Itsuko Okuda

Magnetic resonance-thoracic ductography: imaging aid for thoracic surgery and thoracic duct depiction based on embryological considerations

PurposeWe describe the optimal protocol of magnetic resonance-thoracic ductography (MRTD) and provide examples of thoracic ducts (TD) and various anomalies. The anatomical pathway of the TD was analyzed based on embryological considerations.MethodsA total of 78 subjects, consisting of noncancer adults and patients with esophageal cancer and lung cancer, were enrolled. The MRTD protocol included a long echo time and was based on emphasizing signals from the liquid fraction and suppressing other signals, based on the principle that lymph flow through the TD appears hyperintense on T2-weighted images. The TD configuration was classified into nine types based on location [right and/or left side(s) of the descending aorta] and outflow [right and/or left venous angle(s)].ResultsMRTD was conducted in 78 patients, and the three-dimensional reconstruction was considered to provide excellent view of the TD in 69 patients, segmentalization of TD in 4, and a poor view of the TD in 5. MRTD achieved a visualization rate of 94%. Most of the patients had a right-side TD that flowed into the left venous angle. Major configuration variations were noted in 14% of cases. Minor anomalies, such as divergence and meandering, were frequently seen.ConclusionMRTD allows noninvasive evaluation of TD and can be used to identify TD configuration. Thus, this technique is considered to contribute positively to safer performance of thoracic surgery.

Assessment of Configuration of Thoracic Duct Using Magnetic Resonance Thoracic Ductography in Idiopathic Lymphedema

The structure and the function of the peripheral lymph channels have been investigated, but the thoracic duct has not. This study used magnetic resonance thoracic ductography for 2 patients with idiopathic lymphedema to evaluate the configuration of the thoracic duct in these patients. Anomalies of the thoracic duct were detected in both cases. This result suggests that deformity of the thoracic duct is one of the causes of idiopathic lymphedema. Characterization of the etiology could lead to a breakthrough in resolving the occurrence of idiopathic lymphedema and developing a treatment procedure for it. In addition, visualization of the thoracic duct may assist in selecting the optimal therapy for each idiopathic lymphedema patient.

A large calcified retroperitoneal mass in a patient with chronic renal failure: liposarcoma with ossification

Here we describe a 65-year-old Japanese man with chronic renal failure (CRF) and a large, dense, calcified abdominal mass. The patient had a history of proteinuria, which was diagnosed as focal glomerulosclerosis. This diagnosis was confirmed by renal biopsy in 2002, with worsening renal function by July 2005 when a large area of calcification was detected on abdominal radiography, which further increased in size on follow-up radiography in December 2006. The calcified mass was surgically resected and histopathologically diagnosed as myxoid-type liposarcoma composed of dedifferentiated, myxoid, and well-differentiated components with areas of osseous metaplasia. Soft tissue calcifications and ossifications are often benign, but malignant tumors should be considered when the calcified mass is retroperitoneal, occurs in a patient with no history of chronic infection, and is not located near a large joint or associated with administration of calcium carbonate or a vitamin D derivative.

A case of a fibroadenoma coexisting with an invasive lobular carcinoma in the breast

A case of a fibroadenoma coexisting with an invasive lobular carcinoma of the breast in a 60-year-old female is presented, and its pathological features are correlated with high-resolution magnetic resonance imaging (HR-MRI) and other imaging findings. The patient presented with the chief complaint of having a palpable mass in her right breast for 3 months. Mammography revealed a lobular mass with a micro-lobulated margin, which suggested a malignant nature; however, it included coarse calcifications. Sonographic imaging and HR-MRI findings were compatible with malignant tumor. Cytology was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery was performed as a curative operation. The pathological features revealed a fibroadenoma coexisting with an invasive lobular carcinoma. This case suggests that radiologists should always pay attention to the associated malignant imaging characteristics, such as the shape and border of the mass, whenever a mass demonstrates benign-like calcifications.

Imaging aid for thoracic surgery: multidetector-row computed tomography evaluation of the tracheobronchial structure and bronchial tube selection for one-lung anesthesia.

ObjectiveThe tracheobronchial structures were evaluated by multidetector-row computed tomography (MDCT), which provided imaging information for one-lung anesthesia during thoracic surgery.MethodsThe subjects consisted of 100 patients. Three-dimensional (3D) images of the tracheobronchial structures and the bronchial tubes were created.ResultsIndividual differences were found in the tracheobronchial structures in 100 patients. The length and the diameter of the right main bronchus were measured with 3D images and were not related to the patient’s physical appearance, such as body height. Problematic intubation cases included a short right main bronchus <10 mm, an anomaly of the right bronchus, and tracheal stenosis.ConclusionThe 3D images demonstrated problematic areas of the tracheobronchial structure and helped the anesthesiologists select the most appropriate bronchial tube suitable for the tracheobronchial structure variations. Therefore, this technique is considered to contribute to safer performance of one-lung anesthesia.

Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis.

Destructive spondyloarthropathy (DSA) is the most serious spinal complication of dialysis‐related amyloidosis in patients on long‐term hemodialysis (HD), but we could not find any information about DSA in patients on peritoneal dialysis (PD) for over 10 years. We retrospectively evaluated factors contributing to DSA in HD and PD patients. Sixty‐seven patients on dialysis for 10 to 19 years were compared between a PD group (n = 23) or a HD group (n = 44). In the PD group, nine patients (39%) developed DSA. The mean age of DSA patients was significantly higher than that of non‐DSA patients (66.2 ± 10.0 vs. 51.0 ± 12.8 years, P = 0.03). The frequency of cervical spine DSA did not show any difference between the PD and HD groups, but the frequency of lumbar spine DSA showed a significant difference (22% vs. 5%, P = 0.04). The serum beta‐2 microglobulin (B2MG) level was significantly higher in PD patients than in HD patients (38.4 mg/L vs. 27.4 mg/L, P = 0.0025). Mechanical stress such as elevation of the intra‐abdominal pressure due to infusion of PD fluid (1500 mL to 2000 mL) for over 10 years might contribute to lumbar DSA in patients on long‐term PD.

Rectus sheath haematoma in a patient receiving haemodialysis

A 65-year-old woman visited the emergency department due to severe right lower quadrant pain of sudden onset after intense coughing due to bronchitis. She had been receiving haemodialysis for glomerulonephritis for 25 years. Physical examination revealed severe and rebound tenderness on the right lower quadrant area. Complete blood count revealed a white cell count of 4700/μl, haemoglobin level 9.0 g/dl, platelets 14.8×104/μl, C reactive protein 0.3 mg/dl, prothrombin time 12 s and partial thromboplastin …

Massive mucinous cystadenoma of the appendix with intussusception in an adult: usefulness of reconstructed computed tomography images

We present an adult patient with a massive mucinous cystadenoma of the appendix that induced intussusception. Multiplanar reconstruction images and maximum intensity projection images enabled us to assess the tumor accurately and characterize the intussusception. Thus, reconstructed computed tomographic images proved highly useful for diagnosis.

Abstract presented at the Joint meeting of the 21st meeting of the Japanese Research Society of clinical anatomy and the 6th meeting of the Society for aging image

Abstract presented at the Joint meeting of the 21st meeting of the Japanese Research Society of clinical anatomy and the 6th meeting of the Society for aging imagepresented at the Joint meeting of the 21st meeting of the Japanese Research Society of clinical anatomy and the 6th meeting of the Society for aging image Itsuko Okuda • Keiichi Akita Springer-Verlag France SAS, part of Springer Nature 2018 Introduction: Herewith are the abstracts of the presentations of the Joint Meeting of the 21st meeting of the Japanese Research Society of Clinical Anatomy (JRSCA) and the 6th meeting of the Society for Aging Image (SAI). The meeting was held at Mita Hospital, International University of Health and Welfare, Tokyo on October 21, 2017.