PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

No abstract available.
Heart Ventricles* ; Hemodynamics*

No abstract available.
Child* ; Esophageal and Gastric Varices* ; Humans ; Hypertension, Portal* ; Portal Vein*

PURPOSE: To describe CT findings and differential points of cystic thymic lesions. MATERIAL AND METHOD: We evaluated retrospectively total 19 masses with well marginated cystic lesions at thymic area on CT scans. They were 10 teratomas, 3 congenital thymic cysts, 2 multilocular thymic cysts(associated with thymoma and myasthenia gravis in each), 2 cysts Assciated with thymic Hodgkin's lymphomas an ectopic parathyroid cyst, and an infected thymic cyst. The radiological abnormalities evaluated were thickness of the wall, presence or abscene of septa, mural nodule, solid component, calcification and fat component. RESULTS: All three cases of congenital thymic cysts and an ectopic parathyroid cyst appeared as thin-walled unilocular cyst with homogeneous internal density and without identifiable solid component. In multilocular thymic cyst, there were thick wall and solid components(n=2), thick internal septa and calcifications(n=l). The cysts of teratomas manifested thick walls(n=9), internal septa(n=4), calcifications(n=6), fat components(n=4), and solid components(n=4). Cysts in Hodgkin's diseases appeared as multilocular or unilocular and had thick wall and septa without calcification. infected thymic cyst presented with multilocular cystic mass with identifiable wall and septa, calcification, and solid components. CONCLUSION: The thymic diseases with cystic lesion include teratomas, congenital thymic cysts, multilocular thymic cysts, parathyroid cyst, .and Hodgkin's disease. Congenital thymic cyst and ectopic parathyroid cyst are thin-walled unilocular cystic lesions. Cystic lesions associated with teratoma, Hodgkin's disease, and multilocular thymic cyst are thick-walled cystic lesions with or without solid component.
Hodgkin Disease ; Mediastinal Cyst ; Myasthenia Gravis ; Retrospective Studies ; Teratoma ; Thymoma ; Tomography, X-Ray Computed

A 21-year-old woman presented with productive cough and hemoptysis. Chest radiograph shows a large thin-walled cystic lesion with an air-fluid level in medial portion of the left lower lung zone and opacity in paravertebral area of the right lower lung zone. Chest CT scan shows a thin-walled cavitary lesion in the posterior basal segment of left lower lobe with an air-fluid level. Area of consolidation containing air-filled cysts was also observed in medial aspect of right lower lobe. Selective angiogram obtained from aberrant artery arising from descending abdominal aorta showed two main branches of the artery supplying bilateral pulmonary lesions.
Aorta, Abdominal ; Arteries ; Bronchopulmonary Sequestration* ; Cough ; Female ; Hemoptysis ; Humans ; Lung ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Young Adult

Unilateral absence of a pulmonary artery is an uncommon anomaly, which presents as an isolated lesion or in combination with other congenital heart disease such as TOF or PD^. We encountered three cases of isolated unilateral absence of a pulmonary artery;one was left pulmonary artery agenesis with right sided aortic arch and the others were right pulmonary artery agenesis with left sided aortic arch. Plain chest radiograph showed considerable loss of unilateal lung volume and lack of ipsilateral hilar shadow. Pulmonary angiogram which was done in two cases, revealed proximal interruption of a pulmonary artery. Chest CT was done in only one case, on which right pulmonary artery was absent and was replaced by adipose tissue. CT with its clean demonstration pulmonary artery without any evidence of aquired obstruction of a pulmonary artery by pulmonary embolism or tumor invasion, maybe a valuable method for evaluaton of the unilateral absence of a pulmonary artery.
Adipose Tissue ; Aorta, Thoracic ; Heart Defects, Congenital ; Lung ; Pulmonary Artery* ; Pulmonary Embolism ; Radiography, Thoracic ; Tomography, X-Ray Computed

PURPOSE: To determine the factors that are related to local recurrence after Radiofrequency thermal ablation (RFTA) of hepatic tumors. MATERIALS AND METHODS: We selected 30 patients with 51 hepatic nodules less than 5 cm in diameter (HCC, n=33; metastasis, n=18) who underwent RF thermal ablation between May 1999 and April 2000. Ablation was defined as 'complete'if immediately post-procedual CT showed that a nodule's margin was completely covered by ablation. Every three months, follow-up CT scans were examined for signs of local recurrence, and a nodule was assessed in terms of its size, the histologic diagnosis, adjacent vessels, perfect ablation (a safety margin of more than 5mm beyond the tumor margin), and whether hyperemia was observed after ablation. Finally, a group in which there was local recurrence (group A, n=15) and another showing no recurrence (group B, n=36) were compared. RESULTS: Mean nodule size in group A and group B was 3.26 and 2.24 cm, respectively. Local recurrence was noted in 7 of 33 HCC nodules (21.2%), and in 8 of 18 (44.4%) which were metastatic. There was recurrence in 9 of 31 nodules with adjacent vessels (29.0%), and in 6 of 20 (30%) without adjacent vessels. In two of 17 perfectly ablated nodules (11.8%) there was local recurrence, but this was observed in 13 of 34 imperfectly ablated nodules (38.2%). Finally, local recurrence was seen in 14 of 36 nodules showing hyperemia (38.9%) but in one of 15 (6.7%) without hyperemia. Using chi-square analysis, it was thus shown that with regard to local recurrence, tumor size, perfect ablation and peritumoral hyperemia were statistically significant factors (p<0.05). CONCLUSION: Local recurrence after RF thermal ablation of hepatic tumors clearly increases in nodules which are larger. The degree to which ablation is perfect, and the presence of peritumoral hyperemia, may be factors related to the local recurrence observed after RFTA.
Diagnosis ; Follow-Up Studies ; Humans ; Hyperemia ; Neoplasm Metastasis ; Recurrence* ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: This study was designed to compare analgesic efficacy and side effects of intrathecal morphine and fentanyl with epidural bupivacaine. METHODS: Twenty nine healthy women, ASA physical status 1 or 2 with an uncomplicated pregnancy and single fetus in vertex position were given lumbar epidural or combined spinal-epidural analgesia. In the epidural analgesia group (n = 18), 0.25% bupivacaine 8 - 10 ml and fentanyl 50 - 75ng was injected into the epidural space. In the CSE group (n = 11), analgesia performed dural puncture with a 27 gauge spinal needle and fentanyl 15ng and morphine 0.2 mg in 2 ml normal saline solution was injected. In both groups, whenever the patient requests further analgesia, we injected 0.125% bupivacaine 10 ml and fentanyl 50 - 75ng into the epidural space. RESULTS: There was no significant difference between the two groups in duration of analgesia, the second stage of labor and pushing. The CSE group offers rapid onset time. The total dose of bupivacaine and fentanyl administered during analgesia was significantly more in the epidural group than the CSE group. After intrathecal fentanyl 15ng and morphine 0.2 mg, the duration of analgesia was 162 +/- 122 min. After the first 0.25% bupivacaine 10 ml and fentanyl 50 - 75ng, it was 92.5 +/- 5 min in the epidural group and 190 +/- 101 min in the CSE group (P < 0.05). CONCLUSIONS: Compared with epidural analgesia, Intrathecal fentanyl 15ng and morphine 0.2 mg as part of CSE analgesia provide rapid onset time and prolonged analgesia, and a lower total dose of local anesthetics for labor and delivery. However women who received CSE analgesia were more likely to itch (64%) than solely epidural analgesia.
Analgesia* ; Analgesia, Epidural* ; Anesthetics, Local ; Bupivacaine ; Epidural Space ; Female ; Fentanyl ; Fetus ; Humans ; Morphine ; Needles ; Pregnancy ; Punctures ; Sodium Chloride

No abstract available.
Pulmonary Artery*