Objective: We sought to assess whether manual thrombus aspiration could reduce infarct size in patients with acute ST-elevation myocardial infarction (MI) undergoing primary percutaneous coronary intervention (PCI). Background: The efficacy of manual thrombus aspiration during primary PCI for acute MI remains controversial. Methods: Between April 2009 and Mar 2011, 86 consecutive patients presenting with first acute STEMI (Killip≤II) within 12 hours after the symptom onset were randomized to manual thrombus aspiration (group I, N=44) or conventional PCI without thrombus aspiration (group II, N=42). The use of glycoprotein IIb/IIIa inhibitor (GPI) was left to the discretion of the operator. All patients received aspirin 300 mg and clopidogrel 600 mg before PCI and underwent delayed enhancement (DE) multi-detector computed tomography (MDCT) immediately after PCI without injection of an additional contrast media for assessment of infarct size, determined as the total volume of myocardium showing DE. DE MDCT was repeated at 2 months after PCI. The primary endpoint was infarct size reduction at 2 months. Results: Baseline clinical characteristics and angiographic findings were similar between the 2 groups. There were no differences between group I and II in symptom-to-door time, door-to-balloon time, PCI-to-MDCT time, Pre-PCI TIMI 0/1, post-PCI TIMI 3, or the use of GPI. Markers of myocardial reperfusion showed better outcome in group I but without statistical difference: ST-resolution rate >70% (74% vs. 65%), myocardial blush grade 3 (88% vs. 68%), and corrected TIMI frame count <28 (31% vs. 24%). Initial infarct size determined by DE MDCT and left ventricular ejection fraction (LVEF) by 2-dimensional echocardiography were similar between group I and II (17±18 mL vs. 22±23 mL and 58±11% vs. 55±10%, respectively). At 2 months, there was no difference in infarct size and left ventricular ejection fraction between the groups: 14±10 mL vs. 17±12 mL and 62±12% vs. 60±2%, respectively. No adverse cardiac events occurred in either group during the 2-month clinical follow-up. Conclusion: Manual thrombus aspiration was not associated with reduction in infarct size in patients with acute ST-elevation MI undergoing primary percutaneous coronary intervention.
Purpose: We wanted to evaluate the potential role of dynamic incremental computed tomography (CT) for making the diagnosis of malignant solitary pulmonary nodule (SPN) by investigating the dynamic enhancement patterns. Materials and Methods: Forty patients with presumed malignant SPN (diameter 16.2 seconds, and the average degree of maximum contrast enhancement was 66.422.17 HU. Most primary lung cancer showed rapid contrast enhancement with slow washout. The differences of the enhancement patterns among the histopathologic subtypes were not statistically significant (p > 0.05). Conclusion: Dynamic incremental chest CT was useful for making the diagnosis of malignant SPN that showed an established dynamic contrast enhancement pattern regardless of the histopatholgic subtypes.
A 33-year-old woman had suffered from symptoms of congestive heart failure and pneumonia for seven days.She did not exhibit cyanosis or hypoxemia.Images of chest multidetector computed tomography (MDCT) with coronal multiplanar reformatting (Picture A-C, posterior → anterior) and volume rendered reconstruction (Picture D) showed anoma-lous drainage of the left hepatic vein (LHV) into the left atrium (LA) via the common trunk (★), partial anomalous pulmonary venous return in the right inferior pulmonary vein (arrowhead) into the common trunk and an intrahepatic communication (empty arrow in Picture B) between the inferior vena cava (IVC) and LHV.The anterior right hepatic
Pulmonary invasive mucinous adenocarcinoma (PIMA) is a variant of invasive adenocarcinoma of the lung (1). The incidence of this tumor is known to be rising (2). The tumor cells demonstrate goblet cell histology with copious intracytoplasmic mucin material (1, 2). Imaging may show a broad spectrum of findings, but lobar or segmental consolidation is found in the majority (1, 3-5). This case presented as a large mass-like consolidation with multiple internal air-cysts and/or pseudo-cavitations which mimicked complicated congenital cystic lung disease in a patient with relatively young age to consider lung cancer. Therefore, we report a case of PIMA presenting as a large cavitary mass in a 23-year-old male with clinical and radiological findings, and a review of the literature. CASE REPORT
Bronchiolitis interstitial pneumonitis (BIP), an unclassified and newly described interstitial pneumonia, has a combined feature of prominent bronchiolitis, interstitial inflammation, and fibrosis. It is distinct from bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia (BOOP). BIP has a better prognosis than common cases of interstitial pneumonia. However, BIP has a poorer prognosis than BOOP. BIP ’s response to corticosteroids is not as successful as BOOP’s response to this treatment. We encountered the case of a 31-year-old woman with BIP with an initial presentation of dyspnea and a cough that had lasted for 3 months. The patient’s chest CT scan demonstrated patchy ground glass opacities and multiple ill-defined centrilobular nodules in both lungs, suggesting military tuberculosis or nontuberculous mycobacterial infection. A video-assisted thoracoscopic lung biopsy resulted in the diagnosis of BIP. Clinical symptoms, pulmonary lesions, and pulmonary function tests were improved after oral glucocorticoid therapy.
A Case of Pulmonary Alveolar MicrolithiasisPulmonary alveolar microlithiasis (PAM) is a rare disease with unknown etiology and pathogenesis.It is characterized by diffuse, innumerable, and minute calculi, called microlithiasis in the alveoli.More than half of reported cases are asymptomatic at the time of diagnosis.We describe the first case of PAM in Korea.A 19-yr-old man without respiratory symptoms presented with interstitial thickening on the chest radiograph.His chest high resolution CT scan showed diffusely scattered, ill defined tiny micronodules and interstitial thickening.Open lung biopsy confirmed the diagnosis of PAM.He was followed up for 6 months without treatment, and no progression was noticed.
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