Comparison of Stent-Assisted Coil Embolization Versus Coil Embolization Alone for Ruptured Cerebral Aneurysms with Mild Symptoms: A Single-Clinic Experience

Purpose@#To evaluate the safety and efficacy of stent-assisted coil embolization (SAC) in acutely ruptured cerebral aneurysms without severe symptoms, and thus, the usefulness of the stent itself in patients with subarachnoid hemorrhages. @*Materials and Methods@#From January 2017 to June 2019, 118 patients were treated with coil embolization for acutely ruptured cerebral aneurysms without severe symptoms (Hunt & Hess grade ≤ 3). The periprocedural complications, six-month modified Rankin scores (mRS), and six-month radiologic outcomes were compared between 56 patients with SAC and 62 patients without SAC (non-SAC). @*Results@#The rate of good clinical outcomes (mRS ≤ 2), as well as the rate of hemorrhagic and ischemic complications, showed no significant difference between the SAC and non-SAC groups.Moreover, compared to the non-SAC group, the SAC group showed a lower recanalization rate on the six-month follow-up angiogram (20% vs. 39.3%, p = 0.001). @*Conclusion@#Although stent use was not significantly associated with clinical outcomes in coil embolization of ruptured cerebral aneurysms with non-severe symptoms (Hunt & Hess grade ≤ 3), it significantly decreased the rate of recanalization on follow-up cerebral angiograms.

Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury

Background@#To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD). @*Methods@#We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment. @*Results@#In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%). @*Conclusion@#Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.

Comparison of MRI Sequences for the Detection of Cerebral Venous Sinus Thrombosis During Follow-Up Examination

PURPOSE@#To compare the diagnostic performance of magnetic resonance (MR) sequences for the evaluation of cerebral venous sinus thrombosis (CVST) during follow-up examinations.@*MATERIALS AND METHODS@#Thirteen cases that were confirmed to be CVST between January 2006 and March 2016 were included in this study. Two neuroradiologists independently examined each initial and follow-up MR sequence image in random order.@*RESULTS@#Gadolinium-enhanced T1-weighted imaging (Gd-enhanced T1WI) was the most sensitive sequence for the detection of CVST in the initial and follow-up MR examinations (82% and 55.3%, respectively). Among the non-enhanced MR sequences of the initial examination, gradient-recalled echo was the most sensitive (77.4%), fluid-attenuated inversion recovery (FLAIR) had low sensitivity (34.4%). The overall diagnostic performances of all MR sequences except for FLAIR decreased during the follow-up. FLAIR was the most sensitive during follow-up, and was also the only sequence with increased sensitivity during follow-up (from 34.4% to 55.6%).@*CONCLUSION@#Gd-enhanced T1WI had the best diagnostic performance for CVST in both initial and follow-up MR examinations. Therefore, it is reasonable to use Gd-enhanced T1WI to evaluate CVST during follow-up examinations. However, for patients who cannot tolerate MR contrast agents, the use of FLAIR to assess the remaining CVST during the follow-up may be helpful.

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

Non-infected and Infected Bronchogenic Cyst: The Correlation of Image Findings with Cyst Content / 결핵및호흡기질환

We hereby report a case on bronchogenic cyst which is initially non-infected, then becomes infected after bronchoscopic ultrasound (US)-guided transesophageal fine-needle aspiration (FNA). The non-infected bronchogenic cyst appears to be filled with relatively echogenic materials on US, and the aspirate is a whitish jelly-like fluid. Upon contrast-enhanced MRI of the infected bronchogenic cyst, a T1-weighted image shows low signal intensity and a T2-weighted image shows high signal intensity, with no enhancements of the cyst contents, but enhancements of the thickened cystic wall. The patient then undergo video-assisted thoracic surgery 14 days after the FNA. The cystic mass is known to be completely removed, and the aspirate is yellowish and purulent. To understand the image findings that pertain to the gross appearance of the cyst contents will help to diagnose bronchogenic cysts in the future.

Adenocarcinoma of the Lung Progressing to Multiple Cystic Lesions in a 29-Year-Old Man / 결핵및호흡기질환

Cystic lesions or progressive cystic changes in adenocarcinoma of the lung have rarely been reported. We report a case of lung adenocarcinoma that progressed from ground-glass opacities (GGOs) and consolidations or nodules to extensive cystic lesions during 12 months in a young adult patient. A 29-year-old male was initially diagnosed with primary lung adenocarcinoma by transbronchial lung biopsy of the right lower lobe and lung to lung metastasis in both lungs according to imaging findings. The initial chest computed tomography (CT) scans showed multifocal GGOs, consolidations, and nodules in both lungs. Despite treatment with palliative chemotherapy, the patient's follow-up CT scans showed multiple, cystic changes in both lungs and that the lesions had progressed more extensively. He died of hypoxic respiratory failure one year after his diagnosis.

Thoracic Splenosis: A Case Report and the Importance of Clinical History

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.

Bacteriologic Analysis of Expectorated Sputum in Patient with Bronchiectasis / 결핵및호흡기질환

BACKGROUND: Bronchiectasis (BE) remains a rare respiratory disease in Korea. This retrospective study was done to investigate the potential pathogenic microorganisms (PPMs) that cause in patients with BE, through the use of sputum specimens. METHODS: One hundred eleven adult patients, who had undergone chest computed tomography (CT), sputum gram stain/culture, and BE detected by chest CT, were included in this study. Sputum adequacy was determined by using Murray-Washington classification. RESULTS: The mean (+/-SD) age of patients was 60.9 (+/-14.0). The number of PPMs was 167 (67%) in the total 248 isolated organisms. The most frequent PPMs were P. aeruginosa (23.4%), K. pneumoniae (10.5%), and S. aureus (8.4%). The proportion of adequate sputum (AS) was 25.8% in the total sputum specimens. The patients with AS were 41 (37%) and the patients with inadequate sputum (IS) were 70 (63%). The proportion of P. aeruginosa was higher in AS compared to that of IS (44% vs. 19%, p=0.004). The BE score was also higher in P. aeruginosa (+) patients compared to that of P. aeruginosa (-) patients (10.8 vs. 7.6, p=0.001). CONCLUSION: Although the proportion of AS in the total sputum was low, PPMs were isolated in most patients with BE. It is likely that P. aeruginosa was isolated in AS and AS patients had higher BE scores.

A Case of Nitrogen Dioxide-Induced Pulmonary Edema in Oxygen Torch / 대한산업의학회지

BACKGROUND: Welders tend to be exposed to a variety of hazards including metal fumes, toxic gases, electricity, heat, noise, and radiation such as ultraviolet and infrared light. Noxious gases generated during welding include carbon monoxide, ozone, and nitrogen oxide. Although the effects of metal fumes have been well studied, few reports have investigated the influence of noxious gas exposure in welders. CASE REPORT: We encountered a patient who developed non-cardiogenic pulmonary edema within a day after fairing up a steel plate with an oxygen/LPG torch. The patient was a 43-year-old female who complained of dyspnea which became exacerbated the following morning. Her chest X-ray and chest CT scan showed an extensive ground glass opacity which was more prominent in the both upper lungs. Both her symptoms and chest X-ray findings improved. We attributed the patient's symptoms to non-cardiogenic pulmonary edema caused by nitrogen dioxide exposure, by reasoning that: 1) the patient's clinical course and radiologic findings suggested pulmonary edema 2) the event happened following fairing work with oxygen/LPG torch that usually induces a high concentration of nitrogen dioxide, and 3) the other possible causes of pulmonary edema could be excluded. CONCLUSION: Nitrogen dioxide-induced pulmonary edema should be considered in oxygen torch contrary to arc welding.

US Guided Fine-needle Non-suction Technique: A Useful and Comfortable Method for Thyroid Nodule

as useful as the conventional suction technique for the cytopathological evaluation of thyroid nodules.

Effectiveness of Intra-arterially Administered Abciximab as a Rescue Method for Intracranial Acute In-Stent Thrombosis

PURPOSE: To determine the efficacy and safety of the intra-arterial administration of glycoprotein IIb/IIIa inhibitor for resolving acute in-stent thrombosis complicating stent-assisted angioplasty for intracranial atherosclerosis. MATERIALS AND METHODS: We placed 60 therapeutic stents (24 internal carotid arteries, 20 vertebrobasilar arteries, and 16 middle cerebral arteries) for the treatment of symptomatic intracranial atherosclerosis. Among the 60 stenting procedures, acute in-stent thrombosis occurred after stent deployment in 11 cases (18.3%). As the method of dissolving the acute in-stent thrombosis, 2 mg abciximab were intra-arterially administered through a guiding catheter. Angiography was then performed after 10-20 minutes to identify any undissolved material resulting from the thrombosis. If the thrombosis was still observed on the angiography, an additional 2 mg of abciximab were administered, and this procedure was repeated until complete thrombolysis was obtained. Post-procedural non-enhanced brain CT was performed for the evaluation of possible hemorrhagic complications. RESULTS:After each intra-arterial administration of 2 mg of abciximab, successive angiographies showed the process of resolution of the acute thrombosis. All 11 acute in-stent thromboses were completely dissolved within 40 to 80 minutes. The total dosage of infused abciximab was 8 mg in one case, 10 mg in eight cases, and 16 mg in two cases. Post-procedural non-enhanced brain CT revealed no hemorrhagic complications. CONCLUSION: The intra-arterial administration of abciximab can be a safe and effective therapeutic method for acute in-stent thrombosis complicating the stenting of stenotic intracranial arteries.