Search

We herein report a rare case of autoimmune pancreatitis with small intestinal obstruction. A 72-year-old male was admitted to our hospital with abdominal fullness and vomiting and diagnosed with autoimmune pancreatitis by imaging and laboratory tests. Imaging studies also revealed narrowing of the proximal jejunum with dilated bowels and intramural cystic lesion adjacent to the pancreatic body. Small bowel resection was performed to alleviate stenosis. Pathological evaluation demonstrated invasion of IgG4-positive cells and fibrosis.

An 86-year-old male underwent pancreatoduodenectomy with resection and reconstruction of portal vein for pancreatic cancer. He was admitted to our hospital because of severe anemia and dyspnea ten months later. Computed tomography showed varices at the biliary-enteric anastomosis in the elevated jejunum caused by portal venous stenosis, which was suspected as the cause of anemia. Therefore, the patient underwent balloon dilatation of the portal vein followed by stent placement and coil embolization of the collaterals using a transileocolic portal vein approach. After the procedure, portal venous flow was improved, and the collaterals disappeared. The patient has been asymptomatic with no recurrence for three years and four months.

A 39-year-old female presented to our hospital with diarrhea, vomiting, anemia, and hypoalbuminemia. Virtual enteroscopy was performed to evaluate the small bowel; we found annular stenoses at 89, 100, 116, 147, and 154 cm from the ligament of Treitz. Small bowel resection was performed, and annular ulcers were confirmed at 58, 71, 90, 130, 138, 218, and 225 cm from the ligament of Treitz. Clinical records and pathological examination failed to determine the cause of these ulcers, and we diagnosed chronic multiple ulcers of the small intestine. Thus, we believe that virtual enteroscopy can be beneficial in preoperatively diagnosing multiple ulcers and stenoses in the small bowel.

We reported a case of tracheal agenesis (TA) that was diagnosed during surgery. A female infant, weighing 1,104 g, was born at the 29 weeks of gestation. She showed severe respiratory distress without crying. Oxygenation was improved by mask ventilation, but tracheal intubation was very difficult. Tracheoesophageal fistula (TEF) was suspected because significant amount of air from nasogastric tube was noticed. Physical examination and X-ray findings suggested Gross E type TEF, duodenal atresia and cloaca. On the second day of life, ligation of TEE gastrostomy and colostomy were scheduled. Although operation was started without problems, ventilation became impossible when TEF was clamped and release of clamping made it possible. Bronchoscopic investigation revealed that tracheal tube was located in the esophagus. We have never doubted the esophageal intubation, because patient was ventilated preoperatively and signs of respiratory distress syndrome were successfully treated by the surfactant replacement therapy through tracheal tube. Type II TA according to Floyd's classification was diagnosed by bronchoscopic and echographic investigations. Distal esophageal ligation, gastrostomy and esophagostomy were performed. She died on the 12th day of life in spite of vigorous ventilatory and cardiovascular support.

A 55-year-old man was admitted to our hospital with chronic cough. Although his chest X-ray was normal, chest computed tomography revealed a nodular lesion that was causing beaded stenosis of the lumen of the upper lobe bronchus. Nodules approximately 10 mm in size were seen in the mediastinum. We could not deny the possibility of vascular disease, and enhanced chest computed tomography was performed, which showed these abnormalities to be caused by a dilated and convoluted bronchial artery. Because no pulmonary diseases that would lead to secondary vascular dilatation were evident, a diagnosis of primary racemose hemangioma of the bronchial artery was made. We performed bronchial artery embolization to prevent potential fatal bleeding from vascular rupture. The patient has been followed regularly as an outpatient, and recanalization has not been detected. Primary racemose hemangioma of the bronchial artery is a rare entity; it is also rare for this entity to be detected by findings of a nodular protrusion in the bronchial wall or in a patient presenting with a cough. Here, we report this case and review previous reports.

A 82-year-old woman was referred to our department for further evaluation of her atelectasis in the left lower lobe of the lung which was found under preoperative examination for a renal pelvic tumor resection. Bronchoscopic examination was performed, and a pin-hole stenosis at the orifice of the left main bronchus was detected. Tuberculous bronchial stenosis was suspected because she had pulmonary and laryngeal tuberculosis 50 years ago. The dilatation of the stenosis was supposed to be necessary in order to prevent a pulmonary complication during the perioperative period. The stenotic area was dilated using argon plasma coagulation. Eight weeks after the procedure, a bronchoscope 6mm in external diameter could pass the dilated area. We reported a rare case with tuberculous bronchial stenosis in which the patient had never experienced a severe complication for 50 years despite the pin-hole stenosis in the left main bronchus.

The fusion imaging of the 3D MR cisternography (MRC) and 3D MR angiography (MRA) was applied for the assessment of the major cerebral arterial stenosis. The outer wall configurations of the stenotic lesions of the intracranial major cerebral arteries within a cisternal space were depicted by 3D MRC. Flow-related vascular structures were shown by 3D MRA. Fusion imaging was created by compositing volumetric data of MRC and co-registered MRA by using a workstation with transparent perspective volume-rendering technique. Stenotic lesions of the intracranial cerebral arteries were assessed as a discrepancy of 3D MRC and 3D MRA findings on a fusion image. Fusion imaging of 3D MRC/MRA could visualize stenotic lesions of the intracranial major cerebral arteries caused by atherosclerotic plaques; and this may provide useful information in the management of acute and chronic ischemic stroke caused by atherosclerosis of the intracranial major cerebral arteries.

A 57-year-old male was referred to our hospital with a complaint of dizziness. Abdominal computed tomography and retrograde pyelography revealed a left renal tumor associated with hydronephrosis due to pelviureteric junction (PUJ) obstruction. A radical nephrectomy was performed and histological diagnosis was renal cell carcinoma. Only five cases of renal cell carcinoma with hydronephrosis due to PUJ obstruction have been previously reported in the Japanese literature.

To evaluate major cerebral arterial stenotic lesions within a cisternal space, the outer wall contours of the arteries were depicted on three-dimensional (3D) MR cisternograms. The 3D MR cisternograms were reconstructed by perspective volume-rendering algorithm from the source volume data obtained from the T2-weighted 3D fast spin-echo sequence. Those images were compared with coordinated 3D MR angiograms, and then with 3D CT angiograms through the similar visual projections. The presence of stenotic lesions was indicated by the morphological discrepancy between the outer wall configuration of the itracisternal stenotic artery depicted on the 3D MR cisternograms and the intraluminal boundary shown on the 3D CT angiograms. With application of these techniques, spatial expansion of the stenotic lesions was able to be visualized. In this way, clinical 3D evaluation of the therapeutic effect on and follow-up of intracisternal major cerebral arterial stenotic lesions would be possible in patients with acute ischemic stroke.

Purpose: To compare the quality and diagnostic accuracy of images of intracranial steno-occlusive lesions obtained by conventional MRA and turbo MRA reconstructed using the zero-filled interpolation technique in the slice-select direction., Materials and Methods: Eighteen patients with suspected steno-occlusive lesions of the intracranial arteries were studied with two types of three-dimensional time-of-flight angiography and conventional digital subtraction angiography. In total, 45 steno-occlusive lesions were quantitatively measured using calipers and correlated with DSA stenosis. A phantom that simulated vessels with stenosis was also imaged using the two types of MRA under the same conditions as those employed in the clinical study., Results: Compared with conventional MRA, turbo MRA reduced the jaggedness of vessels and offered appearances more similar to those of DSA in the antero-posterior and lateral views. The severity of stenosis was classified into five grades based on the percentage of occlusion: not significant (0-24%), mild (25-49%), moderate (50-74%), severe (75-99%), and occlusive (100%). Neither turbo MRA nor conventional MRA showed any discrepancy from DSA above grade-1 stenosis., Conclusion: The advantage of turbo MRA is its ability to reduce the jaggedness of vessels on conventional MRA, and to simplify the recognition of vessel contours without prolonging acquisition time. Turbo MRA and conventional MRA have equally high diagnostic accuracy for steno-occlusive lesions.

The morphology and circulation of the pulmonary arteries and shunt vessels were evaluated by magnetic resonance imaging (MRI) in 8 patients with cyanotic heart disease after a Blalock-Taussig shunt operation. Their ages ranged from one month to 17 years. MRI permitted assessment of the size and patency of the Blalock-Taussig shunts, as well as the size and morphology of the pulmonary arteries in all patients. Measurements of the vessel diameters on MRI correlated well with the angiographic measurements (main pulmonary artery, r = 0.98; right pulmonary artery, r = 0.98; left pulmonary artery, r = 0.98; and Blalock-Taussig shunt, r = 0.97). MRI successfully imaged 3 of 4 shunt obstructions and 3 of 4 pulmonary stenoses with high resolution. In assessing peripheral pulmonary stenosis or obstruction, MRI was superior to echocardiography, the latter being unable to image peripheral pulmonary arteries satisfactorily. We concluded that MRI is an excellent noninvasive method for serially evaluating the anatomy and function of Blalock-Taussig shunts and pulmonary arteries, which is particularly useful for children with cyanotic congenital heart disease.

A 59-year-old woman who accidentally swallowed a foreign body (fish bone) 9 months ago was admitted to our hospital because of cough, hemosputum and sleep wheezing for two months. Chest roentgenograms and chest CT scanning revealed severe stenosis of the right lower lobe bronchus and truncus intermedius, suggesting lung cancer. Bronchoscopic examination revealed an intrabronchial foreign body. The biopsy specimen from granulation tissue revealed bronchial actinomycosis. The foreign body was removed bronchoscopically after an extensive chemotherapy with penicillin G (for actinomycosis) and prednisolone (for granulation tissue of the bronchus). This was considered to be a rare case of bronchial actinomycosis without a pulmonary lesion produced by a foreign body.

Reported are two rare cases of a clinically unknown large cell carcinoma of the lung, associated with severe stenosis of the bilateral main bronchi. Case 1: A 61-year-old man was admitted to our hospital because of chief complaints that included a cough, hemosputum, and dyspnea. Based on the bronchoscopic findings that revealed severe stenosis of the bilateral main bronchi and a specimen that was biopsied from tracheal spur, a diagnosis of large cell carcinoma of the lung was made. Although anticancer chemotherapy and irradiation therapy produced a slight improvement in the patient's symptoms, at the 10th hospital week the patient died of suffocation. Case 2: A 77-year woman was admitted to hospital with chief complaints that included a cough and hemosputum. A bronchoscopy revealed severe stenosis of the bilateral main bronchi. After the 4th hospital day the patient complained of increasing dyspnea. At the 9th hospital day the patient died of suffocation. An autopsy results revealed a large cell carcinoma (giant type) of the lung.

Two cases of hypertrophic cardiomyopathy (HCM), in whom giant negative T waves resolved during 10 years, are reported. Case 1: A 33-year-old man was admitted in 1975 for careful evaluation because of an ECG abnormality. The ECG revealed a giant negative T wave (GNT) in V5 (-15 mm) and high voltage (SV1 + RV5 = 81 mm). The thickness of the apical wall was 18 mm; the anterior wall, 12 mm; the posterior wall, 16 mm; and the interventricular septum, 17 mm on the left ventriculogram and biventriculogram. The coronary angiogram was normal. From these data, this patient was diagnosed as having HCM. However, follow-up studies disclosed resolution of the GNT with decreased high voltage (SV1 + RV5 = 26 mm). The catheterization performed in 1985 showed a decrease of wall thickness: the apical wall to 10 mm; the anterior wall, 9 mm; the posterior wall, 14 mm; and the interventricular septum, 14 mm. Ejection fraction was markedly decreased from 79.8% to 27.1%, and the wall motion was generally reduced. The coronary angiogram was normal. These findings resemble the clinical pictures of dilated cardiomyopathy (DCM). Case 2: A 58-year-old man was admitted in 1974 because of easy fatiguability. His ECG revealed a GNT in V4 (-10 mm) and high voltage (SV1 + RV5 = 75 mm). The patient was diagnosed as having HCM by cardiac catheterization, right ventricular biopsy and other procedures. In 1985, the depth of the GNT and the voltage of SV1 + RV5 regressed significantly (SV1 + RV5 = 26 mm). The thickness of the apical wall was, 12 mm; the anterior wall, 19 mm; the posterior wall, 13 mm; and the interventricular septum 14 mm during recatheterization. Coronary angiography disclosed stenoses of the left main trunk (75%), the left anterior descending artery (99%) and the left circumflex artery (50%). The right coronary artery was totally occluded. In conclusion, these two cases of HCM had similar changes in their ECG during long-term follow-up studies, but the process was different. One case finally showed clinical pictures of DCM; the other, severe coronary stenoses. These suggested that blood flow to the myocardium is an important determinant for the development of clinical features simulating DCM in cases with HCM.