindle cell hemangioendothelioma usually occurs in the subcutis or dermis of the distal extremities, particularly the hand (1). A child presenting with jaundice, thrombocytopenia, and hepatomegaly was initially suspected to have a liver disorder based on the clinical findings. However, a computed tomography (CT) scan of the abdomen revealed a pancreatic lesion. Treatment of hemangioendothelioma of the pancreas by pancreaticoduodenectomy (2) or temporary choledochal and duodenal bypass followed by corticosteroid and radiation therapy (3) has been reported previously. Our patient was treated with interferon-a,at with good results initially.

Intrathoracic Tracheal Obstruction Caused by a Carotid Mycotic Aneurysm in a Patient with Deep Neck Infection – A Case Report

Upper airway obstruction secondary to a carotid mycotic aneurysm has not been previously reported. We describe a patient with a mycotic aneurysm associated with a deep neck infection and presenting with acute tracheal obstruction. Recognition of this condition is important to avoid inadvertent rupture of the aneurysm in the course of diagnostic aspiration or surgical drainage. Physical findings, including a pulsating mass and an arterial bruit, in addition to appropriate imaging studies, may be helpful in suggesting the diagnosis. In particular, both neck and chest contrast-enhanced computed tomography scans may give important clues to the presence of a vascular lesion. In a patient with an infected neck mass and tracheal compression, a common carotid mycotic aneurysm should be considered in the differential diagnosis.

Small Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic carcinoma of the breast is a rare form of breast cancer and has a poorer prognosis than other breast malignancies. Preoperative diagnosis of this tumor by imaging is difficult because of its rarity. Sonography of this small neoplasm has not been reported previously. We describe a case of this rare tumor together with the preoperative mammographic and sonographic findings. When these images present in a lesion, metaplastic breast carcinoma should be included in the differential diagnosis.

Pulmonary hamartoma mimicking primary bronchoalveolar cell carcinoma

A 52-year-old man with transitional cell carcinoma underwent a chest CT because of a newly developed pulmonary nodule observed on a chest radiograph. In addition to the nodule, a 2.8×2.4 cm well-circumscribed, pure ground-glass opacity with air cyst formation was incidentally found (figure 1). There was no …

Multiplanar reconstruction technique for difficult computed tomography-guided lung biopsy: Improved accuracy and safety: MRT for difficult biopsies

We assessed the value of the multiplanar reconstruction technique (MRT) for computed tomography‐guided lung biopsy. We evaluated 72 difficult biopsy cases (traditional method = 44; MRT = 28) to compare patient and lesion characteristics, diagnostic accuracy, complications, radiation dose, and procedure duration. Diagnostic accuracy was significantly higher using MRT than the traditional method (100% vs. 84.1%, respectively; P = 0.038). There were no severe complications in the MRT group, but one case each of severe pneumothorax and fatal hemothorax in the traditional method group. The dose‐length product rate was lower and the procedure duration slightly higher in the MRT than in the traditional group (336.83 vs. 479.64 and 33.39 vs. 25.93 minutes, respectively). MRT using computed tomography‐guided lung biopsy could improve diagnostic accuracy and avoid severe complications compared to the traditional method.

Benign features of infection‐related tumor‐like lesions of the lung: A retrospective imaging review study

Differentiation of benign and malignant pulmonary tumor‐like lesions is challenging but increasingly important. We evaluate the most common imaging features in benign lesions based on the frequency of their appearance and compare with corresponding frequencies in malignant tumors from literature.