• 대한두개안면성형외과학회지
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• 제21권1호
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• pp.53-57
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• 2020

A mucocele is an epithelium-lined, mucus-filled cavity in the paranasal sinuses. Mucocele may develop due to scarring and obstruction of the sinus ostium caused by midface sinus trauma, such as orbital bone fracture or endoscopic sinus surgery. The authors report two cases of orbital mucocele as complications following midface sinus injury (endoscopic sinus surgery in one case, and orbital fracture repair in the other). In both cases, imaging studies showed a large orbital mucocele accompanied by bony erosion and orbital wall remodeling, compressing the ocular muscle. Using an open approach, the lesion was excised and marsupialized. The symptoms resolved, and the postoperative eyeball position was normal. Orbital mucocele may cause serious complications such as ocular symptoms, orbital cellulitis, osteomyelitis, and the formation of an abscess with the potential to invade the brain. Therefore, surgeons should consider the possibility of mucocele as a late complication of surgery and initiate an immediate work-up and surgical treatment if needed.

• Journal of Korean Neurosurgical Society
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• 제47권4호
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• pp.295-297
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• 2010

Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.

• The Korean Journal of Pain
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• 제19권2호
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• pp.278-281
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• 2006

The diagnosis of pyomyositis in the pelvic region is difficult, as its incidence is relatively, with symptoms that mimic those of discogenic pain. Sciatica is a common presentation of a prolapsed lumbar disc. Less common causes, such as spinal stenosis, pelvic tumors or even primary nerve tumors can also cause these symptoms. Magnetic resonance imaging (MRI) is a useful diagnostic tool. Herein, the case of a patient with an acute pyogenic infection in the iliopsoas muscle, presenting with sciatica, is reported. This is a rare infective disease, which if promptly treated with intravenous antibiotics, can be completely resolved; otherwise, it can result in deep abscess formation, sepsis and death.

• Investigative Magnetic Resonance Imaging
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• 제23권3호
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• pp.276-278
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• 2019

The cisterna chyli, a dilated lymphatic sac in the retrocrural space, is usually located to the right of the aorta. We report a case of a left-sided cisterna chyli, which was incidentally detected on the radiologic examinations of a preoperative workup for cholangiocarcinoma. Computed tomography (CT) and magnetic resonance (MR) images revealed a cisterna chyli measuring 2.5 cm in length in the left retrocrural space. The dilated lumbar lymphatics joined with the cisterna chyli, which was continuous with the left-sided thoracic duct. To the best of our knowledge, this is the second antemortem case of a left-sided cisterna chyli in literature. The cisterna chyli can mimic retrocrural lymphadenopathy, solid tumor with cystic degeneration, abscess or hematoma. The left-sided cisterna chyli should be referred to as a structure so as to be cautious in surgical approach.

• 대한두경부종양학회지
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• 제39권1호
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• pp.27-31
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• 2023

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a rare immunological small vessel disease which usually affects respiratory tract and kidneys. However, salivary gland involvement in GPA is rare as a primary manifestation. We report a case of GPA with the primary presentation of submandibular gland involvement. A 48-year-old female patient presented submandibular swelling with a skin defect that lasted for 1 month. Although the biopsy result was chronic inflammation, the skin defect did not heal for a month. Further imaging study revealed multiple lung and renal masses. More clinical manifestations such as gingivitis, ischemic change of finger joint and nasal tip skin, and positive c-ANCA test was presented. Additional biopsy was made at the submandibular gland, lung, and finger skin. The patient was finally diagnosed with GPA and treated with steroid pulse therapy and cyclophosphamide. The patient showed improvement of prior clinical symptoms.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.488-491
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• 2023

Silicone breast implant insertion is a commonly performed surgical procedure for breast augmentation or reconstruction. Among various postoperative complications, infection is one of the main causes of patient readmission and may ultimately require explantation. We report a case of infective costochondritis after augmentation mammoplasty, which has rarely been reported and is therefore difficult to diagnose. A 36-year-old female visited the clinic for persistent redness, pain, and purulent discharge around the left anteromedial chest, even after breast implant explantation. Magnetic resonance imaging showed abscess formation encircling the left fourth rib and intracartilaginous and bone marrow signal alteration at the left body of the sternum and left fourth rib. En bloc resection of partial rib and adjacent sternum were done and biopsy results confirmed infective costochondritis. Ten months postoperatively, the patient underwent chest wall reconstruction with an artificial bone graft and acellular dermal matrix. As shown in this case, early and aggressive surgical debridement of the infected costal cartilage and sternum should be performed for infective costochondritis. Furthermore, delayed chest wall reconstruction could significantly contribute to the quality of life.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제50권2호
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• pp.110-115
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• 2024

A 22-year-old male patient presented to the clinic with severe pain in the preauricular area with an inability to completely occlude the jaw. Facial computed tomography and magnetic resonance imaging revealed a well-defined lesion that was tentatively diagnosed as a benign tumor or cystic mass. Surgical approach of a lesion in the condyle is delicate and problematic as many vulnerable anatomical structures are present. There are several methods for surgery in this area. Typically, an extraoral approach is dangerous because of potential injuries to nerves and arteries. The intraoral approach also presents difficulties due to the lack of visibility and accessibility. On occasion, coronoidectomy may be performed. The goal here was to determine an easier and safer new surgical approach to the condyle. We reached the anterior part of the pterygoid plate in the same method as in Le Fort I surgery. From this point, through the external pterygoid muscle, approaching the anterior aspect of the condyle is relatively easy and safe, with minimal damage to the surrounding tissues. Pus was drained at the site, and the lesion was diagnosed as an abscess. Pain and inability to close the mouth resolved without recurrence.

• Investigative Magnetic Resonance Imaging
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• 제15권1호
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• pp.22-31
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• 2011

목적: 이 연구의 목적은 간 병변 발견에 있어 1.5-T 자기공명영상에서 자유 호흡 확산강조 영상과 호흡 유발 확산강조 영상의 유용성을 비교하는데 있다. 대상 및 방법: 47명의 환자(평균 57.9세, 남성:여성 = 25:22)가 한번의 간 자기공명 영상검사에서 자유호흡 확산 강조 영상과 호흡유발 확산 강조 영상을 동시에 시행하였다. 이를 두 명의 영상의학과 의사가 호흡유발 이미지 세트(B50, B400, B800 확산강조 영상과 ADC map)와 자유호흡 이미지 세트를 2주간의 시간 간격을 두고 무작위로 후향적 분석을 시행하였다. 영상분석을 위하여 특정영역(ROI)를 설정한 후에 간의 신호대 잡음비 (signal-to-noise ratio, SNR)와 대조도(contrast-to-noise ratio, CNR)를 계산하였다. 결과: 32개의 낭종, 13개의 혈관종, 7개의 간세포암, 6국소 호산구성 간질환, 2개의 전이, 1개의 초점성 결절성 과증식과 글리슨막의 가성지방종을 포함하는 총 62개의 병변이 두 명의 평가자에 의하여 분석되었다. 비록 통계적 유의성을 없었으나, 전체적인 병변 발견의 sensitivity는 호흡유발 확산강조 영상이 [평가자 1:평가자 2, 47/62(75.81%):45/62(72.58%)] 자유호흡 확산강조 영상보다 [44/62(70.97%):41/62(66.13%)] 더 높은 수치를 보였다. 특히 1 cm보다 작은 국소 간 병변 발견의 sensitivity는 호흡유발 확산강조 영상이 [24/30(80%): 21/30(70%)] 지유호흡 확산강조 영상보다 [17/30(56.7%):15/30(50%)] 더 우월하였다. 진단적 정확도활 계산하기 위하여 ROC curve (Az value)를 구하였으며 자유호흡 확산강조 영상과 호흡유발 확산강조 영상간에는 통계적 차이는 없었다. 간의 신호대 잡음비 (SNR)와 대조도 (CNR)는 호흡유발 확산강조 영상이 ($87.6{\pm}41.4$, $41.2{\pm}62.5$) 자유호흡확산강조 영상보다 ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) 높았으며 통계적인 유의성이 있었다. (p value < 0.001). 결론: 1.5-T자기공명 시스템서 1 cm보다 작은 간 병변발견에 있어서 호흡유발 확산강조 영상이 자유호흡 확산강조 영상보다 좋으며 이는 호흡유발 확산강조 영상이 높은 신호대 잡음비 (SNR)와 대조도(CNR)를 보이기 때문이다.

• Journal of Korean Neurosurgical Society
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• 제60권4호
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• pp.448-455
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• 2017

Objective : To investigate the magnetic resonance imaging (MRI) findings and the patterns of postoperative spinal infection according to the passage of time. Methods : Institutional review board approval was obtained, and informed consent was not obtained for the retrospective review of patients' medical records. A total of 43 patients (27 men and 16 women; mean age, 64) diagnosed with postoperative spinal infection were included in this study. We retrospectively reviewed the MRI findings and the medical records and categorized the infection sites based on MRI, i.e., anterior, posterior, and both parts. The duration of the clinical onset from surgery was divided, i.e., acute (${\leq}2weeks$), subacute (2-4 weeks), and late (>4 weeks). Results : Postoperative spinal infection was involved in the posterior part in 31 (72%), anterior part in two (4.7%), and both parts in 10 patients (23.3%). Abscess or phlegmon in the back muscles and laminectomy site were the most common MRI findings. The number of patients with acute, subacute, and late clinical onset were 35, two, and six, respectively (mean, 33.4 days; range, 1-730 days). The mean duration of the clinical onset was 12 days in the posterior part, 15.2 days in both parts, and 456.5 days in the anterior part. Conclusion : Postoperative spinal infection usually occurred within four weeks in the posterior part and over time the infection was considered to spread into the anterior part. For the evaluation of postoperative spinal infection, the posterior surgical field was more important than the vertebral body or the disc space on MRI.

• Tuberculosis and Respiratory Diseases
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• 제70권4호
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• pp.347-351
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• 2011

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.