Nam Yeol Yim

Clinical Characteristics and Corticosteroid Treatment of Acute Eosinophilic Pneumonia

The clinical characteristics and optimal duration of corticosteroid treatment for acute eosinophilic pneumonia (AEP) have not been fully evaluated. This was a retrospective study of prospectively collected data from 137 patients with AEP, treated with standardised protocol, to clarify the clinical characteristics and compare the efficacies of 2 weeks versus 4 weeks of corticosteroid treatment for AEP. The majority of the patients altered their smoking habits within a median (interquartile range) of 17 (13–26) days prior to development of AEP. 80 (58%) patients presented with acute respiratory failure. A total of 127 (92%) patients were treated with corticosteroids: 4 weeks, n=42; 2 weeks, n=85. Major symptoms were resolved in 3 days and the severity of respiratory failure was inversely correlated with clinical outcomes. After adjusting for differences in baseline characteristics between the groups, the differences in adjusted mean (95% confidence interval) for resolution of dyspnoea and disappearance of all symptoms were 0.57 (-0.71–1.86) and -0.04 (-1.91–1.83) days, respectively. The difference in adjusted proportion of resolution of radiological abnormalities was 6.92% (-8.19–22.02). In conclusion, the duration of corticosteroid treatment could be shortened to 2 weeks, even in patients with respiratory failure.

Hepatocellular Carcinoma in the Cirrhotic Liver with Helical CT and MRI: Imaging Spectrum and Pitfalls of Cirrhosis-Related Nodules

OBJECTIVE This article reviews the imaging spectrum of cirrhosis-related nodules on CT and MRI and differentiates between hepatocellular carcinoma (HCC) and common focal lesions that can simulate HCC in the cirrhotic liver. CONCLUSION Knowledge of cirrhotic nodules and focal lesions and how they mimic HCC will improve the diagnosis and characterization of focal lesions in cirrhotic liver on CT and MRI.

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.

A Hyaluronic Acid-Conjugated Gadolinium Hepatocyte-Specific T1 Contrast Agent for Liver Magnetic Resonance Imaging.

PurposeIn this study, we synthesized hyaluronic acid-conjugated gadolinium (HA-diethylene triamine pentaacetic acid (DTPA)-Gd) and evaluated as hepatocyte-specific magnetic resonance imaging (MRI) contrast agent for the diagnosis of hepatic metastasis.ProceduresWe conducted Fourier transform (FT)-IR analysis to determine the conjugation of HA and DTPA and performed cell viability assays using NIH3T3 and FL83B cell lines. We also conducted T1-weighted MRI of HA-DTPA-Gd and gadoxetic acid to compare the paramagnetic properties of both.ResultsHA-DTPA-Gd had a higher efficiency in liver MRI compared with the commercially available liver-specific contrast agent (p < 0.001). HA-DTPA-Gd, which possessed a higher T1 relaxivity, showed excellent capability for the diagnosis of hepatic metastasis through an in vivo MRI study in comparison with gadoxetic acid (p < 0.001).ConclusionBased on this study, we believe that HA-DTPA-Gd has promising potential for use as a contrast agent for liver MRI of hepatic metastases.

Retrograde Tempofilter II™ Placement within the Superior Vena Cava in a Patient with Acute Upper Extremity Deep Venous Thrombosis: the Filter Stands on Its Head

The Tempofilter II is a widely used temporary vena cava filter. Its unique design, which includes a long tethering catheter with a subcutaneous anchor, facilitates the deployment and retrieval of the device. Despite this, the Tempofilter II has been used only in the inferior vena cava of patients with lower extremity deep venous thrombosis. In this article, we present a case of superior vena cava filtering using the Tempofilter II in patients with upper extremity deep venous thrombosis.

Role of interventional radiology in trauma care: retrospective study from single trauma center experience

PURPOSE Although interventional management is now regarded as essential in trauma care, the effect on clinical result remains uncertain. We conducted this retrospective study to figure out the role of interventional management in trauma care. MATERIALS AND METHODS Medical records of patients enrolled in the trauma database of our trauma center were reviewed for the period of January 2009 to December 2012. During this period, we have evaluated how many interventional procedures were conducted and the clinical effect of interventional procedure on trauma care. RESULTS Based on our institutional trauma database, medical records of 2017 patients were reviewed (male/female, 1475:542; mean age, 50.03 years). Their mean injury severity score was approximately 26.28. Among them, 111 patients have been treated with interventional procedure. The number of interventional procedures increased significantly over time, up to 15% (P < .005). During the same period, the overall survival rate did not show significant change. The survival rate of the patients, who have been treated with interventional procedures for traumatic vascular injury, was higher than possibility of survival from trauma injury severity score (86.4% vs 65.59%). CONCLUSION The need for interventional procedure in trauma care is increasing. Although interventional procedure could not affect the overall survival rate in trauma care, it can improve survival rate remarkably in patients with traumatic vascular injury.

Iliac Vein Stent Fracture Due to a Migrated Retrievable Vena Cava Filter

We report a case of iliac vein stent fracture due to hooking by a migrated retrievable inferior vena cava filter in a 55-year-old woman with acute deep venous thrombosis related to May-Thurner syndrome.

Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session.

PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention.