Both idiopathic pulmonary fibrosis (IPF) and pulmonary involvement of collagen vascular disease(CVD) are well known cause of diffuse interstitial lung disease which lead to fibrosis and honeycombing. We analyzed HRCT findings of 33 patients with IPF and 14 patients with CVD in terms of predominant pattern, site of involvement, mediastinal lymph node enlargement, pleural change and pulmonary volume loss. Criteria of mediastinal lymph node enlargement and pleural thickening were 15mm in long diameter and 3mm, respectively. Volume loss of the lung was measured by using hilar height ratio (apex to hilum/hilum to diaphragmatic dome). Mean age was 61 years for IPF and 46 years for CVD and male: female ratio was 27:6, 4:10, respectively. Predominant HRCT pattern was honeycombing for IPF (63%), and ground-glass opacity for CVD (66%) (p=0.001). Predominantly, subpleural involvement was seen in 90% for IPF and 74% for CVD. Mediastinal lymph node enlargement was seen in 47% of the patient with IPF and 14% with CVD (p=0.004). pleural thickening was seen in 97% of the patients with IPF and 42% with CVD (P=0.002), Pleural effusion was seen in 10% of the patients with IPF and 36% with CVD (P=0.009). Hilar height ratio of more than 1.5 was seen in 84% of the patients with IPF and 29% with CVD. In conclusion, our study shows that patients with IPF are prone to have more progressed stage of pulmonary fibrosis than the patients with CVD on HRCT.
Collagen* ; Female ; Fibrosis ; Humans ; Idiopathic Pulmonary Fibrosis* ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Male ; Pleural Effusion ; Pulmonary Fibrosis

PURPOSE: To evaluate characteristic MR findings of primary cardiac and pericardiac tumors. MATERIALS AND METHODS: There were myxomas (n=7), malignant lymphoma (n=l), lipoma (n=l), and pericardiac mesotheliomas (n=2). We analyzed location, size, shape, signal intensity, contrast enhancement, and associated findings of adjacent structures such as pericardiac and pleural effusion, and mediastinal lymph node enlargement. RESULTS: Locations of the myxomas were left atrium in four cases, left ventricle in one, right atrium in one, and right ventricle in one. Mean diameter was 3.5cm (range, 2-7cm). They were polypoid or Iobulated in shape, and attached to interatrial or interventricular septurn in all cases except in right atrial myxoma which was attached to lateral wall. Their peduncles were demonstrated in three left atrial myxomas. The signal intensities were iso or slightly high on T1-weighted images and high on T2-weighted images. Pleural and pericardial effusions were shown in the three cases. Malignant lymphoma was manifested as large mass in right ventricle infiltrating to right atrium, interventricular septum, right paratracheal and retrocardiac area. It had slightly high intensity in both T1- and T2-weighted images with a strong contrast enhancement and associated with both pericardiac and pleural effusion. Lipoma was polypoid in shape and attached to lateral wall of left ventricle with bright T1 and high T2 signal intensity. Pericardiac mesothelioma was manifested as a pericardiac and atrial mass with diffuse irregular uneven thickening of pericardium which had iso signal on T1- and high T2-weighted images with moderate contrast enhancement. Conculsion: MR imaging is a very useful method in demonstration of the location, extent, tissue characteristics of the mass, and relationship with its adjacent structu res in evaluation of cardiac and pericardiac tumors.
Heart Atria ; Heart Ventricles ; Lipoma ; Lymph Nodes ; Lymphoma ; Magnetic Resonance Imaging* ; Mesothelioma ; Myxoma ; Pericardial Effusion ; Pericardium ; Pleural Effusion

PURPOSE: To compare breath-hold gadolinium enhanced MR angiography(MRA) with digital subtraction angiography. MATERIALS AND METHODS: Ten patients underwent angiography and breath-hold gadolinium enhanced MRA;the latterperformed at 1.5T with 3D FSPGR after a bolus injection of gadopentetate dimeglumine(0.4mmol/kg) RESULTS: Sevenof ten pathologic conditions(70%) evaluated by both techniques had a similar appearance. The conditions examinedwere as follows : the artery feeding renal cell carcinoma(n=2): renal artery stenosis(n=2); pulmonaryAVM(n=2);abdominal aortic aneurysm(n=1); atheromatous plaque in the lower abdominal aorta(n=1);an enlargedbronchial artery(n=1); and an aberrant renal artery(n=1). For evaluating an anatomic relationship, a reconstructed3D image obtained by MRA is more advantageous. CONCLUSION: Breath hold contrast enhanced MRA is a potentiallyuseful noninvasive screening method for detecting vascular abnormality of the aorta and its branches.
Angiography ; Angiography, Digital Subtraction ; Aorta ; Arteries ; Gadolinium ; Humans ; Mass Screening ; Renal Artery

PURPOSE: Splenectomy, pancreas-preserving splenectomy, pancreato-splenectomy are common combined operations of a total gastrectomy for gastric cancer. We attempted to determine the efficacy of these procedures after comparing and analyzing the complication rate and the five-year survival rate from the gastric cancer patients. METHODS: 121 advanced gastric cancer patients, except T4 patients, underwent radical total gastrectomy accompanied with splenectomy. and analyzed the clinical findings eg. age, sex, location of tumor, histological differentiation, lymph node metastasis, number of dissected LN, complication and the 5-year survival rate. RESULTS: 44 out of 121 patients underwent a pancreato- splencetomy, 53 patients underwent a pancreas-preserving splenectomy, and 24 patients underwent a simple splenectomy. There were no statistical difference in the patient's age, sex, location of tumor, histological differentiation, lymph node metastasis, the number of dissected LN and the 5 year-survival rate in stage II, IV with each operation. However, a pancreas-preserving splenectomy showed a better 5-year survival rate (53.7%) than a simple splenectomy (25.0%) and pancreato-splenectomy (32.1%) in stage III. The complication rate was 25% in a simple splenectomy, 17% in a pancreas-preserving splenectomy, 30% in a pancreato- splenectomy. Diabetes mellitus occurred in 3 patients who underwent a pancreato-splenectomy, in 1 patient with an iatrogenic splenic vein excision during a pancreas-preserving splenectomy. CONCLUSION: A pancreas-preserving splenectomy is the best choice in stage IIIa total gastrectomy patients with the lowest complication rate.
Diabetes Mellitus ; Gastrectomy* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Splenectomy* ; Splenic Vein ; Stomach Neoplasms ; Survival Rate

OBJECTIVES: To evaluate characteristic computed tomography (CT) and magnetic resonance (MR) imaging findings of granulocytic sarcomas of the head and neck. METHODS: The CT (n=11) and MR (n=1) images obtained from 11 patients (7 males and 4 females; mean age, 23.5 yr; age range, 1 to 69 yr) with histologically-proven granulocytic sarcomas of the head and neck were retrospectively reviewed. Histological confirmation was done by bone marrow biopsy in 9 patients, and/or local biopsy in 4 patients. The imaging findings were analyzed with particular attention to location, size, shape, margin, bone destruction, internal architecture, pattern and degree of enhancement, and multiplicity of the lesions. RESULTS: The masses were most commonly located in the orbital cavity (n=8); other locations included lymph nodes (n=5) and palatine/pharyngeal/lingual tonsils (n=3). The mass sizes varied from a mean diameter of 1.3 to 5.8 cm (average, 2.6 cm). Multiple lesions were found in 6 patients. The shapes of the tumors were ovoid in 12 patients and irregular in 4 patients. Most lesions had poorly-defined margins (13/16) and invaded adjacent bony structures (5/16). On the pre-contrast CT images, the masses were iso- (5/8) or low-density (3/8) in comparison with muscle. The MRI, which was obtained in one patient in this study, showed that the mass was iso-signal intensity on T1-weighted images and iso-signal intensity on T2-weighted images compared to the gray matter of the brain. On the post-contrast CT images, there was homogenesous (n=12) or heterogeneous (n=4) enhancement, with mild (n=10), moderate (n=4), and marked (n=2) enhancement in the solid portions of the lesions. CONCLUSION: Although rare, granulocytic sarcomas arise in various locations in the head and neck area (most commonly in the orbit) in the form of well-demarcated, and mildly- and homogenously-enhancing masses with adjacent bony invasion.
Biopsy ; Bone Marrow ; Brain ; Head ; Humans ; Lymph Nodes ; Magnetic Resonance Spectroscopy ; Male ; Muscles ; Neck ; Orbit ; Palatine Tonsil ; Retrospective Studies ; Sarcoma, Myeloid

This essay illustrates the various CT findings of the hepatic venous invasion of the hepatocellular carcinoma with an anglographic correlation. The thrombosed hepatic vein is directly visualized as a dilated tubular structure or multiple nodules of the similar attenuation to that of the parenchymal tumor, connecting the parenchymal tumor and the inferior vena cava on contrast enhanced CT scans. Enhancement of the thrombosed vein on spiral CT scans obtained in early arterial phase can suggest thrombosis caused by tumor invasion rather than a simple thrombosis. When the thrombosed hepatic vein is not directly visualized and replaced by a large tumor, the tumor thrombi within the inferior vena cava or right atrium can suggest the presence of the hepatic venous invasion.
Carcinoma, Hepatocellular* ; Heart Atria ; Hepatic Veins* ; Thrombosis ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Veins ; Vena Cava, Inferior

PURPOSE: To determine the usefulness of CT for diagnosing metastases to primary and secondary echelon lymph nodes (LNs) and to investigate various CT findings of metastatic LNs in thyroid carcinomas. MATERIALS AND METHODS: We retrospectively reviewed the CT and histologic findings in 59 patients with thyroid carcinomas who had undergone thyroidectomy and neck dissection. Primary echelon LNs (Level VI) were removed by central neck dissection in all patients, and in 21, a total of 136 levels of secondary echelon LNs (Level II-V) were excised away by lateral neck dissection. CT criteria of metastatic LNs included large size, significant homogeneous enhancement, calcification, and cystic change. We evaluated the ability of CT to detect primary and secondary echelon LN metastasis and tried to determine which CT features were useful for the diagnosis of LN metastasis. RESULTS: Histologically, LN metastasis was found in 31 (53%) of 59 patients, including 30 with metastasis to primary echelon LNs. Of the 136 levels of secondary echelon LNs resected in 21 patients, 44 were found at histology to harbor metastatic foci. The sensitivities, specificities, positive and negative predictive values, and accuracies of CT in the diagnosis of metastasis to primary and secondary echelon LNs, respectively, were 27% and 93%, 100% and 93%, 100% and 87%, 57% and 97%, and 63% and 93%. While all secondary echelon LNs with at least one of the following CT criteria-large size (n=19), cystic or necrotic change (n=14), or calcifications (n=8)-were histologically proven to be metastatic, six (24%) of 25 such LNs with a sole sign of significant enhancement at CT were found to be due to reactive lymphadenopathy. CONCLUSION: Although CT was unable to detect metastasis to primary echelon LNs, it was useful in the detection of secondary echelon LN involvement. Large size, cystic change, and calcification are considered highly reliable signs of metastatic LNs.
Diagnosis* ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Neck Dissection ; Neoplasm Metastasis* ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

PURPOSE: Development of renal scarring is associated with delayed diagnosis and treatment of urinary tract infection(UTI). This study was performed to clarify how soon treatment should be started to inhibit renal scarring after onset of UTI and the factors associated with renal scarring in children with a first episode of febrile UTI. METHODS: We retrospectively reviewed 163 patients with a first episode of febrile UTI under the age of 2 years from April 2000 to April 2004. All patients had a DMSA renal scan and voiding cystourethrogram done in the diagnostic period, 6 months after which a follow-up renal scan was done. After patients were divided into 2 groups according to the duration of fever prior to start of treatment, the duration of fever after start of treatment, and total duration of fever, initial and follow-up DMSA scan findings were analyzed among the different groups. We compared the factors associated with renal scars between the groups with and without renal scars. RESULTS: The initial DMSA renal scan identified abnormal finding in 23% of the patients who were treated < or =24 hr from the onset of disease and in 43% of those with fever more than 24 hr. Renal scars developed in 33% of patients who were treated < or =24 hr and 38% of those with fever >24 hr prior to treatment. Renal scars developed in 34% of patients with remission of fever < or =48 hr after treatment and in 50% of those with fever >48 hr after treatment. The risk for renal scars was significantly higher in children who had total duration of fever >72 hr(67%) than in those with shorter duration(19%). In children with renal scars, VUR was most highly associated with an increased risk of renal scar formation. CONCLUSION: Although children with a first episode of febrile UTI are treated within 24hr after onset of the fever, renal damage cannot be prevented completely and it is mainly associated with VUR.
Child* ; Cicatrix* ; Delayed Diagnosis ; Fever ; Follow-Up Studies ; Humans ; Retrospective Studies ; Succimer ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Omental pregnancy is an extremely rare form of abdominal pregnancy that may cause life threatening massive hemorrhage in case of rupture. It may occur by primary implantation of the fertilized ovum in the omentum. The diagnosis is very difficult, but prompt surgical intervention is required when it is suspected, because perinatal mortality and maternal mortality in abdominal pregnancy were 85~95% and 0.5~6%. We experienced a case of omental pregnancy in the first times and reported it with brief review of literature.
Diagnosis ; Female ; Hemorrhage ; Maternal Mortality ; Omentum ; Perinatal Mortality ; Pregnancy* ; Pregnancy, Abdominal ; Rupture ; Zygote