Analysis of the Risk Factors That Affect Esophageal Transit Delay When Performing Wireless Capsule Endoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Capsule endoscopy has become an excellent diagnostic tool for various small bowel diseases. However, some cases of delayed passage of the capsule in the esophagus without obstruction have been reported. The aims of this study were to analyze the risk factors associated with esophageal transit delay. METHODS: From Nov. 2002 to July. 2008, 141 patients underwent capsule endoscopy. Among them, 3 patients were excluded. The 138 patients were divided into two groups (the delayed esophageal transit time (DETT) group, and the normal esophageal transit time (NETT) group), and we compared their characteristics, including age, gender, the reason for examination, the total transit time and the rate of an incomplete examination. RESULTS: DETT occurred in 7 patients (5.1%). The mean age (61.14+/-0.70 vs. 44.01+/-7.37, respectively, p=0.02) was higher in the DETT groups. No statistically increased risk was found for gender and the indications for the procedure. The DETT group showed a higher rate of incomplete examination than did the NETT group (7/7 vs. 41/131, respectively, p=0.001). CONCLUSIONS: Even though delayed esophageal transit on capsule endoscopy is not a serious complication, it could lead to an incomplete examination. Therefore, checking the chest X-rays after swallowing the capsule can be helpful to notice delayed esophageal transit earlier in the procedure.

A Case of Capsule Endoscopy in a 42-month-old Girl / 대한소화기내시경학회지

Capsule endoscopy (CE) provides a minimally invasive examination of the entire small intestine, and is the preferred procedure for evaluation of patients with GI bleeding of unknown origin. Even though the FDA approved its use for pediatric patients between 10 and 18 years old in January 2004, little information is available regarding the effectiveness of CE in the younger pediatric population (below 6 years old) because of safety issues. A 42-month child with recurrent melena was referred to evaluate the cause of gastrointestinal bleeding. Despite extensive evaluation, including EGD, colonoscopy, a small bowel series, and Meckel's scan, the bleeding source was not identified. Finally, wireless CE demonstrated angiodysplasia on the mucosa of proximal jejunum. This is the first pediatric case of endoscopy-assisted CE under intravenous sedation without endotracheal intubation in Korea.

MRI Finding of Ethylmalonic Encephalopathy: Case Report

Ethylmalonic encephalopathy is a rare syndrom characterized by developmental delay, acrocyanosis, petechiae, chronic diarrhea, and ethylmalonic, lactic, and methylsuccinic aciduria. We report the MRI finding of ethylmalonic encephalopathy including previously unreported intracranial hematoma.

Inflammatory Pseudotumor of the Extraorbital Head and Neck: CT and MR Imaging Findings

PURPOSE: To determine the MR and CT imaging findings of inflammatory pseudotumor of the extraorbital head and neck. MATERIALS AND METHODS: We reviewed the MR (n=10) and CT (n=9) imaging studies of 11 patients with this condition (M:F=5:6, age range: 35-75 years), analysing each case in terms of location, occupying space, signal intensity, intracranial involvement, degree of contrast enhancement and adjacent bone change. Follow-up images were obtained in nine cases, and the response of each patient to steroid treatment was reviewed. RESULTS: Lesions involved the masticator space (n=8), the buccal space (n=6), the nasopharynx (n=5), the paranasal sinus (n=4), the parapharyngeal space (n=3), the prevertebral space (n=2), the orbit (n=2), the carotid space (n=2), the paravertebral space (n=1), parotid space (n=1), and the oral cavity (n=1). In ten of eleven cases, there was adjacent bone change. In three cases, the cavernous sinus was involved, and in two, the dura. One case involved both of them. At T2-weighted imaging, the lesions showed hypointensity in nine of ten cases; in four of nine, signal intensity was markedly low, and in no case was it diffusely high. In five of nine cases, the mass decreased in size after steroid therapy. CONCLUSION: Inflammatory pseudotumor showed iso-to hypointensity at T2-weighted imaging. Lymphadenopathy was not apparent.

A Pitfall in the Diagnosis of Bilateral Choanal Atresia: A Case Report

Choanal atresia is a rare congenital anomaly involving unilateral or bilateral posterior nasal choanal obstruction. Multiple associated anomalies have been described. We describe the case of a 1-month-old boy with bilateral choanal atresia, misdiagnosed after CT as a midline meningocele because the floor of the midline anterior cranial fossa was not ossified and secretion had accumulated in the obstructed posterior nasal choana.

Anterior Cruciate Ligament Tear: Comparison of MR Features between Complete and Partial Tear

PURPOSE: To determine the MRI features which distinguish complete and partial tear of the anterior cruciate ligament (ACL) and to thus improve MRI interpretation. MATERIALS AND METHODS: In 80 patients, we analyzed MR findings of direct and indirect signs of ACL tear (complete tear, 61 cases, partial tear, 19 cases) confirmed by arthroscopy or surgery, and compared the relative incidence of each sign in cases of complete and partial tear. RESULTS: Direct and indirect signs were found in 61 (100%) and 60 cases (98.4%), respectively, in complete tears, but in 16 (84.2%) and 15 cases (78.9%), respectively, in partial tears. Poor visualization, discontinuity and hyperintensity were seen in all complete tears but in only nine case (47.4%) of partial tear. A wavy or abnormal contour was seen in 53 cases (86.9%) of complete tear and 14 (73.7%) of partial tear. A wavy contour without other direct signs was seen in only five cases (26.3%) of partial tear. Three cases (15.8%) of partial tear showed normal MR finding. Indirect signs, i. e. abnormal ACL angle, abnormal ACL-Blumensaat line angle, abnormal posterior cruciate ligament (PCL) line, abnormal PCL angle, PCL buckling, anterior displacement of tibia, posterior displacement of lateral meniscus, bone bruise, Segond fracture, tear of collateral ligaments, PCL, and tear of meniscus were commoner in complete than in partial tears. Two cases of O'Donoghue's triad and two of popliteus injury were seen only in complete tears. CONCLUSION: Direct and indirect signs of ACL tear were more commonly noted in complete than in partial tears. The latter showed MR features varying from normal to almost complete tear. We suggest that a wavy contour other direct signs is indicative of a partial tear, and that O'Donoghue's triad and popliteus muscle injury are indirect signs of a complete tear.

Extrahepatic Biliary Obstruction: CT Patterns of Ductal Dilatation and Changes of Extrahepatic Ductal Wall

PURPOSE: To assess the efficacy of ancillary CT findings other than the obstructive lesion per se for the differential diagnosis of extrahepatic biliary obstruction. MATERIALS AND METHODS:CT findings of 49 patients with extrahepatic bile duct obstruction(22 benign and 27 malignant lesions) were assessed with emphasis on the patterns of ductal dilatation, contrast enhancement, and diffuse thickening of the extrahepatic ductal wall. Degree of central and peripheral intrahepratic ductal dilatation was graded by comparing with the adjacent portal radicles and hepatic parenchymal thickeness. RESULTS: Diffuse circumferential thickening and contrast enhancement of the extrahepatic ductal wall were more frequent in benign cases, but only thickening was statistically significant(p < 0.01). Peripheral intrahepatic ducts were more severely dilated by malignant causes(p < 0.01). With the same degrees of extrahepatic and central ductal dilatations, peripheral intrahepatic ducts were more severely dilated in malignant than in benign cases. CONCLUSION: These results may help to interpret the CT findings of extrahepatic biliary obstruction, particularly when the cause of biliary obstruction is uncertain.