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Cardiac tumors are rare diseases with various imaging findings. However, differentiating cardiac tumors based on imaging findings is challenging because of similarities in imaging features. We present two cases of cardiac tumors, including primary cardiac lymphoma and cardiac metastasis, in which the differential diagnosis was difficult.
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We report an ectopic mediastinal parathyroid adenoma in a patient with chronic kidney disease who presented with refractory hypercalcemia. Technetium-99m-sestamibi scintigraphy is a valuable imaging technique for the detection of an ectopic parathyroid adenoma in the mediastinum. The combination of intense contrast enhancement and the identification of a polar vessel on a computed tomography scan will ensure that a radiologist can differentiate a parathyroid adenoma from other pathologies in the mediastinum. By virtue of the advancement of imaging modalities, localization of an ectopic mediastinal parathyroid adenoma prior to surgery is possible and unnecessary neck exploration is avoidable.
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Pulmonary metastases present a wide spectrum of radiological findings, some of which have been known to be useful for analogizing the possible origin or site of primary tumors. In the present report, we describe a unique case of pulmonary metastasis manifesting on chest computed tomography as multiple nodules with tortuous, serpentine, aneurysmal, dilated, inner intratumoral vessels. The metastasis originated from uterine sarcoma.
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Phlegmonous esophagitis, a rare and life-threatening disorder, is characterized by bacterial infection of the submucosal and muscularis layers of the esophagus. Herein we report a case of acute phlegmonous esophagitis with mediastinitis complicated by an esophageal perforation in a patient with diabetes mellitus and alcoholic liver cirrhosis.
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OBJECTIVE: To assess clinical feasibility of low-attenuation cluster analysis in evaluation of chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Subjects were 199 current and former cigarette smokers that underwent CT for quantification of COPD and had physiological measurements. Quantitative CT (QCT) measurements included low-attenuation area percent (LAA%) (voxels ≤ −950 Hounsfield unit [HU]), and two-dimensional (2D) and three-dimensional D values of cluster analysis at three different thresholds of CT value (−856, −910, and −950 HU). Correlation coefficients between QCT measurements and physiological indices were calculated. Multivariable analyses for percentage of predicted forced expiratory volume at one second (%FEV1) was performed including sex, age, body mass index, LAA%, and D value had the highest correlation coefficient with %FEV1 as independent variables. These analyses were conducted in subjects including those with mild COPD (global initiative of chronic obstructive lung disease stage = 0–II). RESULTS: LAA% had a higher correlation coefficient (-0.549, p < 0.001) with %FEV1 than D values in subjects while 2D D−910HU (−0.350, p < 0.001) revealed slightly higher correlation coefficient than LAA% (−0.343, p < 0.001) in subjects with mild COPD. Multivariable analyses revealed that LAA% and 2D D value−910HU were significant independent predictors of %FEV1 in subjects and that only 2D D value−910HU revealed a marginal p value (0.05) among independent variables in subjects with mild COPD. CONCLUSION: Low-attenuation cluster analysis provides incremental information regarding physiologic severity of COPD, independent of LAA%, especially with mild COPD.
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Índice de Massa Corporal , Análise por Conglomerados , Volume Expiratório Forçado , Doença Pulmonar Obstrutiva Crônica , Produtos do TabacoRESUMO
OBJECTIVE: To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). MATERIALS AND METHODS: Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAA(I-950), LAA(E-856), CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLC(CT)), and functional residual capacity (FRC(CT)) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. RESULTS: The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLC(CT), FRC(CT), and age showed significant associations with lung attenuation (p < 0.05), and only TLC(CT) was significantly associated with inspiratory Pi10. CONCLUSION: In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.
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Feminino , Humanos , Masculino , Volume Expiratório Forçado , Capacidade Residual Funcional , Pulmão , Valores de Referência , Testes de Função Respiratória , Estudos Retrospectivos , Fumaça , Fumar , Espirometria , Tórax , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total , Capacidade VitalRESUMO
BACKGROUND AND OBJECTIVES: Carbon monoxide (CO) poisoning can cause tissue hypoxia and left ventricular systolic dysfunction (LVSD) requiring intensive medical management. Our objectives were to find incidence and clinical course of LVSD CO intoxicated patients and make a clinical scoring to predict LVSD. SUBJECTS AND METHODS: We included all consecutive patients with CO exposure in the emergency room. LVSD was defined by LVEF 100/min), pulmonary edema on chest X-ray, serum NT pro-BNP (>100 pg/mL), troponin-I (>0.1 ng/mL) and lactic acid (>4.0 mg/dL) after a univariate analysis. Combining these into a clinical score, according to their beta score after a multivariate analysis (rage=0-16), allowed prediction of LVSD with a sensitivity of 84% and specificity of 91% (reference ≥8, area under the curve=0.952, p<0.001) CONCLUSION: About 31% showed LVSD in patients with CO poisoning, and most of them (86%, 18 of 21 patients) recovered within 3 days. Patients with a higher clinical score (≥8) might have LVSD.
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Humanos , Masculino , Hipóxia , Intoxicação por Monóxido de Carbono , Monóxido de Carbono , Carbono , Estudos de Coortes , Estenose Coronária , Ecocardiografia , Eletrocardiografia , Serviço Hospitalar de Emergência , Seguimentos , Frequência Cardíaca , Incidência , Ácido Láctico , Análise Multivariada , Intoxicação , Edema Pulmonar , Sensibilidade e Especificidade , Tórax , Troponina I , Disfunção Ventricular EsquerdaRESUMO
Unicuspid aortic valve (UAV) is an extremely rare form of congenital aortic valvular abnormality. Although UAV shows similar clinical characteristics to bicuspid aortic valve, the clinical symptoms develop at earlier age and progress at a faster pace in UAV. In this report, we are presenting a 42-year-old male with severe aortic stenosis associated with unicommissural UAV. The patients underwent a successful Bentall operation.
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Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Aneurisma Aórtico , Estenose da Valva Aórtica , Valva Aórtica , Dente Pré-MolarRESUMO
OBJECTIVE: To evaluate the diagnostic performance of obliteration of normal heterogeneous enhancement of the spleen (ONHES) on arterial phase (AP) computed tomography (CT) images in diffuse infiltrative splenic lymphoma (DISL). MATERIALS AND METHODS: One hundred and thirty-six patients with lymphoma who had undergone two-phase (arterial and portal venous) abdominal CT were included in this study. We retrospectively evaluated the diagnostic performance of ONHES on AP CT in diagnosing DISL. Two observers evaluated ONHES on AP CT using the 5-point confidence level and assessed the presence or absence of subjective splenomegaly on axial CT images. Another two observers measured the splenic index as proposed by objective CT criteria. Statistical analysis included interobserver agreement and diagnostic performance of CT findings. RESULTS: Eleven of the 136 patients with lymphoma had DISL. The area under the receiver operating characteristic curve of ONHES (0.948 for observer 1 and 0.922 for observer 2) was superior to that of the splenic index (0.872 for observer 3 and 0.877 for observer 4), but the difference was not statistically significant (p > 0.05). The diagnostic performance of ONHES in conjunction with subjective splenomegaly showed higher diagnostic performance, as compared with subjective splenomegaly alone (accuracy: 100% and 85.3% for observer 1, 98.5% and 87.5% for observer 2; positive predictive value: 100% and 35.5% for observer 1, 90.9% and 39.3% for observer 2, respectively). CONCLUSION: Obliteration of normal heterogeneous enhancement of the spleen in conjunction with subjective splenomegaly can improve the diagnostic performance for DISL. Our results suggest that ONHES on AP CT images could be useful as an adjunctive diagnostic indicator of DISL in patients with lymphoma.
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Humanos , Linfoma , Estudos Retrospectivos , Curva ROC , Baço , Esplenomegalia , Tomografia Computadorizada por Raios XRESUMO
No abstract available.
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BACKGROUND: The efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy can be measured based on the rate of treatment response, based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria or progression-free survival (PFS). However, there are some patients harboring sensitive EGFR mutations who responded poorly to EGFR-TKI therapy. In addition, there is variability in the PFS after EGFR-TKI treatment. METHODS: We performed a retrospective analysis of the medical records of 85 patients with non-small cell lung cancer, who had achieved a stable disease or better response at the first evaluation of treatment response, after receiving a 2-month course of gefitinib. We calculated the tumor shrinkage rate (TSR) by measuring the longest and perpendicular diameter of the main mass on computed tomography before, and 2 months after, gefitinib therapy. RESULTS: There was a significant positive correlation between the TSR and PFS (R=0.373, p=0.010). In addition, a simple linear regression analysis showed that the TSR might be an indicator for the PFS (B+/-standard error, 244.54+/-66.79; p=0.001). On univariate analysis, the sex, histologic type, smoking history and the number of prior chemotherapy regimens, were significant prognostic factors. On multivariate regression analysis, both the TSR (beta=0.257, p=0.029) and adenocarcinoma (beta=0.323, p=0.005) were independent prognostic factors for PFS. CONCLUSION: Our results showed that the TSR might be an early prognostic indicator for PFS in patients receiving EGFR-TKI therapy.
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Humanos , Adenocarcinoma , Carcinoma Pulmonar de Células não Pequenas , Intervalo Livre de Doença , Tratamento Farmacológico , Modelos Lineares , Prontuários Médicos , Proteínas Tirosina Quinases , Receptores ErbB , Estudos Retrospectivos , Fumaça , FumarRESUMO
OBJECTIVE: To evaluate the impact of radiation dose and reconstruction algorithms on radiologists' preferences, and whether an iterative reconstruction in image space (IRIS) can be used for dose reduction in chest CT. MATERIALS AND METHODS: Standard dose chest CT (SDCT) in 50 patients and low dose chest CT (LDCT) in another 50 patients were performed, using a dual-source CT, with 120 kVp and same reference mAs (50 mAs for SDCT and 25 mAs for LDCT) employed to both tubes by modifying the dual-energy scan mode. Full-dose data were obtained by combining the data from both tubes and half-dose data were separated from one tube. These were reconstructed by using a filtered back projection (FBP) and IRIS: full-dose FBP (F-FBP); full-dose IRIS (F-IRIS); half-dose FBP (H-FBP) and half-dose IRIS (H-IRIS). Ten H-IRIS/F-IRIS, 10 H-FBP/H-IRIS, 40 F-FBP/F-IRIS and 40 F-FBP/H-IRIS pairs of each SDCT and LDCT were randomized. The preference for clinical usage was determined by two radiologists with a 5-point-scale system for the followings: noise, contrast, and sharpness of mediastinum and lung. RESULTS: Radiologists preferred IRIS over FBP images in the same radiation dose for the evaluation of the lungs in both SDCT (p = 0.035) and LDCT (p < 0.001). When comparing between H-IRIS and F-IRIS, decreased radiation resulted in decreased preference. Observers preferred H-IRIS over F-FBP for the lungs in both SDCT and LDCT, even with reduced radiation dose by half in IRIS image (p < 0.05). CONCLUSION: Radiologists' preference may be influenced by both radiation dose and reconstruction algorithm. According to our preliminary results, dose reduction at 50% with IRIS may be feasible for lung parenchymal evaluation.
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Atitude do Pessoal de Saúde , Meios de Contraste , Processamento de Imagem Assistida por Computador , Doses de Radiação , Intensificação de Imagem Radiográfica/métodos , Radiografia Torácica , Radiologia , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: To determine whether the image quality (IQ) is improved with iterative reconstruction in image space (IRIS), and whether IRIS can be used for radiation reduction in chest CT. MATERIALS AND METHODS: Standard dose chest CT (SDCT) in 50 patients and low dose chest CT (LDCT) in another 50 patients were performed, using a dual-source CT, with 120 kVp and same reference mAs (50 mAs for SDCT and 25 mAs for LDCT) employed to both tubes by modifying a dual-energy scan mode. Full-dose data were obtained by combining the data from both tubes and half-dose data were separated from a single tube. These were reconstructed by using a filtered back projection (FBP) and IRIS: full-dose FBP (F-FBP); full-dose IRIS (F-IRIS); half-dose FBP (H-FBP) and half-dose IRIS (H-IRIS). Objective noise was measured. The subjective IQ was evaluated by radiologists for the followings: noise, contrast and sharpness of mediastinum and lung. RESULTS: Objective noise was significantly lower in H-IRIS than in F-FBP (p < 0.01). In both SDCT and LDCT, the IQ scores were highest in F-IRIS, followed by F-FBP, H-IRIS and H-FBP, except those for sharpness of mediastinum, which tended to be higher in FBP. When comparing CT images between the same dose and different reconstruction (F-IRIS/F-FBP and H-IRIS/H-FBP) algorithms, scores tended to be higher in IRIS than in FBP, being more distinct in half-dose images. However, despite the use of IRIS, the scores were lower in H-IRIS than in F-FBP. CONCLUSION: IRIS generally helps improve the IQ, being more distinct at the reduced radiation. However, reduced radiation by half results in IQ decrease even when using IRIS in chest CT.
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Processamento de Imagem Assistida por Computador , Doses de Radiação , Intensificação de Imagem Radiográfica , Radiografia Torácica , Tomografia Computadorizada por Raios X/métodosRESUMO
The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.
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Adulto , Humanos , Masculino , Angioplastia , Aorta , Dor no Peito , Anomalias dos Vasos Coronários , Vasos Coronários , Morte Súbita , Comunicação Interventricular , Tomografia Computadorizada Multidetectores , Isquemia Miocárdica , Intervenção Coronária Percutânea , SíncopeRESUMO
Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.
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Humanos , Fístula Arteriovenosa , Ponte de Artéria Coronária , Embolização Terapêutica , Fístula , Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna , Transplantes , VeiasRESUMO
Inadvertent left internal mammary artery (LIMA)-great cardiac vein (GCV) anastomosis is a rare complication of coronary artery bypass graft surgery. Patients with iatrogenic aortocoronary fistula (ACF) were usually treated surgical repair, percutaneous embolic occlusion with coil or balloon. We report a case of iatrogenic LIMA to GCV anastomosis successfully treated with coil embolization and protected left main coronary intervention through the percutaneous transfemoral approach.
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Humanos , Fístula Arteriovenosa , Ponte de Artéria Coronária , Embolização Terapêutica , Fístula , Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna , Transplantes , VeiasRESUMO
We report here a case of streaky fat deposition in the middle layer of the left ventricular myocardium, without any underlying etiology, and this was seen on computed tomography coronary angiography. This report suggests that left ventricular middle layer fat deposition should be investigated in order to determine its etiology, the pathogenesis and the prognosis.
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Humanos , Masculino , Pessoa de Meia-Idade , Tecido Adiposo/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Ventrículos do Coração/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
The Cabrol procedure is one of several techniques used for re-implantation of a coronary artery. After replacement of the ascending aorta and aortic valve using a composite graft, second Dacron tube grafts are used for anastomosis between the ascending aortic graft and the coronary arteries. Ostial stenosis is one of the complications associated with the Cabrol operation. However, there have been no reported cases of acute thrombosis of a Cabrol graft. Here we report a case with acute ST elevation myocardial infarction due to thrombotic total occlusion of a right Cabrol graft-to-right coronary artery (RCA) twelve days after surgery in a patient with Marfan syndrome. He was successfully treated with primary percutaneous coronary intervention (PCI).
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Humanos , Aorta , Valva Aórtica , Constrição Patológica , Vasos Coronários , Oclusão de Enxerto Vascular , Síndrome de Marfan , Infarto do Miocárdio , Intervenção Coronária Percutânea , Polietilenotereftalatos , Trombose , TransplantesRESUMO
Hydrogel buckles, which are used in scleral buckling surgery for retinal detachment, have been associated with late complications after successful retinal reattachment surgery, including strabismus, extraocular motility restriction, extrusion through the eyelid or conjunctiva, intraocular erosion, and scleral erosion. Hydrogel buckles sometimes appear as well-marginated, circumferential, lobulating, contoured cystic masses mimicking orbital cysts on orbital CT or MRI. We report the radiologic findings in 5 patients whose hydrogel buckles needed to be differentiated from orbital cysts.
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Humanos , Túnica Conjuntiva , Pálpebras , Corpos Estranhos , Hidrogéis , Órbita , Descolamento Retiniano , Retinaldeído , Recurvamento da Esclera , Estrabismo , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: We wanted to evaluate the regional differences in such perfusion parameters as pulmonary blood flow (PBF), mean transit time (MTT) and pulmonary blood volume (PBV) in the entire lung of healthy volunteers with using three-dimensional, contrast-enhanced MR imaging (3D CEMRI). MATERIALS AND METHODS: Six healthy volunteers underwent dynamic 3D CEMRI (TR/TE 2.7/0.6 msec; flip angle 40degree; matrix 128x96; reconstructed matrix 256x192; rectangular field of view 450x315 mm; coronal 100-150mm-thickx10 slabs; temporal resolution 1.0 sec; 35 dynamic phases) For all subjects, 2 mL of Gd-DTPA mixed with 3 ml of physiologic saline was administered as a bolus at a rate of 5 mL/sec, and this was followed by 20 mL of physiologic saline flush. From the signal intensity-time curves, the PBF, MTT and PBV maps were generated using indicator dilution theories and the central volume principle on a pixel-by-pixel basis. A total of 54 round, 1-cm sized ROIs were placed in the lung in each subject (6 ROIs per slabx9 slices except for the most posterior slab). The regional differences of the measured parameters were statistically evaluated in the gravitational direction and in the upper-mid-lower direction by one-way ANOVA tests. RESULTS: The calculated PBF, MTT and PBV in the entire lung were 141.8+/-53.4 mL/100 mL/min (mean+/-SD), 5.35+/-1.38 sec, and 13.4+/-6.48 mL/100mL, respectively. In the gravitational direction, there was a significant increase in the PBF and PBV as it goes to the posterior direction (p < 0.05). No statistical difference was found in PBF or PBV between the upper, mid and lower lung zone areas. CONCLUSION: Regional difference in the various perfusion parameters of the lung in healthy volunteers can be quantitatively assessed with performing 3D CEMRI.