We report a rare case of acquired multiple coronary-cameral fistulae. A 46-year-old man presented to the cardiology department clinic complaining of recently aggravated exertional chest pain. He had been treated 10 years ago for an acute ST segment elevation myocardial infarction (STEMI) with percutaneous coronary intervention (PCI). During revascularization, diffuse multiple fistulae from the left anterior descending (LAD) artery to the left ventricle (LV) had been observed. The current chest pain was evaluated by elective coronary angiography but no significant stenosis was observed. However, newly developed diffuse fistulae from the distal right coronary artery (RCA) to LV were found during angiography, as well as LAD-LV coronary fistulae. Multiple coronary-cameral fistulae were thought to be causing chest pain. A beta-blocker was prescribed and, after 3 months of follow-up, exertional chest pain had subsided without further complication.
Angiography ; Arteries ; Cardiology ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Fistula ; Follow-Up Studies ; Heart Ventricles ; Ischemia ; Myocardial Infarction ; Percutaneous Coronary Intervention

A 51-year-old male patient with chronic hepatitis B was referred to our hospital due to a 1-cm liver nodule on ultrasonography. Alpha-fetoprotein (AFP) was slightly elevated. The nodule showed prolonged enhancement on dynamic liver magnetic resonance imaging and appeared as a hyperintensity on both diffusion-weighted and T2-weighted imaging. The nodule was followed up because it was small and typical findings of hepatocellular carcinoma (HCC) were not observed in the dynamic imaging investigations. However, liver contrast-enhanced ultrasonography performed 1 month later showed enhancement during the arterial phase and definite washout during the delayed phase. Also, AFP had increased to over 200 ng/mL even though AST and ALT were decreased after administering an antiviral agent. He was presumptively diagnosed as HCC and underwent liver segmentectomy. Microscopy findings of the specimen indicated bile duct adenoma. After resection, the follow-up AFP had decreased to within the normal range. This patient represents a case of bile duct adenoma with AFP elevation mimicking HCC on contrast-enhanced ultrasonography.
Bile Duct Neoplasms/*complications/*diagnosis/pathology ; *Bile Ducts, Intrahepatic ; Hepatitis B, Chronic/*complications/*diagnosis/pathology ; Humans ; Liver/pathology/ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed ; alpha-Fetoproteins/*metabolism

BACKGROUND/AIMS: The aim of this study was to evaluate the relationship between controlled attenuation parameter (CAP) and hepatic steatosis, as assessed by ultrasound (US) in patients with alcoholic liver disease (ALD) or non-alcoholic fatty liver disease (NAFLD). METHODS: Patients with either ALD or NAFLD who were diagnosed with fatty liver with US and whose CAP scores were measured, were retrospectively enrolled in this study. The degree of hepatic steatosis assessed by US was categorized into mild (S1), moderate (S2), and severe (S3). RESULTS: A total of 186 patients were included: 106 with NAFLD and 80 with ALD. Regarding hepatic steatosis, the CAP score was significantly correlated with US (ρ=0.580, p<0.001), and there was no significant difference between the NAFLD and ALD groups (ρ=0.569, p<0.001; ρ=0.519, p<0.001; p=0.635). Using CAP, area under receiver operating characteristic curves for ≥S2 and ≥S3 steatosis were excellent (0.789 and 0.843, respectively). For sensitivity ≥90%, CAP cutoffs for the detection of ≥S2 and ≥S3 steastosis were separated with a gap of approximately 35 dB/m in all patients and in each of the NAFLD and ALD groups. CONCLUSIONS: The CAP score is well correlated with hepatic steatosis, as assessed by US, in both ALD and NAFLD.
Adult ; Aged ; Fatty Liver, Alcoholic/classification/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease/classification/*diagnostic imaging ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index ; Ultrasonography/methods/*statistics & numerical data

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P<0.001; S0/1 [15%], S2 [17%], S3 [26%], P=0.021). Multivariate analysis showed that the independent predictive risk factors for diabetes were hypertension (OR, 1.98; P=0.001), LSM F4 (OR, 1.86; P=0.010), male gender (OR, 1.60; P=0.027), and age>50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.
Causality ; Comorbidity ; Diabetes Complications/diagnosis/epidemiology/physiopathology ; Elastic Modulus ; Elasticity Imaging Techniques/methods/statistics & numerical data ; End Stage Liver Disease/*epidemiology/physiopathology/*ultrasonography ; Fatty Liver/*epidemiology/physiopathology/*ultrasonography ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Incidence ; Liver/physiopathology/ultrasonography ; Liver Cirrhosis/*epidemiology/physiopathology/*ultrasonography ; Male ; Middle Aged ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity

High prevalence of diabetes mellitus in patients with liver cirrhosis has been reported in many studies. The aim of our study was to evaluate the relationship of hepatic fibrosis and steatosis assessed by transient elastography with diabetes in patients with chronic liver disease. The study population consisted of 979 chronic liver disease patients. Liver fibrosis and steatosis were assessed by liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) on transient elastography. Diabetes was diagnosed in 165 (16.9%) of 979 patients. The prevalence of diabetes had significant difference among the etiologies of chronic liver disease. Higher degrees of liver fibrosis and steatosis, assessed by LSM and CAP score, showed higher prevalence of diabetes (F0/1 [14%], F2/3 [18%], F4 [31%], P<0.001; S0/1 [15%], S2 [17%], S3 [26%], P=0.021). Multivariate analysis showed that the independent predictive risk factors for diabetes were hypertension (OR, 1.98; P=0.001), LSM F4 (OR, 1.86; P=0.010), male gender (OR, 1.60; P=0.027), and age>50 yr (OR, 1.52; P=0.046). The degree of hepatic fibrosis but not steatosis assessed by transient elastography has significant relationship with the prevalence of diabetes in patients with chronic liver disease.
Causality ; Comorbidity ; Diabetes Complications/diagnosis/epidemiology/physiopathology ; Elastic Modulus ; Elasticity Imaging Techniques/methods/statistics & numerical data ; End Stage Liver Disease/*epidemiology/physiopathology/*ultrasonography ; Fatty Liver/*epidemiology/physiopathology/*ultrasonography ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Incidence ; Liver/physiopathology/ultrasonography ; Liver Cirrhosis/*epidemiology/physiopathology/*ultrasonography ; Male ; Middle Aged ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Factors ; Sensitivity and Specificity