PURPOSE: To prove whether the arterioportal shunt, especially transvasal shunt is one of the cause of the hypovascular hepatocellular carcinoma. MATERIALS AND METHODS: We evaluated the early phase images of table incremental dynamic CT and hepatic angiography in 20 cases of hepatoceltular carcinomas with transvasal arterioportal shunt. RESULTS: In hepatic arteriography, 18 cases were hypovascular and the remained 2 cases showed hypervascular tumor staining than surrounding normal hepatic parenchyme. In the early phase dynamic CT, 18 cases were hypodense(including 4 cases of focal hyperdensity in hypodense background), one was isodense and remaining one was hyperdense. CONCLUSION: Arterioportal shunt, especially transvasal shunt may make originally hypervasular hepato-cellular carcinoma to hypovascular lesion in the early phase dynamic CT or hepatic arteriography. In attempt to differentiate hepatic masses by tumor vascularity in recently widely used table incremental dynamic CT, the vascular patterns of the mass should be considered by close evaluation of vascular pattern of the liver, such as morphology of perfusion abnormality and arterioportal shunt, etc.
Angiography ; Carcinoma, Hepatocellular* ; Liver ; Perfusion

Patients with thalamic lesions can experience ataxia on the contralesional side. We report here a 24 year old female patient who presented with a left thalamic tumor and experienced bilateral ataxia of the upper and lower extremities after a left thalamic resection. Her right-sided ataxia was more severe than that of the left side. The bilateral ataxia was likely to be from cerebellar ataxia. The right-sided ataxia may have been caused by injury of the dentatorubrothalamic tract originating from the dentate nucleus of the right cerebellum and terminating in the contralateral ventrolateral nucleus of the left thalamus. We believe that the left sided ataxia in this patient was due to an uncrossed dentatorubrothalamic tract, which control the movement of the ipsilateral side of the human body.
Ataxia

Focal nodular hyperplasia is a benign hepatic tumor mainly composed of nodules of hepatocytes and Kupffer cells separated by fibrous septa. In general, it is difficult to differentiate focal nodular hyperplasia and hepatocellular carcinoma on ultrasonography, conventional CT(computerized tomography), and angiography. But IV bolus CT is of particular value in the diagnosis of focal nodular hyperplasia because it can divide enhanced CT into early and late phase and can characterize tumor vascularity and analyze any intratumoral elements. In our case, it was seen as a hypoechoic mass lesion on ultrasonograpl'hy and hyperdense mass lesion on early-phase IV bolus CF and isodense mass, lesion on late-phase IV bolus CT. On angiography, hypertrophy of the feeding artery and tumor staining were well visualized. The patient underwent operation and the mass was pathologically confirmed to a focal nodular hyperplasia. We report the first case of focal nodular hyperplasia on IV bolus CT in Korea.
Angiography ; Arteries ; Carcinoma, Hepatocellular ; Diagnosis ; Focal Nodular Hyperplasia ; Hepatocytes ; Humans ; Hypertrophy ; Korea ; Kupffer Cells ; Liver* ; Ultrasonography

We performed IV bolus CT scan in 40 patients with final diagnosis of various hepatic masses in order to evaluate hemodynamic changes and differentiating characters of the lesions. Preenhanced, early and late phase post enhanced, and delayed CT scans were obtained with rapid IV bolus injection of contrast materials and table sliding method for pertinent scans. In hepatomas, early enhanced CT scan directly showed hypervascular change and active viable portion of the mass and late phase CT scan showed capsular enhancement. In addition, extracapsular invasion and post-embolization recurrence were more easily visualized. In hemangiomas, early and late enhancing types could be categorized according to the time of maximal enhancement. In metastatic liver malignancies and cholangiocarcinomas, specific findings were seen in early phase and delayed CT scans and not in conventional CT scan. In conclusion, IV bolus CT scan is a very useful CT method in demonstrating the characteristic hemodynamic patterns and in differential diagnosis of the hepatic masses.
Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Contrast Media ; Diagnosis ; Diagnosis, Differential ; Hemangioma ; Hemodynamics ; Humans ; Liver ; Methods ; Recurrence ; Tomography, X-Ray Computed*

A case of foregut cyst communicated with esophagus and lined by bronchial mucosa is reviewed and its embryologic base of maldevelopment it discussed. It is not always easy to distinguish between digestive and respiratory cyst in mediastinum. There is whole range of intermediate between a cyst with ciliated and one with squamous or columnar mucosa. Origin of this dysembryoplasia is difficult to determine when on consider that the esophagus is covered with ciliated epithelium until the eleventh week of fetal life and that ciliated growth are found on its wall until the sixth month of the fetal life. And we concluded, general agreement is that cysts which have gastric epithelium in whole or in part, represent a distinct type and should be classified as (gastro) enteric cyst, mediastinal cyst containing cartilage were considered definitely as respiratory (bronchial or bronchogenic) cyst.
Cartilage ; Epithelium ; Esophagus* ; Mediastinal Cyst ; Mediastinum ; Mucous Membrane*

Generalized pustular psoriasis is a severe form of paoriasis and is frequently associated with arthritis and nail deformity. We present a case of generalized pustular psoriasis in a 40 year-old man, with nail change, arthritis of both knee and ankle joints, spondylitis, and glomerulonephritis. We found a positive results of HLA A-9, B-27 in this patient. Skin lesions, arthralgia and hematuria improved marked1y by plasmapheresis and application of topical corticostertoid.
Adult ; Ankle Joint ; Arthralgia ; Arthritis* ; Congenital Abnormalities ; Glomerulonephritis* ; Hematuria ; Humans ; Knee ; Plasmapheresis ; Psoriasis* ; Skin ; Spondylitis*

Desmoid tumor is a type of fibromatosis usually arise in deep musculo-aponeurotic structures, primarily of the trunk and extremities. It is characterized by proliferation of fibroblastic tissue and does not metastasize but may be locally aggressive. Eventhough the surgical margin reveals clean, recurrence often occurs. To analyze the extent of the tumor and homodynamic characteristics exactly, we performed IV bolus CT. Desmoid tumors show peripheral rim enhancement on early phase scan and more strong, central enhancement on late phase IV bolus CT, which reflects abundant fibroblastic components of the tumor. We report two cases of pathologically confirmed desmoid tumor performed IV bolus CT.
Abdominal Wall ; Extremities ; Fibroblasts ; Fibroma ; Fibromatosis, Aggressive* ; Recurrence

Authors compared early phase scan of the IV bolus CT (two phase incremental bolus dynamic CT) with late enhanecd scan similar to the conventional contrast enhanced CT for evaluation of the advantages of the IV bolus CT with two viewpoints of the pancreatic or peripancreatic mass and peripancreatic lymphadenopathy in 68 patients-28 cases of the pancreatic cancer, 6 cases of the pancreatitis and 34 cases of the pancreatic or peripancreatic metastasis. On the diagnosis of the pancreatic or peripancreatic mass, IV bolus CT could show the lesion(s) more easily in 41% (Grade II; 13/31) and much more easily in 34% (Grade III; 10/31) when compared with conventional contrast CT scan. The diagnosis of the peripancreatic lymph node involvement was also easy in 51%(Grade II; 20/39) and much easier in 37% (Grade III; 14/39). We thought that these differences were originated from the increase of the contrast between the lesion and normal portion because the early enhanced scans reflected the active blood flow change more exactly. Therefore IV bolus CT had advantages in comparison with the conventional drip infusion contrast CT in the diagnosis of the presence and pathologic extension of the pancreatic and peripancreatic lesion.
Diagnosis ; Infusions, Intravenous ; Lymph Nodes ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreatitis ; Tomography, X-Ray Computed

Authors compared early phase scan of the IV bolus CT (two phase incremental bolus dynamic CT) with late enhanecd scan similar to the conventional contrast enhanced CT for evaluation of the advantages of the IV bolus CT with two viewpoints of the pancreatic or peripancreatic mass and peripancreatic lymphadenopathy in 68 patients-28 cases of the pancreatic cancer, 6 cases of the pancreatitis and 34 cases of the pancreatic or peripancreatic metastasis. On the diagnosis of the pancreatic or peripancreatic mass, IV bolus CT could show the lesion(s) more easily in 41% (Grade II; 13/31) and much more easily in 34% (Grade III; 10/31) when compared with conventional contrast CT scan. The diagnosis of the peripancreatic lymph node involvement was also easy in 51%(Grade II; 20/39) and much easier in 37% (Grade III; 14/39). We thought that these differences were originated from the increase of the contrast between the lesion and normal portion because the early enhanced scans reflected the active blood flow change more exactly. Therefore IV bolus CT had advantages in comparison with the conventional drip infusion contrast CT in the diagnosis of the presence and pathologic extension of the pancreatic and peripancreatic lesion.
Diagnosis ; Infusions, Intravenous ; Lymph Nodes ; Lymphatic Diseases ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pancreatitis ; Tomography, X-Ray Computed

Carcinoma of the breast can produce cutaneous metastases which sbow highly diversified clinical pictures. The cutaneous metastases produce four definite clinical types: inflammatory carcinoma, telangiectatic carcinoma, nodular carcinoma, and carcinoma, en cuirasse. We present a case of 78-year-old nulliparous woman who had several painful dark purplish colored zosteriform papulovesicular eruptions, suggestive of herpes zoster, on the right breast, right axilla, scapular area, and upper arm for three month. Two month later, well dermacated linearly arranged erysipeloid eruptions appeared around the previous skin lesions and the right chest wall. Histopathological findings showed metastatic ductal carcinoma with massive vascular permeation but the primary focus was undetermined.
Female ; Humans ; Neoplasm Metastasis