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Uterine torsion is a rare gynecological emergency. It occurs mainly in gravid uterus and extremely rarely in non-gravid uterus. In this article, we report a case of torsion of non-gravid uterus accompanied by a large intramural leiomyoma with focus on computed tomography and magnetic resonance imaging.

Transcatheter arterial chemoembolization (TACE) is a useful palliative therapeutic modality for hepatocellular carcinoma (HCC). Postembolization syndromes, such as fever, abdominal pain, and elevated liver enzyme levels are commonly known complications of TACE. One post-TACE pulmonary complication, lipiodol pneumonitis, is rarely reported. Lipiodol pneumonitis after TACE appears to be associated with chemical injury due to accidental perfusion of lipiodol to the lung vasculature, promoted by arteriovenous shunts within the hypervascular HCC. Here, we report a 42-year-old man with unresectable HCC and hepatic vein thrombosis. The patient was initially treated with TACE. The following day after TACE, acute respiratory symptoms such as dyspnea and cough developed with decreased oxygen saturation. Chest X-ray and computed tomography showed multiple patches and diffuse ground-glass opacities in both lung fields, suggesting of lipiodol pneumonitis. The patient’s condition and radiologic abnormalities subsequently improved after 2 weeks of conservative treatment alone. (J Liver Cancer 2020;20:60-66)

Background: We sought to investigate whether serum immune and inflammatory parameters can help to predict distant metastasis (DM) in patients with unresectable hepatocellular carcinoma (HCC) undergoing curative radiation therapy (RT). Methods: A total of 76 RT courses were analyzed. The following variables were included in the analysis: systemic inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), absolute lymphocyte count, lymphocyte-to-monocyte ratio, albumin, albumin-to-alkaline phosphatase ratio, RT-related parameters, and levels of total protein, hemoglobin, α-fetoprotein, and PIVKA-II. Distant control (DC) and overall survival (OS) rates were calculated and compared. Results: The mean age was 61.4 years, and most patients were men (n = 62, 81.6%). The median RT fraction number and fractional doses were 12 (range, 4–30) and 5 (range, 2–12) Gy, respectively. With a median follow-up of 12 (range, 3.1–56.7) months, the 1-year DC and OS rates were 64.4% and 55.2%, respectively. The development of DM significantly deteriorated OS (p = 0.013). In the multivariate analysis, significant independent prognostic indicators for DC and OS rates were the highest posttreatment PLR (≤235.7 vs. >235.7, p = 0.006) and the lowest posttreatment PNI (≤25.4 vs. >25.4, p < 0.001), respectively. Conclusions: Posttreatment serum PLR might be helpfully used as a predictive biomarker of DM in unresectable HCC patients undergoing RT. Future research is necessary to confirm our findings.

Solid pseudopapillary neoplasm (SPN) of the pancreas is an uncommon neoplasm characterized by low-grade malignant potential and uncertain histogenesis, and usually afflicts relatively young women. The tumors typically manifest as well-marginated, mixed density lesions consisting of a solid peripheral and central cystic component in conjunction with hemorrhagic foci. SPN with apparent high-grade malignant transformation is a rare histologic variant. Herein, we report a rare case of SPN with high-grade malignant transformation diagnosed in a 75-year-old female, with emphasis on differential diagnoses and role of normalized ADC values. SPN with malignant transformation should be included in the differential diagnosis in cases of mixed solid and cystic masses with hemorrhagic components, irregular margin and lower normalized apparent diffusion coefficient (ADC) values in an elderly female patient, as was the case discussed below.

This study demonstrates the feasibility and safety of the axial approach for real-time ultrasound-guided percutaneous renal biopsy along Brödel avascular plane.In this retrospective analysis of 41 percutaneous biopsies performed from June 2014 to June 2015, patients' medical records, pathology results, complication rate, and pain score before and during the procedure were reviewed.The average number of sampled glomeruli was 16.1 ± 7.2 (mean ± SD). There were no major complications. The 2 minor complications, transient macrohematuria and small perirenal hematoma, occurred at a rate of 4.89% but regressed spontaneously in both cases.The axial approach along Brödel avascular plane is a feasible alternative approach for percutaneous biopsy of the native kidney.

Gastric volvulus is defined as an abnormal degree of rotation of one part of the stomach around another (1). Gastric volvulus may lead to severe complication such as gastric ischemia, perforation, and even death. The mortality rate is reportedly 30– 50% (2). Wandering spleen is defined as a movable spleen that can migrate from its normal position to any part of the abdomen or pelvis. Splenic torsion itself is a rare condition with an annual incidence of < 0.2% with or without association of wandering spleen (3). Splenic torsion is potentially fatal, if not urgently managed with surgery. It may cause ischemia, infarction, and even necrosis of the spleen (1). Gastric volvulus and wandering spleen can occur independently. However, these disease entities share a common congenital etiology of anomalous intraperitoneal visceral attachment originating from the dorsal mesogastrium. To our knowledge, only a few cases have been reported previously in literature. Herein, we described a case of gastric volvulus associated with wandering spleen and intestinal non-rotation in a 15-year-old girl, focusing on the multidetector computed tomography (MDCT) findings. Multidetector Computed Tomography Findings of Mesenteroaxial Gastric Volvulus Combined with Torsion of Wandering Spleen: A Case Report and Literature Review 유주 비장의 염전과 동반된 장간막축성 위 염전의 다중검출기 전산화단층촬영 소견: 증례 보고 및 문헌 고찰

Multidetector computed tomography (MDCT) is essential for the prediction of lymph node (LN) metastasis in gastric cancer. However, the measurement method and size criteria for metastatic LNs using MDCT are unclear.MDCTs of gastric cancer patients who underwent surgery and had pathological staging were reviewed by radiologists. The two-dimensional cutoff values for LNs with suspected metastasis were calculated, and clinicopathological data were analyzed using those cutoff values.The total number of enrolled patients was 327. The cutoff values of the maximal area with metastatic LNs were obtained significantly at stations 3, 4, and 6, and those values were 112.09, 33.79, and 85.88 mm(2), respectively. The common cutoff value was 112.09 mm(2), and the area under the curve was 0.617 (P = 0.002). The overall survival rate of the patients with LNs less than 112.09 mm(2) was significantly better than those with LNs greater than 112.09 mm(2) (P0.001). In multivariate analysis, the maximal LN area was an independent prognostic factor (adjusted hazard ratio, 1.697 [95% confidence interval 1.116-2.582]).Using two-dimensional values for LNs measured by MDCT is a practical method of predicting metastatic LNs in gastric cancer. The maximal LN area value would be useful in both the preoperative staging and prognosis prediction of gastric cancer.

This study aims to evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct (CBD) stones in acute biliary pancreatitis (ABP).The medical records of patients presenting with ABP from January 2008 to July 2013 were reviewed to assess the value of MRCP in detecting CBD stones in ABP. Endoscopic retrograde cholangiopancreatography (ERCP) was used as the reference standard to assess the diagnostic yield of MRCP in detecting choledocholithiasis. When ERCP was unavailable, intraoperative cholangiography or clinical follow-up was used as the reference standard.Seventy-eight patients who underwent MRCP were diagnosed with ABP, and thirty of the 78 patients (38%) were confirmed to have CBD stones per the study protocol. The sensitivity of MRCP in detecting CBD stones in ABP was 93.3% compared to 66.7% for abdominal CT (P 0.008). The overall accuracy of MRCP in detecting choledocholithiasis was 85.9% compared to 74.0% for abdominal CT (P 0.041). The area under the receiver operating characteristic curve (AUC) of MRCP in detecting CBD stones was 0.882, which was more accurate than the AUC of 0.727 for abdominal CT (P = 0.039). In 38 patients who underwent ERCP, the sensitivity and negative predictive value of MRCP in detecting CBD stones were both 100% regardless of the dilatation of the bile duct (≥7 mm versus 7 mm).MRCP is an effective, noninvasive modality to detect CBD stones in ABP and can help identify patients who require ERCP.

Ultrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis. MAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period. MAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients. The date of trial registration ( NCT02551250 ) in this study was September 15, 2015, and follow-up is still ongoing.

The extent of serosal exposure varies depending on the cross-section of the stomach that is viewed, affected by the visceral peritoneum of the omentum. Although multidetector computed tomography (MDCT) is the most useful method to predict serosal exposure, the MDCT criteria for such exposure by cross-sectional location remain to be established. The MDCT of gastric cancer patients who underwent surgery, and for whom pathological reports were available, were reviewed by radiologists. The MDCT criteria for invasion depth were divided into five grades: (1) smooth margin; (2) undulating margin; (3) streaky margin within vessels; (4) nodular margin within perigastric vessels; and (5) streaky or nodular margin over the perigastric vessels. The five grades were compared in terms of pathological tumor depth by curvature and wall group. A total of 125 patients of stage ≥ T2 were enrolled. The five MDCT grades correlated with tumor depth (P

OBJETIVO: Descrever os achados de imagem de RM no hemangioma hepático com realce perilesional. MATERIAIS E MÉTODOS: Realizou-se uma pesquisa no banco de dados da unidade de RM para identificar todos os casos de hemangioma hepático com realce perilesional entre março de 2008 e julho de 2009. Todos os pacientes foram submetidos a RM pré-contraste em imagens ponderadas em T1 e T2 e em imagens dinâmicas após injeção de gadolínio. Características do hemangioma e do realce perilesional foram avaliadas nas imagens de RM. RESULTADOS: Sete hemangiomas em sete pacientes (cinco homens, duas mulheres; faixa etária entre 41-69 anos; média de 57 anos) foram incluídos no presente estudo. O tamanho das lesões variou de 7 a 20 mm (média de 12,4 mm). Na fase dominante arterial hepática, todos os sete hemangiomas mostraram realce perilesional cuneiforme que se atenuou nas imagens dois minutos após injeção de gadolínio. Quatro dessas lesões demonstraram realce capsular adjacente. CONCLUSÃO: Todos os hemangiomas hepáticos com realce perilesional eram lesões capsulares medindo menos que 2 cm. Tal localização sugere que esses hemangiomas podem recrutar vasos capsulares responsáveis pelo realce perilesional OBJECTIVE: To describe the MR imaging features of hepatic hemangioma with perilesional enhancement. MATERIALS AND METHODS: A search was performed of the MRI section database to identify all cases of hepatic hemangioma with perilesional enhancement between March 2008 and July 2009. All patients underwent MR examinations including precontrast T1- and T2-weighted images and postgadolinium dynamic images. On MR images, characteristics of the hemangioma and perilesional enhancement were evaluated. RESULTS: Seven hemangiomas in seven patients (five men, two women; age range, 41-69 years; mean, 57 years) were included in this study. Lesion size ranged from 7 to 20 mm (mean, 12.4 mm). On hepatic arterial dominant phase, all seven hemangiomas exhibited wedge-shaped perilesional enhancement which faded on two minutes postgadolinium images. Four of these lesions demonstrated adjacent capsular enhancement. CONCLUSION: All hepatic hemangiomas with perilesional enhancement were < 2 cm capsule-based lesions. This location suggests that these hemangiomas may conscript capsular vessels to account for the perilesional enhancement

This article describes the appearance of miscellaneous cystic and endocrine neoplasms using magnetic resonance imaging (MRI). Magnetic resonance imaging is a useful diagnostic modality in the assessment of various pancreatic neoplasms. Pancreatic endocrine tumors are moderately low in signal intensity on T1-weighted fat-suppressed images and moderately high in signal intensity on T2-weighted fat-suppressed images and demonstrate homogeneous, ring, or diffuse heterogeneous enhancement on immediate postgadolinium gradient echo images. Cystic pancreatic neoplasms, including intraductal papillary mucinous neoplasm, are well demonstrated and subcategorized according to their characteristic cystic configurations on MRI and MR cholangiopancreatography images. Microcystic serous cystadenomas are demonstrated as a honeycombed appearance on T2-weighted images and have a central stellate scar. Mucinous cystic neoplasms usually appear as multilocular cystic masses, with benign forms of macrocystic tumors possessing uniform thickness septations and malignant forms exhibiting irregular septations and tumor nodules. The presence of tumor stroma, invasion of adjacent tissue, or liver metastases can be assessed by MRI. The connection between the pancreatic duct and the cystic tumor is usually well shown on MR cholangiopancreatography images.

Objective To describe computed tomographic (CT) and magnetic resonance (MR) imaging findings of transitional cell tumors, including newly established transitional cell carcinoma, according to tumor type with pathological correlation. Methods We retrospectively reviewed the CT and MR images of 22 patients with transitional cell tumors of ovary (14 benign Brenner, 2 borderline Brenner, 2 malignant Brenner, and 4 transitional cell carcinomas) for the following factors: size, location, configuration, signal intensity, staging, and accompanying ovarian tumors. Results Sixteen tumors were detected on CT or MRI (8 benign, 2 borderline, and 6 malignant tumors), and the mean size of measurable tumors was 8.8 cm. Benign Brenner tumors were homogeneous solid (n = 6) or unilocular cystic (n = 2). Two borderline Brenner tumors were multilocular cystic. Malignant tumors, including malignant Brenner tumors and transitional cell carcinomas, were heterogeneous solid (n = 3) or multilocular cystic (n = 3). The signal intensity of solid components on T2-weighted images was isointense compared with that of muscle in benign and borderline Brenner tumors and hyperintense in malignant tumors. Conclusions The CT and MR appearance of transitional cell tumors varied according to tumor type. Benign Brenner tumors were homogeneous solid or unilocular cystic pattern, and malignant tumors were heterogeneous solid or multilocular cystic.

The purpose of this study was to identify differences in multidetector-row computed tomography (MDCT) findings of adnexal torsion (AT) according to the anatomical subtypes and identify MDCT findings that may predict conservative treatment.A total of 295 consecutive women with pelvic pain who underwent preoperative MDCT and subsequent surgery less than 24 h after admission were included in this retrospective study. Among them, 116 women (mean age: 33.9 years; range: 3-80 years) with histopathologically confirmed AT after surgery were included in the final analysis.On histopathological examination, an underlying ovarian mass was found in 98 women (98/116, 84.5%). In the group without ovarian mass (n=18), massive edema (12/18, 66.7% vs. 16/98, 16.3%; P0.001) was frequently found. However, in the group with ovarian mass (n=98), twisted tube or pedicle (5/18, 27.8% vs. 55/98, 56.1%; P=0.027) and concentric or eccentric wall thickening (5/18, 27.8% vs. 82/98, 83.7%; P0.001) demonstrated a statistically significant higher incidence. Based on the surgical and pathological results, the 116 women were classified into three subtypes including ovary-tubal (89/116, 77%), ovary only (22/116, 19%) and tubal only subtype (5/116, 4%). In the ovary-tubal subtype, tubal thickening (88/89, 98.9% vs. 11/22, 50.0%; P0.001), twisted tube or pedicle (57/89, 64.0% vs. 3/22, 13.6%; P0.001) and remaining tubal enhancement (52/89, 58.4% vs. 7/22, 31.8%; P=0.025) were more frequently observed than in the ovary only subtype. There was no significant difference between the relative frequency of imaging findings in the cystectomy group and adnexectomy group of the ovary-tubal type.Knowledge of common and characteristic MDCT findings of AT according to the anatomical subtypes is important to make accurate diagnosis and avoid delayed treatment.

Objectives To report the multidetector-row computed tomography (MDCT) findings of small bowel obstruction (SBO) caused by Meckel's diverticulum. Materials and methods Ten patients (9 men and 1 woman; age range, 2–44 years; median age, 21 years) with surgical proven Meckel's diverticulum who presented SBO on the preoperative MDCT were included in the study. Results On MDCT, all patients presented with SBO, either high-grade ( n = 6) or low-grade obstruction ( n = 4). Meckel's diverticulum was identified in five patients ( n = 5, 50%) on preoperative MDCT. In the five patients in whom a diverticulum was not seen on preoperative MDCT, MDCT showed a transition site on ileum with dilated proximal loops ( n = 3), pneumoperitoneum ( n = 1), jejuno-jejunal intussusception ( n = 1). Transition zone was located near midline in four patients (4/5, 80%). Conclusion The diagnosis of Meckel's diverticulum complicated SBO can be made with certainty when the diverticulum is visualized on preoperative MDCT. However, the preoperative diagnosis is difficult if the Meckel's diverticulum is not noted on the MDCT. When the obstructive processes are visualized in the lower abdomen or pelvis, particularly near the midline, one should keep in mind that SBO may be caused by Meckel's diverticulum without prior surgical history.

Purpose To retrospectively evaluate the multidetector computed tomography (MDCT) findings of extraperitoneal ascending appendicitis. Materials and methods The MDCT examinations of 10 patients with extraperitoneal ascending appendicitis confirmed by laparoscopic surgery were retrospectively analyzed. Preoperative MDCT examinations were obtained after intravenous administration of iodinated contrast material in all patients. Transverse and coronal reformatted MDCT images were reviewed in consensus by two radiologists. The presence of the extraperitoneal triangle sign, the split interfascial plane sign, and the other classical findings of appendicitis were evaluated. Results Luminal dilatation, wall enhancement of the inflamed appendix, and fat infiltration were present in 10/10 patients (100%). The perforation of the inflamed appendix with abscess formation was present in 4/10 patients (40%). The split interfascial plane sign was present in 7/10 patients (70%), and parts of inflamed appendix or periappendiceal abscess were located behind the right extraperitoneal triangle in 8/10 patients (80%). Conclusion The split interfascial plane sign and the presence of an appendiceal tip or periappendiceal abscess located in the right extraperitoneal triangle are highly suggestive of extraperitoneal ascending appendicitis on MDCT.

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p

We present a case of an intraperitoneal bronchogenic cyst located at inferior surface of the liver, next to the gallbladder which clinically mimicked a gallbladder tumor. This is the first case reported in Korea, and we offer reviews of the related literatures. A 48-yr-old woman was admitted to our hospital because of intermittent abdominal pain in right upper quadrant. Computed tomography showed a large mass alongside the gallbladder. During laparotomy, the mass showed an ovoid cystic nature, which was attached to the normal gallbladder and liver bed. Cyst excision with cholecystectomy was performed, and histopathological examination revealed a bronchogenic cyst. Most bronchogenic cysts have a benign nature, but malignant changes have also been reported. Therefore, if a cystic tumor in the abdomen is suspected during preoperative diagnosis, a bronchogenic cyst should be considered in the differential diagnosis.

Most bone grafts performed today utilize autograft, allograft, and alloplast with moderate clinical success1-3). Autografts have the advantage of optimal biologic incorporation, histocompatibility and little chance of disease transmission. But it has lack of availability in clinical use, and the harvesting of graft tissue may cause patient morbidity. In contrast, allografts get much wider availability and little patient morbidity associated with graft procurement. However, problems with unreliable graft incorporation, immune response, and possible disease transmission represent clear drawbacks to their use. While several synthetic graft materials have also been introduced, most alloplastic materials function primarily as a biocompatible defect filler4). Several attempts have been made to resolve these problem use of biodegradable polymers and combination of ceramics with bioactive polymers such as collagen and polylactides5-7). Chitosan is a biodegradable cationic polysaccharide composed of N-acetylglucosamine residues which is known to accelerate wound healing and bone formation8). Many previous reports corroborated enhanced wound healing912) and hemostatic effect13-17) of chitosan. It is hypothesized that the major path for chitosan breakage down in vivo is through lysozyme, which acts slowly to depolymerize the polysaccharide18). The biodegradation rate of the polymer is determined by the amount of residual acetyl content, a parameter that can easily be varied8). One possible approach toward addressing the respective problems inherent in autograft and allograft material is employing tissue engineering which is actively researched today. Tissue engineering is a science in which material properties of synthetic compounds are manipulated to enable delivery of an aggregate of dissociated cells into host in a manner that result in the formation of new tissue. Thus the major goal of tissue engineering is in vitro construction of transplantable vital tissue19).

Although ultrasonography is regarded as the gold standard in the diagnosis of obstructive nephropathy, dilatation is sometimes not observed by ultrasonography. We report upon a case of minimally dilated obstructive nephropathy due to an ureter stone in a kidney donor with volume depletion. A 54-year-old man was admitted due to anuria and abdominal pain of 2 days duration. Ten years previously, his right kidney was donated for transplantation, and one month before admission, he abstained from all food except water and salt, for 30 days for religious reasons. He had lost 8 kg of body weight. On admission, he had clinical signs of volume depletion, i.e., a dehydrated tongue and decreased skin turgor. Laboratory data confirmed severe renal failure, his blood urea nitrogen level was 107.3 mg/dL, and his serum creatinine 16.5 mg/dL. The plain X-ray was unremarkable and ultrasonography showed only minimal dilatation of the renal collecting system. On follow-up ultrasonography, performed on the 5th hospital day, the dilatation of the collecting system had slightly progressed and a small stone was found at ureter orifice by cystoscopy. Removal of stone initiated dramatic diuresis with a rapid return of renal function to normal by the third day.

Hepatic artery pseudoaneurysm is a rare and potentially life-threatening vascular disorder. Careful consideration and early management of this lesion can be life-saving. The authors report a case of a hepatic artery pseudoaneurysm which was successfully controlled by endovascular repair using a covered stent-graft.

Objectives The purpose of this presentation is to review the pathologic spectrum of cystic masses that may involve the female groin region, with a correlation of the lesions with their sonographic appearance. Methods We reviewed the sonographic findings of palpable groin masses showing a cystic pattern in female patients. The groin region is best depicted with a high-frequency (7.5- to 12-MHz) linear array transducer. Color Doppler sonography and an extended field of view are helpful in the differential diagnosis of variable groin masses. Results There are various cystic masses involving the female groin, such as round ligament cysts, varicosities of the round ligament, inguinal herniation of the ovary, cystic lymphangiomas, epidermal inclusion cysts, abscesses, and pseudoaneurysms. Conclusions Sonography with color Doppler imaging is helpful for the differential diagnosis of the pathologic spectrum of cystic masses involving the female groin.

Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.

Background. Increased intima-media thickness (IMT) of the radial artery is associated with early failure of radiocephalic arteriovenous fistula (AVF) in haemodialysis patients. Therefore, non-invasive measurements of radial artery IMT before AVF operations are very important in predicting AVF patency. This study was designed to evaluate the accuracy of highresolution ultrasonography in measuring radial artery IMT in pre-dialysis uraemic patients. Methods. This study enrolled 43 pre-dialysis uraemic patients awaiting radiocephalic AVF operations for the first time. In this study, 17 age- and sex-matched uncomplicated hypertensive patients and 15 healthy subjects were included as a control. We measured the internal diameter (ID) and IMT of the radial artery using high-resolution ultrasonography on the wrists of uraemic patients as well as the control group before the AVF operation. We obtained specimens of the radial artery during the AVF operation and directly measured the IMT by histological examination. Results. The radial artery IMT of the uraemic patients (0.41±0.09 mm) was significantly thicker, compared to both those of the hypertensive (0.33±0.05 mm, P

Hypoalbuminemia frequently occurs in Hemorrhagic Fever with Renal Syndrome (HFRS), but clinical significance of hypoalbuminemia is not well known. This study was designed to evaluate hypoalbuminemia as a marker of severity of disease in patients with HFRS. We evaluated the relationship between the level of serum albumin and clinical parameters representing the severity of disease in 144 patients with HFRS. The patients were divided into three groups based on the level of serum albumin; Group I (normal serum albumin), Group II (serum albumin /=3.0 g/dL), and Group III (serum albumin

Inflammatory pseudotumor is a benign disease, which is histologically composed of the inflammatory cells such as mature lymphocytes, plasma cells, and histiocytes. It usually occurs in the respiratory system, liver, central nervous system, and gastrointestinal tracts. However, inflammatory pseudotumor rarely occurs in the spleen. Pathologic diagnosis is essential for the definitive diagnosis because of the difficulty in distinguishing pseudotumor from lymphoproliferative disorders of the spleen. We report a case of inflammatory pseudotumor of the spleen. A 35-year-old woman complained of the intermittent epigastric pain for several months. Physical examination and laboratory findings were normal. Ultrasonography and abdominal computerized tomography showed a low attenuation splenic mass suggesting lymphoma. However, the pathologic findings of the resected spleen were consistent with those of the inflammatory pseudotumor. The spleen weighed 230 g containing a 6 x 5 x 5 cm-sized, well-circumscribed gray mass. The microscopic findings indicated the inflammatory cell infiltrations.

Behçet’s disease (BD) is a multisystem autoimmune disorder characterized by recurrent orogenital ulcers, uveitis, and skin lesions. The vascular manifestations include thrombophlebitis, stenosis, occlusion, and pseudoaneurysm. BD infrequently precipitates aortic pseudoaneurysm rupture into the sigmoid mesocolon and lumen of the adjacent colon. Here we report an extremely rare case of spontaneous abdominal aortic pseudoaneurysm rupture via the sigmoid mesocolon into the lumen of the sigmoid colon in a 37-year-old patient with BD.

Leiomyosarcoma is the second most common primary retroperitoneal malignant tumor in adults, which commonly originates in the inferior vena cava (1). A leiomyosarcoma arising from the renal vein is particularly uncommon. After the first report of Varela and Garro in 1967, only about 30 cases have been reported in the published medical literature (2, 3). The renal vein leiomyosarcoma is grossly classified into three subtypes: completely extravascular; completely intravascular and mixed (1, 4). To the best of our knowledge, there have been only few reports detailing the imaging findings of renal leiomyosarcoma with both extraand intravascular components (1, 4). We report an uncommon case of left renal vein leiomyosarcoma with combined components, focusing on the multidetector computed tomography (MDCT) and MR imaging findings with review of the literature. This case report was approved by the ethics committee at our institution and an informed consent was waived.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with a low malignant potential and a high local recurrence rate after surgical excision (1). DFSP can be found anywhere on the body, but is often found on the chest and shoulders (1). DFSP arises in the dermis and invades deeper tissues such as fascia, muscle and bone (1, 2). Due to its tendency for local invasion and asymmetric spread, DFSP in the perianal area can extend to the anal sphincter and show similar imaging findings to those of a malignant tumor arising from the anorectal fistula. However, DFSP in the perianal area is extremely rare, and only one case has been reported in the English medical literature (3). To the best of our knowledge, there is no report regarding the detailed imaging findings of DFSP radiologically mimicking mucinous adenocarcinoma arising from the anorectal fistula. We present an extremely rare case of perianal DFSP mimicking mucinous adenocarcinoma arising from fistula in ano, and focus on the CT and MR imaging findings. This report was approved by the ethics committee at our institution, and the requirement for informed consent was waived.