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Biomedical subjects

K S Shinn

Publications and source records attributed to K S Shinn.

44 records · Page 3Linked to original sources
PubMedDate not supplied

Embolic control of lumbar artery hemorrhage complicating percutaneous renal biopsy with a 3-F coaxial catheter system: case report.

A case is presented in which massive retroperitoneal hemorrhage from the left first lumbar artery complicating a percutaneous renal biopsy was successfully controlled by superselective embolization with microcoils. An anterior radiculomedullary artery (artery of Adamkiewicz) originated from the lumbar artery. To minimize the risk of ischemic damage to the spinal cord from embolization, the extravasating branch of the lumbar artery had to be superselectively catheterized using a 3-F coaxial catheter system. Computed tomography (CT) scan localized the hematoma within the left posterior pararenal space in the retroperitoneal space.

Arteries↗
PubMedDate not supplied

Intestinal infarction secondary to mesenteric venous thrombosis: CT-pathologic correlation.

We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.

Adult↗
PubMedDate not supplied

CT analysis of intestinal obstruction due to adhesions: early detection of strangulation.

We evaluated the CT of intestinal obstruction due to adhesions in 20 postoperative patients, with emphasis on early detection of strangulation. Ten patients with surgically proven strangulated obstruction (strangulation group) were compared with another ten patients (nonstrangulation group) in whom seven improved with conservative management and three had confirmed simple obstruction on surgical exploration. Beak-like luminal narrowing ("beak") was the most common CT finding at the obstructed site in both groups. The CT findings that suggested strangulated obstruction were serrated beaks, mesenteric edema or vascular engorgement, and moderate to severe bowel wall thickening. In contrast, simple obstruction could be assumed when the beak was smooth, there were no mesenteric changes, and the bowel wall was normal or mildly thickened. Computed tomography is a useful tool for detecting strangulation in patients with postoperative adhesive intestinal obstruction.

Adolescent↗
PubMedDate not supplied

Eosinophilic cholangitis: US, CT, and cholangiography findings.

We report a case of eosinophilic cholangitis, with US, CT, and cholangiographic findings. The lesion showed marked wall thickening of cystic and common bile ducts on US and CT together with mild diffuse narrowing of the common duct on cholangiography.

Bile Ducts↗
PubMedDate not supplied

Gastrointestinal leiomyoma and leiomyosarcoma: CT differentiation.

PURPOSE: Our goal was to evaluate CT efficacy in differentiating gastrointestinal leiomyoma and leiomyosarcoma. METHOD: We retrospectively reviewed CT scans of 45 patients (21 men, 24 women, mean age 55 years) with surgically proven gastrointestinal leiomyomas (n = 21) and leiomyosarcomas (n = 24) with respect to size, contour, enhancing pattern, mesenteric fat infiltration, calcification, ulceration, regional lymphadenopathy, direct invasion, distant metastasis, and growth pattern after visual inspection by two radiologists in agreement. On the basis of these CT features, subjective diagnosis was also categorized into three groups (Group I: probably benign, Group II: probably malignant, Group III: diagnostic malignant). The results were compared with the final histopathologic diagnosis. RESULTS: In addition to the features of direct invasion and distant metastasis suggesting diagnostic malignancy, the CT features favoring malignancy with statistical significance included larger size (> 5 cm), lobulated contour, heterogeneous enhancement, mesenteric fat infiltration, ulceration, regional lymphadenopathy, and exophytic growth pattern (p < 0.005). However, calcification was not significant in differentiating the two entities (p = 0.25163). A subjective analysis revealed 89% sensitivity, 85% specificity, and 87% accuracy for diagnosis of leiomyosarcoma. CONCLUSION: CT features are useful in differentiating leiomyoma and leiomyosarcoma in gastrointestinal tract.

Adult↗
PubMedDate not supplied

Staging of early endometrial carcinoma: assessment with T2-weighted and gadolinium-enhanced T1-weighted MR imaging.

This study evaluated the usefulness of T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images correlated with patients' menopausal status in assessing the depth of myometrial invasion in stage I endometrial carcinoma. MR images of 46 patients with stage I endometrial carcinoma were retrospectively reviewed. Twenty-five patients were premenopausal, and 21 were postmenopausal. The staging accuracy without regard to menopausal status was 59% for T2-weighted images and 61% for gadolinium-enhanced T1-weighted images. However, when staging accuracy was evaluated separately in the premenopausal and postmenopausal patient groups, T2-weighted imaging had an accuracy of 80% in the premenopausal group and gadolinium-enhanced T1-weighted imaging had an accuracy of 81% in the postmenopausal group. Therefore, T2-weighted imaging was more accurate in premenopausal patients and gadolinium-enhanced T1-weighted imaging was more accurate in postmenopausal patients. The overall accuracy of staging with MR imaging improved to 80% when patients' menopausal status was considered. Therefore, menopausal status should be considered when T2-weighted and gadolinium-enhanced T1-weighted MR images are used to stage early endometrial carcinoma.

Adult↗
PubMedDate not supplied

Idiopathic transverse myelitis: MR characteristics.

PURPOSE: To describe the MR characteristics that can distinguish idiopathic transverse myelitis from other intramedullary lesions. METHODS: A total of 32 initial and follow-up MR studies in 17 patients with clinically proved transverse myelitis were reviewed retrospectively. The location, size, pattern, and segmental length of areas of hyperintensity were estimated on T2-weighted axial and sagittal images. In 15 of the patients, whose neurologic abnormalities were limited to the spinal cord, the location and pattern of intramedullary contrast enhancement were evaluated on sagittal and axial T1-weighted images. Follow-up MR studies were available for 10 patients. The statistical significance of cord enhancement between the groups with and without cord expansion was calculated. RESULTS: Common MR findings of idiopathic transverse myelitis included a centrally located hyperintensity occupying more than two thirds of the cross-sectional area of the cord (88%); a length of 3 to 4 vertebral segments (53%), with variable presence of cord expansion (47%); a small central area of intensity, isointense with normal cord, in the core of hyperintensity (47%); focal, peripheral cord enhancement (53%), particularly in patients with cord expansion; and a slow regression of T2 hyperintensity with an enhancing nodule. Although no linear correspondence was observed between MR findings and neurologic signs and symptoms, all but 4 patients improved clinically as MR findings improved or remained stable. CONCLUSIONS: MR findings are helpful in detecting transverse myelitis and in differentiating this entity from multiple sclerosis and cord tumors, but clinical assessment and observation of MR changes over time are essential in making the diagnosis.

Adult↗