Yup Yoon

Acetic Acid as a Sclerosing Agent for Renal Cysts: Comparison with Ethanol in Follow-Up Results

AbstractPurpose: To compare follow-up results of sclerotherapy for renal cyst using 50% acetic acid with those using 99% ethanol as sclerosing agents. Methods: Eighty-one patients underwent sclerotherapy and 58 patients, 23 males, 35 females, aged 6–76 years, having a total of 60 cysts, were included in this study; the others were lost to follow-up. The renal cysts were diagnosed by sonography, computed tomography (CT), or magnetic resonance imaging (MRI). Sclerotherapy was performed using 50% acetic acid for 32 cysts in 3 1 patients and 99% ethanol for 28 cysts in 27 patients. Under fluoroscopic guidance, cystic fluid was aspirated as completely as possible. After instillation of a sclerosing agent corresponding to 1 1.7%–25% (4–100 ml) of the aspirated volume, the patient changed position for 20 min and then the agent was removed. Patients were followed up by sonography for a period of 1–49 months. The volume of the renal cyst after sclerotherapy was compared with that of the renal cyst calculated before sclerotherapy. Medical records were reviewed to analyze complications. Results: The mean volume after sclerotherapy of the 17 cysts followed for 3–4 months in the acetic acid group was 5.1% of the initial volume, and for the 14 cysts in the ethanol group it was 10.2%. Complete regression during follow-up was shown in 21 cysts (66%) in the acetic acid group; the mean volume of these cysts before the procedure was 245 ml. The mean volume of the nine (32%) completely regressed cysts in the ethanol group was 184 ml. Mild flank pain, which occurred in three patients in each group, was the only complication and resolved the next day. Conclusion: Acetic acid was an effective and safe sclerosing agent for renal cysts, tending to induce faster and more complete regression than ethanol.

Bone bruises: MR characteristics and histological correlation in the young pig

PURPOSE To correlate magnetic resonance (MR) signal characteristics of bone bruises with histological findings. MATERIALS AND METHODS In 14 tibiae of young pigs, bone bruises were created in the proximal tibial metaphysis. The signal intensity seen on the MR images were correlated with histological findings. The following findings were evaluated: (a) changes of signal intensity on the tibiae; (b) changes of histology on the tibiae; and (c) changes of (a) and (b) on follow-up examinations. RESULTS We observed three types of injuries on T1-weighted images: focal or diffuse low signal, normal signal and linear low signal intensities. Severe hemorrhagic areas showed low signal intensities on all sequences of MR imaging. Fast spin-echo (FSE) T2-weighted images showed a more distinct low signal intensity than T1-weighted images. FSE short tau inversion recovery (STIR) and FSE fat saturated (FSE-FS) T2-weighted images showed similar signal intensities with FSE T2-weighted images. FS T1-weighted enhanced images showed low signal intensities with variable enhancements. Upon histological examination, hemorrhages and edemas were prominent at the subcortical areas of the contusion sites. The areas of dense, low signal intensities in all imaging sequences showed signs of severe hemorrhage. The areas of diffuse low signal and enhanced areas showed mixed areas of hemorrhages and edemas. Follow-up MR imaging showed evolution of the processes of hemorrhages and edemas with fatty marrow changes. CONCLUSIONS MR imaging can depict changes in the bone marrow resulting from direct injury to the bone. MR imaging is a useful tool for evaluating the evolution of bone bruises.

Spinal involvement of hematopoietic malignancies and metastasis: Differentiation using mr imaging

The purpose of this study was to determine the usefulness of magnetic resonance imaging (MRI) for distinguishing spinal involvement of hematopoietic malignancies (lymphoma, leukemia, and multiple myeloma) from metastasis. 62 spinal MRIs were obtained in 60 patients with hematopoietic malignancies (n = 24) and metastasis (n = 36) in clinically and pathologically proven cases. MRI findings were evaluated in each group of patients for the pattern of involvement, signal change of vertebral body, location of paraspinal mass formation, location of epidural mass formation, cortical destruction, contour change, and compression fracture. Diffuse involvements were more commonly seen in hematopoietic malignancies than in metastasis (p < 0.05). Signal change confined to anterior element was seen in 9 metastasis but was not seen in hematopoietic malignancies. Cortical destructions were more commonly seen in metastasis than in hematopoietic malignancies (p < 0.05). Other findings did not show any statistical significance in both groups. MRI findings such as diffuse involvement, posterior epidural mass formation, and cortical destruction were useful to distinguish spinal involvement of hematopoietic malignancies and metastasis.

Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration.

The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided needle aspiration in the treatment of prostatic abscess. Fourteen patients with prostatic abscess were evaluated with this technique and treated with sonographically guided needle aspiration. Using this technique, all cases (100%) had one or more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients (71.0%), the lesion showed internal septa or solid portion. The margins of the hypoechoic area were well defined and thick in 11 patients (79.0%) and poorly defined in 3 patients (21.0%). The estimated volume of the prostatic abscess ranged between 2 and 28 ml (mean, 12.0 ml). The presence of a pus collection within the prostate was confirmed by transrectal ultrasonographically guided aspiration in all patients. However, successful treatment of prostatic abscess with transrectal needle aspiration was done in 12 (86.0%) of 14 patients; the treatment failed in 2 (14.0%) of 14 patients. One patient was treated with perineal incision and drainage and the other with transurethral resection. The amount of pus drained ranged between 1 and 39 ml (mean, 12.0 ml). On follow‐up transrectal ultrasonographic examination, no remaining abscess pocket was found within the prostate in any of the cases. One year later, the prostatic abscess recurred in one case. In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an effective method for treating prostatic abscess.

Sonographic findings of intestinal tuberculosis

Sonograms in 41 patients with intestinal tuberculosis were analyzed. The sonographic findings of intestinal tuberculosis were thickening of the wall in the ileum, cecum, or ascending colon (or in more than one of these). We detected the wall thickening in 38 cases by sonography (detection rate, 93%). The ileum was the most frequent site of involvement. The patterns of bowel wall thickening were diffuse in 30 cases and focal in eight cases and were concentric in 28 cases and eccentric in six cases. The associated findings were ascites, lymphadenopathy, omental cake, and cecal spasm in order of decreasing frequency. The sonographic findings are not specific for the diagnosis of intestinal tuberculosis, but when noted in the appropriate clinical situation would be of great help in the diagnosis of intestinal tuberculosis.

Small intestinal phytobezoars: sonographic detection.

Three cases of small intestinal phytobezoar, suggested by sonography and later confirmed at surgery, are reported. Sonographic findings of bezoar were intraluminal mass presenting as an arclike surface echo casting clear posterior acoustic shadow within the lumen of the dilated small bowel. Compression of the mass with a transducer induced fluid shift around the mass. We propose that diagnosis of bezoars can be suggested on the basis of sonographic findings.

Percutaneous endovascular stent-graft for iliac pseudoaneurysm following lumbar discectomy.

In a 24-year-old woman, an iliac pseudoaneurysm following lumbar discectomy was successfully treated by percutaneous placement of a self-expanding stent-graft. A postprocedural angiogram demonstrated complete exclusion of the pseudoaneurysm without leakage of contrast agent.

Acetic acid sclerotherapy for treatment of a biliary leak from an isolated bile duct after hepatic surgery

Bile duct leakage from the main biliary tree is not uncommon after hepatic surgery. In this case, successful percutaneous treatment was performed for bile leakage from an isolated bile duct after left hemihepatectomy in a 48-year-old woman who underwent surgery for biliary cystadenocarcinoma and developed a biloma at the left subphrenic space. Diagnostic procedures revealed that the right posterior segmental bile duct drained aberrantly into the left bile duct, which remained undrained after resection and led to biloma formation. Ablation of the isolated bile duct was performed with acetic acid, resulting in avoidance of repeated operation and other complications.

Superior aspect of the perirenal space: Anatomy and pathological correlation

To study the anatomy of the superior aspect of the perirenal space, we analysed 50 computed tomographic (CT) scans with reference to the anatomy of Gerotas fascia, and dissected five cadavers laying special emphasis on the ascent of Gerotas fascia. We also reviewed 10 scans of patients with a large lesion in the right upper abdomen regarding localisation of the lesion. We conclude that Gerotas fascia does not cover the upper portion of the kidney and adrenal gland so that the superior aspect of the perirenal space is open towards the upper abdominal extraperitoneal space. Thus, a large lesion arising from the right adrenal gland or kidney easily invaginates the liver through the bare area mimicking a hepatic lesion, and vice versa. This explains the difficulty in localising a large lesion in the right upper abdomen.

Radiologic anatomy of the rabbit liver on hepatic venography, arteriography, portography, and cholangiography.

Seo TS, Oh JH, Lee DH, et al. Radiologic anatomy of the rabbit liver on hepatic venography, arteriography, portography, and cholangiography. Invest Radiol 2001;36:186–192. rationale and objectives. The radiologic anatomy of rabbit liver has received little study but is important in many experimental investigations. methods.Twenty-four rabbits were studied by using hepatic venograms, aortograms, hepatic arteriograms, cholangiograms, and portograms. results.In all cases, the right, middle, and left hepatic veins drained into the inferior vena cava just below the diaphragm, and the caudate lobe hepatic vein drained more inferiorly. The proper hepatic artery was a branch of the common hepatic artery in 96%. The first branch of the proper hepatic artery was the caudate lobe artery. The remaining main hepatic artery was divided into the right and left hepatic arteries. The left hepatic artery was further divided into the medial and lateral segmental branches in 95%. The anatomy of the portal vein or bile duct was the same as the hepatic artery in 100% of cases. conclusions.Knowledge of the normal patterns and variations of the vessels and bile duct will be helpful for experiments of the rabbit liver in future studies.