복부 둔산에 의한 장관 파열 위치 진단을 위한 CT 소견

연재우 대한영상의학회 1996 대한영상의학회지 Vol.35 No.4

Purpose : We evaluated the CT criteria useful for the diagnosis of the site of bowel perforation in patientswith this or mesenteric injury caused by blunt abdominal trauma. Materials and Methods : CT findings of 26patients with blunt abdominal trauma were retrospectively analyzed by two observers who were unaware of operativefindings, and the results of their analysis were compared with those findings. Twenty cases of bowel perforationfound at the jejunum (8), ileum (9), and colon (3), and six cases of mesenteric injuries were confirmed byoperation. We evaluated CT findings of 1) segmental bowel wall thickening, b) focal mesenteric fat infiltration, c) loculated fluid collection and d) extraluminal air adjacent to the bowel, and in addition analyzed thelocations of ascites and free air, and the associated injuries of solid organs. Results : The most common findingat the site of bowel perforation was segmental bowel wall thickening (17 cases), followed by focal mesenteric fatinfiltration (12 cases), loculated fluid (12 cases) and extraluminal air ajacent to the bowel (9 cases). Segmentalbowel wall thickening was present at 34 sites, and the perforations were confirmed at 17 of these(50%). Focalmesenteric fat infiltration was present at 19 sites ; the perforations were proven at 12(63%). Loculated fluidcollections were confirmed at 12/20 sites(60%), and extraluminal air adjacent to the bowel at 9/12(75%). Thepositive predictive value of criteria a, b, d, c) was 100%, and the positive predictive values of a, b, c) and a, d) were 60 and 67%, respectively. We observed ascites in 16 cases and intraperitoneal free air in 8 cases, thelocations of ascites and free air did not, however, significantly correlate with the perforation sites. Conclusion: Extraluminal air adjacent to the bowel was the most specific criterion, and segmental bowel wall thickening wasthe most sensitive criterion. of all criteria, the finding ‘a, b, c, d’ most accurately predicted the site ofbowel perforation.

속립성 폐결핵 환자에서 단순흉부촬영영상 결절들의 연속 변화

연재우 대한영상의학회 1998 대한영상의학회지 Vol.38 No.6

Purpose : To evaluate sequential changes in miliary nodules, as seen on chest radiographs in patients withmiliary tuberculosis. Materials and methods : We retrospectively analyzed sequential changes in miliary nodules,as seen on the chest radiographs of 13 patients with miliary tuberculosis who recovered completely ofterantituberculous medication. Two were children and 11 were adults, and their ages ranged from 2 monts to 73years(mean, 38 years). In cases in which miliary tuberculosis had been diagnosed from initial chest radiographs,follow-up chest radiographs were obtained 5 to 15(mean, 10) months later. After complete resolution of miliarynodules, as seen on chest radiographs, high-resolution CT scanning was performed in three patients. Results : Asseen on follow-up chest radiographs obtained at one week, the number and size of miliary nodules had decreased ineight of nine patients (89%), and on those obtained at one month, these decreases were seen in all 13 patients.The mean duration of complete resolution of miliary nodules was 6.3 months ; in children, this was 3.5(range, 2-5)months, and in adults, 6.8 (range, 3-10) months. In all three patients involed, high-resolution CT scans obtainedafter complete radiographic resolution of miliary nodules showed no recurrence. Conclusion : In patients withmiliary tuberculosis, the size and number of nodules had decreased within one month of adequate chemotherapy andon chest radiographs, complete resolution was seen at 6.3 months, on average.

Transcatheter Removal of Bone Cement Embolism in the Right Atrium after Percutaneous Vertebroplasty: The Embolus Broke in Half and Migrated to the Right Pulmonary Artery Intraoperatively

이선향,연재우,권진태,김혁중,장석기 대한영상의학회 2021 대한영상의학회지 Vol.82 No.4

Bone cement embolism often occurs during percutaneous vertebroplasty. Bone cement pulmonary arterial embolism generally requires no treatment because of the small size and asymptomatic manifestation. Intracardiac bone cement embolisms are rare but associated with a risk of severe complications. Intracardiac bone cement embolisms are mainly removed through open heart surgery. To the best of our knowledge, only three cases of intracardiac bone cement embolisms removed with interventions have been reported. Here, we report another case of successful transcatheter retrieval of a 6-cm-long cement embolism in the right atrium after percutaneous vertebroplasty. The embolus broke in half and migrated to the right pulmonary artery intraoperatively. Using two snares and a filter retrieval device, we advanced from opposite directions. Further, we gently grasped and pulled the fragments of the right pulmonary artery and aligned them in a linear fashion directly into the sheath for uneventful removal.

장간막의 원발성 악성 섬유성조직구종: 증례 보고

박종헌,연재우,한은미,장석기,강수민,안인옥 대한영상의학회 2007 대한영상의학회지 Vol.57 No.6

A malignant fibrous histiocytoma of the mesentery is rare, and multifocal involvement as a primary tumor is very rare. In this report, a case of malignant fibrous histiocytoma of the mesentery presenting with two masses and multiple peritoneal seeding in a 48-year-old man is described. A physical examination revealed a large, firm, and non-tender mass in the right lower abdomen of the patient. Computed tomography of the lesion revealed a partially, indistinctly marginated and heterogeneously enhancing mass with irregular peritumoral strands in the mesentery of the right lower abdomen, while sonograms of the lesion revealed an ill-defined low-echoic mass. The final pathology demonstrated the presence of a storiform-pleomorphic malignant fibrous histiocytoma. 장간막에 생기는 악성 섬유성조직구종은 드문 원발성 종양이며 다발성으로 생기는 경우는 매우 드물다. 저자들은 최근 발생한 우하복부에 만져지는 종괴를 주소로 내원한 48세 남자 환자에서 장간막에 발생한 두개의 커다란 종괴와 복막 암종증이 동반된 1예를 경험하였기에 초음파, 컴퓨터단층촬영 및 조직 병리소견을 함께 보고하고자 한다. 이 종괴는 초음파에서 경계가 불분명한 저에코로 보였고 컴퓨터단층촬영에서는 부분적으로 경계가 불분명한 불균한 조영증강을 보였으며 주변으로 불규칙한 선상 구조물들이 있었다. 최종 병리 진단은 장간막에서 발생한 다형성 악성 섬유성조직구종이었다.

Hepatic pseudolymphoma mimicking hypervascular tumor: A case report

임보라,연재우,김혁중,장석기,백소야,박상종 대한영상의학회 2018 대한영상의학회지 Vol.79 No.6

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-years-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor (NET), CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging (DWI), the hepatic nodule showed a high signal intensity on a high b-value. On FDG PET/CT, we revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

Primary Hepatic Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

곽경수,장석기,연재우,백소야,박상종,김혁중 대한영상의학회 2016 대한영상의학회지 Vol.74 No.3

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare lesion. Primary hepatic lymphomas are known to present as a single mass in > 70% of cases, and in many instances with no specific features on imaging. Herein, we described a case of primary hepatic MALT lymphoma in a 71-year-old woman. A computed tomography (CT) scan revealed a mass, 4.5 × 3.0 cm, in liver segment 2 (S2) that was poorly defined, with subtle enhancement during the arterial phase. Gadoxetic acid-enhanced magnetic resonance imaging also showed an arterially enhancing mass in S2, with low signal intensity during the hepatobiliary phase and high signal intensity on diffusion-weighted imaging with a high b-value. On fluorodeoxyglucose positron emission tomography/CT imaging, the mass showed a high standardized uptake value. Ultrasonography (US) revealed a hypoechoic mass, and US-guided core needle biopsy confirmed a hepatic MALT lymphoma.

Primary Diffuse Large B-Cell Lymphoma of the Seminal Vesicle: a Case Report

곽경수,장석기,연재우,권계원,손정환,김혁중 대한자기공명의과학회 2016 Investigative Magnetic Resonance Imaging Vol.20 No.4

Primary diffuse large B-cell lymphoma of the seminal vesicle is an extremely rare disorder, with only two cases reported in the English literature. Here, we present imaging findings of a case of primary diffuse large B-cell lymphoma of the seminal vesicle. On transrectal ultrasonography, the mass presented as a 3.0-cm-sized heterogeneous, hypoechoic lesion in the right seminal vesicle. Computed tomography (CT) revealed a mass with rim-like enhancement in the right seminal vesicle. On magnetic resonance imaging (MRI), the tumor showed iso-signal intensity on T1-weighted images and heterogeneously intermediate-high signal intensity on T2-weighted images. The tumor showed rim-like and progressive enhancement with nonenhancing portion on dynamic scanning. Diffusion restriction was observed in the mass. On fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) imaging, a high standardized uptake value (maxSUV, 23.5) by the tumor was noted exclusively in the right seminal vesicle.

관해상태의 간문맥혈전증 동반 간세포암 환자에서 간좌엽절제술 후 PIVKA-II가 호전된사례

장정문,박상종,유양재,김세화,연재우,이수호 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

The Surgical Rate and Recurrence Rate in Right Colonic Diverticulitis Using the CT-Based Modified Hinchey Classification

김동환,김혁중,장석기,연재우,고유선,이경호 대한영상의학회 2015 대한영상의학회지 Vol.73 No.2

Purpose: The purpose of this report is to retrospectively analyze the need for surgery, and the recurrence rate, using a CT-based method in patients with right colonic diverticulitis. Materials and Methods: For the purposes of our study, we included 416 patients with a mean age of 41.9 (238 of which were men), with a diagnosis of colonic diverticulitis that was based on CT findings. These findings were reviewed by two independent radiologists, who localized diverticulitis and determined it using a modified Hinchey classification. We were able to follow-up with 384 patients over a period of 30 months. Results: Out of the 416 patients, 396 of them had right colonic diverticulitis. In right colonic diverticulitis, the κ value in determining the modified Hinchey classification was 0.80. 98.2% (389/396) of the patients with right colonic diverticulitis had stages Ia–II. The surgery rate was 4.6% (17/366) and 28% (5/18) for right and left colonic diverticulitis, respectively (p < 0.001). In the instances of right colonic diverticulitis, the surgery rate was 2.8% (10/359) for stages Ia–II, while all seven patients with stage III or IV underwent surgery. The recurrence rate was 6.5% (23/356) and 15% (2/13) for right and left colonic diverticulitis, respectively (p = 0.224). Conclusion: The CT-based modified Hinchey classification of right colonic diverticulitis showed good interobserver agreement. Most patients with right colonic diverticulitis had lower stages (Ia–II) at the point of CT, rarely needed surgery, and had a low recurrence rate.

만성B형 간염 환자에서 발생한 A형 간염에 의한 다발성 장기부전 1예

윤한결,김나영,김자선,이기종,연재우,백소야,박영민 대한내과학회 2011 대한내과학회지 Vol.80 No.-

Hepatitis A virus is a major cause of viral hepatitis worldwide. The prevalence of hepatitis A in young adults has recently been increasing in Korea. Hepatitis A infection rarely complicates fulminant hepatitis, acute pancreatitis, and acute renal failure. We experienced a case of multiple organ failure involving fulminant hepatitis, acute pancreatitis, and acute renal failure complicating a hepatitis A superinfection in a chronic hepatitis B patient. The patient was a 38yearold man who presented with febrile sense and myalgia. He was initially alert, but became confused and developed acute renal failure and acute pancreatitis. He received continuous renal replacement therapy and conservative treatment and completely recovered from the multiple organ failure. It is important to consider a variety of potential complications in hepatitis A patients, especially in those with underlying chronic liver disease. (Korean J Med 2011;80:S111-S116) A형 간염 바이러스는 세계적으로 바이러스성 간염의 주요한 원인이다. 최근 우리나라에서는 젊은 성인에서의 A형 간염이 증가하고 있다. A형 간염은 드물게 전격성 간염, 급성 췌장염, 급성 신부전을 일으킨다. 저자들은 만성 B형 간염 환자가 A형 간염 바이러스 중복감염에 의해 전격성 간염, 급성 췌장염, 급성 신부전의 다발성 장기 부전을 보인 증례를 경험하였다. 38세 남자 환자가 열감, 근육통이 있어 내원하였다. 초기에 의식이 명료하였으나 의식이 혼탁해지고 급성 신부전, 급성 췌장염이 발생하였다. 환자는 지속적 신대체 요법과 보존적 치료를 받았으며, 다발성 장기 부전에서 완전히 호전되었다. 특히 기저 간 질환이 있는 환자에서 A형 간염의 여러 합병증에 대한 주의를 기울여야 할 것으로 생각된다.