Il Young Kim

Gallbladder perforation: Comparison of US findings with CT

We compared the ultrasound (US) findings of gallbladder (GB) perforation with computed tomography (CT) in 13 patients with GB perforation confirmed at surgery. The common findings of GB perforation were pericholecystic fluid collection and layering of GB wall on US, pericholecystic fluid collection, streaky omentum or mesentery, and GB wall defect on CT. Pericholecystic fluid collection, layering of GB wall, and cholelithiasis were similarly detected on US or CT. GB wall defect and/or bulging of the GB wall suggested a site of perforation was revealed in five patients (38.5%) on US and nine (69.2%) on CT. CT further disclosed the findings of streaky omentum or mesentery (84.6%). CT was superior to US for diagnosis of GB perforation.

Intraperitoneal seeding from hepatoma.

We report three cases of intraperitoneal seeding from hepatoma. Manifestation of intraperitoneal seeding from hepatoma were intraperitoneal masses (N = 2) and peritoneal thickening (N = 1). Main vascular feeder to intraperitoneal masses was omental branches of the gastroduodenal artery and/or the superior mesenteric artery.

Computed Tomographic Findings of Ruptured Hepatic Malignancy

Massive hemorrhage from ruptured hepatocellular carcinoma is uncommon. We report our experience in three cases of ruptured hepatocellular carcinoma diagnosed by computed tomography (CT). CT was useful in detecting ruptured hepatocelluar carcinoma showing the parenchymal tumor per se, defining the extent of the hematoma, and showing serial density changes with the age of the hematomas.

Transient arterial enhancement of the hepatic parenchyma in patients with acute cholangitis.

Objectives: Our objectives were to determine the clinical significance of transient arterial enhancement (TAE) of the hepatic parenchyma in patients with suspected biliary disease and to investigate the relationship between the pattern and extent of TAE and acute cholangitis. Methods: A retrospective review of dynamic computed tomographic scans in 76 patients with suspected biliary disease was performed. Patterns of TAE were classified as polymorphous, sectorial, peribiliary, diffuse, and a combination of features. The extent of TAE was evaluated by counting the involved liver segments. The extent of TAE was correlated with laboratory and clinical findings. Patients were also divided into 2 groups: cholangitis group (n = 40) and noncholangitis group (n = 36). The pattern and extent of TAE were compared between these 2 groups. Results: Among the laboratory findings that showed significant correlation with the extent of TAE, the white blood cell count and C-reactive protein concentration were found to have a relatively high correlation (r = 0.540 and 0.514, respectively). The presence of abdominal pain, fever, and cholangitis showed a statistically significant difference with the extent of TAE (P < 0.01). Statistically significant differences in the pattern and extent of TAE between the 2 groups were found (P < 0.001). Diffuse or diffuse heterogeneous TAE patterns that involve more than 5 liver segments, such as a polymorphous combined with a peribiliary pattern and a diffuse pattern, had a high association with acute cholangitis. Conclusions: Transient arterial enhancement in patients with suspected biliary disease is well correlated with clinical parameters suggestive of inflammation. Transient arterial enhancement provides useful complementary information for biliary infection in the computed tomographic diagnosis of acute cholangitis.

Tumours involving the intrathoracic vagus and phrenic nerves demonstrated by computed tomography: Anatomical features

Four cases of mediastinal tumours involving the intrathoracic vagus and phrenic nerves are presented and their computed tomographic (CT) features are described with particular attention to the intrathoracic course of these nerves. One case of mediastinal plexiform neurofibromatosis appeared as a series of low attenuation masses along the intrathoracic course of the nerves. Three examples of neurilemmomas of the vagus nerve appeared as masses with central low attenuation; one in the retrocaval area, one to the left of the aortic arch, and one in the right paraoesophageal area. Familiarity with the CT anatomy of the vagus and phrenic nerves will greatly assist in the diagnosis of mediastinal tumours.

Diffuse pattern of transient hepatic attenuation differences in viral hepatitis: a sign of acute hepatic injury in patients without cirrhosis.

Objectives: Our objective was to describe the transient hepatic attenuation differences (THADs) on dynamic computed tomography in patients with viral hepatitis who had no evidence of cirrhosis. Methods: After excluding patients who had known causative factors for the development of THAD, a retrospective review of dynamic CT scans in 67 patients with viral hepatitis was performed to determine whether THAD was present. The patients were assigned to 3 groups according to the magnitude of alanine aminotransferase (ALT) level alteration (normal to mild, moderate, and marked) or hepatitis type (acute hepatitis, acute exacerbation of chronic hepatitis, and chronic infection), and differences in the presence of various CT features including THAD among these groups were evaluated. Results: Five THADs observed had a focal pattern, and 18 THADs had a diffuse pattern. All of the diffuse THADs were observed in patients with marked ALT level alteration (ALT level > 400 IU/L) and in patients with a clinical diagnosis of acute hepatitis or acute exacerbation of chronic hepatitis. In addition, there were significant differences of the presence of other CT findings including hepatomegaly, periportal tracking, gallbladder wall thickening, perihepatic lymphadenopathy, and splenomegaly among these groups (each P < 0.05). Conclusions: A diffuse THAD of the liver and other CT features indicates acute hepatic injury in patients with viral hepatitis who have no clinical evidence of cirrhosis.

Pulmonary Manifestations of Fat Embolism on Thin-section CT: A Case Report

We report thin-section Ct findings of pulmonary fat embolism confirmend by dlincal features and microscopic examination of cells obtained by bronchoalveolar lavage. Initial thin-section CT showed extensive air space consolidation and multiple ill-defined nodular densities in both lungs. A perfusion scan showed multiple small perfusion defects in the peripheral portion of both lungs.

Acute Pancreatitis: CT Grading and Its Significance

Purpose: To assessthe prognosticvalue of computed tomography (CT) in acute pancreatitis, initial CT examinations were classified into 5 grades in terms of the degree of disease severity and CT findings were correlated with clinical cou rse, objective prog nostic sig ns, and compl ications. Material and Methods : In 29 consecutive patients with acute pancreatitis, the CT examination and clinical course were reviewed without knowledge of each other finding. 80th Ranson ’s prognostic signs and modified Glascow prognostic signs were used for evaluation of acute pancreatitis. Results: Of the 29 patients, 25 patients recovered with medical treatment while 4 patients (14%) developed pseudocysts and the other 4 patients (14%) developed abscesses. CTfindings ofthe acute pancreatitis are as follows; 10 patients (35%) in grade Äwith normal pancreas, 2 patients (7%) in grade 8 with pancreatic en largement, 2 patients (7%) in grade C with intrinsic pancreatic abnormalities associated with haziness, 3 patients (10%) in grade D with single, ill-defined fluid collection, and 12 patients (41%) in grade E with extensive and two or multiple fluid collections or presence of gas in or adjacent to the pancreas. Correlation coefficient is 0.46 (p=0.012) between CT findings and Ranson ’ s prognostic signs, 462 (p=0.0115) between CTfindings and modified Glascow prognostic signs . Conclusion: CT gradings of acute pancreatitis may be useful in predicting clini cal course.

Retroperitoneal duodenal rupture: role of the plain abdomen

Retroperitoneal duodena l rupture is ra re a nd is often difficult to diagnose on the pla in a bdominal x -ray. From a review of the plain a bdomen films of 21 cases with re troperitoneal duodenal rupture‘ confirmed by operation . pneumoretroperitoneum was revealed in 16 cases ; Air in the peritoneum was ma nifes ted as a bubbly s hadow in 12 cases. a rena l ha lo in 9 cases. air shadow along the righ t psoas m a rgin in 2 cases. a ir a long the dia phragm a tic crus in 2 cases a nd a ir in the righ t properi toneal fa t in 2 cases. US a nd CT a lso revealed air bubbles a nd f1 uid collection a round the righ t kidney. We recommend the pla in a bdom en as a useful diagnostic m ethod fo r detection of pneu moretroperitoneum