A Case of Sclerosed Hemangioma Mimicking Intrahepatic Cholangiocarcinoma / 대한소화기학회지

Hemangioma is one of the most frequently encountered benign hepatic neoplasm which can develop secondary degeneration. Sclerosed hemangioma is a rare disease histologically characterized by large amount of collagen and elastic fibril between sclerosed small vessels. Its differential diagnosis is very difficult. It should be included in the differential diagnosis of other hepatic lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic hepatic tumor. A 77-year old male was admitted with upper abdominal discomfort. Abdominal ultrasonography revealed GB stone, dilated common bile duct with bile duct stone, and a 4.6 cm sized hyperechoic mass at segment 5 and 6 of the liver. Abdominal dynamic computed tomography demonstrated dilated intrahepatic bile ducts and a 5x5 cm sized mass which showed minimally delayed enhancement. Abdominal magnetic resonance imaging revealed the mass with low signal intensity in T1 weighted image, high signal intensity and focal low signal in T2 weighted image which showed minimal enhancement. We removed common bile duct stone with endoscopic retrograde cholangiopancreatography then decided to undergo right lower segmentectomy of liver due to possibility of cholangiocarcinoma. Histopathological examination of hepatic mass showed large amount of fibrous tissue with occasional residual vascular channels. We describe one case of sclerosed hemangioma mimicking cholangiocarcinoma.

Hepatic Metastasis of Thymoma: A Case Report

Thymoma is the most common neoplasm in the anterior mediastinum, and extrathoracic involvement is rare. Moreover, cystic liver metastasis is extremely rare; few cases have been reported in the literature to date. We report here on a case of cystic liver metastasis of thymoma treated with surgical resection, describing the ultrasonography, CT and MRI findings.

Intrahepatic Cholangiocarcinoma with Sarcomatous Change: Case Report

Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.

Hepatoblastoma in a Patient with Familial Adenomatous Polyposis: Case Report

Familial adenomatous polyposis and hepatoblastoma are rare conditions; the latter is closely related to the FAP gene. We describe the imaging findings of hepatoblastoma in a patient with polyposis coli.

Mycotic Aneurysm of Abdominal Aorta Causing the Right Renal Arterial Stenosis: Case Report

Mycotic aneurysm of the abdominal aorta is a rare disease. Despite intensive antibiotic therapy, rupture leads to a high mortality rate, so early diagnosis and treatment is very important. Rupture is the most common complication of abdominal aortic aneurysm, while renal artery stenosis is very rare. We report the radiologic findings of mycotic aneurysm of the suprarenal abdominal aorta leading to right renal artery stenosis induced by mass effect and renovascular hypertension.

CT and MR Findings of Langerhans Cell Histiocytois Involving the Spleen: A Case Report

Langerhans cell histiocytosis (LCH) is systemic disease resulting from the proliferation and dissemination of abnormal histiocytic cells of the Langerhans cell system. Common sites of involvement include the skin, bone, bone marrow, lung, lymph nodes and central nervous system, and the condition manifests in a variety of ways. We present the CT and MR findings of a case of LCH involving the spleen, an organ involved relatively rarely. Post-contrast CT revealed multiple hypodense nodules. T1-weighted MR images of the spleen depicted no definitive lesion, but T2-weighted images showed abnormal low signals scattered throughout this organ. In addition, post-contrast, fat-saturated T1-weighted MR images lesions showed multiple, low-signal-intensity lesions.

Diagnostic Value of Source images of 3D TOF MR Aniography in the Evaluation of the Hemifacial Spasm

PURPOSE: To evaluate the diagnostic value of source images of 3D TOF MR angiography in patients with hemifacial spasm. MATERIALS AND METHODS: Thirteen patients with surgically-confirmed hemifacial spasm and 30 who were not suffering from this condition were included in this study. T1 and T2-weighted images and 3D TOF MR angiography were performed. In 43 randomly-selected individuals, we retrospectively determined whether source images obtained during 3D TOF MR angiography could be used to evaluate symptoms. The results were correlated with surgical findings. RESULTS: Sensitivity was 92% and specificity was 86%. In all 13 patients with hemifacial spasm, neurovascular compression was detected during their operation. Offending vessels were the anterior inferior cerebellar artery (AICA) in four cases, the posterior inferior cerebellar artery (PICA) in seven, both the vertebral artery and PICA in one, and the vertebral vein, also in one. There were ten false-positive cases in the asymptomatic control group, nine of which showed neurovascular contact in the root entry zone of the facial nerve; one case showed indentation of the pons. CONCLUSION: Source images obtained during 3D TOF MR angiography are useful in the preoperative evaluation of hemifacial spasm.

APPLICATION OF SLIDING TRANSPOSITION FLAP ON LOWER LEG DEFECTS

No abstract available.

THE POSTOPERATIVE ANALYSIS OF CLOSED REDUCTED NASAL BONE FRACTURE

No abstract available.

Diagnostic Accurracy of MR Imaging and Pattern of Injury in the Posterior Cruciate Ligament injury

PURPOSE: To evaluate the diagnostic accuracy of MR imaging in posterior cruciate ligament(PCL) injuries, to describe the variety of these injuries and to assess the type and frequency of associated knee injuries. MATERIALS AND METHODS: We retrospetively analysed 75 cases with knee injuries. In all cases, the prescence of a PCL tear was determined by arthroscopy or surgery and the type of tear and patterns of associated knee injuries were described. RESULTS: Twenty-eight PCL tears were identified with arthroscopy or surgery. Figures for the sensitivity, specificity, and accuracy of MR diagnosis for the PCL injury were 86%, 94% and 91% respectively. Twenty-one cases(75%) had complete PCL tears and seven (25%) had partial tears. The commonest tear site was midsubstance(18 cases, 64.3%). Twenty-seven cases(96%) had associated knee injuries ; the remaining patient(4%) had isolated PCL injuries. There were 19 cases(68%) of ligamentous injuries, ten (36%) of meniscal tear, ten (36%)of bony injuries, and 20 (71%) of joint effusions. Of the ligamentous injuries, those involving the medialcollateral ligament were most often seen(10 cases, 36%). CONCLUSIONS: MR imaging is an accurate method for the detection and evaluation of PCL injury and associated knee abnormalities.

Diagnostic Accuracy of Low Tesla MR Imaging in the Internal Derangement of the Knee

PURPOSE: This study is for the evaluation of low tesla(0.064T) MR imaging diagnostic accuracy in the internal derangement of the knee. MATERIALS AND METHODS: We retrospectively analysed the MR images of 36 injured knees of 35 patients. The presence of tear was determined by arthroscopy or surgery in all cases. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of low tesla MRI for the diagnosis of anterior cruciate ligament injury were 83%, 88%, 86%, 77%, 91%, for the posterior cruciate ligament 75%, 95%, 86%, 92%, 83%, for the medial collateral ligament 83%, 96%, 92%, 91%, 92%, for the lateral collateral ligament 67%, 97%, 94%, 67%, 97%, for the menisci 75%, 93%, 89%, 75%, 93%. CONCLUSION: The low tesla MRI is an accurate method in detection and evaluation of the internal derangement of the knee.

Three Cases of Iridoeorneal Endothelial Syndrome

Iridocorneal endothelial syndrome is a disease characterized by corneal endothelial degeneration, corneal edema, peripheral anterior synechia, iris stromal change, and secondary glaucoma. This syndrome is considered to have three major variations: Chandler's syndrome, progressive (essential) iris atrophy, and Cogan-Reese syndrome. We experienced three cases of iridocorneal endothelial syndrome with transient intraocular pressure elevation.