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.

High-Resolution CT Findings of Re-Expansion Pulmonary Edema

OBJECTIVE: To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax. MATERIALS AND METHODS: HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed. RESULTS: Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%). CONCLUSION: The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.

Consolidations in Nodular Bronchiectatic Mycobacterium Avium Complex Lung Disease: Mycobacterium Avium Complex or Other Infection?

PURPOSE: The objective of this study is to define the clinical implications of consolidations in nodular bronchiectatic type Mycobacterium avium complex (NB-MAC) infection. MATERIALS AND METHODS: A total of 69 patients (M : F = 17 : 52; mean age, 64 years; age range, 41-85 years) with MAC isolated in the sputum culture and nodular bronchiectasis on the initial and follow-up CT scans were included. We retrospectively reviewed the incidence of consolidation and analyzed its clinical course by using radiographic changes with or without anti-MAC drug therapy. RESULTS: In 44 of the 69 cases (64%), focal consolidations were seen on the initial and follow-up CT images. In 35 of the 44 (80%) cases, consolidations completely regressed, and in 3 cases (7%), consolidations partially regressed within 2 months with only antibiotics. In 2 cases (5%), the consolidations remained stable for over 2 months without anti-MAC drug therapy. Only in 4 cases (9%) did the consolidations improve after anti-MAC drug therapy. In 11 of the 38 cases (29%) with responsiveness to antibiotics, non-mycobacterial micro-organisms were identified in sputum, including pseudomonas, hemophilus, staphylococcus, and others. CONCLUSION: In NB-MAC, consolidations are commonly present on CT. In these conditions, most of consolidations result from pneumonia other than MAC.

Pulmonary Actinomycosis: CT Studies of Diagnostic and Post-treatment Findings

PURPOSE: To investigate the value of the computed tomography (CT) in the study of diagnostic and post-treatment findings of pulmonary actinomycosis. MATERIALS AND METHODS: Clinical data and CT findings were retrospectively analyzed in 10 patients with histopathologically confirmed pulmonary actinomycosis. We analyzed the initial CT findings in search of patterns and distributions which suggest possible lung abnormalities and found the pleura, chest wall, and lymphadenopathy to be involved as part of the indicators of lung abnormalities. We analyzed follow-up CT findings for changes in the lungs after antibiotic therapy and recurrence after surgery. RESULTS: Of the 10 patients analyzed by CT for lung lesions, seven had been diagnosed with alcoholism and nine were male. The initial CTs (n=10) indicated that all the pulmonary lesions were solitary without chest wall involvement. However, a transfissural extension was observed in 20% of the study population (n=2). Furthermore, peripheral lung distribution and adjacent pleural thickening was observed in 70% of the study population (n=7). Within the consolidation (n=6) or mass (n=4), a central low density with peripheral enhancement was seen in 70% of the study population (n=7). A follow-up CT of the seven cases following antiobiotic therapy revealed that four cases showed minimal improvement or aggravation of their lung lesions, whereas three cases showed resolution or improvement. The improvement of the central low density was related to the improvement of consolidation or mass. Furthermore the presence of fibrosis was observed after the resolution of pulmonary lesions (n=2). No relationship was found between the duration and response of antibiotic therapy. A follow-up CT (n=4) subsequent to a lung resection revealed the onset of chest wall actinomycosis and a thickened pleura in one case. CONCLUSION: The results of this study highlight the value of the CT in pulmonary actinomycosis in order to diagnose and evaluate antibiotic responses, complications, or post-surgical recurrences of lung lesions.

A CT Criteria of Cardiomegaly

PURPOSE: To determine computed tomography (CT) criteria for cardiomegaly. MATERIALS AND METHODS: We analyzed posteroanterior chest radiographs and CT scans of 200 patients (M:F=130:70, mean age 49 years old) that were performed on the same day. On plain radiographs, the cardiothoracic ratio (R) was calculated using a standard method. On CT, we measured the maximal cardiac width (D(c)) and the maximal thoracic width of a patient (D(t1)). A second thoracic width was measured at the same scan level of D(c). Thus, two cardiothoracic ratios were derived in one patient-D(c)/D(t1) (R(1)) and D(c)/D(t2) (R(2)). We analyzed the appropriateness of R(1) and R(2) in the diagnosis of cardiomegaly to establish criteria for the use of the cardiothoracic ratio (ROC curve). RESULTS: When cardiomegaly was defined as a value of R that was greater than 0.5, both R(1) and R(2) were useful indicators of cardiomegaly. For a cut-off value of 0.5 for the cardiothoracic ratio for cardiomegaly, the sensitivity of R(1) and R(2) was 84% and 68%, respectively, and the specificity of R(1) and R(2) was 72% and 86%, respectively. CONCLUSION: The cardiothoracic ratio on CT can be easily obtained by measurement of the maximal cardiac width divided by the maximal thoracic width at the same scan level. When the cardiothoracic ratio on CT is over 0.5, the presence of cardiomegaly can be suggested.

CT Halo Sign in Pulmonary Epithelioid Hemangioendothelioma: A Case Report

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare low-grade malignant vascular tumor of minimal clinical expression in young women. Bilateral multiple pulmonary nodules, up to 2 cm in size, are typical CT findings. We describe an atypical case of PEH with a fatal outcome in a 65-year-old male, showing multiple pulmonary nodules with a typical CT halo sign by pulmonary hemorrhage.

Non-Malignant 18F-FDG Uptake in the Thorax by Positron Emission Tomography Computed Tomography Fusion Imaging

Fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) has been used exclusively to diagnose malignancies. However, increased FDG uptake is not always limited to malignant tissue. Many false positive findings for PET have been reported. Moreover, the use of PET/CT may allow the reassessment of previously recognized patterns of physiological bio-distribution of a tracer. In this report we demonstrate the physiological FDG uptake of normal structures in the thorax using PET/CT imaging and illustrate many benign pathological conditions with standardized uptake values greater than 2.5.

The Vascular Pedicle Width seen on Chest PA in Normal Korean Adults

PURPOSE: We wanted to measure the vascular pedicle width (VPW) in normal Korean adults and correlate the VPW with the body physique and we also wanted to establish the index for normal VPWs, which could be utilized in reading chest PAs. MATERIALS AND METHODS: The VPW was measured on the posteroanterior (PA) chest radiographs of 262 normal Korean adults (134 men and 128 women, age range: 22-88 years, mean age: 45.2 years), who visited the hospital for a general health examination. The relationship between the VPW and the height and the Body Mass Index (BMI) was evaluated. Correlations between height and the thoracic spine length (TSL) and between the BMI and the lateral chest wall thickness (CWT) were analyzed as well. RESULTS: The mean VPW was 47.4 (+/-6.4) mm. The VPW was positively correlated with the height (p<0.01) and the BMI (p<0.01) of the subject. The patient's height was well correlated with the TSL, and the BMI was correlated with the CWT (r=0.75, r=0.76). The table for the normal VPWs according to patient's TSL and CWT was established. CONCLUSION: By measuring the TSL and the CWT on chest PA, which reflect the height and BMI, respectively, and by utilizing the provided table for the normal VPW, we can determine the normality of a patient's VPW.

The Ultrasonographic Findings of Trigger Points of Myofascial Pain Syndrome in a Rabbit Model

PURPOSE: Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain. Myofascial trigger points (MTrPs) have been repeatedly described by numerous authors. However, there have been few studies in which their existence and behavior was supported and their location confirmed. The purpose of this study was to determine whether diagnostic ultrasonography is an objective diagnostic tool which is able to significantly identify or detect the soft tissue changes in the region of clinically identified active MTrPs by using a rabbit experimental model. MATERIALS AND METHODS: Ten MPS model rabbits were used in this study. We made an MPS animal model by causing the rabbits to overuse one leg for 3 weeks by cutting the contralateral L4 spinal nerve root. We compared the ultrasonographic findings of the taut band at pre-OP with those at post-OP during the consecutive three week period. To find the taut bands of the muscle, after skin exposure, the muscles were gently rubbed or pinched with the thumb and index finger on the two opposing surfaces of the muscle across the direction of the fibers. Then, the muscle was held in the same way, but with a 5-8 MHz stick probe being used in place of the thumb. After the palpation of various muscles, we selected the hardest and largest myofascial trigger nodule, in order to observe the ultrasonographic and power Doppler findings of the MPS. The size, shape, echogenecity and vascularity of the MTrPs were observed. RESULTS: The analysis of the results of the ultrasonography revealed that all MTrPs have a hyperechoic area. The mean thickness of the hyperechoic lesion in the biceps was 0.96+/-0.14 cm in the MPS site (at pre-OP?), and 0.49+/-0.12 cm at post-OP 3weeks (p < 0.01). The hyperechoic lesions in all of the studied biceps femoris of the rabbits were observed by high resolution ultrasonography. No definitively decreased vascularity was observed within the hyperechoic area by power Doppler imaging. CONCLUSION: Until now, there has been no objective method for the diagnosis of MPS. However, this study suggests the possibility of using diagnostic ultrasonography as an objective diagnostic tool, by identifying the tissue changes in the region of clinically indicated active MTrPs.

Sequential Change in the Findings of Fat Necrosis on US, MRI and Tissue Specimen Radiogram Correlating with Histopathologic Findings: Experimental Study in Pigs

PURPOSE: This study compared the sequential findings of ultrasound, MRI and tissue specimen radiograms of experimentally induced fat necrosis in pigs with the histopathology findings. MATERIALS AND METHODS: Fat necrosis was induced in five experimental groups containing three pigs per group (3-day, 2-week, 4-week, 6-week and 8-week groups), which were divided according to the amount of time after inducing fat necrosis until when the tissue specimen was obtained. Ultrasound (US) and MRI (T1 weighted images, T2 weighted images, STIR sequence, T1 fat-suppressed contrast enhanced images) were obtained. X-ray tissue specimen radiograms were obtained after sacrificing the pigs. The changes in the findings of these imaging modalities were compared with the histopathology findings. RESULTS: Ultrasound showed the lipase-induced masses of fat necrosis to be isoechoic (47%) and mixed echoic (42%) masses in 3-day group, mixed (56%, 41%) and hypoechoic (42% and 59%) masses in the 2-week and 4-week groups respectively, and hypoechoic (67% and 56%) masses in the 6-week and 8-week groups. MRI showed the T1 weighted images to have significantly high rate of isosignal intensity in the 3-day, 2, 4 and 6-week groups, but the isosignal intensity lesions decreased gradually while the low signal intensity lesions increased with time. The T2 weighted images showed that the high signal intensity lesions were the main type of lesion in the early stage but the isosignal intensity lesions increased markedly in the late stage. The STIR (short tau inversion recovery) sequence showed that all the masses of fat necrosis were observed to have high signal intensity in the 3-day group, and the high signal intensity lesions decreased while the isosignal intensity lesions increased significantly during the follow-up period between 2 weeks to 8 weeks. All the masses of fat necrosis were enhanced on the fat-suppressed contrast-enhanced T1 weighted images. Among the total 45 cases X-ray tissue specimen radiograms, fat necrosis was observed as a radiopaque mass in 28 cases (62%). Among these 28 cases, calcifications within the masses were observed in 4 cases from the 8-week group and 1 case from 6-week group. Two cases from 2-week group were observed as spiculated masses. The histopathology findings of fat necrosis were acute inflammatory cell infiltration, edema and hemorrhage in the 3-day group, the proliferation of fibroblasts, connective tissue and capillaries around the fat necrosis in the 2-week group. However, the number of vessels decreased gradually and the fibrosis had progressed further in the 4, 6 and 8-week groups. CONCLUSION: The sequential findings of fat necrosis on US, MRI and tissue specimen radiogram were correlated with the histopathology findings. These results may be helpful for the differentiating fat necrosis from more ominous breast masses.

Clinical Role of Interstitial Pneumonia in Patients with Scrub Typhus: A Possible Marker of Disease Severity

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.

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.

CT Analysis of Lung Cancer and Coexistent Emphysema

PURPOSE: To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. MATERIALS AND METHODS: Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. RESULTS: Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p=0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. CONCLUSION: The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT. The location or type of lung cancer was not significantly correlated to the location or the degree of coexistent emphysema.

Airway Obstruction in Rheumatoid Arthritis: CT Manifestations, Correlated with Pulmonary Function Testing

In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF25-75%) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF25-75% (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.

Percutaneous Microwave Coagulation Therapy combined with Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Preliminary Results

PURPOSE: To evaluate the efficacy of percutaneous microwave coagulation therapy (PMCT) combined with transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Twenty-five nodular HCCs [long diameter of 1.2 -10 (mean, 3.4) cm] in 19 patients (15males and 4 females) were treated by PMCT 4-138 days after TACE. Under ultrasound guidance, the carcinomas were punctured with a 14-G guideneedle through which a microwave electrode(25.0 cm in length, 1.6mm in diameter) was inserted. To coagulate the HCCs and surrounding hepatic parenchyma, microwave irradiation at 60W for 45 -60 seconds was then applied. One to three sessions of PMCT were performed at intervals of 2-6 days, and one week to 29 months later, the therapeutic effect was evaluated by spiral CT, angiography, and serum alpha-fetoprotein. RESULTS: Eighteen of 25 HCCs (72.0%) were necrotized completely, but seven (28.0%) recurred. Ninety percent of HCCs smaller than 4 cm in long diameter showed complete remission, but all those larger than 4 cm recurred. Alpha-fetoprotein levels decreased markedly in five patients (26.3%), while in 12 (63.2%), asparate aminotransferase (AST)/alanine aminotransferase (ALT) showed transient elevation. Minor complications occurred after PMCT (mild abdominal pain in 8 patients, fever in 7, pleural effusion in 3, portal vein thrombosis in 1, and hepatic abscess in 1), but in no case was this serious. CONCLUSION: PMCT combined with TACE provides effective and safe treatement for nodular HCCs with a long diameter of less than 4 cm.

Effect of Percutaneous Thrombin Injection under Ultrasonography Guidance for Occlusion of Common Femoral Artery Pseudoaneurysm after Failed Ultrasonography-guided Compression: A Case Report

The occurrence of pseudoaneurysm of the femoral artery after catheterization is uncommon. Ultrasonography-guided compression is currently the first choice of treatment, with a success rate of more than 90%. Recently, however, with the increasing use of larger percutaneous instruments and periprocedural anticoagulation, the incidence of pseudoaneurysm unresponsive to ultrasonography-guided compression is increasing. The authors encountered a case of pseudoaneurysm of the common femoral artery which did not respond to the repeated use of this technique, though treatemnt involving was successful. We believe that in ultrasonography-guided percutaneous thrombin injection was successful. We believe that in cases involving occlusion of a a pseudoaneurysm in which ultrasonography-guided mpression has failed, this is a simple, safe, and time-saving procedure.

Determination of the Activity of Pulmonary Tuberculosis: the Utility of High-Resolution Computed Tomography

PURPOSE: To evaluate the utility of high-resolution computed tomography(HRCT), as used to determine the activity of tuberculosis, and to analyze the HRCT findings in active and in inactive tuberculosis. MATERIALS AND METHODS: We analyzed the HRCT findings of 100 patients (54 men, 46 women; average age, 54 years) who according to the results of chest radiography had pulmonary tuberculosis of undetermined activity. We assessed HRCT findings such as the presence of a entrilobular, macro-, or micronodule; consolidation, ground-glass opacity, cavity, interlobular septal thickening, irregular linear opacities, bronchial wall thickening, bronchovascular bundle distortion, bronchiectasis, atelectasis, and pericicatrical emphysema. We compared the ratio of the area of nodule and consolidation to that of whole lung, and compared the findings between active and inactive tuberculosis. RESULTS: Eleven of 100 patients were excluded because the final diagnosis was other than tuberculosis. In 59 patients, the presence of active pulmonary tuberculosis was proven by positive sputum smear and/or culture for Mycobacterium tuberculosis. On the basis of the negative results of these tests, pulmonary tuberculosis was found to be inactive in 30 patients; serial chest radiographs indicated that their condition remained stable over a 6-month period. For HRCT, sensitivity was 96.6%, specificity 56.7%, positive predictive value 81.4%, negative predictive value 89.5%, and accuracy 83.1%. For active tuberculosis, the presence of centrilobular nodules, tree-in-bud, macronodules, cavity within the nodule, and consolidations was statistically significant, while for inactive tuberculosis, that of irregular linear opacities, micronodules, bronchiectasis, and cicatrization atelectasis was similarly significant. The CT score for the area of nodules and consolidations was higher in active than in inactive tuberculosis, but only the nodule score showed statistical significance. CONCLUSION: HRCT can be a useful diagnostic tool for evaluating the activity of pulmonary tuberculosis

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 com-ponent 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 examina-tion demonstrated the presence of adenocarcinoma.

Fate of Abstracts Presented at the Scientific Meetings of the Korean Radiological Society

PURPOSE: To determine the publication rate of abstracts presented at the scientific meetings of the Korean Radiological Society(KRS) and to compare the contents of publication articles and presentation abstracts. MATERIALS AND METHODS: Between 1992 and 1996 it was determined whether or not 2457 abstracts presented at meetings of the KRS were published in the Journal of the Society. Publications that matched presentations were identified, and the proportion of abstracts published was calculated. Differences in publication rates between spring and autumn meetings, and between scientific sessions(SS) and scientific exhibitions(SE) were examined. The elapsed time between presentation and publication was recorded. The contents ( authors, title, purpose, materials and methods, results, and conclusion) of abstracts presented at scientific meetings of the KRS were compared with those of articles published in the Journal of the KRS. RESULTS: We found that the mean proportion of abstracts published as articles was 25%. There was a significantly different publication rate between spring and autumn meetings, and between SS and SE. The mean time lapse between presentation and publication was 13.3 months. The mean number of authors was 4.8 in the case of abstracts and 5.8 in the case of articles. Of the 614 articles, 98 (16 %) showed no evidence of a change of first author. Articles were more likely to mention an additional coauthor( 81 % versus 66 % , p < 0.05) when the first author was a resident than when he or she was a staff member. The purpose and conclusion of the studies remained the same in a high percentage of cases (87% for purpose and 71% for conclusion). CONCLUSION: The fact that only 25% of the abstracts presented at scientific meetings of the KRS have been published is one that should be of concern to the investigators involved. It is important that studies undertaken should proceed to the publication stage. though it is recognized that the discrepany in this respect is probably due to factors which are not academic.

CT Diagnosis of Tracheobronchial Rupture Following Blunt Trauma with Demonstration of the Injury Site: A Case Report1

Tracheobronchial disruption is a rare injury associated with blunt trauma, and for proper management, accurate diagnosis is essential. We describe a case of isolated tracheal rupture following blunt trauma, and the related CT findings, including details of the injury site. Preoperative bronchoscopy was not performed, but the patient immediately underwent surgery, which was successful. This case demonstrates that CT scanning is very helpful both for diagnosis of tracheobronchial injury and for delineation of the exact injury site.