Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

강웅래,김영환,김시형,안은정,이영환 대한영상의학회 2012 대한영상의학회지 Vol.66 No.3

Purpose: To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD). Materials and Methods: Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures. Results: Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up. Conclusion: Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases

강웅래,김영환,이영환 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.3

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair

김윤수,강웅래,김영환 대한영상의학회 2021 대한영상의학회지 Vol.82 No.2

Purpose To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). Materials and Methods From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher’s exact test. Results Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0- 10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson’s chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher’s exact test). No fibrous changes in the lesions were observed on follow-up CT scans. Conclusion The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

Endovascular Exclusion of Hepatic Artery Pseudoaneurysm after Living-Donor Liver Transplantation with a Stent-Graft Using Conical Remodeling: A Case Report

백승대,강웅래,김영환 대한영상의학회 2019 대한영상의학회지 Vol.80 No.3

Hepatic artery complications after liver transplantation include hepatic artery thrombosis, stenosis, pseudoaneurysm (PA), and others. Among these complications, hepatic artery PA is reported to have a low incidence, but it is associated with a devastating and often fatal outcome and a high risk of rupture. Herein, we present the case of a 56-year-old male patient who underwent living-donor liver transplantation because of alcoholic liver cirrhosis. A silent PA of the hepatic artery proper was detected incidentally on computed tomography scan during routine follow-up 15 days after surgery, and was successfully excluded by implantation of a coronary balloon-expandable stent-graft using ‘conical remodeling’ by two-step ballooning. This technique can be effectively used for PA of visceral arteries with tapering-small diameter, in which flow preservation is critical to patient care.

속발성 분만 후 출혈의 임상 및 혈관 조영술의 특징과경도관 동맥 색전술의 결과

백승대,강웅래,지승우,김영환,차중근 대한영상의학회 2018 대한영상의학회지 Vol.79 No.6

Purpose: To analyze of clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage. Materials and Methods: Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center. Results: Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (P<.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n=7), and microcoil (n=7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months. Conclusion: Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered. 목적: 속발성 분만 후 출혈 환자에서 임상 양상 및 혈관 조영술의 특징과 경도관 동맥 색전술의 결과를 알아보고자 하였다. 대상과 방법: 속발성 분만 후 출혈로 인해 단일 3차 의료기관에서 동맥 색전술을 시행한 38명의 환자를 대상으로 분만 방식, 출혈 원인, 임상 증상, 혈관 조영술 소견, 색전 물질과 방법, 결과 등에 대하여 후향적으로 분석하였다. 결과: 20명(53%)의 환자가 제왕절개를 시행하였으며, 출혈 원인은 의인성 혈관 손상(n=11), 잔류 태반(n=10), 자궁근 무력증(n=8), 후천성 자궁 동정맥 기형(n=5) 등 이었다. 간헐적(50%) 및 지속적(50%) 대량 질출혈이 임상적으로 관찰되었다. 7명(18%)의 환자에서 내원 시 저혈량 쇼크를 보였다. 혈관 조영술 상 18명이 양성 소견을 보였으며, 제왕절개 후 가성동맥류 빈도가 통계학적으로 의미 있게 높았다(P<0.001). 젤폼 이외에 N-butyl cyanoacrylate(7예), 미세코일(7예)을 사용하였다. 출혈 부위 초선택이 가능하였던10명의 환자(26.3%)에서는 단측 혈관 선택 색전술만으로 지혈이 성공적이었다. 기술적 성공률은 100%였으며, 임상적 성공률은 97.4%이였다. 추적 관찰이 가능했던 16명에서 정상 월경 주기를 보였으며, 1예의 정상 임신이 관찰되었다. 결론: 속발성 분만 후 출혈은 저혈량 쇼크를 보일 수 있으며, 양성 출혈 소견을 보이는 빈도가 높았다. 따라서 조기 혈관 조영술과 동맥 색전술이 필요하리라 생각된다.

Transcatheter Arterial Embolization of Pancreatic Arteriovenous Malformation Presenting as Retroperitoneal Bleeding: A Case Report

지승우,강웅래,김영환 대한영상의학회 2016 대한영상의학회지 Vol.75 No.4

We report a case of pancreatic arteriovenous malformation presenting mesenteric and peripancreatic hemorrhages. A 62-year-old man presented to the emergency department of our hospital with acute periumbilical pain. Diffuse mesenteric and peripancreatic hemorrhages and an approximately 1 cm aneurysmal sac were observed on contrast-enhanced computed tomography. Celiac and superior mesenteric angiography revealed pancreatic arteriovenous malformation, which was then treated with transcatheter arterial embolization using n-butyl-2-cyanoacrylate. Complete obliteration of pancreatic arteriovenous malformation was evident on a follow-up computed tomography performed 2 months later.

Imaging Findings of a Primary Paraganglioma of the Liver: A Case Report

지승우,강웅래,박재복 대한영상의학회 2016 대한영상의학회지 Vol.75 No.5

Primary hepatic paraganglioma is an extremely rare type of tumor originating from extra-adrenal chromaffin cells. We report a case of primary intrahepatic paraganglioma in a 52-year-old man, with pathologic confirmation through right hepatectomy. An imaging study indicated a predominately hemorrhagic septated cystic mass and peripheral marked enhancement of the solid portions, which showed persistent enhancement.

Ultrasound and MRI Findings of Intraneural Capillary Hemangioma of the Median Nerve Mimicking Traumatic Neuroma: A Case Report

송한별,이영환,강웅래,이성문,채승범 대한영상의학회 2018 대한영상의학회지 Vol.78 No.2

Intraneural hemangioma of the median nerve is extremely rare. Only a few cases have been reported in literature. The researchers present ultrasound (US) and MRI findings of a case of 38-year-old-man with intraneural capillary hemangioma of the median nerve. The patient had a small, palpable mass in the volar aspect of the wrist and symptoms of carpal tunnel syndrome. US showed an infiltrative intraneural mass, without significant blood flow despite a compression test. The researchers initially misdiagnosed this mass as an in-continuity neuroma. The mass showed heterogeneous, but predominantly high signal intensity on T2-weighted image, as well as heterogeneous enhancement. The MRI findings were helpful for correct diagnosis on the retrospective review.

소낭성 동맥류 파열로 발현된 흉부 대동맥에서 기원한 미분화성 다형성 육종: 증례 보고

김도우,김영환,강웅래,조준우,장재석 대한영상의학회 2020 대한영상의학회지 Vol.81 No.5

Cases of undifferentiated pleomorphic sarcoma of the thoracic aorta are rare, and usually present with embolic events, renovascular hypertension, or back pain. Mural-based undifferentiated pleomorphic sarcomas that present as ruptured saccular aneurysms are extremely rare and are difficult to differentiate from mycotic aneurysms or penetrating atherosclerotic ulcers. Herein, we report a case of histopathologically proven undifferentiated pleomorphic sarcoma arising from the wall of the descending thoracic aorta that manifested as a mass after thoracic endovascular aortic repair for the treatment of a ruptured saccular aneurysm. We present findings obtained by CT and PET to provide helpful information for the accurate diagnosis and appropriate treatment of future cases. 흉부 대동맥 미분화성 다형성 육종은 매우 드문 질환으로 색전 사례, 신혈관성 고혈압, 등 통증 등의 증상을 보일 수 있다. 특히 대동맥 벽에서 기원하여 소낭 동맥류 파열로 보고된 경우는 극히 드물며 진균성 동맥류나 관통성 죽상경화 궤양과 감별이 어렵다. 이에 저자들은 소낭성 동맥류 파열로 혈관 내 흉부 대동맥 치료를 시행한 후 종괴가 발생하여 수술적 생검으로 확진된 미분화성 다형성 육종의 전산화단층촬영과 양전자방출단층촬영 소견을 보고하고자 하며 이를 통해 정확한 진단과 적절한 치료에 도움을 주고자 한다.

코일을 이용한 역행성 경정맥 폐색술에 의한 십이지장 정맥류 출혈의 성공적 치료: 증례 보고

박세진,김영환,강웅래,지승우 대한영상의학회 2020 대한영상의학회지 Vol.81 No.1

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration. 십이지장 정맥류는 간경화증에 의한 문맥압 고혈압 환자에서 발생할 수 있으며, 치명적인 심한 상부 위장관 출혈을 일으킬 수 있으나 아직까지 명확한 치료 지침이 정립되어 있지는 않다. 일차적으로 내시경으로 치료를 시도하고 지혈 실패 시 목정맥경유간속문맥전신순환연결술, 풍선 혹은 혈관 마개를 이용한 역행성 경정맥 폐색술, 피부간경유 폐색술 등과 같은 중재적 치료를 고려할 수 있다. 저자들은 내시경적 치료에 실패한 십이지장 정맥류 출혈 환자에게저하된 간 기능과 해부학적인 구조의 제한으로 인해 코일을 이용한 역행성 경정맥 폐색술을시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.