Sun Wha Song

CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

Purpose To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. Materials and Methods From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. Results Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. Conclusion CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

Risk factors for progression of aortic arch calcification in patients on maintenance hemodialysis and peritoneal dialysis

Vascular calcification is accelerated during dialysis and is known to be an important risk factor for cardiovascular disease. Progression of aortic arch calcification (AoAC) can be simply estimated with an AoAC score (AoACS) using plain chest radiography. The objective of this study was to evaluate risk factors for AoAC progression. The enrolled subjects were 125 newly treated hemodialysis patients and 59 peritoneal dialysis patients. In the patients who had undergone chest radiography before initial dialysis therapy and every year, we estimated AoACS and then divided the patients into two groups based on the presence or absence of AoAC progression. We also compared the baseline clinical and biochemical profiles in the two groups. Eighty‐five (46.2%) were men (mean age, 58.6 ± 12.7 years). Seventy‐six patients (41.3%) had AoAC before initial dialysis, with a mean AoACS of 13.0 ± 20.4%. The mean duration of follow‐up was 2.7 ± 1.0 years. Half of the patients (50%) had progressive AoAC. Age >65 years (p = 0.003), dialysis duration (p = 0.004), diabetes (p = 0.015), and the presence of AoAC at baseline (p = 0.001) were related to AoAC progression. No significant association was found between AoAC progression and the baseline clinical parameters, including gender, obesity, hypertension, and dialysis modality. In a multivariate analysis, dialysis duration (p = 0.003) and the presence of AoAC at baseline (p < 0.001) were independent risk factors for AoAC progression in patients undergoing dialysis. The duration of dialysis and the presence of AoAC before initial dialysis were significantly related to the progression of AoAC in these patients. The results suggest that patients should be carefully managed from the predialysis stage to prevent AoAC progression and to reduce cardiovascular morbidity.

Malignant solitary fibrous tumor of the pleura: computed tomography-pathological correlation and comparison with computed tomography of benign solitary fibrous tumor of the pleura

PurposeThe aim of this study was to determine the computed tomography (CT)-pathological correlation of malignant solitary fibrous tumors of the pleura (MSFP) and to compare these findings with CT findings of benign solitary fibrous tumors of the pleura (BSFTP).Materials and methodsWe retrospectively identified the clinical, CT, and pathological findings in seven cases of MSFP. There was a CT-pathological correlation for the MSFPs. Additionally, 12 cases of BSFTP from case files were compared with the clinical and CT features of the MSFPs.ResultsOn CT, the MSFP appeared as a heterogeneously enhancing mass >10 cm (100%). Pleural metastasis (57.1%) and lung metastasis (14.3%) were associated. In the CT-pathological correlation, the enhancing area was mixed cellular and collagenous tissue with hypercellularity, mitosis, and pleomorphism. Hemorrhage, necrosis, cystic, or myxoid degeneration produced areas of intratumoral low attenuation. MSFPs showed a higher incidence of intratumoral low-attenuation areas (P = 0.034) and pleural metastasis (P = 0.009); and on CT, MSFPs tended to be larger than BSFTPs (P = 0.076).ConclusionMSFPs showed a >10 cm pleural mass with low-attenuation regions on CT, which corresponded to hemorrhage, necrosis, cystic, or myxoid degeneration. MSFPs had a higher incidence of intratumoral lowattenuation areas and pleural metastasis, and on CT they tended to be larger than BSFTPs.

Clinical Feasibility of Multiplanar Reconstruction Images of Temporal Bone CT in the Diagnosis of Temporal Bone Fracture with Otic-Capsule-Sparing Facial Nerve Paralysis

The aim of this study is to evaluate the feasibility of multiplanar reconstructive (MPR) imaging of temporal bone CT in the diagnosis of temporal bone fracture with oticcapsule-sparing facial nerve paralysis. Twelve patients with traumatic facial nerve paralysis with otic-capsule sparing and temporal bone fractures were selected. Multiplanar reconstruction images were obtained with the V-works 4.0 software program (Cybermed, Seoul, Korea) using axial scanning of high-resolution temporal bone CT of the fracture line. The clinical profiles of the patients displaying temporal bone fractures were examined in relation to the findings. Multiplanar images of the fracture line provided information regarding the direction of the external force that fractured the temporal bone. The fracture line was more continuous in the MPR images than in the axial view. All patients showed an imaginary extended fracture line directed toward the otic capsule. The direction of the fracture line toward the middle ear cavity is important, as it may suggest insult to the otic capsule. The MPR image parallel to the fracture line of the temporal bone provides a guideline for the vector of the force that induced the fracture. Thorough investigation of the critical organs during surgical exploration is recommended if the direction of the fracture in the MPR image points toward the otic capsule in the middle ear even if the fracture line relative to the otic capsule is not well defined in the axial or CT view.

Cystic hypersecretory ductal carcinoma of the breast: a rare cause of cystic breast mass

We present the case of a surgically confirmed, invasive, cystic hypersecretory ductal carcinoma (CHDC) of the breast in a 43-year-old woman. The initial sonography showed a complex cyst, which required a core biopsy; however, the diagnosis was delayed as the patient refused to undergo the biopsy and the cyst decreased in size, as seen on follow-up sonography. Excision biopsy was performed, and invasive CHDC was diagnosed after regrowth of the cystic lesion. Meticulous sonographic evaluation of a cystic breast mass is always important, and pathology confirmation must be considered if the lesion shows features suspicious for malignancy, as a CHDC could be the cause of a cystic breast mass.

Clinical Utility of Three-Dimensional Facial Computed Tomography in the Treatment of Nasal Bone Fractures: A New Modality Involving an Air-Bone View with a Volume Rendering Technique

To evaluate the utility of three-dimensional (3D) reconstruction when planning the surgical treatment of nasal bone fractures. The axial scan of high-resolution facial bone CT was reconstructed in 3D using the program V-works 4.0 (CyberMed, Seoul, Korea) with a volume and surface rendering technique. For detailed stereoscopic examination of the nasal valve area, an air-bone view with the volume rendering technique was obtained using thresholds for air, cartilage, and bone. In most nasal bone fractures, 2D and 3D CT had similar detection rates. However, to determine the fracture angle and dimpled area, and identify multiple fractures, surgeons can get better information to help with the reduction of the fractured bone from 3D reconstruction images. Additionally, with a septal deformity, this view helps in deciding on the need for septal surgery during nasal reduction. The air view of the nasal passage provides clues to obstruction of the nasal cavity. We could identify the contour and location of the fracture site accurately from 3D CT images. The detection rate of fractures was similar to that of 2D CT. However, 3D CT enabled the accurate determination of the distance and direction of the fractured bony fragment from normal bone structure. Additionally, a stereoscopic image of the fracture site facilitated an understanding of the location and range of reduction. The air-bone view gave more information about the pathological obstruction of the nasal air passage.

Evaluation of temporal bone pneumatization with growth using 3D reconstructed image of computed tomography

OBJECTIVE To evaluate temporal bone pneumatization with growth using 3D reconstructed computed tomography (CT) images. PATIENTS AND METHODS Eighty-four temporal bones of 42 patients under the age of 16 years who had undergone head and facial bone CT were included in this retrospective study. The bony growth of the temporal bone and the head size were evaluated with horizontal- and vertical-plane CT images. Pneumatization of the temporal bone was investigated with 3D reconstruction software using axial CT images, dividing them as follows: medially, anterosuperiorly, posterolaterally, and inferiorly. Pneumatization of each individual part was compared with that of other parts and was also evaluated according to the aging process. RESULTS The mean pneumatization was measured as 1696.7mm3 in patients aged under 2 years, 3609.1mm3 in those aged 2-4 years, 5351.1mm3 in those aged 5-7 years, 7295.9mm3 in those aged 8-10 years, 7797.5mm3 in those aged 11-13 years, and 8526.6mm3 in those aged 14-16 years. The degree of temporal bone pneumatization of each part was correlated with that of other parts (p<0.05). The volume of pneumatization increased with growth of the temporal bone and with aging. The degree of pneumatization of specific parts might be related to developmental periods. CONCLUSION The pneumatization of one part might affect the pneumatization of other nearby parts, or all parts might be affected by the same driving force of pneumatization.