Hae Won Park

Evaluation of solid breast lesions with power Doppler sonography

We compared the abilities of power and conventional color Doppler sonography to depict the vascularity of solid breast lesions and evaluated the usefulness of power Doppler sonography in differentiating between benign and malignant breast lesions.

Radiological features of leiomyomatous tumors of the colon and rectum.

PURPOSE The purpose of this study was to evaluate the radiological features of 12 pathologically proven cases of colorectal leiomyomatous tumors. METHOD A retrospective analysis of radiologic findings was performed in 12 patients with pathologically proven colorectal leiomyomatous tumors (2 leiomyomas and 10 leiomyosarcomas). Available radiologic studies included abdominal CT scans in 11 patients, double contrast barium studies in 4, and pelvic MRI in 1. On imaging, we evaluated the size, tumor margin (smooth or lobulated), morphologic appearance, growth patterns (endocolic, exocolic, or combined), contrast enhancement patterns, presence or absence of calcification within the tumors, and metastasis. RESULTS The involved tumor sites were the colon in 2 patients and the rectum in 10. The mean tumor size was 7.9 cm (range 2-15 cm): It was 3.5 cm in leiomyomas and 8.8 cm in leiomyosarcomas. On imaging studies, the tumor margin was smooth in three patients and lobulated in nine, with endocolic growth in one, exocolic in four, and combined in the remaining seven. Eight of the 12 tumors showed varying degrees of internal necrosis with heterogeneous contrast enhancement. Dystrophic calcification was noted in five patients. Metastasis was seen in the liver in three patients at the time of initial diagnosis, and lymphadenopathy was noted in two patients (paraaortic space in one and perirectal space in two). CONCLUSION Although rare, the diagnosis of leiomyomatous tumor may be suggested especially when the tumor occurring in the colorectum shows exocolic growth or calcification with varying degree of internal necrosis.

Ultrasound elastography in the early diagnosis of plantar fasciitis

BACKGROUND The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis. MATERIAL AND METHODS We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet. RESULT Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively]. CONCLUSION US elastography is useful for the early diagnosis of plantar fasciitis.

Endovascular Treatment for Rupture of Intrahepatic Artery Aneurysm in a Patient with Behçet's Syndrome

WEB This is a Web exclusive article. ehcet’s syndrome is a multisystem disorder characterized by recurrent aphthous stomatitis, genital ulceration, and relapsing uveitis. It most often affects men between 20 and 40 years old. The syndrome is most prevalent in the Mediterranean region, Middle East, and Far East. The cause of Behcet’s syndrome is unclear [1, 2]. Cardiovascular involvement appears in only 7–29% of patients [1, 2]. Vascular involvement of Behcet’s syndrome manifests as arterial occlusion, aneurysm, venous occlusion, and varices [1, 2]. To our knowledge, spontaneous rupture of an intrahepatic artery aneurysm has not been reported in patients with Behcet’s syndrome. We describe a case of spontaneous rupture of an intrahepatic artery aneurysm in a patient with Behcet’s syndrome that we successfully treated by performing transcatheter arterial coil embolization.

Multiple cystic lymphangiomas of the spleen: radiologic and histopathologic findings.

Splenic cyst(s) may be noted as an incidental finding on conventional imaging techniques, or as a result of evaluation of a patient with left upper quadrant pain, left shoulder pain, abdominal enlargement, or splenomegaly. Lymphangioma of the spleen is an extremely rare and benign neoplasm in adults, which is characterized by cystic dilatation of the lymphatic vessels in splenic parenchyma. This report describes a case of multiple splenic lymphangiomas in a 41-year-old female. She underwent abdominal ultrasonography for a health check-up. She had no symptoms, and physical examination did not reveal any abnormalities apart from splenomegaly. Ultrasonography and computed tomography showed multiple variable-sized cysts replacing the normal parenchyma of the spleen. There were wall calcifications in several cysts. The patient underwent laparoscopic splenectomy, and the final diagnosis was multiple lymphangiomas of the spleen.

Preoperative prediction model for conversion of laparoscopic to open cholecystectomy in patient with acute cholecystitis: based on clinical, laboratory, and CT parameters.

Objective To identify preoperative computed tomography (CT) predictors associated with conversion from laparoscopic to open cholecystectomy and to propose the risk scoring model for prediction of conversion by integrating clinical, laboratory, and CT parameters. Methods The institutional review board approved this retrospective study, and informed consent was waived. One hundred eighty-three patients who underwent a laparoscopic cholecystectomy for acute cholecystitis were evaluated for clinical, laboratory, and CT parameters. Associations between conversion and these parameters were assessed by using univariate and multivariate logistic regression analysis. The risk scoring model was devised using a regression coefficient–based scoring method. Results Conversion to open cholecystectomy was performed in 30 patients (17%). Multivariate analysis identified age older than 60 years, male, and pericholecystic fluid as independent predictors of conversion. The preoperative prediction model to calculate the risk score for conversion showed sensitivity of 83% and specificity of 72%, with an area under the receiver operator curve of 0.83. Conclusions Pericholecystic fluid collection was the only CT parameter with clinical parameters of age older than 60 years and male in prediction for conversion in acute cholecystitis. The preoperative prediction model using these 3 parameters can be adapted easily in clinical practice with a good discrimination.

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

Purpose To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment. Methods Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test. Results Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction. Conclusion For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.