• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.237-243
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• 2021

This is a rare case of a 73-year-old male patient who presented with hematochezia and was treated using transcatheter arterial embolization following upper gastrointestinal bleeding in the third portion of the duodenum. The cause of the bleeding was not found on gastrointestinal endoscopy and CT. On the third day of hospitalization, the hemoglobin level continued to decrease. A technetium-99m-labeled red blood cell scan revealed suspicious bleeding in the diverticulum of the third portion of the duodenum. Superior mesenteric artery angiography showed active bleeding from the posteroinferior pancreaticoduodenal artery, which was embolized with N-butyl cyanoacrylate. The patient was discharged on the seventh day after embolization without re-bleeding or complication. We report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. Herein, we report a rare case of a patient with active bleeding from a duodenal diverticulum that was difficult to diagnose using routine modalities. We also conducted a relavant literature review.

• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1160-1167
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• 2022

Epipericardial fat necrosis (EPFN) is a relatively rare cause of acute chest pain, with only five pediatric cases having been reported in the English-language medical literature to date. EPFN can be diagnosed based on the clinical symptoms of acute pleuritic chest pain and classic CT features of typically ovoid fatty lesions surrounded by a rim or capsule in the mediastinal or pericardial areas. Previous studies have reported that contrast-enhanced MRI can detect typical fat signal changes in adults with EPFN. We report a pediatric EPFN case diagnosed using gadolinium-enhanced MRI. Thus, contrast-enhanced MRI may be used to confirm EPFN in the differential diagnoses of the causes of acute chest pain.

• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.817-825
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• 2021

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) characterized by an inhaled inciting antigen that leads to the inflammation of the lung parenchyma and small airway with immunologic reactions. Over the last decades, the most effective therapeutic option for HP has been limited to antigen avoidance. The differential diagnosis of HP from other ILDs is the beginning of treatment as well as diagnosis. However, the presence of several overlapping clinical and radiologic features makes differentiating HP from other ILDs particularly challenging. In 2020, a multidisciplinary committee of experts from the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax suggested a new clinical practice guideline classifying HP into nonfibrotic and fibrotic phenotypes on the basis of chest high-resolution CT (HRCT) findings. Therefore, we introduced a new diagnostic algorithm based on chest HRCT in the clinical practice guideline for the diagnosis of HP.

• Journal of the Korean Society of Radiology
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• v.83 no.6
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• pp.1385-1393
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• 2022

Metaplastic carcinoma of the breast is a heterogeneous group of neoplasms with mixed epithelial and mesenchymal differentiation. Metaplastic carcinoma of the breast is a rare and aggressive malignancy, with high recurrence and metastasis. Metaplastic carcinoma with chondroid differentiation is an uncommon subtype that tends to have a relatively good prognosis than that of other subtypes. We report the imaging features of three cases of pathologically proven metaplastic carcinoma with chondroid differentiation as follows: a high-density mass with amorphous or coarse heterogeneous calcifications on mammography; a microlobulated or partially indistinct, complex cystic, and solid mass on sonography; and a relatively circumscribed or partially indistinct, irregular mass with heterogeneous T2 high-signal intensity and heterogeneous or rim enhancement with initial fast enhancement and delayed washout on MRI.

• Journal of the Korean Society of Radiology
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• v.82 no.5
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• pp.1186-1195
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• 2021

Purpose In the adult emergency department of a university hospital, we investigated the frequency of major discrepancies between the preliminary reports by radiology residents and the final reports by certified radiologists. Materials and Methods Based on CT and MRI scans obtained between December 2016 and November 2019, we selected cases with diagnoses or treatment plans that could be changed due to discrepancies between preliminary and final reports and classified them by the type of discrepancy. We also examined the distributions of the major discrepancies and stratified them by residents' working time zone, experience, and subspecialty. Results Based on the 72137 preliminary reports evaluated, 1348 tests (1.9%) showed major discrepancies. Most of the major discrepancies were false negatives (72.0%), followed by misdiagnosis (26.3%) and false positives (1.7%). Acute findings (87.2%) were more common than non-acute findings (12.8%). The major discrepancy rate increased toward the second half of the 24-hour shift, with the highest rate of 2.9% occurring between 2 am and 4 am. The major discrepancy rate did not vary with experience, and it varied from 0.6% to 4.5% for each subspecialty. Conclusion The major discrepancy rate was less than 2%, and it increased with longer working hours during a 24-hour shift.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1191-1196
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• 2023

Bronchial artery aneurysm (BAA) is a rare disease, and multiple aneurysms of a single bronchial artery are rarer. Regardless of the size of the lesion, it is at risk of rupture and can cause massive hemoptysis or severe pain. We report a rare case of bronchial artery embolization (BAE) of multiple aneurysms of a single bronchial artery. During medical examination, a 64-year-old female was diagnosed with multiple BAAs and endobronchial lesions in the right lower lung on CT 10 years prior to presentation to our hospital. Further evaluation of the lesions was recommended; however, the patient was lost to follow-up. The patient complained of dyspnea and visited our hospital, and the size of the BAA had increased on CT. BAE was done successfully using N-butyl-2-cyanoacrylate and detachable coils. Follow up CT after BAE showed significant decrease in extent of inflammatory lesion in the right lung.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1158-1162
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• 2023

Ortner's or cardiovocal syndrome is hoarseness attributable to left recurrent laryngeal nerve (RLN) palsy associated with mechanical compression of the nerve by pathologically enlarged cardiovascular structures. Ortner's syndrome is a rare condition, and to our knowledge, only a few cases have been reported in Korea. Furthermore, this condition is extremely uncommon in pediatric patients with thyrotoxicosis-related RLN paralysis. We report a case of reversible Ortner's syndrome in an adolescent who presented with secondary pulmonary hypertension related to thyrotoxicosis.

• Journal of the Korean Society of Radiology
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• v.85 no.3
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• pp.654-660
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• 2024

Primary malignant fibrous histiocytoma (MFH) is a malignant tumor of mesenchymal origin that rarely occurs in the urinary tract, particularly in the urinary bladder. Unlike urothelial carcinoma, which accounts for most bladder cancers, it occurs in the submucosal portion of the bladder wall and consists of the lamina propria, muscularis propria, and adventitia. It is presumed to originate from poorly differentiated pluripotent mesenchymal cells in which fibroblasts and histiocytes are partially differentiated. Radiologically, it is known as the "non-papillary tumor" and is commonly diagnosed as a large mass without necrosis, which shows invasion beyond the muscularis propia. Although the prognosis of this rare malignancy depends on pathological parameters, it generally has a poor prognosis with high local tumor recurrence. Here, we present a case of primary MFH in the urinary bladder with clinical symptoms of lower abdominal pain without gross hematuria that recurred rapidly and showed an aggressive disease course.

• Journal of the Korean Society of Radiology
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• v.85 no.2
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• pp.394-408
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• 2024

Purpose To develop models to predict programmed death ligand 1 (PD-L1) expression in pulmonary squamous cell carcinoma (SCC) using CT. Materials and Methods A total of 97 patients diagnosed with SCC who underwent PD-L1 expression assay were included in this study. We performed a CT analysis of the tumors using pretreatment CT images. Multiple logistic regression models were constructed to predict PD-L1 positivity in the total patient group and in the 40 advanced-stage (≥ stage IIIB) patients. The area under the receiver operating characteristic curve (AUC) was calculated for each model. Results For the total patient group, the AUC of the 'total significant features model' (tumor stage, tumor size, pleural nodularity, and lung metastasis) was 0.652, and that of the 'selected feature model' (pleural nodularity) was 0.556. For advanced-stage patients, the AUC of the 'selected feature model' (tumor size, pleural nodularity, pulmonary oligometastases, and absence of interstitial lung disease) was 0.897. Among these factors, pleural nodularity and pulmonary oligometastases had the highest odds ratios (8.78 and 16.35, respectively). Conclusion Our model could predict PD-L1 expression in patients with lung SCC, and pleural nodularity and pulmonary oligometastases were notable predictive CT features of PD-L1.

• Herbal Formula Science
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• v.29 no.4
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• pp.321-329
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• 2021

This case study reports the effects of complex Korean medicine treatment, including Nangan-jeon, on Lambert-Eaton myasthenic syndrome (LEMS) accompanied by chronic constipation and abdominal pain as the main symptoms. A 39-year-old woman diagnosed with LEMS with major symptoms, including chronic constipation and acute abdominal pain, received Western treatment. The treatment efficacy was weak and symptoms recurred, so the patient received outpatient treatment and 13 days of hospitalization for active Korean medicine treatment, including Nangan-jeon. During outpatient treatment and hospitalization, defecation frequency and the numeric rating scale (NRS) for abdominal pain and abdominal cold feeling were measured. The NRS for abdominal pain and cold decreased from 8 at admission to 3 and 0, respectively, at discharge. Defecation frequency increased significantly from once or twice a month to once every 2-3 days during hospitalization. This study results that complex Korean medicine treatment, including Nangan-jeon may be useful for treating patients who mainly complain of autonomic neurological symptoms, among patients diagnosed with LEMS. In addition, it is believed that it could be basic data applicable to more LEMS patient treatment cases.