Shin-Lin Shih

Primary synovial osteochondromatosis of the first metatarsophalangeal joint

Abstract. Synovial osteochondromatosis is an uncommon disorder, generally seen in large joints such as the knee, elbow, shoulder, hip and ankle. We report a 35-year-old man with synovial osteochondromatosis of the metatarsophalangeal joint of the great toe. Despite the rarity of the location, the radiographic appearance ought to suggest the diagnosis. Histological confirmation is required, since malignancy cannot be totally ruled out clinically and radiographically.

Hyperdense gallbladder wall sign An overlooked sign of acute cholecystitis on unenhanced CT examination

We reviewed the unenhanced computer tomography (CT) scans of 53 patients with surgically proven acute cholecystitis, where 27 patients presented with hyperdense gallbladder wall. To our knowledge, this sign was never reported before. Because mucosa is highly sensitive to ischemia, early mucosal necrosis and hemorrhage may result in CT-detectable high density. Similar episode may also occur in acute cholecystitis. This sign also reflects high probability for acute gangrenous cholecystitis. We suggest that patients with this sign should have urgent treatment.

Malignant hemangioendothelioma presenting as omental masses in a child.

Malignant hemangioendothelioma is an uncommon lesion of the omentum in children. Multiple foci of malignant hemangioendothelioma is even more rare in the omentum. In the present case, a computed tomography scan of the abdomen showed multiple enhanced nodular lesions. To our knowledge, this is the first report of this tumor occurring in a child.

Spindle cell hemangioendothelioma of the pancreas treated with interferon-alpha2a.

To the Editor: Spindle cell hemangioendothelioma usually occurs in the subcutis or dermis of the distal extremities, particularly the hand (1). A child presenting with jaundice, thrombocytopenia, and hepatomegaly was initially suspected to have a liver disorder based on the clinical findings. However, a computed tomography (CT) scan of the abdomen revealed a pancreatic lesion. Treatment of hemangioendothelioma of the pancreas by pancreaticoduodenectomy (2) or temporary choledochal and duodenal bypass followed by corticosteroid and radiation therapy (3) has been reported previously. Our patient was treated with interferon-a,at with good results initially.

A fetus with VACTERL association, unilateral aplasia of the humerus and partial hemihypoplasia.

We report simultaneous occurrence of right partial hemihypoplasia and ipsilateral aplasia of humerus in a fetus with VACTERL association. Our case has further demonstrated the overlap between VACTERL and body hemihypoplasia.

Small Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic carcinoma of the breast is a rare form of breast cancer and has a poorer prognosis than other breast malignancies. Preoperative diagnosis of this tumor by imaging is difficult because of its rarity. Sonography of this small neoplasm has not been reported previously. We describe a case of this rare tumor together with the preoperative mammographic and sonographic findings. When these images present in a lesion, metaplastic breast carcinoma should be included in the differential diagnosis.

Successful Treatment of Infected Lymphocele Following Major Gynecologic Surgery by Computed Tomographic-guided Drainage

Objective: Lymphocele is a well-known complication of major gynecological surgery. Most collections are asymptomatic and self-limited, but infected lymphoceles need further management. We evaluated the effectiveness of this minimally invasive procedure as an alternative to surgical treatment. Material(s) and method(s): From July 1998 through July 2003, 13 cases of infected lymphoceles were retrospectively reviewed. Location of the lymphoceles, size, and duration of drainage were recorded. Result(s): Fever and pain were the most common presenting symptoms. The interval between the initial surgical procedure and the presentation of an infected lymphocele ranged from 1 to 31 months (mean 5.8 months). CT-guided drainage resulted in relief of pain and defervesence in all 13 patients. The causative organisms included both gram positive and gram negative bacteria. The duration of catheter drainage ranged from 6 to 29 days (mean 12.9 days). All patients tolerated the procedure well, and there were no significant complications. Conclusion(s): While lymphoceles may form a few weeks after surgery, but we found that infected lymphoceles usually became clinically apparent a few months instead of weeks after operation. CT-guided percutaneous drainage is effective, safe, and well tolerated. It provides a good alternative to open surgery for infected lymphocele.