Pao-Sheng Yen

Primary medulla oblongata germinoma: a case report and review of the literature.

We describe a case of primary intracranial medulla oblongata germinoma in a 16-year-old girl who presented with progressive headache and blurred vision. Magnetic resonance imaging demonstrated a heterogeneous exophytic mass arising from dorsal aspect of medulla oblongata with extension into fourth ventricle. The differential diagnosis for this patient had included ependymoma, exophytic glioma, medulloblastoma and choroid plexus papilloma. After surgical resection and radiation therapy, she remains alive and recurrence-free for 7 years.

Marjolin's ulcer : MR appearance

1All authors: Department of Medical Imaging, Buddhist Tzu Chi Medical Center, Hualien, No. 707, Section 3, Chung Yang Rd., Hualien, Taiwan 886. Address correspondence to P.-Y. Chang. alignant degeneration of untreated chronic wounds is a well-known complication. These rare, aggressive tumors that originate in chronically nonhealing wounds are called Marjolin’s ulcer [1]. A multidisciplinary approach is necessary in these patients. Here we report a case of Marjolin’s ulcer and the MRI findings.

Repeat percutaneous vertebroplasty at cemented vertebra with fluid sign and recurrent pain.

Six patients (three females and three males) were referred from their clinicians for evaluation with complaints of recurrent pain. A follow-up MRI showed fluid at the cemented vertebral bodies. Repeat percutaneous vertebroplasty (PV) was performed in these six patients at the cemented vertebrae. Pain scores, mobility scores, and spine MRIs before the 1st P V, prior to the repeat PV, and 1 and 3 months after the repeat PV were obtained. One month after the repeat P V, the six patients had a mean pain score reduction of 6.2 points and a mean postoperative pain level reduction of 2.8 points. Four of the six patients demonstrated an improvement in mobility with a 1.7 point mean decrease one month after the repeat PV. There was decreased fluid and bone marrow edema in four of the six patients on the follow-up MRIs one and three months after the repeat PV. Repeat PV at cemented vertebrae with fluid signs may offer therapeutic benefits for recurrent pain.

Imaging of Renal Tuberculosis in Eastern Taiwan: Correlation with Clinical Course and Different Communities

Hualien, located in eastern Taiwan, is a relatively isolated district. The population is composed of different ethnic communities. Our hospital is the only medical center in eastern Taiwan, so is the most important referral hospital for epidemic diseases. After reviewing our collected cases of renal tuberculosis (TB), we observed a great diversity in staging and outcomes. The aim of this study was to classify different imaging presentations and clinical outcomes in the ethnic communities represented by these cases (non‐aboriginal and aboriginal). We retrospectively reviewed 22 cases from 1991 to 2001. We reviewed laboratory data, radiologic reports, and clinical outcomes. Before TB was proved by biopsy or culture, patients were not treated with an anti‐TB regimen. Roentgenography showed that 68% of patients had renal calcification, 59% had dilated calyces, 55% had lung involvement, and 41% had auto‐nephrectomy. The proportion of mild and severe forms was significantly different between aboriginal and non‐aboriginal groups (0.05 > p ≥ 0.00409). From this series, we recommend routine plain film roentgenography, including chest roentgenography and kidney, ureter, and bladder or abdominal roentgenography, followed by intravenous urography or computerized tomography as investigative tools for renal TB. Based on the significantly different outcomes of the disease between aboriginal and non‐aboriginal groups, a stronger health education program for the isolated district in eastern Taiwan is necessary.

Percutaneous Retrieval of Dislodged Port-A Catheters by Loop Retriever

Objective: Port-A catheter fracture with embolization is a serious complication. The percutaneous retrieval of intravascular foreign bodies avoids the need for surgery in this high risk population. We report on 14 patients who underwent percutaneous retrieval of dislodged Port-A catheters by loop retriever. Materials and Methods: Fourteen patients who had undergone percutaneous foreign body retrieval between 2002 and 2007 were evaluated retrospectively. In all procedures, retrieval of foreign bodies was performed using a 6.3-F angled wire loop retriever. Results: The percutaneous retrieval procedure was successful in all 14 patients. Repositioning of the foreign body was done in seven cases using an RC1 catheter for the intracardiac Port-A catheter fragments. Additional surgery was not required. No further complications, such as damage to the vascular wall, were noted. Conclusion: With the increasing use of indwelling catheters and interventional devices, we are frequently confronted with the problem of dislodged catheters. The percutaneous approach should be considered as the first choice when trying to resolve the problem of an embolized catheter in the cardiovascular system.

Chronically Rejected Renal Allograft Replaced by a Huge Organized Hematoma Mimicking Malignancy

A 44-year-old man received a cadaveric renal allograft, however, the allograft failed after 1 year owing to septic complications. Five years after the complications, the patient noted an enlarged mass in the lower left abdominal area accompanied by discomfort. Abdominal computed tomography (CT) revealed the failed kidney transplant had been replaced by a mass with multiple calcifications. The tumor showed heterogenous-enhancement, as well as some vascular structures that were noted within the tumor. Aortogram demonstrated a huge hypovascular lesion in the lower left abdominal area with displacement of adjacent arteries. He received transplant nephrectomy and histological examination of the tumor showed a hematoma with organization and calcification accompanied by thromboemolism in the blood vessels. A hematoma is a common acute or chronic complication of kidney transplantation. It can be secondary to graft rupture or injury to the vascular pedicle. It is not well known that a hematoma can develop and slow expansion and total replacement can occur after graft failure. CT is limited in helping to determine the definitive pre-operative diagnosis.

Treatment of Pseudoaneurysm of the Ileocolic Artery with Microcoil Embolization in a Post-ileostomy Patient

Pseudoaneurysms arising from branches of the superior mesenteric artery (SMA) are very rare. It is important to recognize and treat a pseudoaneurysm because of the risk of bleeding and even death. Angiography is the standard means for detecting intestinal and mesenteric hemorrhage. Endovascular treatment is a prompt and effective method for control of gastrointestinal hemorrhage. Status post-ileostomy with pseudoaneurysm formation and active bleeding has not been reported in the literature. We present the first case of ileocolic artery pseudoaneurysm post-ileostomy successfully treated by transcatheter arterial microcoil embolization.

Percutaneous Transhepatic Intraductal Forceps Biopsy of Icteric Hepatocellular Carcinoma

Objective: To determine the usefulness and effectiveness of percutaneous transhepatic intraductal biopsy for fragmented tumors of the icteric type hepatocellular carcinoma (HCC). Patients and Methods: Eight patients with chronic hepatitis and obstructive jaundice received percutaneous transhepatic biliary drainage (PTBD). Intraductal forceps biopsy was performed through the established percutaneous transhepatic tract 1 to 2 weeks later following PTBD procedure. Results: Adequate specimen for pathological diagnosis was obtained in all patients. Transient hemobilia occurred in all patients, and minor complications such as low grade fever and pain were occasionally seen. No major complication was encountered. Conclusions: Intraductal forceps biopsy after percutaneous transhepatic biliary drainage is a safe and effective method for tissue confirmation of icteric HCC even in cases with bleeding tendency and with the presence of small amount of ascites.

Transcatheter Arterial Embolization of Pseudoaneurysm of the Internal Maxillary Artery after Mandibular Osteotomy

A patient presented with transaoral hemorrhage for 3 weeks after mandibular osteotomy. Angiographic evaluation showed a pseudoaneurysm of the internal maxillary artery (IMA). Superselective transcatheter arterial embolization of the neck of the pseudoaneurysm was performed by liquid adhesive suspension, and bleeding was arrested with the preservation of the parent artery. Vascular injury at the mandibular osteotomy site is rare but can occur. Transcatheter arterial embolization by liquid adhesive suspension was a prompt and effective solution. (Tzu Chi Med J 2003; 15:191-194)

Magnetic Resonance Imaging of Hallervorden-Spatz Syndrome - A Case Report

A 48-year-old man had suffered from progressive involuntary movement of bilateral arms since the age of 24 years. Clinical examination revealed acanthocytosis and optic nerve atrophy. Cranial magnetic resonance imaging (MRI) demonstrated abnormal hypointensity in the globus pallidus with central zones of hyperintensity on T2-weighted and Proton-weighted images, producing the ”eye of the tiger” sign. Based on the clinical features and MRI findings, Hallervorden-Spatz syndrome was diagnosed. (Tzu Chi Med J 2003; 15:131-134)