Seog Hee Park

N-butyl-2-cyanoacrylate pulmonary embolism after endoscopic injection sclerotherapy for gastric variceal bleeding.

Purpose The purpose of this work was to describe the radiologic and clinical manifestations of n-butyl-2-cyanoacrylate pulmonary embolism (PE) after endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. Method From 1992 to 1999, the medical records of 140 patients who had undergone EIS using n-butyl-2-cyanoacrylate were reviewed for identification of respiratory symptoms and amount of injection, and their pre-and postprocedure chest radiographs were reviewed to identify PE. In patients with PE, pre-and postprocedure chest radiographs (6/6), chest CT scans (3/6), lung perfusion scans (3/6), and follow-up chest radiographs (6/6) were analyzed retrospectively. Results Radiographically evident PE was observed in 6 (4.3%) of 140 patients. In comparison with patients without emboli, these patients received a higher mean volume of injection (4.2 vs. 1.8 ml) (p = 0.0011). Four of the six patients with pulmonary emboli had respiratory symptoms. Chest radiographs and CT scans showed unusual tubular or nodular, radiopaque pulmonary emboli along the pulmonary vessels. Multiple peripheral, wedge-shaped, subsegmental perfusion defects were seen on perfusion lung scans. In five of six patients, the radiographic abnormalities showed complete or partial resolution. There were no fatalities directly associated with PE. Conclusion Radiographically evident PEs are uncommonly observed following EIS and appear to be more common in patients receiving a higher volume of liquid acrylate. Affected patients were either mildly symptomatic or asymptomatic, and there were no direct fatalities of this complication.

Pregnancy- and Lactation-Associated Breast Cancer Mammographic and Sonographic Findings

Objective. To evaluate the mammographic and sonographic findings of pregnancy‐associated breast cancer. Methods. A total of 22 consecutive patients with breast cancer pathologically diagnosed during pregnancy (n = 10) or lactation (n = 12) were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and sonography were performed on 12 patients; sonography only was performed on 7 patients; and mammography only was performed on 3 patients. Mammographic and sonographic findings were evaluated retrospectively. Results. Mammography revealed positive findings in 13 (86.7%) of 15 patients, even though all 15 patients had dense breasts. Mammographic findings included masses (n = 5), masses with calcifications (n = 2), calcifications with axillary lymphadenopathy (n = 2), a mass with axillary lymphadenopathy (n = 1), calcifications alone (n = 1), asymmetric density alone (n = 1), and diffuse skin and trabecular thickening alone (n = 1). Sonographic findings were positive and showed masses for all 19 patients (100%). The common sonographic findings of masses were irregular shapes (n = 15), irregular margins (n = 16), parallel orientation (n = 11), complex echo patterns (n = 14, including marked cystic [anechoic] components [n = 4]), and posterior acoustic enhancement (n = 12). Surrounding tissue effects could be seen in 5 patients, including ductal changes (n = 2), Cooper ligament thickening (n = 1), edema (n = 3), and skin thickening (n = 3). Calcifications within or outside a mass (n = 7) and axillary lymphadenopathy (n = 8) were also detected. Conclusions. Although a mass could not be discernible by mammography because of increased radiodensity during pregnancy or lactation, calcification, asymmetric density, axillary lymphadenopathy, and skin and trabecular thickening were helpful for diagnosis of pregnancy‐associated breast cancer. Sonographic findings of a solid mass with posterior acoustic enhancement and a marked cystic component were somewhat different from the appearance of breast cancer in nonpregnant women, possibly because of the physiologic changes of pregnancy and lactation.

Benign tumors of the tracheobronchial tree: CT-pathologic correlation.

OBJECTIVE The purpose of this essay is to illustrate the CT findings of variable benign tumors of the tracheobronchial tree and to correlate the CT and pathologic findings in 17 patients. CONCLUSION The tracheal tumors were eccentric, well-defined, polypoid masses in all cases. The endobronchial tumors were masses confined within the bronchus in all cases, and atelectasis or pneumonia of the distal parenchyma was frequently associated. Of the six hamartomas, one was a fatty mass, and two were nodules with calcification. The others were soft-tissue-density nodules. The lipomas manifested as fat density on CT scans in both cases. The other benign tumors were low-attenuating, soft-tissue-density masses without characteristic findings on CT scans.

MRI of Tuberculous pyomyositis

PURPOSE The purpose of this article is to describe the findings of MRI in tuberculous pyomyositis (PM). METHOD The MR images of four proven cases of tuberculous PM were retrospectively reviewed and analyzed with clinical and laboratory findings. The location, signal intensity on T1- and T2-weighted spin echo images, presence of abscess, signal intensity of peripheral rim, patterns of contrast enhancement, and associated findings were evaluated. RESULTS On MR images, all cases demonstrated low signal intensity on T1-weighted images and high signal intensity on T2-weighted images in a single muscle. Abscess was seen in all cases. Peripheral rim showed subtle hyperintensity on T1-weighted images and hypointensity on T2-weighted images. After gadolinium infusion, peripheral rim enhancement was observed in all cases. Cellulitis was associated in one case. The patients clinically presented with a palpable mass of long duration. CONCLUSION Tuberculous PM shows characteristic findings of a well demarcated abscess with rim enhancement at MRI and can be distinguished from other soft tissue masses.

Intraarterial Lidocaine Administration for Relief of Pain Resulting from Transarterial Chemoembolization of Hepatocellular Carcinoma: Its Effectiveness and Optimal Timing of Administration

AbstractPurpose: Patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) commonly have significant post-procedural abdominal pain necessitating narcotic administration. It is known that intraarterial administration of lidocaine is effective in controlling the pain during the procedure. However, optimum timing of the lidocaine administration is not precisely known. The purpose of this study was to assess the efficacy of intraarterial lidocaine administration for control of pain resulting from TACE and to evaluate the optimal timing of administration. Methods: In a prospective trial, 113 consecutive patients with HCC who underwent TACE were classified into three groups: those who received a lidocaine bolus intraarterially immediately prior to TACE (group A, n = 30), those who received lidocaine immediately after TACE (group B, n = 46), and those who did not received lidocaine (group C, n = 37). Incidence and degree of post-procedural pain was assessed using a subjective method (visual analogue scales scored from 0 to 10) and an objective method (amount of post-procedural analgesics). Results: The incidence of post-procedural pain in group A (16.7%) was significantly lower than that of group B (38.3%; p = 0.005). The mean pain score was 3.0 in group A and 4.8 and 3.1 in groups B and C, respectively. The mean dose of analgesic used after the procedure in group A (25.0 mg) was significantly lower than those in group B (52.9 mg) and group C (41.0 mg; p = 0.002). Conclusions: Pre-TACE intraarterial administration of lidocaine is much more effective than post-TACE administration in reducing the incidence and the severity of post-procedural pain. Furthermore, in order to reduce the incidence of post-procedural pain and dose of post-procedural analgesics, we recommend routine pre-TACE administration of lidocaine because post-procedural pain might developed even in patients who did not feel any pain during the TACE.

CT Differentiation of Anthracofibrosis from Endobronchial Tuberculosis

OBJECTIVE The purpose of this study was to use CT to differentiate anthracofibrosis from endobronchial tuberculosis (TB), both of which are major causes of benign bronchostenosis. MATERIALS AND METHODS We retrospectively reviewed the clinical and CT findings of 49 patients with anthracofibrosis and 35 patients with endobronchial TB diagnosed on the basis of bronchoscopic, microbiologic, and pathologic findings. Forty-five patients with anthracofibrosis and 32 patients with endobronchial TB had bronchostenosis on CT and were enrolled in the analysis. Nine (20%) of 45 patients with anthracofibrosis had coexistent active TB (two, endobronchial TB; six, pulmonary TB; one, TB pleurisy), and 13 (29%) had pulmonary infections other than TB. Two patients with anthracofibrosis and coexistent endobronchial TB were excluded from the analysis. The CT findings were analyzed with emphasis on the pattern, distribution, and location of bronchostenosis and the number of pulmonary lobes involved. RESULTS Anthracofibrosis was more common than endobronchial TB among elderly patients (p < 0.05). Statistically significant findings on CT were the pattern of bronchostenosis, presence of main bronchus involvement, and number of pulmonary lobes involved (p < 0.05). Bronchostenosis with anthracofibrosis usually involves multiple lobar or segmental bronchi. The main bronchus, however, tends to be preserved in anthracofibrosis. Most cases of endobronchial TB involve one lobar bronchus and the ipsilateral main bronchus with contiguity in extent. CONCLUSION Anthracofibrosis can be differentiated from endobronchial TB on CT. Furthermore, CT is helpful in the diagnosis of anthracofibrosis before bronchoscopy is performed.

MR imaging of solitary pulmonary lesion : emphasis on tuberculomas and comparison with tumors

The aim of this study was to determine whether solitary pulmonary tuberculoma and malignant tumor can be differentiated on the basis of magnetic resonance (MR) signal intensity. Twenty‐eight patients with solitary pulmonary lesions were prospectively studied with MR imaging: T1‐weighted, enhanced T1‐weighted, proton density‐weighted, and T2‐weighted spin echo images were obtained. The confirmation methods used were computed tomography (CT)‐guided biopsy in seven patients with lung cancer and four patients with tuberculosis; surgery in ten patients with lung cancer and five patients with tuberculosis; and laboratory data in two patients with tuberculosis. Morphologic features and MR signal intensity were examined in detail. As the test for detection of tuberculoma, signal difference on T2‐weighted images was carefully analyzed. The signal intensity ratio of the nodule to thoracic muscle signal intensity was measured. The signal intensities obtained from the lung cancers and tuberculomas were variable on pre‐and post‐enhanced T1‐weighted images and proton density‐weighted images. Masses were hypointense in 2 of 17 patients with lung cancer and in 9 of 11 patients with tuberculoma on T2‐weighted images (sensitivity 82%, specificity 89%, accuracy 87%). The mean signal intensity ratios of the tuberculomas to muscle were significantly lower than those of malignant tumors on T1‐weighted, enhanced T1‐weighted, proton density‐weighted, and T2‐weighted images (P < 0.0001). After gadolinium‐DTPA enhancement, 2 malignant tumors and 7 tuberculomas showed a marginal rim enhancement pattern, whereas 15 malignant tumors and 2 tuberculomas revealed a diffuse enhancement. The results of MR imaging were consistent with those of CT in 84% of the patients. MR imaging is a helpful adjunctive method in terms of differentiating a tuberculoma from a malignant tumor. J. Magn. Reson. Imaging 2000;11:629–637.

Bronchiolitis obliterans after allogenic bone marrow transplantation: HRCT findings.

Objective To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT). Materials and Methods During the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV1 value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had follow-up images. Results Abnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7); newly developed or progressed bronchial dilatation (n=4); and increased lung volume (n=3). Conclusion HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

Teratoma with Malignant Transformation in the Anterior Mediastinum: A Case Report

Malignant transformation of teratoma in the anterior mediastinum is rare; the mass usually has a long history and is seen in older patients. We report a case of teratoma with malignant transformation in the anterior mediastinum, complicated by rupture. CT revealed a lobulated, inhomogeneous cystic mass with a fat component and wall calcifications. The lateral wall was disrupted and consolidation in the adjacent left upper lobe was noted, suggesting rupture. A heterogeneously enhanced solid portion, obliterating the fat plane between the mass and the great vessels was present in the medial aspect of the mass, and pathologic examination demonstrated the presence of adenocarcinoma.

Pulmonary tuberculosis after hematopoietic stem cell transplantation: radiologic findings.

Aim To determine the radiologic features of pulmonary tuberculosis in hematopoietic stem cell transplant (HSCT) recipients. Materials and Methods Between January 1996 and December 2005, 10 patients with pulmonary tuberculosis were analyzed. Chest radiographs were available in all of these patients and chest computed tomography (CT) scans were available in 7 patients. We retrospectively analyzed each patients chest radiographic and CT findings. Results On chest radiography (n=10), the most common abnormalities were air-space consolidation (100%) and nodules (80%). Parenchymal lesions appeared mixed with other findings (80%). The most common mixed pattern was nodules with consolidations (80%). Parenchymal lesions were multilobar (80%), patchy (70%), or bilateral (80%). Evidence of a zonal predominance was not seen. On chest CT scans (n=7), the most common parenchymal lesions were consolidation (100%), nodules (71%), tree-in-bud appearance (43%), and ground-glass opacity (43%). Parenchymal lesions seen on CT scans also appeared mixed (86%) and multilobar in distribution (100%). Significant zonal predominance was not noted on CT scans. Cavity was noted in 14% of the study patients and lymphadenopathy was noted in 71% of these patients on CT scans. Conclusions The radiologic features of pulmonary tuberculosis in HSCT recipients were nodules or air-space consolidation. Most of the abnormalities were mixed with other findings and had multilobar distribution, however, a lobar predilection was not seen. Awareness of radiologic findings of pulmonary tuberculosis in HSCT recipients may help the diagnosis of pulmonary tuberculosis.