Jae Chun Chang

Preoperative diagnosis of angiomyolipoma of the liver

We experienced a case of surgically proven hepatic angiomyolipoma, a rare primary benign lipomatous tumor, which was preoperatively diagnosed by defining of its characteristic histologic components and benign radiologic nature with various imaging modalities. It was the first case that full radiologic evaluation was taken and internal vascular proliferation was defined by using dynamic bolus computed tomography (CT) prior to angiography.

Advantades of the intravenous bolus CT scan in differentiation of hepatic masses

W e performed IV bolus CT scan in 40 patients with final diagnosis of various hepa tic m asses in order to evaluate hemodynamic changes and differentiating characters of the lesions. Preenhanced , early and late phase post enhanced , and delayed CT scans were obtained with rapid IV bolus injection of contrast m aterials and table sliding method for pertinen t scans. In hepa tom as , early enhanced CT scan directly showed hypervascula r change and active viable portion of the m ass and late phase CT scan showed capsular enhancemen t. In addition , extracapsular invasion and post-embolization recurrence were more easily visualized In hem angiomas , early and late enhancing types could be categorized according to the time of m aximal enhancem en t. In metastatic Iiver m alignancies and cholangiocarcinom as , specific findin gs were seen in early phase and delayed CT scans and not in conventional C T scan . In conclusion , IV bolus C T scan is a very useful CT method in demonstra ting the characteristic hem odynamic patterns and in differential diagnosis of the hepa tic m asses lndex Words: Liver, Computed tomography, 76 1. 1211 Liver , Primary malignant neoplasm , 761 .32 Liver, Metastatic m alignant neoplasm , 761. 33 Liver , Benign neoplasm , 76 1. 31

Treatment of Traumatic Carotid-Cavernous Fistulas using Debrun's Detachable Balloons

The goal of therapy in patients with traumatic carotid-cavernous fistulas is to occlude the fistula, preferably while maintaining the carotid blood flow. Since the introduction of the concepts of detachable balloon technique to occlude arteriovenous fistulas, the technique has become the treatment of choice in the management of traumatic carotid-cavernous fistulas. The major symptoms of traumatic CCFs are (1)pulsating exophthalmos, (2)orbital and cephalic bruit and murmur, (3) headache, (4) chemosis. (5) extraocular palsies, and (6) visual failure. Traumatic CCFs are combined with multiple associated lesions. We tried the occlusion of fistulas using Goldvalve balloons in 8 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas was successfully occluded in all cases. In 5 cases. the internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in :3 cases. In one case, surgical ligation was done because of symptoms recurred and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in one case during occlusion tolerance test, which was remitted spontaneously. The results of Debrun balloon treatment were relatively excellent. We consider that the first choice of treatment of traumatic CCF is occlusion of the fistula by a detachable balloons.

Radiologic Evaluation of Intraabdomenal Masses in Childhood

The abdominal tumors in children are different from those of adult. These tumors are the third most common one, preceded by leukemia and brain tumors, in children under 15 years. X-ray examination is the most important method among diagnostic approaches. The role of diagnostic imaging is to identify the precise anatomic location and extent of pathologic process with the minimal number of imaging procedures. 23 cases of abdominal tumors were reviewed in respect of age incidence, site of origin, radiologic findings. The results are briefly summarized as follows : 1. Neuroblastoma was the most common(6 cases) and wi1ms tumor(5 cases), choledocal cyst(4 cases), ovarian mass(3 cases), hydronephrosis(2 cases), were descending order in frequency. 2. The most common site was retroperitoneum(60%). Kidney was the single most common site of origin. 3. Radiologic findings. The most common findings of plain radiography was ill defined soft tissue mass and this method was helpful in the presence of calcification especially in neuroblastoma. Ultrasonographic pattern was anechoic(cystic), echoic or mixed pattern, but this method provide less precise anatomical details, nevertheless ultrasonography wes paticullary useful imaging modality for the pediatric abdominal tumors. IVP findings were renal displacement, caliceopelvic system distortion or nonvisualization of kidney, these information was helpful in determining the location of tumors. CT scan showed homogenous or inhomogenous, cystic or solid, mass with their anatomic location. 4. Ultrasonography was the most widely used specific diagnostic method, but had limited value in detecting the anatomic location of tumors. CT scan was superior to ultrasound for determining the extent of tumors.