The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

Lymphorrhea is a rare but potentially severe complication that occurs after various surgical procedures. Untreated lymphorrhea may lead to wound dehiscence, infection, and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually includes leg elevation, drainage, and pressure dressing. However, these methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from a calf wound after endoscopic great saphenous vein (GSV) harvesting for coronary artery bypass grafting (CABG). The patient presented with intractable oozing from the postoperative wound on the right calf. Lymphorrhea perGsisted for 6 weeks despite negative-pressure wound therapy with a long-acting somatostatin. We performed unilateral pedal lymphangiography that confirmed wound lymphorrhea, followed by glue embolization. No recurrence was observed after 8 months of follow-up. This case report demonstrates the successful use of lymphangiography with glue embolization in the control of lymphorrhea after GSV harvesting for CABG.

The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.

Pancreatic pseudocysts are focal fluid collections that develop as a result of inflammatory diseases of the pancreas. They are managed conservatively or with a drainage procedure. Their radiological appearance can mimic cystic neoplasms of the pancreas. Pancreatic cystic neoplasms include various neoplasms with a wide range of malignant potential. Here, we report a patient with a pancreatic pseudocyst that presented with macrocystic attributes on endoscopic ultrasound.
Drainage ; Humans ; Hydrazines ; Pancreas ; Pancreatic Cyst ; Pancreatic Pseudocyst

PURPOSE: We aimed to assess retrospectively the benefit of the use of ultrasonography (US) in comparison with the use of only CT imaging for the detection of the transition zone and adhesions to determine a diagnosis of adhesive small-bowel obstruction (SBO). MATERIALS AND METHODS: Thirty-five patients underwent an additional US examination after CT imaging to determine a diagnosis of SBO. All of the patients were surgically confirmed as having adhesive SBO. The CT images were interpreted for the location of the transition zone, the location and shape of adhesions and for other SBO findings. All of the additional US scans were performed with reference to the CT findings. The standard of reference for the diagnosis was the surgical findings. The diagnostic accuracy and mean confidence score of the transition zone location and the detection rate of adhesions were evaluated for both CT imaging alone and for CT imaging with additional US. RESULTS: The diagnostic accuracy to locate the transition zone was significantly increased with the use of additional US with CT imaging (94.6%, 33/35) as compared to 65.7% (23/35) with the use of only CT imaging (p = 0.01). The mean confidence score was significantly increased (by 0.95) with the use of an additional US examination (p < 0.01). The detection rate for adhesions was 20% (7/35) with the use of only CT imaging and the detection rate was 68.6% (24/35) with the use of an additional US examination. CONCLUSION: The use of a US examination in addition to CT imaging can increase the accuracy and confidence to locate the transition zone and can increase the rate to detect adhesions in patients with adhesive SBO. An additional US examination may be especially helpful when the CT findings are equivocal.
Adhesives ; Humans ; Retrospective Studies

BACKGROUND/AIMS: Intraperitoneal tuberculous abscesses develop infrequently. Because of overlapping features it is difficult to differentiate a tuberculous abscess from carcinomatosis peritonei. The aim of this study was to define the computed tomography (CT) findings and clinical course of the intraperitoneal tuberculous abscess. METHODS: The study included 11 patients (3 males, 8 females, mean age 34.8 years) with a pathologically proven intraperitoneal tuberculous abscess. We analyzed the CT findings and reviewed the medical records retrospectively. RESULTS: Sixteen abscesses were found in 11 patients. The locations of the abscesses were in the right subphrenic space (n=1), right perihepatic space (n=4), left perihepatic space (n=4), left subphrenic space (n=2), perisplenic space (n=3), right lower abdominal space (n=1), and left lower abdominal space (n=1). Five patients were proven to have abdominal tuberculosis while six patients had paradoxical responses to antituberculosis therapy for tuberculous peritonitis. The abscess lesions presented on the CT scan as thin walled cystic enhancing lesions without calcification (n=16), a septated mass (n=12), with enlargement of lymph nodes (n=2), and peritoneal and omental haziness (n=3). The mean duration from commencement of treatment to onset of a paradoxical response was 88 days. All patients had antituberculosis therapy for 6 to 12 months and five patients underwent surgery. The mean follow-up was 15 months. CONCLUSIONS: The intraperitoneal tuberculous abscess appeared as an ovoid cystic lesion with a slightly enhanced thin wall in the upper abdomen, in the perihepatic space on the CT scan; such as lesion can be the primary lesion of abdominal tuberculosis or associated with the paradoxical response of tuberculous peritonitis.
Abdomen ; Abscess ; Carcinoma ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Medical Records ; Peritonitis, Tuberculous ; Tuberculosis

PURPOSE: To survey the current overall quality of mammograms and to improve Korean standards in comparison to the American College of Radiology (ACR) standards for clinical image evaluations. MATERIALS AND METHODS: A total of 104 mammograms, collected from 63 hospitals and clinics, were examined following the revised new Korean standards and ACR standards for clinical image evaluation. The pass and failure rates of the mammogram were evaluated according to each of the standards compared. The pass threshold for the Korean standards was analyzed using the ROC (receiver operating characteristic) curve in association with the ACR standards. The categories of the Korean standards were evaluated in association with failure of the ACR standards. RESULTS: Among the 104 mammograms, 99.0% passed the Korean standards, whereas 86.5% passed the ACR standards. A score of 75.5 was the pass threshold for the Korean standards. Moreover, the Korean standards categories associated with the failure of ACR standards included positioning, compression, and contrast/exposure (p < 0.05). CONCLUSION: The pass rate of the image evaluation for each mammogram following the Korean standards was 99%, compared to 86.5% for the ACR standards. Hence, the Korean standards were not as stringent. Consequently, stricter regulations are suggested for improvement in the quality of mammograms.
Accreditation ; Breast ; Mammography ; Quality Assurance, Health Care ; Social Control, Formal

PURPOSE: This study was performed to evaluate factors that can predict the presence of a malignancy for localized intrahepatic bile duct dilatation without a visible mass or stone as depicted on CT images. MATERIALS AND METHODS: A total of 29 patients (male: 16, female: 13) who had localized intrahepatic bile duct dilatation without a visible mass, stone or injury as depicted on CT images were included in the study. A history of extrahepatic malignancy and biliary stone disease, tumor marker levels, CT findings of the intrahepatic bile duct and associated findings were reviewed. The findings were analyzed between two groups (patients with a malignancy and patients with benign disease) on follow-up. RESULTS: In 29 patients, 11 patients had malignant lesions (four metastases and seven cholangiocarcinomas). The history of an extrahepatic malignancy and the shape of an intrahepatic duct obstruction or stenosis as seen on CT were significantly correlated with the results between the benign and malignant group of patients. The follow-up results of the malignant group of patients indicated that for six patients who had developed a new mass, one patient each showed aggravation of ductal dilatation and thickening of the ductal wall. CONCLUSION: When a patient with localized intrahepatic bile duct dilatation without a definite cause has a history of an extrahepatic malignancy or shows abrupt tapering or irregular narrowing on CT images, short-term follow-up should be performed. The patient should be investigated carefully for mass formation or a change of the dilated bile duct due to a possibility of malignant ductal dilatation.
Bile Ducts ; Bile Ducts, Intrahepatic ; Constriction, Pathologic ; Dilatation ; Dilatation, Pathologic ; Follow-Up Studies ; Humans ; Neoplasm Metastasis

BACKGROUND/AIMS: Upper gastrointestinal endoscopy is usually recommended for the evaluation of esophageal varices in patients with liver cirrhosis. However, the prevalence of varices is extremely variable. We performed this study to determine the predictive values for esophageal varices and to select eligible patients for screening endoscopy. METHODS: Fifty-two patients were enrolled in this study. Laboratory tests including liver biochemistry and complete blood count along with ultrasonography with Doppler measurements and endoscopy were performed. RESULTS: Esophageal varices were present in 25 patients (48%). Variables associated with the presence of esophageal varices on univariate analysis were serum albumin, total bilirubin, prothrombin time and platelet count (p<0.05). Significant variables in ultrasonography with Doppler measurement were diameter of spleen (13.04+/-2.1 cm vs. 10.39+/-1.6 cm, p<0.001), peak velocity of portal vein (30.2+/-7.5 cm/sec vs. 36.1+/-8.0 cm/sec, p<0.01) and portal vein diameter (1.26+/-0.28 cm vs. 1.13+/-0.18 cm, p<0.05). On multivariate analysis, independent variables were platelet count (odds ratio (OR) 0.922; 95% confidence interval (CI), 0.86-0.99), diameter of spleen (OR 5.4; 95% CI, 1.63-17.88) and platelet count/spleen diameter ratio (OR 1.007; 95% CI, 1.01-1.02). The optimal critical value for the diameter of spleen was 11 cm. The sensitivity and specificity with this value were 84% and 63%, respectively. CONCLUSIONS: Doppler measurement was not helpful in distinguishing the presence of varices. However, clinical tests including biochemistry and ultrasonography would be useful in selecting eligible patients for screening endoscopy. Endoscopic screening for esophageal varices is recommended in cirrhotic patients with splenomegaly.
Adult ; Aged ; Blood Chemical Analysis ; Blood Flow Velocity ; Chronic Disease ; Esophageal and Gastric Varices/complications/*diagnosis/ultrasonography ; Female ; Humans ; Liver Cirrhosis/complications ; Liver Diseases/*complications ; Male ; Middle Aged ; ROC Curve ; Severity of Illness Index ; *Ultrasonography, Doppler

PURPOSE: The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. MATERIALS AND METHODS: Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. RESULTS: The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. CONCLUSION: Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.
Biliary Atresia* ; Cholangiography ; Cholecystography ; Cholestasis ; Cytomegalovirus ; Diagnosis ; Dilatation ; Duodenum ; Female ; Gallbladder ; Gastrointestinal Tract ; Hepatitis ; Humans ; Infant* ; Infant, Newborn ; Jaundice, Neonatal ; Male ; Needles ; Punctures ; Ultrasonography