Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.
Child, Preschool ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal/*diagnosis/pathology/ultrasonography ; Renal Veins/pathology/*radiography ; Thrombosis/pathology/radiography ; *Tomography, X-Ray Computed ; Vena Cava, Inferior/pathology/*radiography

Budd-Chiari syndrome (BCS) is a disorder caused by occlusion of the hepatic vein or inferior vena cava. The clinical presentation include abdominal pain, hepatomegaly, ascites, leg edema, collateral venous dilatation of the body trunk, and portal hypertension. In addition, BCS can cause hepatocellular carcinoma (HCC) in some patients, although its pathogenesis is not yet completely understood. The average reported time lag from diagnosis of BCS to full-blown HCC ranges from several years to several decades. Hepatic carcinogenesis in patients with BCS perhaps reflects a prolonged and persistent liver injury in that it occurs in the primary inferior vena cava obstruction rather than the primary hepatic vein thrombosis. Among patients with BCS, membranous obstruction of the vena cava (MOVC) usually presents an insidious and chronic illness, whereas primary hepatic vein thrombosis presents an acute or subacute illness. We experienced a case of a patient with BCS, which progressed rapidly that HCC developed only nine months after the diagnosis of BCS. The factors causing this rapid progression are still unclear and remain to be investigated.
Adult ; Carcinoma, Hepatocellular/*etiology/pathology/radiography ; Disease Progression ; Fatal Outcome ; Female ; Hepatic Vein Thrombosis/*complications/pathology/radiography ; Human ; Liver/*pathology/radiography ; Liver Neoplasms/*etiology/pathology/radiography ; Tomography, X-Ray Computed

We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.
*Autopsy ; Coronary Occlusion/*diagnosis/etiology/radiography ; Coronary Vessels/pathology/radiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction/etiology/pathology ; Myocardium ; Thrombosis/complications/*diagnosis ; Tomography, X-Ray Computed

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
Carcinoma, Renal Cell/pathology ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/diagnosis/*pathology ; Lymph Node Excision/methods ; Male ; Middle Aged ; Nephrectomy/methods ; Renal Veins/*radiography ; Thrombectomy/methods ; Thrombosis/*radiography ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*radiography

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
Carcinoma, Renal Cell/pathology ; Diagnosis, Differential ; Humans ; Kidney Neoplasms/diagnosis/*pathology ; Lymph Node Excision/methods ; Male ; Middle Aged ; Nephrectomy/methods ; Renal Veins/*radiography ; Thrombectomy/methods ; Thrombosis/*radiography ; Tomography, X-Ray Computed ; Vena Cava, Inferior/*radiography

No abstract available.
Aged ; Constriction, Pathologic ; Diagnosis, Differential ; Female ; Humans ; Jejunum/pathology ; Mesenteric Artery, Superior/*pathology/radiography/surgery ; Stents ; Superior Mesenteric Artery Syndrome/diagnosis/radiography ; Thrombosis/radiography/surgery ; Tomography, X-Ray Computed

Although recently, there have been introduced many new diagnostic tools such as renal scanning and renogram, intravenous urogram remains to be one of the most useful method of urological diagnosis. Therefore it seems warranted to review 363 cases of intravenous urograms performed in the department of urology, St. Mary's hospital, Catholic Medical College during the period of January, 1962 to June, 1964. Among others, especial attention was paid to 60 cases of nonvisualizing kidneys. Of 60 nonvisualizing kidneys, renal tuberculosis occupied 27 cases(45%); ureteral and renal stones 13(21.6%); hydronephrosis 9(15%) (metastatic carcinoma 6(10%)and surgical manipulation 3(5%); Wilms' tumor 5 (8.3%) chronic atrophic pyelonephritis 3(5%) ; One case each of renal cell carcinoma, cystic kidney and thrombosis of the renal artery. Inasmuch as the present study revealed renal tuberculosis to be the most common cause of nonvisualizing kidneys, it is felt that one should always consider the possibility of tuberculosis in the diagnosis of nonvisualizing kidneys in Korea. This fact should be stressed because nontuberculous pathology such as chronic pyelonephritis has been implicated to be the most frequent cause of nonvisualizing kidneys by American authors.
Carcinoma, Renal Cell ; Diagnosis ; Hydronephrosis ; Kidney Diseases, Cystic ; Kidney* ; Korea ; Pathology ; Pyelonephritis ; Radiography* ; Renal Artery ; Thrombosis ; Tuberculosis ; Tuberculosis, Renal ; Ureter ; Urology ; Wilms Tumor

PURPOSE: To evaluate the low attenuation of mosaic pattern in pulmonary embolism, as observed on HRCT, and to correlate the findings with the pathologic features of resected lung. MATERIALS AND METHODS: Using permanent embolic materials, pulmonary embolism was induced in eight Yorkshire pigs. Pre-and post-embolic pulmonary angiography was performed and after 6 weeks, the incidence and pattern of parenchymal change in low attenuation (mosaic pattern), as seen on HRCT, was evaluated. The animals were then sacrified and contact radiography of the lung was performed. Thirty-eight segments of pathology were taken from the area in which the presence of embolism had been suggested. Pathologic and HRCT findings were then correlated. RESULTS: On HRCT, low attenuation was seen in 23 of 36 segments (64%) and showed variable patterns : crescent peripheral hyperlucency (61%, n=14), heterogeneous mottled hyperlucency (17%, n=4), lobular hyperlucency (13%, n=3), and homogeneous segmental hyperlucency (9%, n=2). Parenchymal low attenuation was seen on HRCT in 10 of 11 segments (91%) in which large segmental arterial occlusion occurred, and in 3 of 16 segments (19%) in which there was small segmental arterial occlusion. Abnormal pathologic findings were pulmonary congestion, dilatation of pulmonary arteries, interlobular septal thickening, and thrombus formation. Among the 38 pathologic segmental specimens, 29 were from the area in which HRCT findings were positive, and in which pulmonary embolism subsequently occurred. In only four of nine segments (44%) in the area in which HRCT fingings were negative was pulmonary embolism subsequently. CONCLUSION: HRCT findings of pulmonary embolism at six weeks after embolization showed variable patterns of low attenuation, diminished diameter of pulmonary arteries, and normal diameter of bronchi. In cases with large segmental arterial occlusion, the finding of low attenuation was more common ; this may be due to reduced blood flow to the embolic area, in combination with bronchiolar spasm. For the early diagnosis of pulmonary embolism, these findings may be useful.
Angiography ; Animals ; Bronchi ; Dilatation ; Early Diagnosis ; Embolism ; Estrogens, Conjugated (USP) ; Incidence ; Lung ; Pathology ; Pulmonary Artery ; Pulmonary Embolism* ; Radiography ; Spasm ; Swine ; Thrombosis

INTRODUCTIONGas is rarely found within the viscera outside the lumen of the gastrointestinal tract. Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing organisms.

CLINICAL PICTUREA 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma. Postoperatively, she turned septic and encephalopathic with worsening liver function. Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets within.

TREATMENTThe patient was started on a course of broad spectrum antibiotics.

OUTCOMEShe responded and was discharged well.

CONCLUSIONEmphysematous gastritis is a rare condition with high mortality. There is however, still no preferable approach of treatment despite therapeutic advances.

Anti-Bacterial Agents ; therapeutic use ; Emphysema ; diagnostic imaging ; Female ; Gastritis ; drug therapy ; pathology ; Humans ; Middle Aged ; Portal Vein ; Radiography ; Thienamycins ; therapeutic use ; Ultrasonography ; Venous Thrombosis ; diagnostic imaging

A 42-year-old Chinese man presented with left-sided chest pain and splenomegaly. Full blood count revealed erythrocytosis, while plain radiograph and computed tomography of the abdomen and pelvis revealed hepatosplenomegaly with splenic infarction. Further workup confirmed the diagnosis of polycythaemia vera. Clinical and imaging features of polycythaemia vera, as well as the potential pitfalls in image interpretation, are discussed in this article.
Adult ; Brain ; pathology ; Cerebral Infarction ; complications ; diagnosis ; Diagnostic Imaging ; methods ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Polycythemia Vera ; diagnosis ; diagnostic imaging ; Radiography, Abdominal ; methods ; Seizures ; diagnosis ; Splenomegaly ; diagnosis ; Tomography, X-Ray Computed ; methods ; Venous Thrombosis ; diagnosis