Motoichiro Takahashi

Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia.

Anomalous origin of the right coronary artery (RCA) is a rare condition, but may cause myocardial ischemia and sudden death. Multislice computed tomography, which allows three-dimensional visualization of the coronary artery with high spatial resolution, may be the most promising imaging modality for diagnosing this anomaly. We describe a patient with anomalous origin of the RCA arising from the left sinus of Valsalva. Volume rendering, and axial and curved multiplanar images showed stenosis in the proximal portion of the RCA that coursed between the aorta and the pulmonary artery, and an acute angled take-off of the RCA from the aorta. Three-dimensional virtual angioscopic images showed a hypoplastic RCA orifice and luminal narrowing in the proximal portion of the RCA. Multislice computed tomography was thought to be useful for detecting anomalous origin of the RCA and for evaluating possible causes of myocardial ischemia.

A giant left circumflex coronary artery – right atrium arteriovenous fistula detected by multislice spiral computed tomography

A 70-year-old man was referred to our hospital because of symptoms of congestive heart failure. The initial echocardiographic study revealed a dilated and poorly contractile left ventricle, a markedly dilated left circumflex coronary artery (LCx), and an enormously dilated anomalous vessel inferior to the right atrium (RA). Color Doppler flow mapping documented a turbulent flow in the LCx, draining into the RA through the anomalous vessel. An LCx-RA arteriovenous fistula was suspected. Multislice spiral computed tomography (MSCT) imaging was performed using a Somatom Volume Zoom (4-detector-row, Siemens, Stuttgart, Germany) with collimation 1.0 mm, table feed 1.5 mm/rotation, 140 kV, 320 mA, and gantry rotation time 500 ms. Our scan protocol and image reconstruction method have been reported previously. 1 Metoprolol (40 mg) was

Regression of an atherosclerotic coronary artery plaque demonstrated by multislice spiral computed tomography in a patient with stable angina pectoris.

Multislice spiral computed tomography (MSCT) permits direct visualization of not only coronary artery stenosis but also atherosclerotic plaques in patients with coronary artery disease. In this report, we describe a patient with stable angina in whom the regression of the plaque was documented by serial MSCT examinations. In the patient, a 46-year-old man with stable angina, MSCT revealed a stenotic lesion at the proximal portion of the left anterior descending artery. Axial, curved multiplanar reconstruction and cross-sectional images consistently depicted a protruding computed tomography low-signal mass suggesting an atherosclerotic plaque. Intracoronary ultrasound (ICUS) also documented an eccentric soft plaque with an echo-lucent mass suggesting a lipid core. Lipid-lowering therapy with pravastatin was started. Follow-up MSCT performed 7 months later documented an increase in the luminal area while the external vessel area remained unchanged. The regression of the plaque was also confirmed by a follow-up ICUS study. MSCT was thought to be feasible for serial evaluation of the plaque size and texture.

Primary leiomyosarcoma of the inferior vena cava: case report

The patient was a 63-year-old woman with a chief complaint of blood-stained sputum. A tumor of the inferior vena cava was found on chest computed tomography (CT) and identified as a primary tumor based on multidetector CT and contrast-enhanced MR angiography. An intrapelvic tumor was also discovered. On autopsy, the two tumors were diagnosed as leiomyosarcoma and ovarian fibroma, respectively.

Assessment of coronary artery abnormalities in a patient with Kawasaki disease by multislice computed tomography

The high spatial resolution of multislice computed tomography (MSCT) permits direct visualization of the coronary artery system. In this report, we describe coronary artery abnormalities in a young adult with Kawasaki disease. MSCT detected a giant coronary artery aneurysm, coronary artery stenosis in the first diagonal artery, and a multi-layered structure in the right coronary artery and the left circumflex artery. These findings corresponded well to those obtained by coronary angiography. MSCT has the potential to be the standard diagnostic tool for the follow-up evaluation of coronary artery disease in adolescents and young adults with Kawasaki disease.

A Case of Lipiduria After Arterial Embolization for Renal Angiomyolipomas

We report the case of a 31-year-old woman who suffered lipiduria after selective transcatheter arterial embolization for renal angiomyolipoma (AML). Computed tomography confirmed cystic liquefactive necrosis with fat-fluid level in AML. Although the process by which AML fat tissue excretion occurs is not clear, we speculated that the infarcted AML was connected to the urinary collection duct system and subsequently its adipose component was excreted into the urine.

Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI

The characteristics of jejunal ectopic pancreas in dynamic gadolinium-enhanced magnetic resonance imaging are described in a 40-year-old man with bowel obstruction. The pre-contrast signal intensity and post-contrast enhancement pattern of ectopic pancreas are the same as those of the pancreas.

Radiological assessment following thermoradiation therapy for primary pleural synovial sarcoma: case report

Primary pleural synovial sarcoma is a rare disease with poor outcomes. Although hyperthermia therapy as part of a combined treatment regimen can offer improved local tumor control, only two reports of hyperthermia therapy for synovial sarcoma have appeared in the literature, and these sarcomas were not of pleuropulmonary origin. This report of an advanced inoperable primary pleural synovial sarcoma is the first to address the use of hyperthermia therapy in combination with chemoradiotherapy for this disease, together with radiological assessment following that therapy. Computed tomography performed after thermoradiation showed a decrease in tumor size and a characteristic unenhanced low-density area in the tumor suggesting that tumor necrosis resulted from the therapy. These image findings were helpful in assessing the tumor response to thermoradiation. We believe that hyperthermia therapy combined with chemoradiotherapy should be regarded as an option for advanced primary pleural synovial sarcoma. This would give computed tomography important role in evaluating this approach.

Subendomyocardial perfusion abnormality and necrosis detected by magnetic resonance imaging in a patient with isolated noncompaction of the ventricular myocardium associated with ventricular tachycardia

A 74-year-old man presented with left ventricular failure and nonsustained ventricular tachycardia. Coronary angiography revealed normal coronary arteries; left ventriculography showed hypokinesis of the lateral wall segment. The ejection fraction was 54%. Cine-magnetic resonance imaging showed a double-layered appearance on four-chamber view and marked trabeculations as well as intratrabecular recesses in the inferolateral segments on short-axis view, findings consistent with isolated noncompaction of the ventricular myocardium (INVM). Contrast-enhanced imaging revealed hypoperfusion and delayed enhancement of the endomyocardium in the inferolateral segments. Subendomyocardial perfusion abnormality and necrosis may constitute the diagnostic criteria of INVM.

Pulmonary spread of laryngeal papillomatosis: radiological findings.

Laryngeal papillomatosis is a rare benign disease seen in children and young adults. The spread of laryngeal papillomas throughout the respiratory tract occurs rarely; and involvement of the distal bronchi, bronchioles, and lung parenchyma is very rare. We report a case of pulmonary spread of laryngeal papillomatosis in a 34-year-old man, focusing on the radiological evidence. Chest radiographs showed pulmonary nodules, but computed tomography scans more clearly demonstrated multiple small nodules showing cavitations and distributed centrilobularly. Pulmonary nodules and cavitations progressed gradually through the 6-year follow-up. The combination of clinical and characteristic radiological features suggests a diagnosis of pulmonary spread of laryngeal papillomatosis.