Small pulmonary carcinoma in inflated and fixed lung

We reported two cases of peripheral adenocarcinoma about 10mm in diameter. High resolution. thin-slice CT images were reviewed in comparison with pathologic findings. The margins of both lesions were ill-defined, and corresponded to superficial tumor replacement of alveolar cells without collapse. In one case, the pulmonary vein was viewed as going toward the central portion of the mass on CT, which suggested the possibility of malignacy because such a finding is different from the pattern of centrilobular inflammation. In the other case, airbronchograms of bronchioles and alveolar ducts on CT suggested the possidility of malignancy instead of ordinary inflammatory changes. These radiological findings corresponded to radiograms of specimens and pathologic findings.Inflated and fixed lung were useful for diagnosis by radiological imaging, including CT

Pulmonary artery in the region supplied by daughter branches

The branching pattern of the pulmonary artery was examined in the autopsied right lung of a 76-year-male, (inflated and fixed lung), in the regions supplied by daughter branches. Ordinarily, the pulmonary arteries are accompanied by the bronchi, but not necessarily by the daughter bronchi. There were two types of branching patterns of the pulmonary artery in the regions be occupied by daughter branches. In one, the pulmonary artery was not accompanied by the daughter bronchi at the beginning of the branch, but was accompanied by the daughter branch in peripheral regions. In the other, some branches of pulmonary artery distributed to the hilar region from neighbouring daughter branch areas. It is very important to consider daughter branches of the pulmonary artery as well as the inherent structure of the lung

Differential diagnosis between a case of AVM and a case of cerebral infarction by IMP SPECT

Two patients who were suspected of having arteriovenous malformation(AVM) by plain and contrast enhancement cranial CT were examined by brain SPECT with I-123-IMP. One case, which showed defects on early and delayed images, was diagnosed as AVM. The other was diagnosed as cerebral infarction with luxury perfusion, based on the finding of hyperperfusion on two images. The final diagnoses of these two patients were confirmed by angiography and/or operation. We considered brain SPECT with I-123-IMP to be very useful for the differentiation between AVM and cerebral infarction with luxury perfusion, which was suspected of being AVM by cranial contrast enhancement CT

Radiological diagnosis and treatment of afferent loop obstruction

Four cases of afferent loop obtruction were reported. Billroth II reconstruction was performed in two patients and Roux-Y reconstruction was performed in the other two patients after gastrectomy. Three of four patients complained of jaundice. CT and ultrasonography showed a dumbell-shaped cystic mass anterior to the abdominal aorta on the transverse image, and a cystic mass between the superior mesenteric vessels and the abdominal aorta on saggital view. These patients were not surgical candidates because of their poor condition. We performed the drainage of the afferent loop via a percutaneus transhepatic biliary catheter as a palliative treatment. In one case the serum bilirubin and amylase level decreased to normal range and the patient survived for 80 days. The other two patients died on the 12th and 28th day after the procedure. One patient is currently alive 20 days after the drainage procedure with improvement of clinical symptoms, serum bilirubin and amylase levels

CT evaluation of vascular invasion in pancreatic carcinoma

A new method of factor analysis has been devised as a dynamic study in nuclear medicine. Instead of whole sequence factor analysis of images, partially-sequenced images of Kr-81m pulmonary ventilation scintigrams, acquired with respiratory-gated signals, were analysed using this method. Incrementing the first and last frame number of the image sequence, the motion of the factor images, was obtained including diaphragmatic images, thoracic images and physiological pathological dead space, during one respiratory cycle. The varying form of the correlation between two factor images over time provided a distinguishable pattern of patients with pathological conditions such as chronic obstructive pulmonary disese from normal subjects

The BHL and multiple nodular shadows with well-defined margin in a case of sarcoidosis

In a recent study, radiologic and pathologic examination of inflated and fixed lung specimens proved useful in the diagnosis of diffuse pulmonary diseases. In general, the margin of the nodular shadow is believed to be ill-defined in cases of sarcoidosis. Our patient was 47-year-old man, who has worked as a stone miner for 16 years. Chest radiography and CT revealed BHL and multiple nodular shadows with well-defined margins throughout the lung field. Those shadows were less than 1cm in diameter. TBLB showed epithelioid granulomas around the double refractile crystals. The finding suggests that the formation of epithelioid cell granuloma is related to silicate particles

Septal lines in pulmonary alveolar microlithiasis with typical Kerley's lines

A 64-year-old woman without any respiratory symptoms was diagnosed as having pulmonary alveolar microlithiasis from the characteristic finding of her chest radiograms. Diffuse fine nodular shadows of microliths were seen throughout both lungs. Linear shadows, which were considered to be typical Kerley's lines (A, B, and C), were also noted. Conventional tomography and high resolution, thin-slice CT disclosed the anatomical structures and the distribution of interlobular septa in vivo, which were responsible for Kerley's lines. Lateral chest radiograms revealed oblique short linear shadows just behind the sternum, which were caused by interlobular septa at the mediastinal side of the upper lung. These shadows seemed to represent new septal lines

A case of primary thoracic hemangiopericytoma: correlation between Ga-67 scintigraphic and pathological findings

A 27-year-old male was admitted to our hospital with the chief complaint of dyspnea. Radiologically, he was found to have a large tumor shadow in the left hemithorax with pleural effusion. The first thoracotomy was done to resect the tumor on January 14, 1988. The second and third thoracotomies were done because of local recurrence in the left hemithorax. Histological diagnosis was of a hmangio-pericytoma. Before the third operation, Ga-67 scintigraphy was performed. Ga-67 accumulation was noted in parts of the tumor mass. Histological findings of the resected tumor were compared with the degree and location of Ga-67 accumulation. Histologically, Ga-67 accumulation occurred in areas of bleeding and necrosis in the tumor tissue, but not in viable parts of the tumor. Ga-67 accumulation usually occurs in viable tumor cells, but our findings were contrary to this generality

A case of benign localized pleural mesothelioma

A case of benign localized pleural mesothelioma is reported. The patient was a 30-year-old female with no complaint. The mesothelioma was detected by routine chest radiography. The chest radiogram on admission revealed a mass located in the right middle-lower lung field adjacent to the lateral chest wall. Physical and laboratory examinations did not show any abnormality. Ultrasonography demonstarated a homogeneous mass between the chest wall and the lung. CT examination revealed a soft tissue mass adjacent to the chest wall having an extrapulmonary sign. A percutaneous needle biopsy was done. These examinations suggested that the mass was a slow growing pleural tumor. The patient underwent tumorectomy with partial resection of the right lung. The tumor was solid and approximately 4cm in diameter and 1.5cm in thickness. It arose from the visceral pleura and was pendunculated. The histological diagnosis was of a benign localized fibrous mesothelioma of the pleura