Ki Joon Sung

CT findings of laryngeal tuberculosis : Comparison to laryngeal carcinoma

Purpose: Our goal was to describe the appearance of laryngeal tuberculosis using CT, with the intent of identifying features distinguishing laryngeal tuberculosis and carcinoma. Method: CT scans of 12 patients with laryngeal tuberculosis were analyzed retrospectively. Clinical symptoms, laryngoscopic exams, and presence of pulmonary tuberculosis on chest radiographs were also reviewed. Results: In laryngeal tuberculosis, bilateral involvement was noted in nine patients (75%), while unilateral involvement was seen in three (25%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frequent finding in tuberculosis (n = 6, 50%). No deep submucosal infiltration of the preepiglottic and paralaryngeal fat spaces was seen even when there was extensive involvement of the laryngeal mucosa. Cartilage destruction was not found in any case. Conclusion: Characteristic CT findings of laryngeal tuberculosis include bilateral involvement, thickening of the free margin of the epiglottis, and good preservation of the preepiglottic and paralaryngeal fat spaces even in the presence of extensive mucosal involvement. By comparison, laryngeal carcinoma presented unilateral involvement, infiltration of the preepiglottic and paralaryngeal fat spaces by a submucosal mass, cartilage destruction, and extralaryngeal invasion.

Lung perfusion CT: The differentiation of cavitary mass

PURPOSE To assess the findings of perfusion maps and to evaluate the usefulness of perfusion computed tomography (CT) in the differentiation of cavitary mass. MATERIALS AND METHODS Fifty-three patients with cavitary lung masses were analyzed. Dynamic chest CT was performed after contrast injection. The volume map, washout map, peak map, and time-to-peak (TTP) map were reformatted using Interactive Data Language (IDL). The perfusion patterns were classified into three scoring groups, and these scorings were repeated after 2-week intervals. Diagnostic confidence levels were assigned by consensus. The kappa statistics was used to determine intraobserver agreement, and Fishers exact test was used to analyze statistical differences in perfusion scores. Receiver operating characteristic (ROC) analysis was performed to evaluate the usefulness of the perfusion maps. RESULTS Perfusion maps were reformatted pixel-by-pixel from the time-to-density curve analyses. Pyogenic cavities showed weak washout and slow TTP (69.6%). Conversely, malignant cavities showed strong washout (73.3%). Tuberculous cavities showed low perfusions in the volume and peak maps (66.7%). Intraobserver agreement was excellent. The performance of the combination of CT and perfusion maps was better than that of CT alone. CONCLUSION Lung perfusion CT could be a promising and feasible method for differentiation of cavitary mass.

A Case of Spontaneous Resolution of Idiopathic Mediastinal Fibrosis

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedels struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retroperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic sclerosing mediastinitis with orbital fibrous dysplasia of unknowm cause, which was confirmed by open lung biopsy, so reported it with a review of literature.

Gallbladder carcinoma: Regional lymph nodes metastases on CT scan

CT scans of 23 patients with gallbladder carcinoma were retrospectively reviewed to determine the incidence of lymphatic spread and to access the pattem of regional lymph node metastases The lymphatic spread were noted in 74% (17/ 23). The involved pattems of regional lymph node metastases were nodes of porta hepatis 65 %, portocaval nodes 41%, superior pancreaticoduoden떠 nodes 47%, posterior pancreaticoduoden떠 nodes 59%, nodes around the celiac trunk 35%, nodes around the superior mesenteric arteη 29% and paraaortic nodes 35%. The findings suggested that the pattern of regional lumph node metastases in gallbladder carcinoma occurred along the normal lymphatic pathway of the gallbladder