Lipiodol-induced pneumonitis following transarterial chemoembolization for ruptured hepatocellular carcinoma / 영남의대학술지

Transarterial chemoembolization (TACE) is a widely accepted nonsurgical modality used for the treatment of multinodular hepatocellular carcinoma (HCC). The careful selection of the candidate is important due to the risk of developing various side effects. Fever, nausea, abdominal pain, and liver enzyme elevation are commonly known side effects of TACE. Hepatic failure, ischemic cholecystitis, and cerebral embolism are also reported, although their incidence might be low. Pulmonary complication after TACE is rare, and the reported cases of lipiodol pneumonitis are even rarer. A 53-year-old man was treated with TACE for ruptured HCC associated with hepatitis B virus infection. On day 19 after the procedure, the patient complained of dyspnea and dry cough. Chest computed tomography showed diffuse ground glass opacities in the wholelung fields, suggesting lipiodol-induced pneumonitis. After 2 weeks of conservative management, the clinical symptoms and radiologic abnormalities improved. Reported herein is the aforementioned case of lipiodol-induced pnemonitis after TACE, with literature review.

Cardiac Tamponade Complicated by Acupuncture: Hemopericardium due to Shredded Coronary Artery Injury

We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest, we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.

One Case of Video-Assisted Thoracoscopic Removal of Acupuncture Needle in Lung Parenchyma / 결핵및호흡기질환

We report the case of a 32-year-old woman presenting with intermittent chest pain resulted from a migratory acupuncture needle. The patient received acupuncture treatment approximately 3 years prior to this presentation, for the treatment of chronic left shoulder and lumbar pain after delivery. Chest radiography revealed a retained needle in the lingular segmental area. Video-assisted thoracoscopy was then used to remove the migratory acupuncture needle attached between the lingular segmental lobe and the pericardial fat. The patient recovered without complications and was discharged home.

A Case of Tumoral Calcinosis in a Hemodialysis Patient with Secondary Hyperparathyroidism / 대한신장학회지

Tumoral calcinosis is a periarticular calcific lesion and rare complication in patients with maintenance hemodialysis. The pathogenesis of tumoral calcinosis is poorly understood but may be due to elevated serum phosphorus, a high calcium phosphorus (Ca x P) product or secondary hyperparathyroidism in hemodialysis patients. A 30-year-old man presented with pain and palpable mass of left shoulder. He had been on maintenance hemodialysis with high flux dialyzer for 10 years. Laboratory finding showed hyperphosphatemia and elevated intact PTH concentration. A shoulder X-ray and CT scan demonstrated a massive calcification. Following partial resection, pain was relieved. Here we report a case of tumoral calcinosis of shoulder in a hemodialysis patient with untreated hyperphosphatemia and secondary hyperparathyroidism.

Use of Epinephrine Infusion During CT Hepatic Arteriography (Pharmaco-CTHA):Clinical Application in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the usefulness of epinephrine infusion (Pharmaco-CTHA) prior to liver to liver spiral CT during hepatic arteriography in patients with hepatocellular carcinoma. MATERIALS AND METHODS: Twenty-two patients in whom hepatocellular carcinoma had been diagnosed underwent three types of liver spiral CT during hepatic arteriography. In the first method, spiral CT scanning was started 5 seconds after injecting 8cc of contrast media at a rate of 0.3cc/sec. In the second, 10 microgram of epinephrine was slowly injected for 1 minute via the catheter and subsequent spiral CT scanning began 11 seconds after injecting 8cc of contrast media at a rate of 0.3cc/sec. In the third method, spiral CT scanning was started 5 seconds after injecting 25cc of contrast media at a rate of 1cc/sec. The following were evaluated and compared with the results of follow-up lipiodol CT: 1) the incidence of false positive lesions; 2) the incidence of false negative lesions; 3) portal enhancement; and 4) lesion conspicuity. RESULTS: Follow-up lipiodol CT of 22 patients showed 16 masses. In 12 patients there was no lipiodol uptake, and in five, four and one patient(s), uptake occurred once, twice, and three times, respectively. With method 1there were nine false-positive lesions, with method 2 there were 13, and with method 3, there were 49. The use of method 2(Pharmaco-CTNA) led to less false-positives than did method 3 (conventional CTHA)(p=0.000). Method 1 showed the lowest false positive rate (nine lesions), but its false-negative rate was two and four times higher than with method 2 (four lesions) and with method 3 (two lesions), respectively. Portal enhancement was observed four times using method 3 and once with method 1, but was absent with method 2. As regards the conspicuity of 16 masses, "good" and "excellent" lesions were seen four times with method 1(25%), ten times with method 2 (62.5%) and thirteen times with method 3 (81.3%). CONCLUSION: The infusion of epinephrine (Pharmaco-CTHA) prior to spiral CT during hepatic arteriography has the advantage of reducing the amount of contrast media required as well as the number of cases which are false positive and show no portal enhancement.

A case of parsely dependent sxercise-induced anaphylaxsis / 천식및알레르기

Exercise-induced anaphylaxis can be associated with ingestion of a specific food. We experienced a case of exercise-induced anaphylaxis followed by ingestion of parsely. A 22- year old female patient was presented with angioedema of the face and chest tightness induced by running after ingestion of parsley within 15 minutes. She had suffered from allergic rhinitis. She had positive reactions to mugwort pollen and parsely extract on skin prick test in a dose dependent manner. Although the oral provocation test with parsely could not induce bronchoconstriction, we could diagnosed as parsely dependent exercise induced anaphylaxis based upon skin prick test and history.

Diagnostic Value of Immediate CT after Chemoembolization in Patients with Hepatocellular Carcinoma: Comparison with 2-3 Week Delayed CT

PURPOSE: Lipiodol CT is a important modality for the diagnosis of hepatocellular carcinoma and compared is usually performed at 2-3 week after Lipiodol injection. Therefore, we assessed and the diagnostic value and merits of immediate CT after chemoembolization from there of 2-3 week delayed Lipiodol CT. MATERIALS AND METHODS: Thirty three cases of chemoembolization which were performed both immediate CT after chemoembolization and 2-3 week delayed Lipiodol CT were reviewed retrospectively. They were divided into four grades according to pattern of lipiodol uptake by three radiologists. The diagnostic value of immediate Lipiiodol CT was compared to delayed Lipiodol CT. RESULTS: Grade 0 was two cases(3.0%) and Grade 1 was seven cases(21.2%). In the cases of Grade 2(23/33, 69.7%) tumor uptake could be dishng wished from parenchymal uptake of Lipiodol by its density and pattern. Tumor uptake showed dense and homogeneous pattern, but parenchymal uptake revealed less dense and hepatoram-like wedge shaped pattern. Lipiodol uptake of tumor in Grade 3(1/24, 3.0%) was equal to that in delayed Lipiodrl CT. Grade 3 and 2(72.7%) of the immediate Lipiodol CT were not inferior to delayed Lipiodol CT in its diagnostic value. CONCLUSION: The immediate Lipiodol CT could make rapid establishment of treatment plan and are expected to be more convenient than delayed CT for the patients.

Radiologic Intervention of Esophagobronchial Fistula in Adults: Effeativeness of Oirect Fistula Occlusion and Pre-surgical Wire Insertion

PURPOSE: To assess the role and efficacy of radiologic intervention in the adult patients with esophagobronchial fistula. MATERIALS AND METHODS: Radiologic intervertion was performed in 4 patients with esophagobronchial fistula. We tried direct occlusion of fistula tract by glue(histoacylate 0.4cc + lipiodol 0.3cc) and coil in 2 patients and performed presurgical wire insertion by using 8F curved catheter via esophageal opening of fistula tract. The latter procedure was carled out to detect the fistula tract easily at operation. RESULTS: Direct occlusions of fistula tract by glue and coil were performed only to fail in 2 patients. Pre-surgical wire incertion by using 8F curred catheter under guidance of fluroscopy in 3 patients were helpful in detecting fistula tract at operation. CONCLUSION: Direct occlusion of the fistulous tract in esophagobronchial fistulas was ineffective. However, presur- gical wire insertion by using cured catheter under fluroscopy guidance is helpful to detect the fistula tract easily at operation.