• 期刊
• OpenAccess

Jejunal Angiodysplasia: A Rare Cause of Gastrointestinal Bleeding

A 69-year-old male patient exhibited frequent episodes of melena and chronic anemia despite multiple blood transfusions. Esophagogastroduodenoscopy and colonoscopy yielded negative results. Contrast-enhanced multidetector computed tomography demonstrated no contrast extravasation in the bowel loop. Superior mesenteric angiography revealed jejunal angiodysplasia with active bleeding. An inadvertent iatrogenic injury at the jejunal branch caused active bleeding in the mesentery near the angiodysplasia. During emergency surgery, a 20 cm jejunal segment was resected using the mesenteric hematoma as a guide. The pathology report revealed angiodysplasia of the jejunum, with hemorrhage. The patient was discharged without complications 12 days after the surgery.

• 期刊
• OpenAccess

Radiation Dose Management in Clinical Interventional Radiology Procedures: A Retrospective Study from a Medical Center in Central Taiwan

PURPOSE. The Society of Interventional Radiology (part of the Cardiovascular and Interventional Radiology Society of Europe) recommends that institutions develop radiation dose management processes to minimize radiation risks in interventional radiology (IR) procedures. Our study aimed to establish a comprehensive radiation dose management system to enhance the quality of medical radiation exposure. MATERIALS AND METHOD. A Philips Allura Xper FD20 (Philips Healthcare, Best, Netherlands) and a Siemens Artis Q biplane (Siemens Healthcare, Erlangen, Germany) were used to perform IR procedures. Our radiation dose management system comprised an immediate notification mechanism and a dose documentation system based on the hospital information system. In particular, we used the reference dose to estimate the patient skin dose and set the dose threshold to alert and inform the radiologists and clinical physicians of the effect of the radiation on patients. We surveyed the range of doses for each IR procedure and the percentage of cases wherein the reference dose exceeded the threshold. Additionally, we analyzed the dose reductions for the IR procedures. RESULTS. We collected 1,465 procedures in 953 patients over 10 months. Among these, head and neck, visceral, pelvic, and extremity procedures could cause skin injuries. The percentage of cases with reference doses over 2 Gy was 1.6% (11/683) during March-July 2021. However, it decreased to 0.9% (7/782) after the application of the system. No skin injuries were observed. For the IR procedures at higher doses, either the mean value or the third quartile dose yielded 1%-40% dose reductions. CONCLUSION. Although radiation-induced tissue reactions are relatively rare, a comprehensive dose management system is beneficial for improving the quality of medical exposure.

• 期刊
• OpenAccess

Pulmonary Artery Intimal Sarcoma Mimicking Lung Cancer With Encasement of Pulmonary Vessels: A Case Report

Pulmonary artery intimal sarcoma (PAIS) is a rare malignant neoplasm with a poor prognosis. PAIS can cause cardiovascular complications and mimic pulmonary thromboembolism or pulmonary hypertension in clinical and radiographic findings. We report the case of a 33-year-old man with PAIS who exhibited a vessel encasement rather than a wall eclipsing sign on chest computed tomography.

• 期刊
• OpenAccess

Low-Grade Pain as a Useful Indicator of Successful Cannulation of Right Adrenal Vein

PURPOSE. Adrenal venous sampling (AVS) is technically challenging because it involves sampling the right adrenal vein (RAV). In our experience, RAV manipulation is often accompanied by mild right chest or flank pain. We assessed the value of low-grade pain as an indicator of successful cannulation of the RAV. MATERIALS AND METHOD. Between July 2018 and June 2019, we prospectively enrolled 63 patients with primary aldosteronism (PA) who underwent nonstimulated AVS at our hospital. A numerical rating scale was used to evaluate pain (range = 0-10) upon contrast media injection into the RAV, accessory hepatic vein, right capsular vein, left adrenal vein (LAV), and right femoral vein. RESULTS. The success rate of AVS was 100% (63/63), based on a selectivity index of ≥ 2 for both adrenal veins. The pain scores for the RAV, LAV, confounding veins (n = 30; 26 accessory hepatic and 4 right capsular veins), and peripheral vein were 1.8 ± 1.9, 0.1 ± 0.4, 0.1 ± 0.4, and 0, respectively. The pain score for the RAV was higher than those of the confounding veins (p = 0.001) and LAV (p < 0.001). Venography with pain information had higher sensitivity and accuracy (p < 0.001 for both) than venography alone in terms of the confirmation of the RAV by two separate readers, with a nonsignificant trend toward higher specificity (p = 0.125 and 0.063 for readers 1 and 2, respectively). CONCLUSION. Low-grade pain is a simple and rapid indicator for identifying the RAV, thereby adding diagnostic value to traditional venography.

• 期刊
• OpenAccess

Comparison of Radiology Report and Deep Learning-Based Automatic Detection Algorithm for Consolidations and Nodules in Chest Radiographs

PURPOSE. This study compared the performance of radiology reports (RRs) and a commercial deep learning-based automatic detection (DLAD) algorithm in detecting pulmonary consolidations and nodules in chest radiographs through computed tomography (CT) as reference. MATERIALS AND METHOD. From June 6, 2019, to January 31, 2020, 453 chest radiographs with CT scans taken 1 month before were analyzed using a commercial DLAD Lunit INSIGHT CXR 2 (Lunit, Seoul, Korea) for consolidation and nodule detection and compared with the original RRs. The CT reports and images were used as the standard reference for consolidations and nodules 5 mm and larger. The sensitivity and specificity of RRs and DLAD to consolidations and nodules were compared through chi-square analysis. Misdiagnosed lesion characteristics were briefly reviewed. RESULTS. Compared with DLAD, the RRs exhibited a higher sensitivity (83.8% vs. 61.0%, p < 0.001) and lower specificity (58.7% vs. 85.5%, p < 0.001) in consolidation detection and a higher sensitivity (69.7% vs. 53.7%, p = 0.021) and lower specificity (61.7% vs. 82.3%, p < 0.001) in nodule detection. A significant difference in specificity was observed between RR nodules and DLAD consolidations across patient sources (consolidations vs. no lesions, p < 0.01; consolidations vs. nodules, p = 0.004). Nodules missed by RRs (12.58 ± 16.15 mm) or DLAD (13.46 ± 8.79 mm) were smaller than average (17.75 ± 17.35 mm). The majority of consolidations missed by DLAD were in the right lower lung (p = 0.041). DLAD was more consistent with ground truth in negative cases when discrepancies between RRs and DLAD emerged. CONCLUSION. The RRs exhibited higher sensitivity and lower specificity than DLAD. RRs and DLAD are complementary, suggesting that diagnostic radiologists can incorporate DLAD into their work to prevent false positives.

• 期刊
• OpenAccess

Reversible Neuroimaging Changes in a Chronic Recreational Propofol User

Adverse events related to propofol use have been reported. A fatal complication known as propofol infusion syndrome had been studied, but a milder form of propofol intoxication exists. We present reversible brain magnetic resonance imaging changes in a man who engaged in recreational propofol use. Cytotoxic edema of the cerebellar and cerebral cortex and leptomeningeal enhancement were observed and resolved in 8 days. Our findings differ from those in the studies on pediatric patients. Cortical cytotoxic edema may be related to propofol-induced impairment of mitochondrial beta-oxidation, resulting in disrupted energy production, and leptomeningeal enhancement may be related to propofol-induced breakdown of the blood-brain barrier.

• 期刊
• OpenAccess

Left Pulmonary Agenesis Incidentally Diagnosed After a Traffic Accident in an Asymptomatic Adult Patient: A Rare Case Report

A 67-year-old female patient presented with a head injury and left shoulder pain after a motorcycle accident. No dyspnea was identified. No operative history was discovered. Echocardiography revealed no congenital heart anomaly. The chest anteroposterior radiograph revealed a radiopaque left lung and mediastinal shifting and occupation of the left thoracic region. Contrast-enhanced multidetector computed tomography (MDCT) of the whole body revealed the absence of left lung, left main bronchus, left main pulmonary artery, and left pulmonary veins. An MDCT diagnosis of type I pulmonary agenesis, according to the Boyden classification system, was made. Other imaging findings included intracranial subdural hematoma; subarachnoid hemorrhage; and fractures of the left clavicle, multiple left ribs, and the left pubic bone. The patient received surgical fixation of the left clavicular fracture and was in a stable condition without respiratory distress after 13-day hospitalization.