Ik Yang

Tuberculous abscess in retromammary region: CT findings.

PURPOSEnOur goal was to evaluate CT findings of tuberculous abscess in the retromammary region of the breast.nnnMETHODnFour patients with tuberculosis extending from the retromammary region to the pleura were examined by CT and the findings were evaluated. All cases were also examined with mammography and two cases were evaluated with sonography. Diagnosis was confirmed by acid-fast bacillus stain, culture, and histologic examination.nnnRESULTSnMammography showed relatively smoothly marginated, round mass density in two cases, nodular density in one, and focal bulging of the pectoral wall in one. A sonogram demonstrated in two cases a fistulous connection from the heterogeneous, fluid-containing lesion with floating internal debris in the retromammary region to the thoracic cavity. In all four cases, CT showed relatively smoothly marginated, inhomogeneous, hypodense lesions with surrounding rims of the cold abscess type. A direct fistulous connection from the retromammary lesion through the thoracic wall into the pleura was seen in two cases. Destroyed rib fragments within the abscess were noted in two cases.nnnCONCLUSIONnA tuberculous abscess in the retromammary region usually showed on CT a focal, smoothly marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct fistulous connection with the pleura or a destroyed rib fragment in the abscess as revealed by CT can be helpful in the differential diagnosis of other infectious types of retromammary abscess.

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Angiomyxolipoma (vascular myxolipoma) of the knee in a 9-year-old boy.

Angiomyxolipoma (vascular myxolipoma) is a very rare variant of lipoma. This tumor is characterized by mature adipose tissue mixed with myxoid stroma and vascular vessels. To date, nine cases have been reported, all of them occurring in adults. Herein, we report a unique case of a 9-year-old boy presenting with a solitary painful mass on the right medial thigh and illustrate the imaging characteristics of this rare tumor.

Spontaneously infarcted fibroadenoma mimicking breast cancer.

Spontaneous infarction is a rare complication occurring in fibroadenomas of the breast, 1 so it is not usually considered in differential diagnoses because of its rareness in the breast. There have been a few cases in the literature that reported patients with infarcted fibroadenomas, but we found only 1 old report to date describing the sonographic features of an infarcted fibroadenoma. 2 Recently, the only case of an atypical infarcted fibroadenoma in an adolescent girl was reported, and it was a predominantly cystic mass. 3 However, our patient had a predominantly solid mixed echoic mass, and this case showed more detailed characteristics of a fibroadenoma with spontaneous infarction. We report this recent case of an infarcted fibroadenoma with high-resolution sonographic features.

Imaging neonatal spontaneous pneumomediastinum using ultrasound

PurposeTo evaluate the feasibility of ultrasound in detecting spontaneous pneumomediastinum in the neonatal intensive care unit (NICU) and illustrate the ultrasound features.MethodsAmong neonates with abnormal mediastinal radiolucency suspected on chest radiography, those referred for ultrasound examination within 2xa0days were included. Anterior mediastinal ultrasound was performed using a linear transducer (5–12xa0MHz) to determine the presence and location of abnormal air in the mediastinum. Clinical data for the neonates were also reviewed.ResultsOn ultrasound, pneumomediastinum appeared as thick linear/curvilinear echogenic lines, some with posterior shadowing located between the anterior chest wall and thymus, in lateral margins of the thymus, between the thymus and the great vessels, and in the middle of the thymic parenchyma.ConclusionsUsing ultrasound, pneumomediastinum was easily visualized, and localization of the abnormal air accumulation was possible. Ultrasound may be used as a radiation-free supplementary imaging modality for neonates with abnormal mediastinal air.

Comparison of the RECIST 1.0 and RECIST 1.1 in Non-Small Cell Lung Cancer Treated with Cytotoxic Chemotherapy

Background : The impact of the RECIST 1.1 on the selection of target lesions and assessment of tumor response was not evaluated in patients with advanced NSCLC who received cytotoxic chemotherapy. Methods: We reviewed medical records of patients with advanced NSCLC who received first-line chemotherapy between January 2004 and December 2013 and compared the selection of target lesions and tumor responses using the two RECIST versions. Results: A total of 88 patients who had at least one target lesion according to the RECIST 1.0 were included in the study. The number of target lesions by the RECIST 1.1 was significantly lower than that by the RECIST 1.0. When adopting the RECIST 1.1 instead of the RECIST 1.0, 40 patients (45.4%) showed a decrease in the number of target lesions. Three patients no longer had target lesion because of the new lymph node (LN) criteria of the RECIST 1.1. Tumor responses showed a high level of concordance between the RECIST 1.0 and RECIST 1.1, with a kappa value of 0.912. Four patients (4.5%) showed disagreement of tumor responses between the two criteria, which were all due to the change of the LN criteria. Conclusion: The RECIST 1.1 showed a high level of concordance with the RECIST 1.0 in the assessment of tumor response in advanced NSCLC patients treated with cytotoxic chemotherapy. The new LN criteria were the major cause of the reduction of target lesions and reclassification of the tumor response.

CT and US findings of ovarian torsion within an incarcerated inguinal hernia

Inguinal hernia is relatively common in children. Although inguinal hernia is not frequently encountered in girls in comparison to boys, there are occasional cases of uterine or ovarian herniation in female indirect inguinal hernia. Incarcerated ovary in hernia sac has the risk of torsion and strangulation. We present an 8-year-old girl with painful mass in her left groin. With computed tomography (CT) and ultrasonography (US), we made the diagnosis of ovarian strangulation within an incarcerated inguinal hernia. Since ultrasound is primarily used for evaluation of groin mass, CT findings of an incarcerated inguinal hernia is rarely reported.

Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

Objective Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blunt abdominal trauma. Materials and Methods We investigated the incidence of bowel transection in 513 patients admitted for blunt abdominal trauma who underwent multidetector CT (MDCT). The MDCT findings of 8 patients with a surgically proven complete bowel transection were assessed retrospectively. We report novel CT signs that are unique for transection, such as complete cutoff sign (transection of bowel loop), Janus sign (abnormal dual bowel wall enhancement, both increased and decreased), and fecal spillage. Results The incidence of bowel transection in blunt abdominal trauma was 1.56%. In eight cases of bowel transection, percentage of CT signs unique for bowel transection were as follows: complete cutoff in 8 (100%), Janus sign in 6 (100%, excluding duodenal injury), and fecal spillage in 2 (25%). The combination of complete cutoff and Janus sign were highly specific findings in patients with bowel transection. Conclusion Complete cut off and Janus sign are the unique CT findings to help detect bowel transection in blunt abdominal trauma and recognition of these findings enables an accurate and prompt diagnosis for emergency laparotomy leading to reduced mortality and morbidity.

Tumor response assessment by measuring the single largest lesion per organ in patients with advanced non-small cell lung cancer.

BACKGROUNDnThe criterion of two target lesions per organ in the RECIST 1.1 is an arbitrary one, not being supported by any objective evidence. We compared tumor responses, respectively, using the RECIST 1.1 (measuring two target lesions per organ) and modified RECIST 1.1 (measuring the single largest lesion in each organ) in patients with advanced non-small cell lung cancer (NSCLC).nnnMATERIALS AND METHODSnWe reviewed medical records of patients with advanced NSCLC who received a first-line chemotherapy between January 2004 and December 2013 and compared tumor responses according to the two criteria using computed tomography.nnnRESULTSnA total of 64 patients who had at least two target lesions in any organ according to the RECIST 1.1 were included in the study. The differences in the percentage changes of the sum of tumor measurements between the RECIST 1.1 and mRECIST 1.1 were all within 10%. Thirty-three patients (51.6%) showed an increase in the absolute value of the percentage change when adopting the mRECIST 1.1, instead of the RECIST 1.1. The tumor responses showed high concordance between the two criteria (k=0.899). Only three patients (4.7%) showed disagreement of the responses between the RECIST 1.1 and mRECIST 1.1. The overall response rates (20.3% vs. 20.3%) and disease control rates (89.1% vs. 90.6%) of first-line chemotherapy were not significantly different between the two criteria.nnnCONCLUSIONnThe modified RECIST 1.1 was comparable to the original RECIST 1.1 in the response assessment of patients with advanced NSCLC. Our result suggests that it may be possible to measure the single largest target lesion per organ for evaluation of the best tumor response.

Imaging Findings of Primary Well-Differentiated Liposarcoma of the Liver: A Case Report

Primary liposarcoma of the liver is extremely rare. We report here on a case of primary well-differentiated liposarcoma in the left hepatic lobe of a 63-year-old woman. Abdominal ultrasonography showed a well-defined, echogenic, round mass. Abdominal computed tomography (CT) and magnetic resonance (MR) images showed an almost fatty, lobulated mass with a few, random distributed vascular structures and a small area of nodular enhancement. The resected tumor appeared as a well-defined, round, tan-yellow mass. Histological analysis showed a well-differentiated liposarcoma.