Jane Chien-Yao Hsu

Usefulness of Electron Beam Computed Tomography in Children With Heterotaxy Syndrome

Children with heterotaxy syndrome frequently have complex cardiac and noncardiac malformations requiring detailed diagnostic evaluation for management planning. Direct delineation of these structures by electron beam computed tomography (EBCT) is validated as a means of diagnosis. From July 1995 to March 1997, 32 patients (16 girls, 16 boys) with clinically impressed heterotaxy syndrome were enrolled in this study. After evaluation by echocardiography, EBCT studies were performed. Interpretation of cardiac anomalies was performed by sequential analysis based on these cross-sectional images. The diagnoses were subsequently confirmed by angiocardiography and surgical findings. Twenty-eight patients had bilateral trifurcated bronchi, and most of these (24 of 28) did not have a spleen. Four patients had bilateral bifurcated bronchi, 2 patients had polysplenia, and the other 2 patients had a lobulated single spleen. We found that laterality could be identified by EBCT in all patients. Comparison of diagnostic yield between echocardiography, catheterization, and EBCT showed that EBCT is superior to echocardiography and catheterization in demonstration of pulmonary venous anatomy and presence of a very small rudimentary ventricle. In addition, associated visceral, bronchopulmonary, mediastinal, and intracardiac anomalies could all be clearly delineated by EBCT at the same time. Thus, EBCT is a promising complementary modality for an overall understanding of heterotaxy syndrome.

Three-dimensional reconstruction of abnormal ventriculoarterial relationship by electron beam CT

PURPOSE Assessment of the relationships of the ventricles and great vessels is critical in evaluating cardiac anomalies before surgery. We investigated the usefulness of 3D CT in their demonstration. METHOD From July 1995 through June 1996, 20 patients with abnormal ventriculoarterial relationships were analyzed by electron beam CT. A 3D gradient shading surface rendering was done on a workstation. We focused on the morphologies of the atria, ventricles, and great vessels and particularly their spatial relationships on the 3D images. RESULTS There were two cases of isolated ventricular inversion, three of anatomically corrected malposition, seven of congenitally corrected transposition, and eight of complete transposition. Anatomic presentations of 3D surface images in all were superior to cineangiography and echocardiography presentations and were consistent with intraoperative findings. CONCLUSION 3D CT images provide useful information that is not available by sectional or projective imaging. Independent segmental analysis of the anomalies by this method provides a complement for surgeons to understand the spatial relationships of the vessels and chambers of the heart, which may be of value in preoperative planning.

Bronchial stenosis mimicking the scimitar syndrome: report of one case.

The scimitar syndrome, also known as hypogenetic lung syndrome, has the classic radiological appearance of hypoplasia of the right lung, dextroposition of the heart, and a curvilinear density in the right lower lung that courses to the right cardiophrenic angle known as a scimitar sign. We report a case with stenosis of the main stem of the left bronchus and an emphysematous change of the left lung which shifted the heart to the right side and compressed the right lung. A curvilinear density was also noted in the right lower lung field. All these radiological findings together mimic the chest radiographic appearance of the scimitar syndrome.

Transcatheter Arterial Embolization Therapy for Metastatic Neoplasms of the Liver

Hepatic transcatheter arterial embolization was performed in 32 patients with metastatic neoplasms in the liver. The procedure required injection of Gelfoam suspension through the transfemorally placed angiographic catheter and aimed to achieve a whole-liver embolization. Prominent necrotic change of the metastatic foci as demonstrated by computed tomography occurred in 25 patients; 12 of 13 from colorectal cancer, 3 of 3 from breast cancer, and 3 of 5 from gastric cancer. Patients with hepatomegaly had regression of the liver size after embolization. Angiographically hypervascular metastatic lesions did not show better response to TAE than hypovascular ones. Epigastralgia, nausea, vomiting, fever, and alteration of liver function were the side effects and these side effects subsided in 1 to 2 weeks. There was no necrotic change of the non-tumorous hepatic parenchyma. We conclude that metastatic hepatic neoplasms may be treated by TAE.