Jung Hyuk Kim

High-resolution ct appearance of miliary tuberculosis

Objective The purpose of this study was to define the range of abnormalities and to assess the contribution of high-resolution CT (HRCT) in the evaluation of miliary tuberculosis involving the lung parenchyma. Materials and Methods The authors retrospectively reviewed HRCT scans of 11 patients with microbiologically or clinically proved miliary tuberculosis. Results In 10 patients, the most characteristic HRCT finding of miliary tuberculosis was the presence of small nodules uniformly distributed throughout both lungs. The profusion of nodules was numerous in all 10 patients. High-resolution CT scans showed both sharply and poorly defined, small nodules varying in sizes from 1 to 2 mm (n = 6), 1 to 3 mm (n = 2), and 1 to 4 mm (n = 2) in diameter. These nodules had a diffuse random distribution in the secondary lobule in all 10 patients. In 1 of the 10 patients with small nodules on HRCT, chest radiography had shown no evidence of miliary nodules in the lung. In addition to nodules, HRCT showed diffuse or localized reticular opacities superimposed on nodules in five patients, especially in the lower lung zones. In 1 of all 11 patients, ground-glass attenuation was the predominant abnormality seen on HRCT. Conclusion We believe that in the appropriate clinical situation, miliary tuberculosis may be suggested on HRCT. Moreover, in cases with no evidence of miliary nodules on the chest radiograph, HRCT scan may depict miliary nodules in the lung parenchyma.

Sonographic evaluation of breast nodules: comparison of conventional, real-time compound, and pulse-inversion harmonic images.

Objective To compare the use of conventional, real-time compound, and pulse-inversion harmonic imaging in the evaluation of breast nodules. Materials and Methods Fifty-two breast nodules were included in this study, conducted between May and December 2000, in which conventional, real-time compound, and pulse-inversion harmonic images were obtained in the same plane. Three radiologists, each blinded to the interpretations of the other two, evaluated the findings, characterizing the lesions and ranking the three techniques from grade 1, the worst, to grade 3, the best. Lesion conspicuity was assessed, and lesions were also characterized in terms of their margin, clarity of internal echotexture, and clarity of posterior echo pattern. The three techniques were compared using Friedmans test, and interobserver agreement in image interpretation was assessed by means of the intraclass correlation coefficient. Results With regard to lesion conspicuity, margin, and internal echotexture of the nodules, real-time compound imaging was the best technique (p < 0.05); in terms of posterior echo pattern, the best was pulse-inversion harmonic imaging (p < 0.05). Real-time compound and pulse inversion harmonic imaging were better than conventional sonography in all evaluative aspects. Interobserver agreement was greater than moderate. Conclusion Real-time compound and pulse-inversion harmonic imaging procedures are superior to conventional sonography in terms of both lesion conspicuity and the further characterization of breast nodules. Real-time compound imaging is the best technique for evaluation of the margin and internal echotexture of nodules, while pulse-inversion harmonic imaging is very effective for the evaluation of the posterior echo patterns.

CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type.

Abstract. The aim of this study was to evaluate differences in the prevalence of patterns of CT bronchus sign in malignant solitary pulmonary lesions (SPLs), according to their histologic cell types and with respect to size, location, and degree of cell differentiation. Computed tomography scans of 78 patients, in whom pathologically confirmed malignant SPLs with CT bronchus sign were present, were randomly selected and reviewed by two radiologists under consensus. All 78 were CT scans done using spiral technique with 10-mm collimation and 10-mm reconstruction intervals with enhancement, and 75 included additional high-resolution CT scans. Lesions were classified into four cell types as squamous cell carcinoma (n = 24), small cell carcinoma (n = 12), adenocarcinoma (n = 23), bronchioloalveolar carcinoma (BAC; n = 9), and others (n = 12), into three degrees of differentiation, into three size groups, and according to location (central or peripheral). Patterns of CT bronchus sign were classified into abruptly obstructing (I), patent (II), displacing (III), or tapered narrowing (IV) types. The relationships between the patterns of CT bronchus sign and cell type and degree of cell differentiation were evaluated. Eighty patterns of CT bronchus sign were observed in 78 patients. According to cell type, squamous cell carcinoma showed most often type-I pattern (45.8 %) but no type-II pattern, which was the most common pattern observed in BAC (77.8 %) and adenocarcinoma (34.8 %; p < 0.01). Small cell carcinoma showed a varied distribution among the four patterns of CT bronchus sign. According to location, in central squamous cell carcinomas, type-I pattern was more common(55 %; p < 0.01). Bronchioloalveolar carcinoma showed more peripheral lesions and in both central and peripheral lesions, type-II pattern was significantly more common (100 and 66.7 %; p < 0.01). In SPLs with CT bronchus sign of obstructing pattern, especially if central location, squamous cell carcinoma should be suspected, whereas in SPLs with patent CT bronchus sign, regardless of the location, the strong possibility of BAC should be considered.

Acinic cell carcinoma of the head and neck: radiologic-pathologic correlation.

Objective: To describe and correlate the imaging and pathologic findings of acinic cell carcinoma (ACC) in the head and neck. Methods: We reviewed the radiologic findings of 12 patients with pathologically proven ACC in the head and neck. They were 6 males and 6 females (ages: 5-75 years, mean 36 years) who undergoing computed tomography (CT, n = 9) and CT with magnetic resonance (MR) imaging (n = 3). Results: The lesions in the superficial lobe of the parotid gland were solid (n = 7), cystic (n = 1), and cystic mass with mural nodule (n = 1) on CT. A parapharyngeal lesion was cystic mass with mural nodule, and a submandibular and a palate tumor were cystic lesions on CT. All solid masses in the parotid gland (n = 7) included focal low-attenuating portions on CT, which were microcyst, hemorrhage, or necrosis on pathologic examination. We could not find intratumoral calcifications or metastatic lymphadenopathy on imaging and histologic studies in all 12 cases. Internal hemorrhage on the MR images was seen in a parapharyngeal and a parotid lesion. Conclusion: Although ACC appears to have nonspecific imaging findings, familiarity with some imaging features can be helpful for differential diagnosis of head and neck tumors.

Cut-off value for needle washout thyroglobulin in athyrotropic patients†

The purpose of this study was to determine the appropriate cut‐off value for fine needle aspiration‐thyroglobulin (FNA‐Tg) associated with postoperative recurrences and validate the diagnostic efficacy of FNA‐Tg in patients after total thyroidectomy compared with concomitant cytology (C).

Ultrasound-guided radiofrequency neurotomy in cervical spine: sonoanatomic study of a new technique in cadavers

AIM To develop an ultrasound-guided technique for radiofrequency (RF) cervical medial branch neurotomy and to validate the accuracy of this new method. MATERIALS AND METHODS Five non-embalmed, fresh cadavers were used; three male and two female cadavers with a median age at death of 67.2 years (range 50-84 years). This study was conducted in two parts. First, two of the cadavers were used to define the sonographic target point for RF cervical medial branch neurotomy using high-resolution ultrasound (12 to 5 MHz). The needles were guided to five consecutive cervical medial branches in the cadavers under ultrasound guidance. Subsequently, the position of the ultrasound-guided needle was verified using C-arm fluoroscopy. Ultrasound-guided RF neurotomy was performed to the C5 medial branches in all five cadavers. In the three cadavers not used in the first part of the study, ultrasound-guided RF neurotomy without C-arm fluoroscopic confirmation was performed to the C3-C7 medial branches. The accuracy of neurotomy was assessed by pathological examination of the cervical medial branches obtained through cadaver dissection. RESULTS In all five cadavers, the sonographic target point was identified in all C3-C7 segments with the 12 to 5 MHz linear transducer. In all 20 needle placements for the first and second cadavers, C-arm fluoroscopy validated proper needle tip positions. In all five cadavers, successful neurotomy was pathologically confirmed in 30 of 34 cervical medial branches. CONCLUSIONS Ultrasound-guided cervical medial branch neurotomy was successfully performed in 30 of 34 cervical medial branches in five cadavers. However, before eliminating fluoroscopic validation of final needle tip positioning, the technique should be validated in symptomatic patients.

Application of 3-Dimensional Ultrasonography in Assessing Carpal Tunnel Syndrome

The aim of study was to assess the usefulness of 3D ultrasonography (3DUS) in the diagnosis of carpal tunnel syndrome.

Spinal cord injury subsequent to transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

Transcatheter arterial chemoembolization is one of the most common treatment modalities for hepatocellular carcinoma. Transcatheter arterial chemoembolization is considered to be a relatively safe procedure, but transcatheter arterial chemoembolization is associated with a number of disastrous complications. Among the ischaemic complications caused by transcatheter arterial chemoembolization, spinal cord injury is very rare, but can occur via the intercostal or lumbar arteries. We report two cases of extremely rare spinal cord injuries after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. The patients had sensory loss below the T9 or T10 dermatomes and paraparesis or paraplegia within 6-8h after transcatheter arterial chemoembolization. One patient sustained paraplegia until death 2 months after transcatheter arterial chemoembolization and the other patient recovered almost completely 2 months after transcatheter arterial chemoembolization.

Granulocytic sarcoma (chloroma) presenting as a lateral neck mass: initial manifestation of leukemia: a case report

We present a rare case of granulocytic sarcoma (chloroma) in the lateral neck as an initial manifestation of acute leukemia in a 37-year-old man. The lesion appeared as a solid mass with homogenous contrast enhancement on CT. Recognition of this rare entity is important, because early, aggressive induction chemotherapy can improve prognosis.

Intramuscular and subcutaneous sparganosis: Sonographic findings.

A case of subcutaneous and intramuscular sparganosis was confirmed on surgical excision of a worm in a 60‐year‐old woman suffering from painful masses in the right thigh. Sonography and MRI revealed an ill‐defined intramuscular lesion and multiple cystic lesions in the subcutaneous tissue. At the time of the excision, a sparganum larva was found in the adductor longus muscle. If an intramuscular mass with a serpiginous cystic tract is seen on imaging studies in an endemic area, musculoskeletal sparganosis should be included in the differential diagnosis of a soft tissue tumor.