Jong Hyeog Lee

de Quervain Disease: US Identification of Anatomic Variations in the First Extensor Compartment with an Emphasis on Subcompartmentalization

PURPOSE To demonstrate the usefulness of ultrasonography (US) in the detection of anatomic variations in the first extensor compartment of the wrist in patients with de Quervain disease. MATERIALS AND METHODS The institutional review board approved this study protocol and waived the informed consent requirement. Fifteen wrists in 13 women (age range, 41-62 years) in whom de Quervain disease was clinically diagnosed and who underwent surgery for intractable pain were included. A musculoskeletal radiologist performed US before surgery. The absence or presence and extent of subcompartmentalization within the first extensor compartment and the number of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slips were evaluated and recorded. Preoperative US findings were compared with surgical records and photographs. RESULTS Subcompartmentalization within the first extensor compartment was observed during surgery in 11 of the 15 wrists (73%), including four (27%) that had subcompartmentalization only in the distal portion of this compartment. US was used to identify all 11 wrists showing subcompartmentalization within this compartment (sensitivity, 100%; 95% confidence interval [CI]: 74%, 100%), as well as three of the four wrists with distal incomplete subcompartmentalization. There was one wrist with false-positive distal incomplete subcompartmentalization. US had a positive predictive value in the detection of subcompartmentalization of 73% (95% CI: 47%, 91%). The number of tendon slips in this compartment detected with US was identical to that identified at surgery with one exception. CONCLUSION US can be used to depict various types of anatomic variations in the first extensor compartment in patients with de Quervain disease.

Calcifying Aponeurotic Fibroma with Osseous Involvement of the Finger: a Case Report with Radiologic and US Findings

Calcifying aponeurotic fibroma is a rare soft tissue tumor that occurs in the distal extremities of children and adolescents. We report ultrasound and X-ray findings of a calcifying aponeurotic fibroma in the finger of a 36-year-old woman, associated with distal phalangeal bone involvement.

Hemoperitoneum Caused by Hepatic Necrosis and Rupture Following a Snakebite: a Case Report with Rare CT Findings and Successful Embolization

We report the computed tomographic and angiographic findings in the case of a recently obtained successful clinical outcome after embolization of the hepatic artery in the case of a snakebite causing hemoperitoneum associated with hepatic necrosis and rupture with active bleeding.

Chemical Ablation of the Gallbladder with Acetic Acid

PURPOSE Chemical ablation of the gallbladder may be a useful alternative to surgery for inoperable disease. The purpose of this study was to investigate the feasibility of chemical ablation of the gallbladder with acetic acid in a canine model. MATERIALS AND METHODS Five beagle dogs underwent percutaneous transhepatic cholecystostomy. Percutaneous occlusion of the cystic duct was performed with use of n-butyl cyanoacrylate (NBCA) and coils. After confirmation of occlusion of the cystic duct, sclerotherapy of the gallbladder was performed with 4-7 mL of 50% acetic acid through the drainage catheter. Acetic acid was retained for 20 minutes with intermittent position change. The drainage catheter was removed immediately after sclerotherapy. The dogs were euthanized 8 weeks after the procedure. The gallbladders and adjacent organs were evaluated grossly as well as microscopically. RESULTS All dogs survived without serious complications during the experimental period. Sclerotherapy was technically successful in all dogs. Gross specimens of the gallbladder showed shrinkage and fibrotic change without retention of any bile, mucus, or pus. Histologic examinations from the body and fundus of the gallbladder demonstrated complete ablation of the mucosa. However, the neck region of the gallbladder near the cystic duct, where NBCA and coils for cystic duct occlusion were located, had focal areas of remnant or regenerating mucosa. CONCLUSIONS Chemical ablation of the gallbladder with 50% acetic acid was effective and safe. Complete ablation was achieved in the majority of gallbladder mucosa except for a small portion located in the gallbladder neck.

Fluid Collection in the Right Lateral Portion of the Superior Aortic Recess Mimicking a Right Mediastinal Mass: Assessment with Chest Posterior Anterior and MDCT

Objective We observed patients in whom the fluid collection in the right lateral portion of the superior aortic recess on computed tomography (CT) scans mimicked a right anterior mediastinal mass on chest PA radiographs. The purpose of this study was to assess chest PA and CT features of these patients. Materials and Methods All chest PA radiographs and CT scans in 9 patients were reviewed by two radiologists on a consensus basis; for the presence of pleural effusion, pulmonary edema and heart size on chest PA radiographs. For the portion of the fluid collection in the superior aortic recess (SAR), a connection between the right lateral portion of the SAR (rSAR) and posterior portion of the SAR (pSAR) on CT scans, and the distance between the right lateral margin of the rSAR and the right lateral margin of the superior vena cava. Results Fluid collection in the rSAR on CT scans caused a right anterior mediastinal mass or a bulging contour on chest PA radiographs in all women patients. All patients showed cardiomegaly, five patients had pleural effusion, and two patients had mild pulmonary edema. Further, eight patients showed a connection between the rSAR and the pSAR. Conclusion The characteristic features of these patients are the right anterior mediastinal mass-like opacity due to fluid collection in the rSAR, are bulging contour with a smooth margin and cardiomegaly regardless of pulmonary edema on the chest PA radiographs, and fluid connection between the rSAR and the pSAR on CT scans.

P35-6 Quantitative assessment of cerebral hemodynamics in a adult moyamoya disease: evaluation with acetazolamide challenged perfusion CT and SPECT imaging

with ischemic lesions. Differences in mean GTE were analyzed using non parametric test. Results: Although group 3 shows higher mean GET score (4.57) than group 1 (3.33) and 2 (2.50), this do not met statistical significant differences (p = 0.05). Conclusions: The GTE score is a simple EEG scoring method that could be helpful in the screening of silent cerebrovascular damage of hypertensive patients. Future investigations should be done to explore the influence of covariates.

P35-7 Cerebral hemodynamics in patients with moyamoya syndrome associated with atherosclerotic occlusion of the middle cerebral arteries

with ischemic lesions. Differences in mean GTE were analyzed using non parametric test. Results: Although group 3 shows higher mean GET score (4.57) than group 1 (3.33) and 2 (2.50), this do not met statistical significant differences (p = 0.05). Conclusions: The GTE score is a simple EEG scoring method that could be helpful in the screening of silent cerebrovascular damage of hypertensive patients. Future investigations should be done to explore the influence of covariates.

PO15.24 Cerebral Hemodynamics in Patients with Symptomatic Bilateral Carotid Occlusion: Evaluation with CT Perfusion Imaging

with PFO had significantly fewer risk factors than patients without PFO (1.45 vs. 2.07; P= .006). Embolic infarct pattern was determined by DWI and MR angiography of the patient and observed more frequently in the patient without PFO than patient with PFO (52.4 vs. 21.4%; P= .006). There is no significant difference between patients with and without PFO in the prevalence of intraand extracranial arterial stenosis/occlusion (38.3 vs. 48.8%; P= .395). The degree of RLS correlate with neither the embolic infarct pattern (P= .101) nor arterial stenosis/occlusion (p = .496). Conclusions: These results consolidate the fact that PFO is an important risk factor for the young stroke patients. However, the infarct patterns of PFO patients were not compatible with embolic mechanism, and amount of RLS in PFO also did not correlate with the embolic infarct pattern. Mechanism other than the embolism might contribute to the ischemic stroke in these patients.